Knee Injury Treatment and Prevention Strategies for Athletes

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• Common Knee Injuries in Sports
• Professional vs. Amateur Athlete Treatment
• Surgical Solutions: Meniscus and ACL
• Cartilage Treatment and Recovery Time
• Running Risks and Joint Impact
• Knee Injury Prevention Strategies
• Defining Safe Running Practices

Common Knee Injuries in Sports

Sports-related knee trauma encompasses a range of injuries with distinct mechanisms. Dr. Pablo Gelber, MD, a specialist in this field, highlights that the approach to a knee injury must be carefully considered. The most frequent issues requiring attention are meniscal tears and damage to the anterior cruciate ligament (ACL). These injuries often occur during sports that involve pivoting, cutting, or direct impact to the knee joint.

Professional vs. Amateur Athlete Treatment

Dr. Pablo Gelber, MD, emphasizes a critical distinction in treating a knee injury between professional and amateur athletes. For professionals, the primary goal is to avoid surgery whenever possible due to the significant economic impact of time away from competition. Conservative knee treatments and biological therapies, such as injections, are prioritized. For amateur athletes, the treatment philosophy is different. Dr. Pablo Gelber, MD, notes that therapy is tailored to the importance of the sport in the patient's life, with a focus on restoring function without necessarily recommending a change in activity.

Surgical Solutions: Meniscus and ACL

When conservative measures fail, surgical intervention becomes necessary for a severe knee injury. The two most common procedures are meniscal repair and anterior cruciate ligament (ACL) reconstruction. Dr. Pablo Gelber, MD, confirms that these surgeries are often unavoidable for athletes to return to their previous level of performance. The decision for surgery is based on the type of tear, the athlete's age, and their desired activity level.

Cartilage Treatment and Recovery Time

Cartilage damage presents a unique challenge in sports medicine. Dr. Pablo Gelber, MD, explains that treatments like cartilage transplantation are available but come with a protracted recovery period of at least nine months. This lengthy downtime is a major risk to a professional athlete's career, making it a last-resort option. For amateur athletes, the timeline is more manageable, allowing surgeons to utilize a fuller range of advanced biological and surgical treatments to restore knee function.

Running Risks and Joint Impact

Running, while beneficial for cardiovascular health, inherently poses a risk of knee overuse injury. Dr. Pablo Gelber, MD, states that the repetitive impact of running "hammers" the knee joints. The risk level is not uniform; it is influenced by factors like the runner's weight, age, biomechanics, and the training surface. This impact makes runners susceptible to conditions like patellofemoral pain syndrome and meniscal wear over time.

Knee Injury Prevention Strategies

Preventing a knee injury requires a multifaceted approach. Dr. Gelber outlines several key strategies for athletes. Maintaining a healthy body weight is paramount to reduce stress on the joints. Incorporating strength training builds supportive musculature around the knee. A biomechanical evaluation can identify alignment issues corrected with orthotics. Finally, using proper footwear and avoiding excessive training volumes are fundamental to preserving long-term knee health.

Defining Safe Running Practices

Dr. Pablo Gelber, MD, offers practical advice for defining safe running distances. He suggests that running three times per week for distances like 10 kilometers can be sustainable if all preventive measures are in place. However, he explicitly warns against abusive practices like running 20 kilometers daily or frequently participating in marathons or Ironman events, which dramatically accelerate joint wear. The key, according to Dr. Gelber, is to be reasonable and listen to your body to avoid a debilitating knee injury.

Full Transcript

Dr. Anton Titov, MD: You are specialized in sports-related knee injuries. Could you discuss common mechanisms of knee injuries that you see in different types of sports? Is there a way to avoid knee injuries? This could be relevant for the sports people who might be watching this interview.

Dr. Pablo Gelber, MD: We perform a lot of surgical treatments on professional athletes. Again, we have to split patients with knee injuries into two groups: professionals and amateurs. These are two different worlds.

As professionals, we try to avoid surgery as much as possible. We try to push conservative knee treatments even more. Every day that athletes are off the pitch is relevant from an economic point of view. So we try not to provide surgical treatments for knee injuries in professional athletes.

The most common surgical solution for professional athletes is meniscal repair and anterior cruciate ligament reconstruction, ACL reconstructions. Those cases, of course, need to be treated surgically. But cartilage problems are different.

For example, we are following the same line of therapy that we were talking about before. We try to avoid aggressive surgical treatment. There are, of course, some cases when the patient, a professional athlete, needs to be treated surgically.

We offer cartilage transplantation treatment too. But we try to avoid that in professional athletes. In professional athletes, we go more for biological treatment. We do different kinds of injections inside the knee. We also do injections inside the bone.

Next, let’s talk about amateur sports people. This is most of the population in the world. It is different. In those cases of a knee injury, it depends on how important the sport is for the patient.

I try to avoid recommending changing the sport. I don’t believe that’s why the patient comes to my office. So we try to keep our therapy within limits of the same type of sport they are doing.

So in those cases, again, the most typical issues are meniscus problems or anterior cruciate ligament (ACL) issues. In these cases, sometimes we’ve got to offer some kind of treatment for the cartilage.

We don’t like to do cartilage treatment in athletes because the recovery time is long. It is never less than nine months. Nine months away from the sport for a professional athlete is a huge number of days off. This can put their careers at risk.

So that’s different. In non-professional athletes, we can take more time to restore the knee function to recovery. And we can suggest doing all treatments we can do in the knee. We will try to restore the knee to the level of function it used to have, as much as possible.

Dr. Anton Titov, MD: We already mentioned running and long-distance running. Obviously, there’s very wide variability in how long people run, how well they tolerate the exercise, how long they have been doing that. So it’s a lot of individual variability.

But what do you think of a safe or healthy kind of running distances and intensity? How to avoid long-term knee overuse injury? Is there such a “safe” distance of running? Or is it individual variability?

Dr. Pablo Gelber, MD: It is a very good question. It is also hard to answer because there is a huge variety. It is not the same if we are talking about a very thin and ideally aged person—it’s one running distance.

If then we are talking about an overweight and more sedentary patient who goes running every week, he wants to run to the mountain. Running, want it or not, is not healthy for the lower limb joints. That’s the fact.

I’m not saying running is not healthy at all. From a cardiovascular point of view, running is very good. From a mental point of view, running is very good. But of course, knees are impacted by just being hammered all the time.

The knees, in our case, are doing this and doing this and doing this. So the best way to prevent or to decrease or to minimize the consequences of repeat impacts on the knees all the time is several.

To be fit, not overweight. Also, to work out not only by running, but also do strength training for your muscles. You should have a test or an evaluation of your limb alignment. Perhaps you need some inner soles to correct the way you are doing the running.

You have to have very good shoes. And try to be reasonable. If you are trying to run 20 kilometers per day, that’s for sure not good for the knees. Even in the best-case scenario, with all the previous conditions accomplished, it won’t be good for the knees.

So try not to abuse the number of kilometers, because we are like a car. I mean, how much does a car last? It’s impossible to answer that. It depends on how much you drive per day.

It is not the same if you drive only in the city or drive 200 kilometers per day across the mountain. So running is the same. Of course, you can go and keep up your car regularly evaluated and assessed regularly. It is better.

But still, even if you do that, it is not the same. If you do this kind of 200 kilometers per day running, then it is the danger even in the city. So that’s the same thing with running.

When a patient or any person runs, he has to consider being reasonable. Of course, you can run. You can run three times per week, 10 kilometers each run. If you fulfill all the previous requirements, I don’t think that will harm your knees too much.

But on the other hand, you maybe don’t fulfill any of those safety requirements that I was talking about before. And you go for one marathon every three or four weeks. You do an Ironman and that kind of thing; then you will have the knee health consequences soon enough.