Knee sprains are a frequent injury in patients of sporting age. Until a few years ago this concept referred to young people, but nowadays the perimeter of affectation of the people who practice sports has been extended exponentially and at this moment we can find capsulo ligamentous injuries of the knee from pediatric age to the third age. The most frequent ligament injuries are those of the internal lateral and anterior cruciate ligaments, which can be alone or accompanied by injury of the meniscus.
These injuries can also be combined, for example an injury of the anterior cruciate ligament, can be isolated or with injury of the internal lateral ligament and affectation of the internal meniscus, of the external one or of both, they are the well-known triads.
The injury of the internal lateral ligament is always treated non-surgically, at the present time a relative immobilization allows to begin the rehabilitation in a fast and safe way, in addition it is possible to accelerate this biological process of healing with the help of the infiltrated platelet growth factors in the high insertion and in the proximal trajectory of the same one, which allows to recover before.
Anterior cruciate ligament injuries in young people are usually treated surgically with arthroscopic replacement of the injured ligament with a taped plasty of either the patellar tendon or the hamstring muscles. In this sense, the advances are coming from the new guides to tunnel the femur, since from the internal face of the knee it is possible to make a placement of the plasty in a more horizontal position with better control of the anterior laxity, all this helped by the new fastening systems of the plastias both at femoral and tibial level allows us to speed up the recovery with less pain and more rapidity. Also in this case the new biological contributions in the form of platelet growth factors that reduce postoperative inflammation and favor the integration of the plasty are of help.
Meniscal lesions can affect both the internal and external meniscus and can be divided into traumatic and degenerative lesions. Traumatic lesions generally correspond to young people while degenerative lesions are part of the onset of aging of the knee.
The external meniscal lesions are in general of worse prognosis than the internal ones due to the shape of the tibial surface, since this compartment is convex in the antero-posterior sense so that the cushioning function of the meniscus is more important and more difficult to supply than in the case of the internal meniscus. It is essential to preserve the meniscus as much as possible, trying to suture as many lesions as possible in young people and in older people to perform meniscectomies as small as possible to try to protect the joint as much as possible.
Important progress is also being made in this field, since new materials allow suturing of longitudinal lesions and the suturing of radial lesions, particularly important in external meniscal lesions in young patients, is being successfully initiated. The new guns with knots all inside and the “mini Loops” with different directions have perfected and have given more security to the meniscal repair procedure, always bearing in mind that these lesions affect in most of the occasions the non-vascular area and therefore with great difficulty of healing. This is why we also rely on the placement of platelet growth factors within the repaired area to give more viability to these sutures.
It is this combination of technical progress and proper management of advances in tissue regenerative therapy that will achieve better and more reliable results.