PATHOPHYSIOLOGY AND SKIING
Mechanisms
Detailed description
Commonly Affected Associated Structures
The knee is in forced valgus, external rotation of the tibia, and slight flexion. Most common mechanism. Often involves deceleration.
Unhappy Triad (O’Donoghue): ACL, Medial Collateral Ligament (MCL/LLI), Medial Meniscus (MM). Often involves a bucket-handle tear of the lateral meniscus (LM) following anterolateral subluxation.
Valgus-External Rotation-Flexion (VALFE)
Pure hyperextension trauma, often due to contact.
May cause injury to the ACL, sometimes the PCL or posterolateral structures if the stress is severe.
Hyperextension
Less common, but possible. Subjects the knee to rotational stress without major valgus.
ACL, then posterolateral structures.
Internal rotation torsion
ACL rupture is a major injury characterized by knee instability. It often occurs with an audible pop and is followed by rapid swelling (hemarthrosis). Consequently, the Anterior Drawer test needs to be done early.
Diagnosis Clinical examination (Lachman, anterior drawer, pivot-shift tests) is essential, often supplemented by MRI to assess associated injuries (menisci, collateral ligaments). Treatment Treatment may be conservative (rehabilitation alone) or surgical (ACL reconstruction, most often using the medial hamstring tendon (MST) with external reinforcement). The decision depends on the patient’s age, activity level, functional instability, and athletic expectations.
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