Sports Injury and Trauma

The ACL connects the thigh bone to the shin bone in the knee and is important in stabilising the knee during activity. An injury to the ACL often renders the knee untrustworthy and causes feelings of “giving way” or “collapsing” during sports. A torn ACL is one of the most common knee injuries, particularly in sports that include pivoting, jumping, or sudden change in direction such as basketball, soccer, or football. Many patients benefit from surgical reconstruction of a torn ligament, particularly where it occurs in conjunction with other ligament or meniscus injury.

Chronic ankle instability is a common result of recurrent ankle sprains, especially in athletes involved in sports with frequent jumping or changes in direction. It may cause ankle pain or cause the ankle to feel untrustworthy during sports or other activity. This may be managed with exercise, bracing or splinting, but if these conservative treatments fail, surgery may be necessary.

Tendons connect muscles to bone. Tendon ruptures, often caused by sudden force or overuse, can severely affect athletic performance. Commonly damaged tendons from sports injuries include pectoralis major, the bicep or tricep attachment at the elbow, hamstring tendons, quadriceps and patellar tendons and the Achilles tendon. Injuries can occur in the mid-substance of the tendon or at the attachment to the bone where they are often accompanied by a small “avulsion” fracture. Tendon injuries often, but not always, require surgical repair.

The rotator cuff is a group of muscles and tendons that stabilise the shoulder. Tears often occur in overhead athletes such as basketball players, baseball pitchers, or tennis players, due to repetitive motion or trauma. Patients may experience pain with shoulder motion, restriction of active shoulder movement, and a loss of strength around the shoulder girdle.

The Meniscus is a crescent shaped fibrocartilage in the knee that helps distribute load across the joint. It may be injured in sports that involve twisting motions, such as soccer, basketball, and football. Meniscus tears can occur in isolation or in conjunction with other knee injuries such as ligament tears and can range from small, partial tears to complete ruptures. Typically Meniscus injuries result in intermittent pain and catching symptoms in the knee. Occasionally a large meniscus tear may be caught in the knee joint resulting in a “locked knee” that is unable to extend.

 The labrum is a tough fibrocartilage that runs around the edge of the shoulder and hip joint. It helps make each socket deeper and provides a suction seal to the hip. In the shoulder labral tears often occur in athletes engaged in overhead activities such as baseball pitching, and may be predisposed to shoulder pain or instability. In the hip, labral tears may produce groin pain which is typically worse when the hp is in a flexed position. Labral tears seen on MRI scans and not associated with symptoms, may not require treatment. 

Hyaline Cartilage is the smooth covering of bone that forms a joint. Injuries to cartilage usually result from trauma to an affected joint, such as an impact injury to the knee or a subluxation/dislocation of an ankle.

Cartilage injuries are often localised areas of damage as opposed to the general wear and tear of cartilage that is known as arthritis. Focal cartilage injuries often require surgical treatment to repair or replace the cartilage, preventing or delaying the onset of post traumatic arthritis.

The knee is the most common place for focal cartilage loss that requires surgical intervention. Urgent review with an MRI as well as a clinical examination is recommended.

High-impact activities or contact sports (e.g. football, rugby, or soccer) can lead to bone fractures. Low energy activities may also cause fracture in the setting of fragile bone; an example of this would be a broken wrist from a simple fall in a patient with osteoporosis.

Excessive repetitive load, often seen in ultra-distance running, or a sudden increase in activity such as boot camp or pre-season training may also cause fractures known as “stress fractures” and typically present with a deep aching pain and limp rather than a sudden inability to bear weight.

Some fractures may be managed with a brace, splint, or activity restriction, but most benefit from early surgical repair.