Sports Injuries ( ACL/ MCL/ Meniscal Tears)

The Knee joint is the complex joint of the knee and is composed of bone, cartilage, ligaments and fluids that enable flexible movements of the knee joint. When any of these structures are injured or damaged they can cause knee problems causing pain and difficulty walking. Some of the most common knee injuries include:

ACL injuries: ACL is a major ligament in the knee. Sports that engage sudden stop and direction changes can cause injury to the ACL ligament. ACL is responsible for preventing the forward sliding of the knee (leg bone over the thigh bone). Damage to the ACL ligament includes a sprain or a tear caused by a direct blow to the knee during any sport activity with a sudden change in direction or hyper-extension from a jump. Damage to the ACL ligament causes rapid and extreme pain and swelling with an unstable feeling knee.
Conventional treatment method for ACL injuries include surgical repair through the construction of a new ligament in the knee.

MCL injuries: MCL is another major ligament in the knee that is located in the inner part of the knee to prevent an inward over-extension of the knee. The ligament helps to stabilize the knee and allow it to rotate in all round range of motion. An injury to the MCL can be caused by a direct blow to the outside of the knee causing a stretch or tear of the MCL or other ligaments. This can lead to pain, tenderness, swelling and stiffness on the inner side of the knee and also feels unstable knee. Sports events can cause a number of isolated MCL medial knee injuries by either a contact or non-contact stress to the outer of the knee that stretches the medial knee structures in the interior of the knee. The extent of the medial knee injury is based upon the amount of tearing in the knee ligament and is classified as:

• Grade I: partial MCL tear
• Grade II: close to complete MCL tear
• Grade III: a complete MCL tear (non-functional ligament)

Conventional treatment method to treat MCL injuries includes non surgical treatment such as using a lightweight cast or brace to restrict knee movement. The affected knee joint is immobilized to keep it stable and for faster healing. Pain relievers help reduce pain and swelling due to an MCL injury.

Meniscus injuries: The meniscus is a cartilage in the knee joint that functions as a shock absorber for the knee joint. A direct blow to the knee or degeneration can lead to meniscus with loss of the cartilage tissue leading to osteoarthritis in the bone. This condition occurs when there is sudden stop or direction change during any physical activity causing swelling, stiffness and popping sensation during joint movement. The condition also causes knee pain, decreased range of motion and a feeling of knee getting locked.

Conventional method for meniscus injury treatment includes an arthroscopic surgery with transplant of cartilage from another area of the knee or a total knee replacement. For mild meniscus injuries, physical therapy or supportive devices are adapted to treat the condition.

ALTERNATIVE TREATMENT METHODS AT BETH YEHUWDAH ARTHRITIS CENTRE, PULLAD & DAYSTAR CLINIC, ALAPPUZHA FOR SPORTS INJURIES (ACL PARTIAL TEAR/ MCL PARTIAL TEAR/ MENISCAL TEARS)-

Prolotherapy in ACL/MCL partial tear and in Meniscal tears: Prolotherapy is a natural and cost effective alternative method to ACL surgery in patients with partial tear of ACL/MCL/meniscal tears. Prolotherapy is an almost painless injection technique under local anesthesia where very thin needles are used to inject high concentrations of dextrose solution (sugar similar to glucose) in to loose and damaged ACL/MCL ligament, and/or Meniscal tears inside the damaged knee joint. Prolotherapy works by increasing the glucose concentration in the fluid outside the cells, which results in movement of fluid from inside the cells to the outside of the cells thereby shrinking the cells and causing temporary cell damage (hyperosmolar damage). As the cells are temporarily damaged, they release many biosignals to the body which results in stimulation of the immune system of the body to accelerate the inflammatory process locally resulting in increased local blood circulation, fibroblast (fibrous cell) proliferation, ligament regeneration, tightening and repair. Prolotherapy is an effective non surgical treatment method used successfully in various joint disease condition. This treatment method has the ability to strengthen the existing intact, but weakened, ligamentous and tendinous structures in the joint. Often it is done under arthroscopic guidance in partial tears of ACL ligament. Along with the treatment technique, it is important to perform series of movement and muscle strengthening exercises to strengthen the already weakened muscles.
Patient Benefits of Prolotherapy:

• Minimally invasive treatment method
• Almost painless injection technique using very thin needles under local anesthesia
• Avoid if not delay Surgery
• Significantly reduces the symptoms associated with sports injury
• Reduced risk of adverse events
• Repairs and tightens ligaments improving joint stability and ease of walking
• Safe and effective treatment method
• Faster healing and recovery
• Prolotherapy results in safe, significant, effective, progressive improvement of knee pain and function.
• The throbbing pain is reduced by stimulating healing mechanism at the source of the joint.

2) Platelet Rich Plasma in Meniscal tears/ partial ACL tear: Plasma rich platelet prolotherapy is the recent trend in treating various joint conditions and is designed to stimulate repair of torn ligaments in the affected joint and to reduce swelling and pain caused by the condition. PRP is treatment where PRP is injected into the joint with meniscal tear/ ACL partial tear and dextrose prolotherapy is given to the surrounding ligaments of the joint which may also be tender in many patients. This treatment can help a patient to avoid surgery and to overcome the disease condition with minimally invasive injection techniques. The treatment method stimulates the natural immune repair mechanisms of the body and delivers the building block essential to build and replace damaged or lost joint tissue. Often it is done under arthroscopic guidance in partial tears of ACL ligament.

How does PRP work? Blood components are of four major types - plasma, platelets, white blood cells and red blood cells. Platelets assist in clotting and are also the “first-responders” of the body post injury; helping repair an injured region and in building up of new tissue and thereby promoting the healing process. Once platelets contact collagen in damaged tissues, the platelets release various biological growth factors (Table 1 as given below) to promote healing in soft tissues locally. Activated platelets commonly release the following growth factors:

Table 1: Various biological growth factors released by PRP when activated

PRP injection delivers a high concentration of autologous (patient’s own) platelets to the joints and soft tissues concerned. Platelets present in the blood are the first responders to an injured area and helps build up new tissues. Introducing high concentration of platelets directly into the joint using PRP injection stimulates the healing process and faster recovery from the joint condition.
Patient Benefits of PRP Prolotherapy:

• Minimally invasive treatment method
• Almost painless injection technique using very thin needles under local anesthesia
• Avoid if not delay Surgery
• Significantly reduces the symptoms
• Reduced risk of adverse events
• Repairs and tightens ligaments improving joint stability and ease of walking
• Safe and effective treatment method
• Faster healing and recovery
• PRP Prolotherapy results in safe, significant, effective, progressive improvement of knee pain and function.

At Beth Yehuwdah Arthritis Centre, Pullad and Daystar Clinic, Alappuzha we provide a variety of options for patients suffering from various sport injuries and joint pain conditions even other than partial tears of ACL/ MCL and meniscal tears. To know more about sports injury treatment plans and cost, book an appointment now.