The authors report a series of 52 cases of serious knee ligament injuries in volleyball players. The most frequent mechanism of injury was landing from a jump in the attack zone. Women were more affected than men. Injuries were more frequent during games than training. Volleyball must then be considered among high-risk sports according to the frequency and gravity of our surgical findings. Results are similar to those obtained in athletes in other sports who underwent the same surgical procedure.
In a prospective study, 40 consecutive patients who underwent anterior cruciate ligament reconstruction with doubled semitendinosus and gracilis tendon autografts were examined pre- and postoperatively by ultrasound to investigate the anatomy of the donor site before and after the harvest of the tendons. The patients underwent ultrasonography at 2 weeks and 1, 2, 3, 6, 12, 18, and 24 months postoperatively. A total of 298 postoperative sonographic evaluations were performed. The semitendinosus tendon was imaged in the sagittal and axial planes: structure and margins were evaluated with the sagittal views; thickness and width were measured with the axial views. In all cases the following sequence of healing was documented: 2 weeks after surgery the semitendinosus tendon site was occupied by an area of increased thickness and decreased echogenicity, suggesting the presence of traumatic edema of the soft tissue surrounding the tenotomy. At 1 month, an irregular hypoechoic structure appeared in a near-anatomic position; at 2 months after surgery, thickness, width, and cross-sectional area of this structure were significantly greater than preoperatively. The amount of regenerated tissue increased up to that seen in the tissue of the 6-month examinations, which also showed a more uniform echostructure. The scans performed at 1 year showed distinct edges and reduction in thickness and width. At 18 and 24 months the echogenicity of the structure occupying the donor site was very similar to that of the normal semitendinosus tendon. However, this structure was clearly identified about 4 cm proximal to the pes anserinus, revealing a more proximal insertion of the regenerated semitendinosus tendon.
The knee is the most frequent site of injury in volleyball players. More than 40% of high level players suffer overuse injuries during this activity; this particularly painful syndrome is caused by the amount of jumping typical in volleyball play, and in its training which aims at strengthening the quadriceps muscle. In volleyball players the extensor apparatus is subject to continuously high stress and the bone tendon junction, being the weakest point, is susceptible to lesion. The prevention and treatment of 'jumper's knee' requires a high degree of cooperation among trainers, doctors and athletes. Although volleyball is a sport without contact between players, traumatic acute injuries are more frequent and more serious than would be expected. It is therefore important to emphasise that volleyball must be considered among the high risk sports that expose the knee not only to twisting, but also to contact with other players. Generally, the lesions are caused by frequent jumps with loss of balance and a consequent 'one-footed' landing. There is no specific method of preventing knee instability. Accurate diagnoses, rest and rapid surgical treatment after the first injury are recommended in order to avoid chronic knee instability with subsequent meniscal lesions and post-traumatic osteoarthritis.
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