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Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur

OBJECTIVES: Cricket is one of the world’s most popular team sports. In the past it was described as a sport of moderate risk for injury however at elite level, the international cricket timetable has massively expanded to encompass several new formats leaving very little time for recuperation. We re...

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Autores principales: Reid, MJ, Thompson, SM, Dawahn, R, Jones, M, Williams, A
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455877/
http://dx.doi.org/10.1177/2325967117S00199
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author Reid, MJ
Thompson, SM
Dawahn, R
Jones, M
Williams, A
author_facet Reid, MJ
Thompson, SM
Dawahn, R
Jones, M
Williams, A
author_sort Reid, MJ
collection PubMed
description OBJECTIVES: Cricket is one of the world’s most popular team sports. In the past it was described as a sport of moderate risk for injury however at elite level, the international cricket timetable has massively expanded to encompass several new formats leaving very little time for recuperation. We report on a series of seven elite level fast bowlers that presented with a similar injury pattern to the antero-medial femoral condyle of the knee in the leading leg. We describe the presentation, investigation and treatment of this lesion and discuss the possible aetiology. This injury pattern has not previously been reported in the literature. METHODS: 7 international level fast bowlers (two Indian and 5 English) presented to our clinic with knee pain in the lead leg (the right knee for left hand bowlers and the left knee for right handed). The mean age of the patients was 27 (20-32) and the mean duration of symptoms was 9 months (2 weeks to 2 years). In all patients a careful history and examination was undertaken followed by appropriate investigations. The main complaint was that of anterior knee pain which was restricting them from bowling. It was associated with a minor fixed flexion in three of the patients and all patients had an effusion at the time of presentation. There were no other symptoms. All patients underwent an MRI scan. A classical appearance of oedema within the medial femoral condyle (Figure 1) was noted. In 4 patients there was ascociated cartilage loss. The injury was also identified on SPECT scan (Figure 2) 3 patients were managed nonoperatively but due to more significant MRI and clinical findings Four went on to require arthroscopic surgery (Figure 3) in the form of microfracture of the lesion. RESULTS: All patients returned to International cricket with a mean of 6 months in the non-operative group and 8 months in the operative group. CONCLUSION: Anterior impingement from the antero-medial tibia and femur can be a potentially career ending lesion in the fastbowler. A strong index of suspicion has to be exercised when a bowler attends with an effusion associated with episodic pain and localisation (which may be difficult to ascertain). This lesion may be present in the asymptomatic bowler, presenting with an associated injury in the same knee. This lesion is typical in this elite group and as such training schedules and medical staff need to be aware of it as a cause of significant injury.
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spelling pubmed-54558772017-06-12 Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur Reid, MJ Thompson, SM Dawahn, R Jones, M Williams, A Orthop J Sports Med Article OBJECTIVES: Cricket is one of the world’s most popular team sports. In the past it was described as a sport of moderate risk for injury however at elite level, the international cricket timetable has massively expanded to encompass several new formats leaving very little time for recuperation. We report on a series of seven elite level fast bowlers that presented with a similar injury pattern to the antero-medial femoral condyle of the knee in the leading leg. We describe the presentation, investigation and treatment of this lesion and discuss the possible aetiology. This injury pattern has not previously been reported in the literature. METHODS: 7 international level fast bowlers (two Indian and 5 English) presented to our clinic with knee pain in the lead leg (the right knee for left hand bowlers and the left knee for right handed). The mean age of the patients was 27 (20-32) and the mean duration of symptoms was 9 months (2 weeks to 2 years). In all patients a careful history and examination was undertaken followed by appropriate investigations. The main complaint was that of anterior knee pain which was restricting them from bowling. It was associated with a minor fixed flexion in three of the patients and all patients had an effusion at the time of presentation. There were no other symptoms. All patients underwent an MRI scan. A classical appearance of oedema within the medial femoral condyle (Figure 1) was noted. In 4 patients there was ascociated cartilage loss. The injury was also identified on SPECT scan (Figure 2) 3 patients were managed nonoperatively but due to more significant MRI and clinical findings Four went on to require arthroscopic surgery (Figure 3) in the form of microfracture of the lesion. RESULTS: All patients returned to International cricket with a mean of 6 months in the non-operative group and 8 months in the operative group. CONCLUSION: Anterior impingement from the antero-medial tibia and femur can be a potentially career ending lesion in the fastbowler. A strong index of suspicion has to be exercised when a bowler attends with an effusion associated with episodic pain and localisation (which may be difficult to ascertain). This lesion may be present in the asymptomatic bowler, presenting with an associated injury in the same knee. This lesion is typical in this elite group and as such training schedules and medical staff need to be aware of it as a cause of significant injury. SAGE Publications 2017-05-31 /pmc/articles/PMC5455877/ http://dx.doi.org/10.1177/2325967117S00199 Text en © The Author(s) 2017 http://creativecommons.org/licenses/by-nc-nd/3.0/ This open-access article is published and distributed under the Creative Commons Attribution - NonCommercial - No Derivatives License (http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits the noncommercial use, distribution, and reproduction of the article in any medium, provided the original author and source are credited. You may not alter, transform, or build upon this article without the permission of the Author(s). For reprints and permission queries, please visit SAGE’s Web site at http://www.sagepub.com/journalsPermissions.nav.
spellingShingle Article
Reid, MJ
Thompson, SM
Dawahn, R
Jones, M
Williams, A
Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur
title Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur
title_full Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur
title_fullStr Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur
title_full_unstemmed Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur
title_short Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur
title_sort fast bowlers knee - anterior impingement from the antero-medial tibia and femur
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5455877/
http://dx.doi.org/10.1177/2325967117S00199
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