haematoma treated with heat rather than R.I.C.E. Beware and advise players accordingly.

Summarising injuries

Intra-articular knee disease is usually witnessed by pain over the knee, occasionally referred to the hip. Hyperextension loss is commonly the earliest sign. The capsular pattern i.e. decreased flexion/extension equally affected. With knee pain without obvious acute injury - look to the patella. x-ray is rarely useful.

TREATMENT

Most injuries will respond to R.IC.E along with exercises for the quads and hamstrings (see page 2 for sportEX’s new online advice leaflets). These can be explained to the patient

online

Launch the videos by clicking on the images

by an interested GP or a physio and accompanied by a printout. Analgesia, NSAIDs and acupuncture are helpful for acute injuries. Intra-articular steroid injection will often relieve pain from OA (see NICE guidelines) to allow quads exercises to strengthen the muscles that extend the knee. Debridement and repair of menisci and cruciate ligament tears are needed surgically if these approaches don’t work. Full repair and rehabilitation of an ACL tear takes a year at least - physios with specialist knowledge of this area are key.

References

1. Pain distribution from the Knee: Travell and Simons Myofascial Pain and Dysfunction: The Trigger Point Manual Vols 2

2. Capsular pattern of Knee Pain - Society of Orthopaedic Medicine

In addition to the videos included in this article, we have a compiled two additional playlists of complementary videos. They can be found on the links below: n YouTube Playlist 1 - Videos and animations on knee anatomy - http://bit.ly/bdwbib n YouTube Playlist 2 - Assessment and diagnosis of the knee - 27 excellent quality videos from the British Journal of Sports Medicine - http://bit.ly/dtJfCx n The online version of this article contains additional videos – to access it you need to have a subscription to sportEX medicine and log in via our website at www.sportex.net

With thanks to Primal Pictures for the permission to reproduce these

n Video: Stabilising role of the ACL n Video: Stabilising role of the PCL n Video: Role of the MCL

animations which all came from Sports Injuries of the Knee. For more information visit www. primalpictures. com

THE AUTHOR

Dr Simon Kay, MBBS MRCGP DRCOG DIPL and MSc Sports medicine, member of FSEM BASEM BMAS SOC and Honoury Education

Fellow Exeter University. Simon is a full-time GP/ Sports Physician, Yorkshire Missionary in Devon. He has been a GP for 25 years and is a keen ex-rugby player. He became interested in sports injuries since injuring his knee in 1988 and completed his Diploma in Sports Medicine in 1997, followed by his MSc in 2006. Since 1999 he has added acupuncture, SOM teaching, manipulation, podiatry and sports therapy teaching to his repertoire. He teaches students, GPs and sports therapists and has been medical officer to various rugby clubs, notably Halifax RUFC and Exmouth RFC, England SW U18 Rugby, and now Exmouth ABA. For more information visit www.sports-doctor.co.uk

n Video: Role of the lateral collateral ligament

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n Video: Patellofemoral tracking

n Video: Tibio-femoral joint motion

sportEX medicine 2010;45(Jul):7-12