Why are Knee Injuries Common in Football?

Knee injuries are very common in football. They can include both noncontact and contact injuries. Unfortunately, there is a very high risk for significant knee injuries, such as an ACL tear, due to the twisting, turning, planting, and other mechanisms that places the knee at risk when playing American football.

What is the Most Common Knee Injury in Football?

One of the most common injuries in football is a tear of the ACL. In this circumstance, about 70% of the time it is a noncontact injury where one is twisting, planting one’s leg, and changing position, and the knee has a pop and the knee slips. In these circumstances, the pop is due to a bone bruise and most commonly it is also associated with an ACL tear. If the knee swells up relatively quickly, this is almost always indicative of an ACL tear. In this circumstance, one should be checked out rather quickly to ensure that there are no other associated injuries to minimize the risk of having long-term damage to one’s knee. Due to the twisting, turning, and pivoting mechanism involved with football and most other sports, when an athlete does tear their ACL while playing football, it is recommended that they undergo surgery to reconstruct the ACL to best restore stability to one’s knee.

Meniscus Tears in Football Player

Other football-related knee injuries include tears of the meniscus. The medial and lateral menisci are important cushions and shock absorbers within the knee. It is certainly felt that the meniscus protects the whole knee, and when one loses their meniscus, it is the end of normal function of that particular knee. Thus, it is important to have a proper diagnosis when one does have a meniscus tear and to try to have it repaired at all costs if possible. If one does have to have the meniscus resected or the surgeon chooses to resect it when it is potentially repairable by another surgeon, the patient is at a very high for the development of osteoarthritis. There are many different types of meniscus tears and likewise there can be multiple ways of performing a meniscus repair. One of the most common causes of meniscus tears in football players is when one tears their ACL; this can cause a tear of either the medial or lateral meniscus or both. In these circumstances, when the ACL tears, the tibia slips forward in the femur and the meniscus can be torn at the same time due to the same forces being directed to the knee. When one does have a meniscus tear with an ACL reconstruction, it is strongly recommended to repair it because there is a very high likelihood that it will heal. This is because there is a lot of important growth factors and stem cells that are released with reaming of ACL reconstruction tunnels, and these being released into the knee results in the meniscus having a very high chance of healing in most circumstances. Even complex meniscus tear patterns, such as a complete split in half tear, called a radial tear, or a tear off of bone at its attachment site, called a root tear, should be repaired, especially in younger people. This is because when one does not have these fixed, the knee is at a very high risk for the development of arthritis and one’s overall knee function will significantly decrease.

Are Knee Dislocations and Multi-Ligament Knee Injuries Common in Football?

Other football-related knee injuries can include multiple ligament injuries such as an ACL tear with an MCL or LCL tear, or a combined 3- or 4-ligament injury, which is almost equivalent to a knee dislocation. In these severe multiligament knee injuries, which often involve a PCL tear, it is recommended to proceed with surgery of all the torn ligaments, preferably in the same surgery, called s one-stage surgery, rather than doing part of the surgery at one stage and then coming back and doing the other ligament surgery at a later stage. Multiple studies have shown that this is best for joint health and several of our studies have demonstrated that all of these ligaments are codependent upon each other, so reconstructing one at a time places them all at risk for failure.

The other relatively common knee injury in a football player is a kneecap dislocation. Lateral patellar dislocations can result in tearing of the structures attaching on the inside part of the kneecap, called the medial patellofemoral ligament and medial patellotibial ligaments, which provide stability to the knee. If one has good bony geometry whereby the end of the femur has a deep groove, often one can heal a kneecap dislocation injury with therapy. However, if the end of one’s femur is relatively flat and the bony confines of the knee do not provide native inherent stability to this knee, there is a much higher risk that the kneecap will dislocate again. This is not to say that one should try some rehabilitation first, but one has to recognize that when the bony geometry is not supportive of the kneecap that once one tears their ligaments, there is a much higher risk they will continue to have the kneecap dislocate in the future. If that does happen, a complete workup is necessary to determine what should be done to best restore the kneecap tracking and stability so it does not happen again.

Overall, football causes the most injuries in sports medicine, and being careful to ensure that one has the proper diagnosis, has a proper exam, and is cleared to return back to sports so they do not hurt themselves further and damage their knee health over the long term, is essential after sustaining an injury while playing football.

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