Ledley King’s hopes of playing a part in England’s World Cup squad have been raised after it was revealed that he wouldn’t require knee surgery for a longstanding knee cartilage problem.
Relieved Spurs coach Martin Jol played down the injury, mindful that his team are hanging on to a Champions League qualifying position. The Dutchman commented, “They said he had a minor tear in his cartilage but I had one of them and couldn’t walk. Sometimes you have to exercise your other muscles and he has done that so well that there is no problem now.”
Jol continued, “He couldn’t have an operation at the end of the season anyway because he wants to go to Germany. These days it is keyhole surgery and you are out for 10 days. So he could have it but there is no need as he does not have a problem. You can operate on somebody’s knee but it is not necessary in this case.”
A torn knee cartilage is one of the most common injuries in football. The term cartilage tear is slightly misleading, since it is the Meniscus within the knee that is actually damaged. There are two menisci within each knee joint that are made from tough fibrocartilage - hence the use of the term cartilage for this injury.
During sports, usually when twisting on a bent knee, the Menisci can get jammed and nipped in between the shin and thigh bones. If the force is sufficient, a tear of the Meniscus will occur. If the torn flap of Meniscal tissue is large then it may get in the way of normal knee joint mechanics, causing the knee to lock. Typically there is also a sensation that the knee ‘gives way’, and because of interference with other structures in the knee joint, there may be irritation and swelling.
In some cases, such as Ledley King’s injury, after the initial swelling and pain, the joint settles down and normal activities can be resumed. This is because the tear in the Meniscus is small or the flap does not affect the joint mechanics. However, if the flap causes locking or giving way, surgery is required. This is carried out arthroscopically, whereby a small camera and burring device are inserted into the knee joint, where the surgeon removes the flap and smoothes off the surface of the meniscus.
Knee swelling following a Meniscal tear is usually caused by inflammation of the capsule that surrounds the knee joint. This is known as a knee joint ‘effusion’, where irritation of the capsule causes it to produce more of the ‘synovial fluid’ that is usually present within the joint. Typically the knee feels hot to touch, although there may or may not be accompanying pain. Surgery always produces an effusion of the knee joint, as the surgeon has to go through the joint capsule to get inside the knee.
Numerous methods to reduce knee swelling have been advocated, including elevation of the limb, ice therapy, Quadriceps muscle exercises, massage and electrotherapy treatment. Research studies of these methods suggest that ‘static’ Quadriceps exercises (where the muscles are contracted without knee movement) are more effective in the reduction of swelling than use of elevation alone and that continuous ice therapy with compression is more effective than using ice packs after injury and surgery to the knee.
The Cryocuff ice therapy device by Aircast Inc is used widely by physiotherapists in the treatment of Premier League players to reduce swelling following knee injury and surgery. Research findings have shown that by lowering the temperature in injured tissues, local inflammation, pain, swelling, and bleeding have been shown to be reduced. Researchers also found that the combination of cold and compression significantly reduced swelling and increased the range of motion in knee joint injuries.