Physical activity to maintain health is always recommended, but conditional on adaptation to the basic physical ability of each person according to age and medical/physical condition. Contrary to popular belief, controlled exercise in sports doesn’t erode knee joint cartilage but on the contrary exercise is a positive factor for maintaining the function of all components of the knee joint (cartilage, ligaments and menisci) and overall functioning.
Most sports injuries to the knee joint are treated with a conservative approach with the exception of sports injuries of the meniscus tear and tears of the anterior cruciate ligament, which usually require surgery.
Meniscus tears
Causes and symptoms
A tear in the meniscus can be caused by cumulative damage or as a result of a major injury. There’s a possibility of combining the two rupture mechanisms caused by a relatively minor injury to the weakened meniscus section from previous cumulative damage. Common symptoms of meniscus rupture are pain, restriction of movement, discharge (leakage of synovial fluid) and knocks in the knee joint. Symptoms appear with the strongest intensity where the injury happens and decrease over time or pass, but intensify again when activity is resumed.
Common treatment methods for meniscus rupture
The initial treatment for a meniscus tear is usually conservative and includes painkillers and anti-inflammatory drugs, activity limitation and physical therapy. For acute cases where the knee joint locks, this might indicate early surgical treatment.
Surgery is proposed when symptoms persist or reappear at any attempt to return to sports. Meniscus tear surgery is minimally invasive: arthroscopy through two five-millimeter incisions in the front of the knee. The operation requires day hospitalization and takes about 15 minutes.
The course of arthroscopic surgery is a rupture to treat meniscus tears
The type of arthroscopic surgical treatment for a meniscus tear is determined by the size and location of the tear: if the tears are located around the meniscus, they can be sutured, and if the tear is at the margin of the meniscus, limited local resection of the torn meniscus will be performed. It should be emphasized that the preservation of the meniscus on the articular cartilage surfaces is reduced minimally due to limited resection.
Return to athletic activity after repairing a meniscus tear
After repairing a meniscus tear, one can exercise again relatively quickly but it's dependent on the type of surgery.
In cases of partial resection of the meniscus, a patient will be discharged after resting two hours in the day hospitalization ward, with full mobility and without the need for crutches. After about a week one can do athletic walking, and after two to three weeks one can start running and gradually return to working out.
In cases of meniscus suturing, walking on a treadmill, for example, is limited for six weeks in order to protect the healing process of the sutured section. After this period of time, you can gradually return to sports.
Rupture of the anterior cruciate ligament
Causes and symptoms
Rupture of the anterior cruciate ligament is caused by rotational injury, most often during running or jumping, Unlike a meniscus tear that can also be caused without an injury (degenerative tear), a tear in the anterior cruciate ligament is caused by a clear acute injury and is accompanied by pain, swelling and limitation in movement.
The symptoms that accompany the rupture of the cruciate ligament are likely to pass over time, but there may be a fear of returning to sports activities due to a feeling of insecurity and instability. The knee joint may keep folding when performing a sharp movement, whether walking or descending stairs or attempting to return to sports activities that involve changes of direction or jumps.
When is surgery recommended?
Surgery is performed to prevent recurrent collapse of the knee joint because this causes cumulative damage and problems with the structure of the knee joint, menisci and articular cartilage. Surgery can be avoided if there are no recurrences and the patient isn’t expected to return to sports that include running and jumping.
Surgery to reconstruct an anterior cruciate ligament
A tear in the anterior cruciate ligament can’t self-heal or be sutured, so it’s required to reconstruct the ligament with arthroscopy surgery without opening the knee joint. Recovery to the cruciate ligament comes from two sources, the first from the patient's body and the second from the tissue bank.
In the first case, the tendon graft is usually taken from the hamstring through a short surgical incision about three inches near the knee, or from a tissue bank. I emphasize that taking the tendon implant from the knee ligament doesn’t impair the future function of the knee joint, but the course of this surgery is longer because it includes a tendon harvesting phase and making a larger insertion incision.
Using a tendon implant from a tissue bank further reduces the scope of the surgery and shortens the recovery time, as there is no need to shorten the tendon and the insertion incision is small. Contrary to popular belief in the past, it’s now customary to offer surgery to reconstruct the cruciate ligament at any age in cases of repeated stumbles and when one wants to return to high-intensity sports that include running and jumping.
The postoperative rehabilitation process to restore the anterior cruciate ligament
The reconstructed cruciate ligament and the ties at its ends are strong enough and durable even in routine activities, so you can step on and even walk the day after surgery without crutches and without limiting the range of motion of the knee joint. It’s recommended to start with physiotherapy where one walks and runs on their own because this helps the implant strengthen over time. You can run again after three months from the day of surgery, and can participate in ball games and even return to full athletic activity after six months.
Dr. Yohanan Horev is an orthopedic specialist with orthopedic specialization and knee surgery, who founded and heads the Knee Surgery and Sports Injury Unit at Laniado Hospital. He has extensive experience in performing arthroscopic surgery to repair meniscus tears and restore the anterior cruciate ligament.
This article was written in partnership with Zap Doctors.