Sports-related knee trauma in athletes. Surgical treatment and rehabilitation. 8

Sports-related knee trauma in athletes. Surgical treatment and rehabilitation. 8

Sports-related knee trauma in athletes. Surgical treatment and rehabilitation. 8

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You are specialized in a sports-related knee injury. Could you discuss common mechanisms of a knee injury 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. 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, it is relevant from an economic point of view. So we try not to provide surgical treatments to a knee injury 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 the 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 the most of the population in the world. It is different. And in those cases of a knee injury, it depends on how important is the sport for the patient. I try to avoid recommending to change 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 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 at risk their careers. 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. 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 variabilities. 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 a individual variability? 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 overweight and a 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. I mean, 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 to be 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 too much your knees. 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 things; then you will have the knee health consequences soon enough.

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