Meniscus injury and thermography: clinical case in a professional football player (reading time 6 minutes)
The knee is one of the regions with the greatest injury rate in professional athletes. Knee injuries account for 21.6% of the “overall” of injuries that football players have throughout a season (Krutsch, V. et al. 2020). The anterior cruciate ligament is the most prevalent injury. The meniscus is another of those affected with a high percentage of knee injuries, in this case, we will analyze the meniscus.
Sillero et al (2015) described in their research at the CEMTRO clinic in Madrid how in general acute joint injuries will respond with a hyperthermic pattern, increasing the vascularization of the area and temperature. In the research, they screened patients through a thermographic assessment before medical diagnosis, to observe what thermal patterns they had with medical examinations without biasing the information, as for example the meniscus injury that had a hyperthermic pattern.
In this case, the cartilaginous tissue that makes up the menisci when it ruptures produces extravasation of its main component and inflammation of the region, increasing the metabolic demand that increases the temperature of the region.
Meniscus are two natural “shock absorbers” that have great joint congruence, the lack of this tissue will cause in the long term a higher prevalence of osteoarthritis (Roos, E. et al. 2003). The best method of preventing this degeneration is the work of motor control and strengthening (Kujala, U. et al. 1995). In this care of the knee joint, the control of the evolution of the temperature can help identify when it is not within the normal pattern or when it is not in accordance with the “thermal scar” generated by the previous injury (Piñonosa-Cano, et al. 2016).
Clinical case: rupture of the internal meniscus.
In this case, we present an injury to the inner meniscus of the right leg during the execution of a test in the preseason (Course Navette), commonly used to calculate the oxygen volume and fitness status of the athlete.
This clinical case is particular, they did a previous thermographic evaluation included in the pre-season tests was carried out, two days before having carried out the Course Navette test. In this evaluation, the temperature of the right knee had a hyperthermic asymmetry of 0.69ºC, which could indicate that at the biomechanical level, it was supporting a greater load and the structures had a differentiated thermal profile (Figure 1).
Unfortunately, the player was injured during the test, and a thermographic evaluation was performed after the moment of injury, where the temperature of the knee region was verified to values close to a 1-degree difference (Figure 2).
This hyperthermic response related to the findings of Sillero et al (2015) suggests that tissue related to arthrokinematics when injured has a hyperthermic tendency, unlike neuromuscular tissue that cools (hypothermic).
Conclusions of the case study.
Analyzing the knee protocol offered by the ThermoHuman software can help reduce the risk of injury through thermography when we are faced with an indication of hyperthermia in a joint region, especially when this hyperthermia occurs repeatedly or has been increasing between successive evaluations.
Joint load damping strategies should be chosen to try to prevent a possible overuse injury, as in this clinical case of meniscus injury in the footballer.
Krutsch, V., Grechenig, S., Loose, O., Achenbach, L., Zellner, J., Striegel, H., … & Krutsch, W. (2020). Injury analysis in professional soccer by means of media reports–only severe injury types show high validity. Open access journal of sports medicine, 123-131.
Sillero-Quintana, Manuel; Fernández-Jaén, Tomás; Fernández-Cuevas, Ismael; Gómez-Carmona, Pedro M.; Arnaiz-Lastras, Javier; Pérez, María-Dolores; Guillén, Pedro. “Infrared Thermography as a Support Tool for Screening and Early Diagnosis in Emergencies”. Journal of Medical Imaging and Health Informatics, Volume 5, Number 6, November 2015, pp. 1223-1228(6)
Cano, S. (2016). Use of infrared thermography as a tool to monitor skin temperature along the recovery process of an anterior cruciate ligament surgery. https://doi.org/10.20868/upm.thesis.41041
Roos, E. M., & Lohmander, L. S. (2003). The Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health and quality of life outcomes, 1(1), 1-8.
Kujala, U. M., Kettunen, J., Paananen, H., Aalto, T., Battié, M. C., Impivaara, O., … & Sarna, S. (1995). Knee osteoarthritis in former runners, soccer players, weight lifters, and shooters. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology, 38(4), 539-546.