Knee Injuries

Introduction

Fact - injuries to the lowest leg have been always a problem for skiers alpine. In the years of the sport, the fractures of the lowest bones of the leg (the tibia and peroné) were common because the forces that twisted generated by a fall were transmitted in the savage of the ski. The subsequent development of the obstacles to send very has been conjectured to the right in the reduction of the incidence of such fractures, but it has unfortunately not produced as much protection to the knee. This joint, with its ligaments, menisci and structures associated of the huesudas, at the moment explains approximately 30-40% of all the alpine injuries of the ski. Although this page is specifically centered in those seen injuries of the knee of the alpine ski, to discover me that many of people find their way to this page that by itself looks for the Info in injuries of the knee. I hope that you find this page useful and have added some specific connections to other pages in injuries of the knee that you will find here. They always sharpen to me to receive regeneration in my site that I satisfy the email so if you have any suggestions in which she made this more useful page to you.

In Scotland, injuries of the knee happen in an approximated index of 0,82 injuries by 1000 days to skier more - that is to say, for every 1000 skiers in the mountain in nobody a day, an average of hardly under one more an injury skier of the will their knee. Watching it another way, injury of the knee happens once ski of every 1218 days (for an explanation of the injury tariffs and how they derive, to see this page). Introduction to carve (“sidecut wonderful”) skis, which they have improved characteristics that give return compared to the traditional skis, was bound initially to an increase in tariffs of injury of the knee. This was Vista in fact in some of the equipment that competed with alpine when first they began to use carving the skis in early years 90. This risk of injury with carving the skis now looks like to have diminished and in fact the last demonstration of stats of injury that carving the skis is protective now against injury - the established hypothesis is that skiers which they changed of traditional “the skinny” skis they have now obtained used to carve the skis and their characteristics that carve improved. Skiers of the nascent one has skied only always in carvers and therefore (not experiencing any other class of ski) it did not need to adapt. Whereas most of injuries of the knee it has a good prognosis, something can lead to significant the functional weakening and can even disable the individual always of the ski again. The exact diagnosis, joined with appropriate investigations and the treatment, are essential in helping to the recovery of damaged skier of injuries such as quickly and successfully as it is possible. The extensive majority of injuries of the knee considered in skiers alpine implies the damage to the ligaments of the knee, particularly the intermediate collateral ligament. Like with others esguinces of the ligament, these are described to divide the one for three depending on the degree on damage and laxity associated on the ligament. Laxity is proven trying to stretch the open ligament - for obvious reasons, this often cannot be done initially because the doctor would finish upon obtaining a black eye of the patient. Once the pain has placed nevertheless (generally approximately 5-7 days) the joint can again be valued.

* Degree 1 - None laxity (“elasticity”) in the ligament when he is tensionado. Little, ace no torn fibers of the ligament. * Degree 2 - Some laxity in the ligament, but full stop defined he is present. Some, but not all, torn fibers of the ligament. * Degree 3 - To finish the elasticity in the ligament. All the torn fibers of the ligament. The following ones are all potentially indicative of serious injury of the knee - to obtain to a doctor a.s.a.p.! * Deformity obvious to the knee * the incapacity to load refers the affected leg * great Degree to swell within a pair of hours of injury * Incapacity to straighten the knee (“it united the knee”) * severe Dulzura completely when you press in a located area

A degree of smaller importance of swelling is generally inevitable with all but injuries more of smaller importance of the knee, becoming generally the term of twenty-four hours of injury. The aspect of the significant swelling (that is to say, the knee seems a globe) in the term of the first two hours of injury it strongly suggests the presence of a haemarthrosis (drain within the joint of the knee) that, in approximately 75% of cases, it means damage to the previous ligament of cruciate. All the cases of the haemarthrosis are due to refer ignition to a ortopédico surgeon for the additional burden and the possible aspiration of the blood within the joint. This needs to be done under sterile conditions. One not to try in the country…. An exact description of the accident joined with an honest burden of the level of the individual of the capacity in the skis will suggest the diagnosis in most of cases. The direction in which the lowest leg moves in the fall will dictate what structures es/son implied and the speed of skier will influence the severity of maintained injury. Skiers of the nascent one is initially taught to assume the position supposed of “snowplough”. This puts the particular tension in the intermediate collateral ligament and requires force of the quadriceps to give return and to maintain to stability, particularly when - more unstable - a ampler position is adopted one more (the right of the photo is seen). With the maintained skis as wide as this, its difficult one to apply to complete muscular control under each leg and therefore control of one or more ski can easily be lost and the ski finishes generally upon twisting the lowest leg towards outside concerning the thigh - the doctors must have names of daft for the things and this movement is called “valgus”. The opposite, where the lowest leg gives return concerning the thigh inwards is called “varus” but this as often does not consider us as injuries of valgus of the ski. With the increase of the capacity, skiers can maintain both legs parallel that it improves the effectiveness to give return and allow so that higher speeds are reached. Whereas this is distant more diversion than fighting with snowplough, one more a higher speed can lead to injuries more severe than they are maintained in case of an accident simply because the forces applied through joint are higher. In center they are are the supposed returns of the “piston rod” - piece snowplough, returned from the parallel of the part - the curse of many a desperate one to skier more intermediate sharpened to progress parallel return to the maximum. If you are in this stage, the danger is trying to ski too fast so that your capacity stops and/or down it inclines beyond your capacities. [Only all we have done he, author including ..... in a certain stage in our races of the ski] In skis, one of the most important things that you can be able in the habit to do is one autoprueba daily to make sure that your obligatory adjustments are appropriate for your individual necessities.

0Protection, rest, ice, compression (it is seen down) and elevation 0Wool + the bandage of compression of crepe (Robert) applied the first 24 hours at least - then replaced by the small board of the extension of zimmer severe injuries 0Less can require few degrees of aid (e.g elasticated the bandage only) 0Crutches if it comes. The bearing of the weight (even partially) can happen generally once the level of the pain allows antiinflammatory drugs 0Non-steroidal unless it is against-indicated [check with a phamacist if] occurs to the case. These are due to continue by near 5 days in a minimum (although the knee feels better) 0Guidance in regular exercises of the quadriceps. The quadriceps is the muscles of the thigh and is essential after any injury of the knee that are maintained adjustment. They would surprise to you how they lose its force quickly when it is not used and this is bad for the joint of the knee. burden 0Physiotherapy and treatment the sooner - the part of this aims to maintain muscles of the intoned quadrangles. 0Assessment of the stability of the ligament once the acute pain has placed, using the unharmed side for the comparison in case of necessity

INTERMEDIATE COLLATERAL ESGUINCES OF the LIGAMENT Incidence: Alpine injury commonest of ski, explaining 20-25% of all the injuries. It more commonly affects possible nascent and skiers under-intermediate. Cause: The affected individuals are generally in the position of “snowplough” with the joint of the knee in a position of valgus (one more a leg lower than inclines outside towards the way concerning the thigh). Injury is from the excessive force of valgus that is applied to the joint of the knee, like result a fall, the skis that are crossed, or to be high and mighty of the position of snowplough. In skiers more experts, it happens generally like unexpected result “to take an edge” that sends unexpected the ski (and thus the lowest leg together with her) towards outside. Presentation/diagnosis: The diagnosis is suggested generally by the description of the fall. The examinations reveals dulzura on the intermediate collateral ligament and pain in the bearing of the weight. The presence of a arthroscopes suggests third rasgón of the degree, a damage associated to the ACL and/or injury to the Judases structures of the knee. Burden: In the acute phase, to hurt disables generally the exact burden of the stability of the ligament. When it is possible, this must be made applying to the tension of valgus with the knee in 30o of the flexion and the foot in the internal rotation (the diagram underneath left is seen). Investigation: Often nonnecessary, but the x-rays will identify associate huesudas injuries whereas MRI detects the other smooth damage of the fine weave (e.g to the ACL/meniscus) Treatment: Esguinces of degree one and two is due to put in a small board of the extension until the pain and the swelling collapse. Rasgones of degree three can require the surgical repair or the use of a cylinder of plaster. Prevention: Pre to ripen the quadrangles that condition, correct obligatory maintenance and the adjustments of the launching and the execution of autoprueba can all the aid reduce the occasions of collateral injury of the ligament. Avoiding the ample positions of snowplough that are intrinsically unstable. They advise the nascent ones to allow that a fall happens rather that trying to be against to which alternadamente they can lead to more damage.

PREVIOUS ESGUINCES OF the CRUCIATE LIGAMENT Incidence: It explains 10-15% of all the injuries of the ski (in some studies even above). Diagnosed often behind schedule if in all. Associated often to injuries to other structures within the knee (e.g. MCL and/or menisco) Cause: The intensive American investigation has identified two main mechanisms that prearrange to the damage of the alpine ACL in skiers. These have been called the ““the shipper-induced” ghost-foot” and panoramas. The first mechanism happens when the tail of the ski in declivity (the “ghost foot”), jointly with the stiff posteriora part of a boot to ski, acts like handle to apply a unique combination of the force that twists and flexion through joint of the knee. The analysis video of more than 14,000 injuries of ski has identified a typical profile that characterizes east mechanism of injury. The ghost profile of the foot 1) ascending posteriora Part of the arm 2) Skier of the balance to the later part 3) Hips underneath 4 knees) ascending Ski a-loaded 5) Weight in the inner edge of the tail in declivity of ski 6) Ski in declivity of the superior coatings of the body

When the six elements of the ghost profile of the foot are present, injury to the ACL of the leg in declivity is extremely probable. The situations that can prearrange to this becoming of the panorama are: - a) Trying to rise whereas still it moves after a fall b) To try a recovery of an unbalanced position c) trying to seat down after perdidoso control to the induced mechanism shipper happens when more to skier it becomes of balance to the later part whereas it tries a jump. By instinct, the leg of skiers extends completely. Consequently the earth to skier more in the tails of the ski that force the posteriora part of the boot to ski against the yearling calf that the tibia towards outside underneath fémur leads and rasgones of the ACL. A third mechanism now recognizes by which to skier more immovable is struck of behind in the lowest leg (often by snowboarder) - this one again applies the sudden extreme pressure in the posteriora part of the yearling calf, forcing the tibia sends with resulting damage of the ACL.

Presentation/diagnosis: The individual often describes feeling or hearing of “exploding” or a clasp of pressure of “”, with the one “of the knee taking” underneath. A haemarthrosis becomes the term of one hour of injury generally. Once the acute swelling has placed, it can have positive a previous sample of the drainage and shows of the change of the pivot in the test. Investigation: The exploration of MRI/las level x-rays to detect huesudo damage, smooth associate of the fine weave and to improve of diagnosis takes. Treatment: Controversial! In the United Kingdom, the general tendency is to inhale the haemarthrosis and to deal initially preservative with the fisioterapia that entablilla and intensive that aims to accumulate muscular force to help to stabilize the joint. In the E.E.U.U and Europe, one pleads the early repair and mobility arthroscopy of the ligament. Agreed generally that if you wish to above continue skiing in the level of a good interval or, you will probably need to have surgery reconstructive to your ACL. If nevertheless, your knee feels stable with the preservative treatment, this can be avoided. Others plead a support of the knee for the additional protection (it is seen down). Prevention: Education to recognize to happen potentially dangerous of the situations. Generally always the aim to maintain the together arms, feet front and gives the skis. The program of the knowledge of the ACL devised by Ettlinger ET has been demonstrated to reduce the incidence of injuries of the ACL by 62% (the reference is seen down). Chascar here for the Web site of Carl Ettlinger. The new obligatory progresses with the double also turn my help to reduce the incidence of injuries of the ACL. More detail in the alpine page of the ski.

FRACTURES OF the TIBIAL PLATEAU Incidence: Approximately 1% of all the injuries of the ski. To affect skiers generally older, more experimented. Cause: Severe tension of valgus often with the compresivas forces e.g as result badly a landing after a jump. Presentation: Haemarthrosis generally. There it can contusionar and/or the abrasions on the lateral aspect of the joint and a deformity associated of valgus of the knee. Investigation: Generally evident in the level x-rays. The exploration of CT could be required to determine the exact degree of breakup and the area of the surface to articulate implied. Treatment: If the fracture moves or it is pressed by the surgery more of of then 4m m is advised to recover the anatomical alignment. These injuries happen frequently in the speed and are damages severe associate to other smooth structures of the fine weave - particularly the ACL and the MCL - that will require the operation. Prevention: To avoid high jumps and the high consequent compresivas forces. it covers MENISCAL INJURIES Incidence: To happen in approximately 5 - 10% of all the injuries of the ski, often in association with damage to another structure. It affects generally the lateral menisco due to a twist of valgus in a knee of the bearing of the weight. Cause: The rotatory tension was applied to a doubled salary, rolls of the bearing of the weight. Generally the turn out to take an edge to the speed. Presentation/diagnosis: The considerable bearing of the weight of the pain and the difficulty but can have little swelling. The position commune dulzura is generally evident, specially the last degrees of the complete extension of the knee. May presents/displays with “united the knee”, where a torn meniscal fragment physically prevents the complete extension with the joint. The tests for rasgones meniscal include the test of the test of McMurray (is seen to the left) and of compression of Apley. Investigation: The image projection can be necessary to exclude associate injuries. Treatment: A blocked knee requires arthroscopy early and the repair. Isolated others rasgones can be handled expectant with the preservative treatment. The severe injuries chondral can be dealt with procedures for example microfracture, the transplants of the cartilage and biotechnology.

The PAPER OF the SUPPORTS OF the KNEE potential the protective paper of supports of the knee, specially in skiers that have had surgery reconstructive of the ACL, has been an controversial subject by absolutely awhile. In September of 2006, Sterett and others of the foundation extensively respected in Vail, Colorado of the investigation of Steadman Hawkins given effect published the results of a study of cohorte in the American newspaper straight medicine of the sports of the one “of supporting functional in injury of the knee in Skiers with the previous reconstruction of the ligament of Cruciate - an advance study of cohorte”. In this study, 257 skier-using with the previous reconstruction of the ligament of cruciate used supports and 563 skier-using with the previous reconstruction of the ligament of cruciate no. Subsequent injuries of the knee of Sixty-one were identified, 51 (8,9 knees injuries/100/estación of the ski) in group nonsupported and 10 (4,0 knees injuries/100/estación of the ski) in the supported group (P =,009). They were not supported skiers were 2,74 times more probable to suffer subsequent injury that skiers supported (quotient of the probabilities, 2,74 [the interval of the confidence, 1.2-4.9]). Logistic modeling of the regression identified not to support as factor of significant risk multivariate independent for subsequent injury of the knee in skiers of much demand with the previous reconstruction of the ligament of cruciate. The authors concluded that due to the increasing risk of subsequent injury of the knee in skiers not supported, functional supporting for skiers with the previous reconstruction of the ligament of cruciate must be recommended. Also they comment, “if the protective effect to support functional can be extrapolated other patients of much demand must still be determined.” A very interesting study that provides evidence to the aid what many of us have long felt that the supports of the knee can protect the knee against subsequent injury.



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