Sports medicine developed in the 1970s as an orthopedic specialty
focusing on competitive athletes. Today, sports medicine includes
the overall care of athletes from many skill levels. Increasingly,
care of recreational athletes has risen to that common for professional
athletes. The initial focus of sports medicine on knee injuries
now also includes other musculoskeletal injuries, including the
shoulder, elbow, and ankle. In addition to the musculoskeletal system,
emphasis is placed on the cardiovascular and pulmonary systems,
and on training techniques, nutrition, and women’s athletics.
This wide range of care requires a multidisciplinary team of medical
personnel, including athletic trainers, physical therapists, cardiologists,
pulmonologists, orthopedic surgeons, and general practitioners.
The bones of the knee are the distal femur, the proximal tibia,
and the patella. These bones depend on supporting ligaments, the
joint capsule, and the menisci to provide stability for the joint.
The menisci, or semilunar cartilages, are C-shaped fibrocartilaginous
disks in the knee that provide shock absorption, allow for increased
congruency between joint surfaces, enhance joint stability, and
aid in distribution of synovial fluid.
The medial and lateral menisci provide a concave surface with
which the convex femoral condyles can articulate. If the menisci
are not present, the convex femoral condyles articulate with the
relatively flat tibial plateaus, and the joint surfaces are not
congruent. This situation decreases the surface area of contact
and increases the pressure on the articular cartilage of the tibia
and femur, which may lead to rapid deterioration of the joint surface.
The medial meniscus is firmly attached to the joint capsule along
its entire peripheral edge. The lateral meniscus is attached to the
and posterior capsule, but there is a region posterolaterally
where it is not firmly attached (Figure 4–1).
Therefore, the medial meniscus has less mobility than the lateral
meniscus and is more susceptible to tearing when trapped between
the femoral condyle and tibial plateau. The lateral meniscus is
larger than the medial meniscus, and carries a greater share of
the lateral compartment pressure than the medial meniscus carries
for the medial compartment.
The medial and lateral menisci with their associated
intermeniscal ligaments. Note: The
lateral meniscus is not attached in the region of the popliteus
(Reproduced, with permission, from Scott WN: Ligament and Extensor Mechanism Injuries
of the Knee: Diagnosis and Treatment.
Mosby-Year Book, 1991.)
Within the knee, the anterior cruciate ligament (ACL) travels
from the medial border of the lateral femoral condyle to its insertion
site anterolateral to the medial tibial spine. This ligament prevents anterior
translation and rotation of the tibia on the femur (Figure
The posterior cruciate ligament (PCL) prevents posterior subluxation
of the tibia on the femur. It runs from ...