Common causes of soft tissue knee injury

What are the most common ways athletes and the general population injure their knees?

Andy: So amongst the causes of soft tissue injury to the knee, sporting activity probably in my practice is the biggest. Obviously, road traffic accidents etc will create major trauma, but in my world it's more about sports. The loading of a knee with rotation is the problem usually, or a rapid deceleration, so certain sports have a particularly high incidence of certain injuries. For example a rupture of the anterior cruciate ligament is related to problems with a bad landing from a jump or from a sudden change in direction that goes wrong.

Probably the highest instance in UK sport is with netball. The problem with netball is you can't take a second step after you've landed and there's this need to offload the ball quickly with rotation. Handball is a game we don't play very much but there's a very high instance in that, probably for similar reasons.

But most of my patients will come from football and rugby where they suddenly have to change direction and the foot either slips or rolls and they twist the knee.

Amongst many of my colleagues however skiing is a big cause of problems. The incidence of injury in skiing is very high and not surprisingly you have a population of fairly well off people who may be fairly sedentary for most of the year. And then they decide to go skiing without much preparation and not surprisingly they get overloaded and injure themselves.

Are soft tissue knee injuries preventable?

Andy: Many of these injuries are preventable. Of course, you do get bad luck and even with the best preparation and prevention programmes, with strength and conditioning, you'll still get hurt. But I think there's good evidence now that prevention strategies with certain strength and conditioning exercises really do translate to reduced ACL rupture. And there are certain at risk groups who we really should be insisting on good preparation for sport.

How is competitve sports increasing the incidence of knee injuries?

Andy: The instance of ACL rupture in youngsters is going up and up as we become more competitive with sport and it really is quite a scary scenario. And at the moment it seems to me that there's a bit of a lack of interest in trying to prevent these injuries - from clubs, from schools etc.

Kids really should be taught the various components of a preventative programme of strength and conditioning which improves their ability to absorb impact and absorb twisting on the knee - and they have been proven to work. So we should be doing that.

Mr Andy Williams is a super-specialist in soft tissue injuries of the knee - indeed his focus is exclusively this. Approximately 80% of his patients are national and international rugby and football players with the imperative of getting them back to high level sports as quickly and safely as possible.