CLINICAL DIAGNOSIS AND TRAINING OPTIMIZATION ON

KNEE SPORTS INJURIES

DIAGNÓSTICO CLÍNICO E OTIMIZAÇÃO NO TREINAMENTO PARA LESÕES ESPORTIVAS NO JOELHO Original Article
Artigo Original
DIAGNÓSTICO CLÍNICO Y OPTIMIZACIÓN DEL ENTRENAMIENTO DE LAS LESIONES DEPORTIVAS DE LA RODILLA Artículo Original

Tianyu Yang1 ABSTRACT

(Physical Education Professional)
Congmeng Jiang2 Introduction: The knee joint is one of the sites of greatest mechanical stress in the lower limbs. The overload
(Physical Education Professional) generated by impacts, blows from falls, and torsions in collisions can generate disabling tissue damage that is difficult
Yunfei Ma3,4 to recover from. Although lacking clinical diagnosis, some studies have pointed out that implementing functional
(Physical science) training in rehabilitation can reduce the period of disability and the harmful effects of immobilization. Objective: Study
the clinical diagnosis and the optimization of training for knee sports injuries. Methods: This experiment uses the
1. Northeastern University at intra-group comparison method. The method used in the experiment is a rehabilitation training protocol for the knee
Qinhuangdao, Department of
joint, focusing on quadriceps muscle strength and balance. The training cycle is six times per week for one month.
physical, Qinhuangdao,
Results: The optimization in exercise training evidenced a good improvement in functional ability and pain condition,
Hebei, China.
2. Graduate School of Northeastern
reflected in the athletes’ balance ability. After training optimization, 9 out of 12 athletes recovered completely, and three
University of Qinhuangdao, improved significantly. Conclusion: Trainers should follow the physical rehabilitation orders and match them with the
QinHuangdao, HeBei, China athletes’ actual situation, sport types, etc., designing the appropriate sports mode for the athletes to promote training
2. Yanshan University, Parallel optimization and reduce sports joint injuries. Level of Evidence II; Therapeutic Studies - Outcome Investigation.
robot and mechatronic system
laboratory of Hebei province, Keywords: Knee Injuries; Sports Injuries; Clinical Diagnosis.
Qinhuangdao, Hebei, China.
3. Yanshan University, Key RESUMO
Laboratory of Advanced Forging & Introdução: A articulação do joelho é um dos locais com maior estresse mecânico nos membros inferiores. A sobrecarga
Stamping Technology and Science gerada por impactos, os golpes por quedas e torções em colisão podem gerar danos teciduais incapacitantes e de difícil
of Ministry of National Education,
recuperação. Embora careça de diagnósticos clínicos, alguns estudos têm apontado que a implementação do treinamento
Qinhuangdao, Hebei, China.
funcional na reabilitação pode reduzir o período de incapacitação e os efeitos deletérios da imobilização. Objetivo: Estudar o
Correspondence:
diagnóstico clínico e a otimização no treinamento para lesões esportiva do joelho. Métodos: Este experimento utiliza o método
Yunfei Ma, Qinhuangdao, Hebei, de comparação intragrupo. O método utilizado no experimento é o protocolo de um treinamento de reabilitação direcionado
China, 066004. a articulação do joelho, com foco na força e equilíbrio muscular do quadríceps. O ciclo de treinamento é de 6 vezes por semana,
[email protected] durante 1 mês. Resultados: A otimização no treinamento do exercício evidenciou uma boa melhora na capacidade de funcional
e condição de dor, refletindo na melhoria da capacidade de equilíbrio dos atletas. Após a otimização do treinamento, 9 dos 12
atletas se recuperaram completamente, e 3 atletas melhoraram significativamente. Conclusão: Os treinadores devem acatar
as ordens de reabilitação física e combiná-las com a situação real dos atletas, tipos esportivos, entre outros fatores, projetando
o modo esportivo adequado aos atletas, visando promover a otimização do treinamento e reduzir as lesões esportivas nas
articulações. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

Descritores: Traumatismos do Joelho; Lesões Esportivas; Diagnóstico Clínico.

RESUMEN
Introducción: La articulación de la rodilla es uno de los lugares de mayor tensión mecánica en los miembros inferio-
res. La sobrecarga generada por los impactos, los golpes de las caídas y las torsiones en colisión pueden generar daños
tisulares incapacitantes y de difícil recuperación. Aunque carecen de diagnóstico clínico, algunos estudios han señalado
que la aplicación del entrenamiento funcional en la rehabilitación puede reducir el periodo de discapacidad y los efectos
nocivos de la inmovilización. Objetivo: Estudiar el diagnóstico clínico y la optimización del entrenamiento de las lesiones
deportivas de la rodilla. Métodos: Este experimento utiliza el método de comparación intragrupo. El método utilizado en
el experimento es el protocolo de un entrenamiento de rehabilitación dirigido a la articulación de la rodilla, centrado en
la fuerza muscular del cuádriceps y el equilibrio. El ciclo de entrenamiento es de 6 veces por semana durante 1 mes. Resul-
tados: La optimización en el entrenamiento de ejercicios evidenció una mejora en la capacidad funcional y en el estado
del dolor, lo que se refleja en la mejora de la capacidad de equilibrio de los atletas. Tras la optimización del entrenamiento,
9 de los 12 atletas se recuperaron por completo, y 3 atletas mejoraron significativamente. Conclusión: Los entrenadores
deben seguir las órdenes de rehabilitación física y combinarlas con la situación real de los atletas, los tipos de deporte, etc.,
diseñando el modo de deporte adecuado para los atletas, con el objetivo de promover la optimización del entrenamiento
y reducir las lesiones articulares deportivas. Nivel de evidencia II; Estudios terapéuticos - investigación de resultados.

Descriptores: Traumatismos de la Rodilla; Lesiones Deportivas; Diagnóstico Clínico.

DOI: http://dx.doi.org/10.1590/1517-8692202329012022_0174 Article received on 03/15/2022 accepted on 05/31/2022

Rev Bras Med Esporte – 2023; Vol. 29 – e2022_0174 Page 1 of 4

 INTRODUCTION the force of both legs. At this time, the elastic belt belongs to the stress
Joint is an important part of supporting human movement. As state, the legs are completely straight and the force is maintained for 3 ~
the largest and most complex joint of human body, knee joint plays 5 seconds, and then take a certain rest, 20 times in each group, and hold
an important role in people’s daily life and movement. If knee joint is three groups every day. Maintain the bending range of the injured knee
damaged, it will cause inconvenience in the process of action, and it will joint at the angle of 45 degrees in a standing position, bend the other
have a certain impact on walking and even standing upright.1 However, leg back, and carry out balance training and rehabilitation training with
compared with the complex functions, the vulnerability of the knee joint both hands behind the body. Maintain this position for two minutes and
is. For people, especially athletes, many sports are against the principles adhere to 5 groups every day. In the whole exercise process, we should
of human mechanics and anatomy, resulting in excessive load on their pay attention to the protection of athletes’ knee joints so that they do
own body. As a part under great pressure, if there is a collision or bump not feel hard during the exercise. However, in order to ensure a single
between the bodies during the movement, the exercise intensity is too variable of the experiment, we need to carry out the same protection as
high If you don’t pass the sports skills, it is very easy to have problems all athletes. In addition, athletes should reasonably arrange the training
with the knee joint, such as ligament injury, articular cartilage injury, load according to their own actual situation. If they feel discomfort of knee
meniscus injury and so on. Due to the limitation of current medical joints during training Pain and so on, we should report to professionals
technology, the damaged knee joint can not be completely restored, in time and ask for help in time to prevent knee injury caused by blind
so it can only be treated and optimized as much as possible.2 training. During the training process, one of the 13 athletes had knee
For athletes, once knee joint injury occurs in the process of sports discomfort, so the experiment was terminated. After removing the falling
training, professional rehabilitation personnel should choose appropriate samples, a total of 12 athletes were compared with the relevant data.
ways for targeted rehabilitation under the premise of complex structure
RESULTS
of knee joint, and return to the field after a period of rest to reach the
original sports level, but there are still some hidden dangers in knee joint Clinical diagnostic criteria and result analysis of knee sports
at this time, If the training is not optimized in time, it will easily lead to the injury
recurrence of the problem. Therefore, in the process of sports training, As a medical image, MRI technology has both the advantages of
athletes should pay attention to optimizing training methods, protecting image diagnosis and the disadvantages of image diagnosis. In terms of
knee joints and improving their sports performance.3 advantages, compared with arthroscopy or other imaging technologies,
MRI is a real non-invasive technology and will not cause damage to the
METHOD detector. In addition, there is no need to inject contrast agent, so as to
Selection of subjects reduce the interference to the detector’s body as much as possible.
Arthroscopy is a common examination method after joint injury, Compared with the current more mature CT detection technology, it
which has the characteristics of high accuracy and small trauma. However, can directly detect the images of cross-section, sagittal plane and various
for athletes, minor injuries may have an adverse impact on their sports inclined body layers without artifacts and other interference. Therefore,
career. Therefore, the application of non-invasive MRI technology is very it is favored by the medical academic community and has become a
necessary. To explore the diagnostic effect of MRI technology, we need mainstream trend of current development. However, MRI technology is
to have enough samples for comparison. However, for athletes, although not mature and there are still many problems. For example, compared
knee joint sports injury is more common, its overall proportion is small. If with arthroscopy, Mr. technology can only be diagnosed by experienced
only athletes with knee joint injury are taken as the research object, there doctors through images, and cannot have a certain understanding of
will be a way of insufficient sample number and error. The study and all regional images and pathology at the same time as arthroscopy. In
the participants were reviewed and approved by Ethics Committee of addition, MRI technology has high requirements for patients. If patients
Northeastern University at Qinhuangdao (NO. NUQIN-ZD19024). The- have metal objects in their bodies, cardiac pacemakers, severe claustro-
refore, in determining the diagnostic effect of MRI technology, Through phobia or more than three months of pregnancy, relevant tests cannot
the way of volunteer recruitment, some knee injury patients who have be carried out. Therefore, its development needs to be further improved.
experienced arthroscopic diagnosis and obtained the diagnostic results When analyzing the clinical diagnosis of knee sports injury, some
were recruited for MRI detection, and the results were compared with patients who have been diagnosed by arthroscopy are examined, and
the results of knee arthroscopy, so as to analyze their effectiveness. the results are compared to explore the characteristics and diagnostic
In the research of knee training optimization, this paper selects 13 athle- effectiveness of knee sports injury, as follows.
tes with knee sports injury as the research object. In order to eliminate the As shown in Figure 1, the MRI and arthroscopic grading diagnosis results
interference of human factors as much as possible, when selecting athletes, of knee cartilage injury are shown. From Figure 1, it can be seen that most
according to the principle of full voluntariness, fully explain and inform the
information to be provided by the experiment, the operation to be carried
out, and the rules to be observed. After obtaining the recognition and
consent of athletes, they will be included in the research object and tested.
Optimal experimental design of knee joint training
After the athletes warm-up to a certain extent, first keep the knee
joint about 70 degrees in the form of knee bending and squatting, with
both feet the same width as the shoulder. The knee joint is located behind
the toes, and the upper body leans back with force. Keep the state of
continuous force for three minutes and hold three groups every day.
Then maintain the sitting position, tie the elastic belt at the ankle joint,
the lower leg will sag naturally, and complete the knee extension through Figure 1. Comparison of MRI and arthroscopic grading diagnosis of knee cartilage injury.

Page 2 of 4 Rev Bras Med Esporte – 2023; Vol. 29 – e2022_0174

of the people who are judged as grade 0 by arthroscopy are also judged knee injury. The key performance is that the diagnosis of mild and most
as grade 0 in MRI, while most of the people who are judged as grade 1 by severe patients is relatively clear, while for patients with moderate injury,
arthroscopy are also judged as grade 0. Most of the people who are judged it is prone to confusion. This may be related to the lack of experience
as the heaviest grade IV by arthroscopy are judged as grade IV, However, for of current diagnostic personnel and the lack of more comprehensive
patients who are judged as grade II and III by arthroscopy, the MRI grade diagnostic samples, which need to be further optimized.
is relatively vague, and there are grades I to IV. therefore, due to the lack
Analysis of training optimization effect of knee sports injury
of experience in MRI image diagnosis, compared with arthroscopy, there
can only be a clear judgment on some mild or severe symptoms, and the As shown in Figure 4, the optimization index of knee joint sports in-
judgment on the intermediate grade is not clear enough. jury is shown. From Figure 4, it can be seen that the pain index is signifi-
As shown in Figure 2, the MRI and arthroscopic grading diagnosis cantly reduced from (2.732 ± 0.678) before training optimization to (0.506
results of the medial and lateral meniscus are shown. From Figure 2, it can ± 0.536) after training optimization, indicating that the pain is reduced.
be seen that the grade assessed by arthroscopy is not different from that P < 0.01 indicates that there is a very significant difference. Lysholm score in-
determined by MRI technology. Only a small number of individuals have creased from (69.391 ± 6.620) before training optimization to (87.038 ± 5.181)
chaotic state, and all grades appear, which shows that compared with after training optimization, indicating that the knee function was improved, P
the articular cartilage mentioned above, the damage state of meniscus is < 0.01, indicating that there was a very significant difference. The range of mo-
relatively obvious, and its observation accuracy is stronger. For some chaotic tion of knee joint was increased from (104.705 ± 1.103) degree before training
states, the analysis may be related to the actual situation of the individual optimization to (112.581 ± 0.299) degree after training optimization, which
case, which also reflects that the accuracy of MRI is closely related to the level showed that the flexibility of knee joint was increased, P < 0.01, indicating
of doctors, and there are still some differences compared with arthroscopy. that there was a very significant difference. The thigh circumference of 10cm
As shown in Figure 3, the MRI and arthroscopic grading diagnosis above the patella was increased from (53.737 ± 5.005) cm before training
results of ligament injury are shown. From Figure 3, it can be seen that optimization to (56.470 ± 4.357) cm after training optimization, which showed
there is little difference between the grade assessed by arthroscopy and that the muscle volume and strength near the knee joint were enhanced and
the grade determined by MRI technology. Only a few individuals have had a better protective effect on the knee joint, P < 0.01, indicating that there
chaotic state, and all grades appear, but there are still some differences was a very significant difference. This shows that the optimization of knee
compared with the meniscus and articular cartilage mentioned above, For motion training has a good improvement on knee motion ability and pain,
example, in the selection of cases, the number of people with ligament P < 0.01, indicating that there is a very significant difference.
injury is relatively small, and most of them are in grade 0 or grade III state, As shown in Figure 5, it shows the impact of training optimization
showing very obvious polarization. Therefore, there are undoubtedly of knee sports injury on balance ability, where OSI is the overall stability
many fewer obstacles in the process of diagnosis. Therefore, the author index, that is, the overall stability index; API is the anterior posterior
believes that in the MRI judgment of ligament, a large number of cases
still need to be continuously collected for integration and processing.
From the comparison of the diagnostic results of articular cartilage
meniscus and ligament injury, it can be seen that compared with more
accurate arthroscopy, MRI diagnostic technology still has some defects in

Figure 4. Training optimization index of knee joint sports injury.

Figure 2. Comparison of MRI and arthroscopic grading diagnosis results of medial
and lateral meniscus.

Figure 3. Comparison of MRI and arthroscopic grading diagnosis of ligament injury. Figure 5. Effect of training optimization of knee sports injury on balance ability.

Rev Bras Med Esporte – 2023; Vol. 29 – e2022_0174 Page 3 of 4

 index; MLI is the internal and external index, i.e. the medical later index. Clinical research shows that knee injury will lead to the weakening
As can be seen from Fig. 5, the OSI index decreased significantly from of muscle strength around the joint. Quadriceps femoris atrophy is very
(0.2935 ± 0.0101) before training optimization to (0.1214 ± 0.0202) after common in injured athletes, and it is also accompanied by the loss of stren-
training optimization, P < 0.01, indicating that there is a very significant gth during knee extension. This phenomenon often occurs during knee
difference; API index decreased significantly from (0.1397 ± 0.0304) before injury and lasts for a long time, which further leads to the loss of stability.
training optimization to (0.0506 ± 0.0299) after training optimization, Obviously, the muscle strength of extensor and flexor muscles around
P < 0.01, indicating that there was a very significant difference; The MLI the knee joint has an important relationship with the normal function
index decreased significantly from (0.1417 ± 0.0299) before training of the knee joint. At present, sports training experts and rehabilitation
optimization to (0.0399 ± 0.0202) after training optimization, P < 0.01, experts at home and abroad have jointly recognized the first quadriceps
indicating that there was a very significant difference. This shows that exercise. Among many training methods, isometric contraction training is
the optimization of knee exercise training has a good improvement on considered to be the most commonly used training method for athletes’
the balance ability of athletes, P < 0.01, indicating that there is a very knee injury or early postoperative rehabilitation, and it is also considered
significant difference. to be the most suitable and effective recovery method.6

DISCUSSION CONCLUSIONS
For athletes with knee injury, only by restoring the normal angle It can be seen from this study that the current MRI technology can
of the joint can we avoid the rapid decline of muscle strength around reduce the damage to the body as much as possible, and its interferen-
the knee joint due to the failure of the knee joint to function normally. ce is the least for athletes. Therefore, it can be used as a way to detect
Knee medial collateral ligament (MCL) injury is the most common type the health of athletes’ knee joints. However, if an athlete has a certain
of knee injury in sports. MCL injury brace shall be used for fixation for injury to his knee joint, he should further use arthroscopic technology
4 weeks, and active and passive rehabilitation training shall be carried for diagnosis on the basis of MRI technology, so as to have a clearer
out. Generally, it will gradually return to the normal joint angle within understanding of his own joint injury. Coaches should collect the doc-
2-3 weeks; After the anterior cruciate ligament (ACL) injury of the knee tor’s advice and combine it with the actual situation and sports types
joint, the brace shall be used for fixation within 8 weeks. Generally of athletes to design their own sports methods for athletes, so as to
speaking, it can be normal two weeks after operation without affecting promote the optimization of athletes’ training and reduce knee sports
the normal angle of the joint.4 The scope of knee joint exercise mainly injury as much as possible.
includes flexion training and extension training. Among them, the flexion
training mainly adopts skateboarding, while the extension movement
All authors declare no potential conflict of interest related to this article
mainly adopts knee hyperextension.5

AUTHORS’ CONTRIBUTIONS: Every author has made an important contribution to this manuscript. TY: writing; CJ and YM: execution.

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