Editors Choice

Why this is the No.1 operation on footballers

This is the most common football injury across all levels of the game that requires surgery, here's why..

F4F Original PhotoAlthough x-ray's are not specifically used to view cartilage, they can show up any bone damage where the articular cartilage has worn away.


How Anterior Cruciate Ligament Injuries Happen

This injury used to end a footballer's career. How does it happen? 




The knee has two shock absorbing cartilages called meniscus. There are medial (inner) meniscus and lateral (outer) meniscus. Injury to the meniscus is caused normally as a result of twisting. They can also occur as part of a combination with other injuries to the ACL, medial and lateral ligaments. To help the knee glide and bend, there is articular cartilage (these coat the ends of the bones) , if this gets damaged then arthritis is likely in the future. 



I flicked the ball round the corner, went to turn and the knee just give way!
Former England forward, Emile Heskey.



Meniscal injuries tend not to be acute (cause sharp pain), in that they will occur to a level to stop an individual playing at the time the injury occurs. They gradually come on and go, usually the symptoms occur the day after, or two days after the injury, when the knee swells up and becomes painful.  


+7 PA ImagesWeight going through the knee can crush the meniscus if the knee is fully flexed.Crunch




The common symptoms are pain to the inner or outer side of the knee, along with swelling. The player will normally limp and pain is made worse by twisting, squatting or kneeling. The diagnosis can be made clinically when the symptoms shown by the injured player are examined by a surgeon. These can be confirmed with special tests such as a Magnetic Resonance Imaging scan (MRI scan), which can show meniscal tears.

There are some effective medical treatments that can limit further damage after a cartilage operation.
Prof. Sanjiv Jari, football4football orthopaedic surgeon




The menisci have a poor blood supply and, therefore, find it hard to heal once they are torn. 50% of lateral meniscal tears can become asymptomatic (show no obvious problems) over time, although the tear is still there. However, an aggravating activity can cause the problem to flare up. Medial meniscus tears, usually once symptomatic (pain and problems present) remain so, although the condition can change in intensity. 


+7 The knee explained




Treatment of these injuries may initially involve trying to reduce the inflammation caused by the tear and therefore, the pain and swelling, by injecting a steroid into the knee. This can be used in players who are in the middle of a season to try to get them through until the end. This is something that has been commonly abused in the football 'dark ages' of the past.

Players were getting regular injections before every game, this was something that should not have happened. Thankfully, with advanced understanding of the associated problems with mismanagement of cortisone, this is hopefully eradicated. When the player remains symptomatic (has pain and problems), then an operation is needed, involving keyhole surgery (arthroscopy) of the knee.

This allows instruments to be placed into the knee to allow the tear to be repaired, although most tears are not repairable. If it is not repairable, the torn part of the meniscus is removed.

This operation performed by skilled orthopaedic surgeons, can be carried out in under 20 minutes!
The football4football injury team


Exercises from physiotherapists need to be done after a football injury. Following the surgery, a player undergoes rehabilitation to reduce swelling, regain motion and regain leg strength. They then go through a programme of gentle exercises that they would normally do during a game of football before they return to proper training and full match play. This is now considered a minor surgical procedure, however some degrees of damage are so severe that they can prevent a footballer playing in the top flight competitively.

There are now injections that players have directly into the knee that act like a lubricant. Unlike the cortisone of the past, they don't mask the injury, but aid active recovery. Because of the nature of the required gliding movement of the knee, they are normally repeated every 6-months to maintain the joint.

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