Knee injuries in winter sports

Many winter sports are related to a strong attachment of the foot to the ski through the boot and binding. As in the majority of serious pathologies of the knee the most important thing is the prevention to be able to avoid them and in this sense to obtain before the season to be with a minimum of strength and elasticity is very advisable. The practice of exercises of quadriceps, or bicycle, and to practice some sessions of stretching of hamstrings and of the anterior rectus will put us in form.

Most injuries are due to three reasons:

1. Overuse injuries

The injuries by overload: The forced position of the knee in semi flexion places in permanent tension the extensor system with what can appear pain in the front face by suffering of the cartilage of the patella (condromalacia in unfortunate term). This same position is used for snowboarding.

It also affects the patellar tendon and the quadriceps tendon to cushion the bending forces transmitted through the knee.

2. Injuries due to direct trauma

Injuries by direct trauma: Generally on the anterior aspect of the knee and can cause either a patellar fracture or an injury of the posterior cruciate ligament by direct blow against the anterior tibial tuberosity.

3. Twisting injuries

Twisting injuries are often more serious and can be summarized in three:

Anterior cruciate ligament injury, internal lateral ligament injury and meniscal injury.

The mechanism of injury is different depending on body positioning and direction of force. With the mechanism of forced valgus, the ski with the leg, they are opening, producing the lesion of the internal lateral ligament in different degrees according to the intensity of the force. If this persists, the anterior cruciate ligament injury occurs, which is often accompanied by a meniscal injury that is the dreaded unfortunate triad of O’Donoghuei.

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Rupture of the anterior cruciate ligament is the most common serious injury. The mechanism can be with the unbalanced body turned backwards, in this case it is the quadriceps itself trying to maintain the statics of the body that breaks it by forcing the anterior translation of the tibia in excess. The other mechanism is the fall forward leaving the foot fixed in internal rotation.

The diagnosis of this injury is made clinically with the Lachman test and the presence of the so-called dynamic tests. With these two tests ratified in addition by the measurement of the anterior drawer with the KT 1000, the diagnosis of certainty is made, leaving the RX and the MRI for confirmation of the injury and evaluation of accompanying injuries.

The treatment of the injury of the internal lateral ligament is always conservative, it is enough to immobilize the knee, but starting very early the functional rehabilitation so that the knee while healing is gaining mobility.

The treatment of cruciate ligament injury in young patients and with sporting aspirations is always surgical, replacing the torn ligament with a plasty, either with hamstring tendons (semitendinosus and gracilis), or with the middle third of the patellar tendon. In both techniques the treatment is always arthroscopic since with this technique the precision for the placement of the tunnels in both femur and tibia is maximum. The same technique allows the evaluation of meniscal lesions as well as their repair.