DIFFERENTIAL DIAGNOSIS DIAGNOSIS AND MANAGEMENT OF KNEE INJURIES

By Dr Mike Langran, MRCGP

FACTS ● 20-25% of all alpine ski injuries

occur to the medial collateral liga- ment

● 10-15% occur to the ACL ● 1% are tibial plateau fractures ● 5-10% are meniscal injuries ● 30-40% of all alpine ski injuries affect the knee joint

Injuries to the lower leg have always been a problem for alpine skiers. In the earliest years of the sport, fractures of the tibia and fibula were common as the twisting forces generated by a fall were transmitted up the leg unchecked from the ski. The subsequent develop- ment of release bindings has been very successful in reducing the incidence of such fractures but unfortunately has not afforded as much protection to the knee.

This joint, with its associated ligaments, menisci and bony structures, currently accounts for approximately 30-40% of all

10 SportEX

alpine ski injuries. In Scotland last year, knee injuries occurred at a rate of 1.33 per 1000 skier days.

The recent introduction of carving ‘super sidecut’ skis, which offer more aggressive turning characteristics than traditional skis, has raised concerns that the risk of injury to the knee may increase further as a result. While the majority of injuries have a good prognosis, some can lead to significant functional impairment and may even preclude the individual from ever skiing again.

Accurate diagnosis, coupled with appro- priate investigations and treatment, are essential in aiding the injured skier’s recovery from such injuries as quickly and successfully as possible.

At the Aviemore Medical Practice we treat all acute snow-sports injuries from the nearby Cairngorm Ski Area, aided by on- site radiography and physiotherapy.

This article will describe the common knee injuries that affect alpine skiers – with tips for diagnosis, treatment and preven- tion.

The vast majority of knee injuries seen in alpine skiers involve damage to knee liga- ments, particularly the medial collateral ligament. As with other ligament sprains, these are graded from one to three depending on the degree of damage and associated ligament laxity.

In the acute phase, it may not be possible (or appropriate) to try and assess liga- ment stability – this should be deferred until the initial pain and swelling has sub- sided. A degree of swelling usually devel- oping within twenty four hours of injury is almost inevitable.

The appearance of significant swelling within the first two hours of injury strongly suggests the presence of a haemarthrosis which, in approx- imately 75% of cases, will signify damage to the anterior cruciate liga- ment.

All cases of haemarthrosis should be referred on to an orthopaedic surgeon for further assessment and joint aspiration.

An accurate description of the accident coupled with an honest assessment of the individual’s level of ability on skis will

TIP