Knee injuries cover a wide range of conditions, from minor sprains to severe ligament and cartilage tears. They are often the result of sports activities, sudden changes in direction, or direct blows, and require accurate diagnosis and timely treatment to prevent permanent damage. The most common types of injuries:

• Ligament injuries: Most commonly involve the anterior cruciate ligament (ACL) and medial collateral ligament (MCL), which tear during sudden decelerations and changes in direction.

• Meniscus injuries: Tears of the meniscus (inner and outer cartilage cushions) occur during rotational movements with the foot stationary.

• Articular cartilage injuries: Damage to the smooth surface of the bones within the joint, which can be acute (due to trauma) or degenerative.

• Tendinitis (inflammation of the tendons): Known as "jumper's knee," it is characterized by inflammation of the patella due to overuse.

 

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Diagnostics and treatment methods

 

An examination by an orthopedic surgeon is essential for making an accurate diagnosis, which is supplemented by imaging tests such as magnetic resonance imaging (MRI), ultrasound, or X-rays.

Treatment depends on the severity of the injury:

• Conservative treatment: Includes rest, ice application, wearing orthoses, and targeted physical therapy.

• Surgical treatment: For more severe ruptures (e.g., anterior cruciate ligament), minimally invasive knee arthroscopy is often used.

 

Pre-operative and post-operative knee rehabilitation are key to successful recovery. Pre-operative rehabilitation reduces swelling and improves strength before the procedure, while post-operative rehabilitation restores range of motion, stability and function, enabling a pain-free return to daily activities.

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Pre-operative ACL Phase (Preparation for Surgery)

 

The goal is to improve functional status before surgery so that postoperative recovery is faster and shorter.  ​

• Strength exercises: Strengthening the quadriceps and hamstrings.

• Reduction/elimination of swelling and pain.

• Improvement of active and passive knee range of motion in extension and flexion.

• Education and information about the risks of surgery, postoperative precautions, rehabilitation process, and potential risk of osteoarthritis (OA).

 

Post-operative ACL Phase (Recovery Phases)

 

Recovery occurs in several progressive phases prescribed by a physician or orthopedic surgeon, and carried out by a licensed physical therapist in collaboration with a kinesiologist. The post-operative phase is divided into 3 phases for ACL injuries:

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Acute Post-Operative Phase (first 3 months):

• ​Regaining full range of motion in the knee joint (flexion/extension)

• Reducing swelling in the knee

• Improving quadriceps strength and equalizing the strength of the operated and non-operated leg

• Normalizing walking pattern

• Maintaining strength in other parts of the body (upper body and trunk)

• Introducing bilateral exercises (squats, deadlifts, bridges)

• Easy cycling (4-6 weeks)

• Progressive preparation for running (10-12 weeks)

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Central (Functional) Post-Operative Phase (3-6 months)

• ​Running progression

• Focus on unilateral exercises

• Various Olympic lifts and explosive weightlifting exercises ("hang clean", "kb swings", etc.)

• Gradual introduction of plyometric exercises (4+ months bilateral, 5+ months unilateral)

• Athletics school exercises, ladders (sagittal and frontal planes), linear acceleration with long deceleration, frontal movements (shuffle-carioca)

• Individual ball training in the sagittal plane (straight line dribbling, technique, wall passing, etc.)

 

Final Post-Operative Phase (6-9 months)

• Progression to running at maximum speed

• Progression to maximal single-leg jumps in all directions

• Progression to changes in direction of movement at maximum intensity

• Return to sport (partial team training without contact 7-8 months, full team training with contact 8-9 months)

• Return to competition with limited minutes 9+ months

 

It is important to dose competitive minutes throughout the first season after returning to sport (month 9-month 24 after injury) because the maturation phase can take more than 24+ months after ACL reconstruction.

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