Name of Injury:
The "Unhappy Triad" or "blown knee." (Also known as the "terrible triad" or O'Donoghue's triad.) It occurs when their is a triple ligamentous injury.



Description of Injury:
Initial Symptoms of this Injury include:

• A partial of complete rupture or tear of the triad ligaments
• Some may hear a "pop" sound
• Swelling of the knee
• Bruising around or on the knee
• Mild to severe pain
• Instability or a feeling of the knee "giving out" (This is because the tibia and femur are sliding against each other.)

The ACL tear
The torn ACL is the most significant of the three injuries in the Unhappy Triad injury. This tear is the most significant because it leaves the knee unstable. A torn ACL requires surgery to repair and recovery can take months, typically 6 to 9 months depending on severity of the injury. Without the ACL, the knee looses its ability to maintain normal function.
The image to the right shows a MRI of an ACL tear while the image below demonstrates the difference between and normal and torn ACL.





The Mensicus Tear
The Meniscus Tear is the second affected area of this injury. The meniscus is C-shaped fibrocartilage within the knee joint that provides cushion and reduces friction and stresses on the bones. The meniscus does not have a very good blood supply, and is slow to heal. Therefore, meniscus tears usually have to be treated surgically. If left untreated, it produces pain, swelling, and popping or catching sensations in your knee. The image to the left is an MRI of a torn meniscus and the picture below is a comparison between a normal and torn meniscus.





The MCL Tear
The medial collateral ligament runs along the inside of the knee and provides stability to the knee joint. The MCL tear makes up the triad of this injury although out of the three it is the least problematic because it does not require surgery for repair. A MCL tear causes pain, swelling, decreased range in motion and some instability. Both images compare the difference between and torn MCL and a normal MCL.


Skeletal Elements Involved:

• Patella
• Femur
• Tibia

Muscle Elements Involved:

• There are no muscles directly involved in this injury. This injury only involves ligaments.
• Quadriceps femoris can be a target during physical therapy to help strengthen and stabalize the knee

Ligaments/ Tendons/Other:

Cause of Injury:
The knee is very susceptible to injury, particularly in such sports as football and soccer. The Unhappy Triad injury is the most common type of football injury and happens when a player is "clipped" by a lateral blow to the knee. This injury occurs when the leg is laterally rotated and forcibly abducted. The ACL and meniscus can be torn in a "plant and turn" motion which can occur when a football player is tackled from the side with one leg firmly planted on the ground. In this type of injury the MCL is torn by a lateral blow or fall. In some cases when there is a severe blow to the medial collateral ligament it tears and can lead to the tearing of the medial meniscus since the two structures are connected. This force is then transferred to the ACL. The ACL is relatively weak, so it tears as well.







Treatment:
Treatment requires surgery. Athletes who sustain this type of injury have a grade three ligament tear. Tearing this triad usually requires a much more invasive surgery, but due to the technological advances in medicine today, arthroscopic surgery(shown below) can be done, and scarring is much less visible. ACL surgery is a common ligament procedure. During reconstruction of the ACL they also take care of the torn meniscus. After the ACL surgery, the MCL can begin to heal with time and immobilization. Most athletes also have to undergo weeks of physical therapy to regain use and strength in the knee. After surgery a knee brace can be worn to stabalize the knee.


During ACL reconstruction, shown in the first image, a graft is made of the torn ligament. The second image demonstrates how a torn meniscus is repaired during a knee arthroscopic surgery.







Famous Sports Figure Afflicted:
Tom Brady(Patriots quarterback):
Brady suffered an injury in his left knee after being tackled in the first game of the season by safety Bernard Pollard in a game against Kansas City. He tore his medial collateral ligaments, the anterior cruciate ligament, the MCL and ACL. In his circumstance his doctors would most likely wait for the MCL to heal before repairing the ACL. Rehabilitation for this type of injury could take six to nine months.






The video below shows the hit Brady endured that injured his knee:



Michael Owen:
After a jog to the side, professional soccer player Michael Owen realized he had a long road in front of him. Owen's injury occurred due to a zig-zag maneuver during a soccer game. This movement on Owen's leg caused his anterior cruciate ligament (ACL) to tear, along with his meniscus. Surgery had to be delayed in order to allow the swelling in his knee to go down. Owen's surgery was a more invasive surgery due to the amount of trauma that occured to his knee. Owen recovered after three months of rehab.

Below is a video of the injury:





Vocabulary:

MCL - medial collateral ligament

ACL- anterior cruciate ligament

Mensicus- shock absorber that sits between the tibia and the femur

ACL - anterior cruciate ligament

Femur- thigh bone

Patella- knee cap

Tibia- shin bone

References and Links:

- Freebase.com (2009). Knee Diagram. Retrieved April 23, 2009, from http://www.freebase.com/view/wikipedia/images/commons_id/1803224.

- knol.google.com(2009). Miniscus. Retrieved April 25,2009, from http://knol.google.com/k/-/-/3moakismmkmno/30nfmi/Meniscus.gif

- "Michael Owen Damaging His Knee." Posted by user coutssey21 June 21, 2006. Retrieved April 23, 2009, from http://www.youtube.com/watch?v=oHgu5e9K3Ww.

- Miller, C. G. (2000). Acute Knee and Chronic Ligament Injuries. Retrieved April 23, 2009, from http://www.jockdoc.ws/subs/kneeligament.htm.

- pinnacle-ortho.com(2009). Normal Knee. Retrieved April 25,2009, from http://www.pinnacle-ortho.com/education_images/knee/ACLtears/acl01.jpg

- Springer, Shira. (2008). Brady has both ACL and MCL tears. Retrieved April 23, 2009, from http://www.boston.com/sports/football/patriots/articles/2008/09/11/brady_has_both_acl_and_mcl_tears/.

- "Tom Brady ACL Tear." Posted by user rg93033 September 7, 2008. Retrieved April 23, 2009, from http://www.youtube.com/watch?v=LuClWeD9ouI.

- Wordpress.com(2009). Back in Action. Retrieved April 25, 2009, from http://sowathrana.files.wordpress.com/2008/08/michael-owen-pes-2008.jpg.

- 4thegame.com(2006). Michael Owen's Injury Explained. Retrieved April 25,2009, from http://www.4thegame.com/features/feature/190756/michael_owens_injury_explained.html.

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