Knee Injury

Overview

The knee is one of the most complex and vulnerable joints in the body, subjected to significant forces during running, jumping, pivoting and contact sport. Knee injuries range from minor sprains and contusions to serious ligament ruptures, meniscal tears and fractures.

Common serious knee injuries include anterior cruciate ligament (ACL) tears, medial collateral ligament (MCL) sprains, meniscal tears and patellar dislocations. These injuries frequently require specialist assessment, imaging and in some cases surgical intervention.

Common Causes

• Sudden pivoting, twisting or cutting movements during sport
• Direct contact or collision causing valgus stress on the knee
• Landing awkwardly from a jump with the knee in an extended position
• Hyperextension of the knee joint
• Repetitive loading causing patellofemoral pain or IT band syndrome
• Falls in cycling, equestrian sport or rugby
• Deceleration injuries particularly common in rugby and team sports

Signs and Symptoms

• Pain at or around the knee joint, which may be immediate or develop gradually
• Rapid swelling of the knee joint, particularly within the first hour (suggests haemarthrosis)
• A popping or snapping sensation at the time of injury
• Instability or a feeling that the knee 'gave way'
• Locking or catching within the joint (suggests meniscal involvement)
• Tenderness on the inner or outer joint line
• Difficulty fully extending or flexing the knee
• Inability to bear weight following significant trauma

Immediate Actions

• Remove the athlete from play immediately
• Apply the PRICE protocol: Protection, Rest, Ice/Cooling, Compression, Elevation
• Apply a cooling wrap or ice pack wrapped in cloth to the knee
• Apply a compression bandage or knee sleeve to limit swelling
• Keep the knee elevated and avoid weight-bearing if pain is significant
• Conduct a basic assessment — test for joint stability, locking and neurovascular status
• If significant structural injury is suspected, arrange transfer to hospital for imaging

When to Seek Medical Attention

Prevention Advice

• Implement evidence-based warm-up programmes such as FIFA 11+ for team sports
• Strengthen the quadriceps, hamstrings and hip abductors to support knee stability
• Develop neuromuscular control and landing mechanics through targeted training
• Avoid sudden increases in training volume or intensity
• Wear sport-appropriate footwear to reduce rotational forces
• Ensure full rehabilitation following any previous knee injury before returning to sport
• Use knee bracing when indicated following ligament injury or reconstruction

Event Environment Considerations

• Pitchside clinicians should assess for ligamentous instability, haemarthrosis and neurovascular compromise
• Suspected ACL or fracture should be managed with immobilisation and prompt hospital transfer
• Patellar dislocations can sometimes be reduced by a trained clinician but should be assessed for associated fracture
• Athletes should not be returned to play following a significant knee injury without clinical assessment
• In high-risk sports such as rugby and polo, event medical plans should include provisions for knee injury management including immobilisation equipment