In skiing, as in contact sports, a sprained knee is a common injury after a fall. In the most severe cases, it is treated in trauma, but an apparently less severe form should not be neglected on pain of complications.
After a severe knee sprain, the long-term prognosis for the reconstruction of the cruciate ligaments, which have been ruptured and which are the main means of stabilizing the knee, depends on how well your resume walking. A key element to avoid osteoarthritis.
A knee sprain is an injury to the ligaments of the knee (the "knee stays") that occurs after the abnormal movement of the leg or sometimes after direct trauma.
The severity of the knee sprain depends on the ligaments affected and the nature of the lesions: simple stretching of the ligament, partial or total ligament tear.
One-third of people who have an anterior cruciate ligament reconstruction surgery after a severe knee sprain will have osteoarthritis in their injured knee within 10 years, a debilitating disease that cannot be cured in any way. This is because people with an anterior cruciate ligament injury end up moving differently during activities like running, jumping, and walking, which cause cartilage damage over time, new research shows. The knee injury itself can also cause chronic and persistent inflammation that leads to changes in the underlying joint tissue.
Knee sprains account for nearly a third of alpine skiing accidents. If the bad adjustment of the bindings is responsible for more than 40% of knee sprains, the lack of physical training is a very common aggravating factor.
HOW TO PREVENT KNEE SPRAINS?
To best prevent knee sprains, especially when you go skiing once a year, it is essential to prepare two months before departure, to arrive in good shape in the mountains.
You should at least walk for at least an hour a day and use the stairs to build your thighs. It is possible to do a little swimming which strengthens all the muscles of the body and to practice a little daily gymnastics. In the best case, it is possible to do a little jogging, at a rate of 40 minutes, two to three times a week (to develop breathing capacities and support).
What is a sprained knee?
A knee sprain is a damage to one or more ligaments of this joint whose stability is ensured by peripheral fibrous elements (a joint capsule, ligaments and tendons of the muscles) and central ligaments, very important for the stability of the knee, which constitute the "central pivot".
The stability of the knee is ensured by an “anterior plane”, rarely affected by the sprain because it is very solid (quadriceps tendon, kneecap, patellar tendon, with part of the joint capsule and various extensions of the lateral tendons and the menisci). The “internal lateral plane” is very frequently affected by sprains, with the internal lateral ligament, the capsule and ligaments of the crow's feet and the internal patellar fin. The "external lateral plane" is sometimes involved and includes the external lateral ligament, the capsule, the tendon of the biceps and fascia lata, and the patellar fins. The “posterior plane” is formed by the capsule and various fibrous structures which converge to form a postero-external angle point and a postero-internal angle point.
What are the mechanisms of occurrence of a knee sprain?
The knee sprain most often occurs as a result of twisting movements (the leg is resting, blocked on the ground), especially during the practice of so-called "pivot" sports, such as football, rugby, sports. combat ... and during alpine skiing.
These twists, often in external rotation of the leg, first cause damage to the capsule (the envelope of the joint), then to the ligament of the knee, then as the tear progresses, it may be the meniscus. corresponding, the central pivot, and a posterior corner point that can be touched. This sequence is typical of the internal sprain. The external sprain may only affect the external ligament. Likewise, one of the cruciate ligaments can be affected by isolation.
The knee sprain can be "benign", in the event of a simple stretching of the ligament, "moderately severe", in the event of a partial tear of some ligament fibers, and "serious" when a ligament is totally ruptured.
Isolated lesions of the lateral ligaments (most often the internal lateral ligament) are generally less serious. Cruciate ligament injuries (most commonly the anterior cruciate ligament) isolated or associated with lateral ligament or menisci injuries are always serious because they are the cause of knee instability.
When to think of a sprained knee?
Signs of a sprained knee are usually a crunching noise during the accident with sharp pain and a feeling of dislocation (the feeling that the knee “rolls to the side and then comes back into place”).
This results in a feeling of instability in the knee and swelling of the joint. These signs may be accompanied by lameness or inability to lean on the traumatized leg and walk.
Not all signs are always present (the knee may not swell) and the pain is not proportional to the severity of the sprain. Thus, it can be moderate during a serious sprain and intense during a benign sprain.
What to do in case of a sprained knee?
After a fall and if you feel some of the signs mentioned above, you must immediately stop the activity or sport in progress so as not to aggravate the lesion and put your knee at rest, avoiding any support on the affected leg.
As soon as possible, cool the knee with cool water or ice to reduce inflammation (do not put the ice directly on the skin but put it in a clean cloth before putting it on the knee) . It is possible to bend the knee without over-tightening and elevating the leg if the knee tends to swell.
If the pain persists, it is possible to take a drug to relieve: paracetamol or a non-steroidal anti-inflammatory drug such as ibuprofen.
If the discomfort is very moderate (no feeling of instability or dislocation), it is possible to be satisfied with this strategy, but if the signs are serious or if they persist, you should consult your doctor.
How to diagnose a sprained knee?
The diagnosis of a knee sprain is mainly made on the clinical examination. Complementary examinations are mainly used to eliminate a possible associated fracture or to decide on the interest of a surgical intervention.
The clinical examination allows, in general, to make an accurate diagnosis of the lesions by analyzing the mobility of the knee and looking for abnormal mobility ("laxity"), an effusion inside the knee joint, a hematoma ( a "blue") on the path of the lateral ligaments.
Additional examinations are not systematic. X-rays can confirm that there is no associated bone fracture or bone tear at the end of a ligament. Other exams may be ordered (mainly MRI) depending on the doctor's examination.
What are the criteria for the severity of a sprained knee?
The fear is to miss a rupture of one of the ligaments of the central pivot with its risk of instability and secondary osteoarthritis. The observation of such a lesion, isolated or associated, determines the therapeutic attitude and a possible surgical repair.
The severity criteria are as follows: high-risk sport, accident mechanism, sensations of the injured person (cracking and dislocation), the extent of functional discomfort after pain sedation, early swelling.
The doctor's examination also finds other signs of severity (presence of blood at the puncture of the knee, increased joint mobility in extension and rotation, the existence of abnormal movements such as laterality and an anterior drawer).
The examinations complete the diagnosis of seriousness (bone tearing on the x-ray, ruptured ligaments on MRI).
What is the treatment for a sprain?
If treated properly, a knee sprain does not cause significant sequelae, but late complications are possible when stiffness persists (with loss of a few degrees of flexion or extension of the knee) or instability (laxity due to unhealed rupture of a ligament). In the long term, this instability promotes abnormal micromovements and wear and therefore the appearance of osteoarthritis. With immobilization, there is often temporary stiffness (and it is necessary to prevent thrombosis).
If the sprain is mild or of moderate severity, it is not recommended to completely immobilize the knee, and support on the injured leg may be retained. The immobilization is very short, just against the pain, and a cast is usually unnecessary. Treatment, therefore, consists of early mobilization with authorized support, associated with medical treatment (analgesics, anti-inflammatories, and icing). Wearing a restraint (knee brace or articulated orthosis) can facilitate an early return to physical activities in safety.
Surgical treatment for a knee sprain consists of surgical repair of the ligaments, or "ligamentoplasty", which may be necessary in the event of a serious sprain (rupture of a cruciate ligament for example) in a young and athletic person. The procedure can be performed in the days following the accident or later when the pain and swelling in the knee have reduced. Indeed, operating urgently on a painful and inflammatory knee exposes a number of complications that can delay healing.
Knee surgery may also be necessary if other injuries are associated with the sprain such as a broken bone ...
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