July 13, 2016
This past Sunday FIFA player of the year Cristiano Ronaldo was injured in the eighth minute of the finals of the European Championships. He attempted to play through the injury but was unable and came off in the 25th minute. For the world’s best player to come off in a final, it meant that he sustained a serious knee injury, with pundits around the world speculating on the extent of his injury.
Watching the match live, it appeared to me to be an MCL injury as he was hit on the outside of his knee forcing the knee inward. These types of valgus stress injuries usually result in an MCL sprain. Other structures such as the ACL and/or meniscus can be injured but since he did not come out of the match immediately it is less likely that they were. It’s very difficult to play soccer with an MCL injury due to not only the cutting and pivoting required, but even more limiting is the inability to pass with the inside of the foot due to the stress on the ligament.
Now that the a few days have passed and Ronaldo has had more thorough evaluations, it has been determined that he indeed has an MCL sprain. This means Ronaldo suffered a stretch in the ligament, and fortunately not a complete tear that would require surgery. These injuries are typically graded on a 1-3 scale with grade 1 being mild with no significant laxity and minimal injury to the ligament. Grade 2 is moderate injury with some laxity and partial tearing of the ligament. Grade 3 is a severe injury with gross laxity and complete ligament disruption often requiring surgical repair. Other structures such as the ACL and either meniscus can be injured as well as the articular cartilage (joint surface cartilage). These all add to the severity of the injury, time frame to return, and if surgery is indicated.
Return to play is variable with this injury, especially in soccer players. With grade 1 injuries, it’s based on the player’s symptoms and ability to progress through rehab and training. Caution needs to be taken with early return as re-injury is possible and if the knee is not 100 percent there is a greater risk of ACL injury to the involved or uninvolved knee. In grade 2 injuries, progression through rehab is based more on the healing of the ligament which is assessed through the amount of laxity or looseness in the knee. This laxity decreases as the ligament heals and the knee “tightens up” over time. Grade 3 injuries require a much longer time frame to heal, if they don’t require surgery. Although the return to play time frames for MCL injuries in soccer can be widely variable, a general guideline is a grade 1 injury takes 2-6 weeks to rehab, 3-8 weeks for grade 2, and 2-4+ months for grade 3. Internet speculation has him out as little as three to four weeks, a middle ground guess of eight weeks, and as much as four to five months as a worst case scenario.
As more details come out regarding Cristiano Ronaldo’s injury, more specific time frames will be given. As a soccer fan, I’m hoping he’s ready for the start of the La Liga season and Champions League. Love him or hate him, Real Madrid matches are more exciting with him on the pitch.
June 15th, 2016
The 17th annual Philadelphia Sports Medicine Congress will be held on Friday June 17 at the National Museum of American Jewish History in center city Philadelphia. The event features lectures by nationally recognized experts in their respective fields focusing on leading edge topics in sports medicine. This course is directed primarily towards athletic trainers, physical therapists, advanced practice nurses, physician assistants, and physicians caring for athletes. The objective of the conference is to review critical issues faced by the sports medicine practitioner in the care of athletes, to provide the most recent advances in care to athletes at all levels of competition, and provide practical, interactive learning of evaluation and treatment techniques. This year’s program will include a wide variety of sports medicine topics from hip pain in athletes to future trends in meniscal repair. The program consists of the following topics and presenters:
Garrison Draper MSc, CSCS Performance Director Philadelphia Union
Topic: GPS and Heart Rating Monitoring in Sports: Implications for Rehabilitation
Theodore Ganley MD Director, Sports Medicine and Performance Center Children’s Hospital of Philadelphia
Topic: Management of ACL Injuries in Athletes with Open Growth Plates
RobRoy Martin PhD, PT, CSCS Associate Professor, Department of Physical Therapy Duquesne University and Staff physical therapist, University of Pittsburgh Medical Center's Center for Sports Medicine
Topic: Conservative Management of Posterior Hip Pain in the Athlete
Todd McGrath MD Non-operative Sports Medicine Specialist 3B Orthopaedics at Aria
Topic: Injection Therapies in Sports Medicine
Nicholas Sgaglione MD Professor, Hofstra University North Shore-LIJ Medical School, Chair Department of Orthopaedic Surgery North Shore Long Island Jewish Medical Center
Topic: Current Concepts and Future Trends in Meniscal Repair
Stephen Thomas PhD, ATC Assistant Professor of Instruction in Kinesiology Temple University
Topic: Pathomechanics of the Throwing Shoulder
Bernie Parent Former Philadelphia Flyer and NHL hall of fame inductee
The idea of the Sports Congress was originally conceived as an educational program, based at Pennsylvania Hospital. Because Joe Torg and Ted Quedenfeld were such influential icons in the field of sports medicine, it seemed natural to recognize their contributions. It was also felt that it was important to make note of the historical aspects of the origins of "sports medicine" in the area and that is why we annually pay tribute to Joe and Ted. The purpose of the Torg award as originally conceived was to recognize individual orthopedic surgeons in the greater Philadelphia area who devoted their careers to the care of athletes, who participated in the educational process, and who have made significant contributions to the body of knowledge of orthopedics. These are the qualities that are embodied by Dr. Torg. In similar fashion, as Ted Quedenfeld was responsible for teaching many if not most of the local athletic trainers at one time, and because he was a role model and one that was held in the highest regard by all of his peers and students, and because it was he who helped create the model of sports medicine with which we presently identify, we chose to honor Ted. This year’s Joe Torg award winner is Dr Michael Ciccotti of the Rothman Institute. Michael Goldenberg MS, ATC of The Lawrenceville School is this year’s Ted Quedenfeld award winner.
On behalf of Course Chairman Arthur Bartolozzi MD and the Course Committee, we are looking forward to another successful Philadelphia Sports Medicine Congress on Friday, June 17. More information can be found at our website phillysmc.org.