In fact, sport is for everyone. We need to use our body and those who do not use it, will lose. In other words a rolling stone gathers no moss. Everyone has to do exercise. It is essential to do exercise 3-4 times a week! When we left our officers and go to the pitch, we either have our cruciate ligaments or Achilles tendons torn. If you are a veteran athlete, your situation will be worse! Veteran athletes theoretically know what to do exactly when the ball is coming to them but their bodies cannot manage to do it. Then injury follows. Every one of us must keep of fit. Those with certain illnesses must keep themselves fit. Especially those having hypertension and diabetes must exercise! We must use our bodies consciously. Not only the athletes, but also everyone should have information about sports and this information must be spread, communicated, discussed and right sports must be found. An athlete's body is very special. Much effort is spent for achieving that body. An athlete starts trainings, exercises from his/her childhood. Families, trainers and coaches support it. They become players of big teams after putting too much efforts and passing from qualifications. And this body is very valuable. It is necessary to serve very well to this body. This body must be well protected. Just like every object, each tissue in our knee has endurance strength, too. If excessive use and excessive repetition exceeds endurance strength of the tissues in the knee, deformations may occur. Over loading may be as a result of a sudden movement or getting under a load or by forcing. Even a normal load coming unexpectedly may cause pain in the knee. For example, anterior cruciate ligament may be torn or meniscus may be ruptured or a problem may emerge in cartilages. If we remember the basic law of physics: ‘’F= m x a’’. Here, "m" represents the body weight while "a" represents how suddenly we do a movement or we stop.


Our muscles, which are the natural knee guards of our knees...


Our muscles are actually the natural knee guards of our knees and when we do something excessively, our muscle fatigues appear. In the absence of a controlled use of muscles, more load is brought onto the cartilages and knees and knee hurts and injuries happen easier. At the end everyone has a physiological capacity. Likewise, our meniscuses, cartilages and soft tissues, ligaments and muscles have a capacity. We must exercise in a manner that does not exceed this capacity. It means; "My physiological capacity is sufficient for lifting 3-5 kgs". We can exercise without overloading and if we continue in the same way, eventually our physiological capacity will increase and we can do exercise more. In other words, if I ask you to run, you can run for 1-2 km. But if you walk before, exercise within you physiological limits and continue walking within these limits, you can start to run for 10 km easily without any challenge after a while. Here, the important thing is continuity. After starting running for 10 km, your physiological running period eventually increases to 10 km. It is necessary to increase intensity slowly while exercising, otherwise sudden decreases occurs as the result of overloading. Let's do exercise without exceeding our physiological limits. Of we exercise continuously within our physiological limits, they will eventually increase.


Are football carpet fields healthy enough for our knees?


Soil is very important for staying inside the physiological limits. Soil is a natural and thick cushion that absorbs our weight while we are running and therefore it reduces the load on our knees and consequently on our cartilages. However, treadmill is not natural. Thus, the shoes we use on the treadmill and our style are very important. In order not to put much pressure on the joints, we want people to have a good style while running. People having a running style not at the desired level, are likely to put increased pressure on their knees and cartilages and to encounter problems. The most common reason for knee injuries at football carpet fields is tripping of our feet on the carpet surface. If we need to change our direction suddenly when our foot is on the ground, our foot may trip on the ground, if not, our cruciate ligaments may be torn. Therefore, those black capsules, which are called pellets, in football carpet fields are important and useful. They prevent our foot tripping on the ground. If they are used excessively, we may slip and fall. It must be noted that the surface underneath the ground you fall is concrete, not soil. Therefore, we must not forget how accurate and physiological a grass pitch is. In grass fields, the grass is important. Grass tufts in pitches that are not well-maintained constitute danger. Therefore, grass pitches must be flat and maintained just like a football carpet field and old grass must be replaced. It is necessary that our teams do their trainings on a grass pitch. In order to prevent freezing of the pitches under cold weather conditions, it is necessary to heat our pitches. Just like the water, soil freezes, too. There must be underground heating when the weather is under -5 degrees. What the players need to do is to use a proper cleat. While cleats with long studs can be used for wet and long grass, those with short studs can be used in dry and short grass. Experience of the player is important for setting the lengths of the studs for the cleats.


Which sports involve more muscle injury risk?


In explosive sports and sports requiring changing direction suddenly and sudden sprints, muscle injuries are more frequent but muscle injury varies depending on the intensity of the training. Muscle injury is encountered when not slept sufficiently and in case inappropriate training schedules. In short, the body must be well-regenerated.


What are the most frequent problems occurring in the knees?


With regards to the knees, treatments other than surgery are always our first choice and knee surgery is one of the treatment methods that are used for preventing negative effects of knee pains and knee problems in our lives. Under the knee surgery, sport injuries around the knee, knee ligament injuries, knee cartilage injuries, cartilage production and transplantations, meniscus surgery, meniscus repairs, fractures around the knees, knee surface covering prosthesis, partial prosthesis and total prosthesis, arrangement disorders and corrective surgeries are performed. 3 most frequently problems seen in the athletes are cruciate ligament tears, meniscus injuries and cartilage problems. Meniscus injuries used to cover cruciate ligament tears. Footballers with torn anterior cruciate ligament, were not operated and their meniscuses were torn as well since they continued playing with torn ligaments. Today, meniscus tears are not seen as frequent as they use to be. This is because anterior cruciate ligament surgeries are performed more. Under knee surgery, meniscus implants, meniscus transplantations and meniscus restorations can be performed with arthroscopic surgery method. In cases such as meniscus transplantation, meniscuses taken from a cadaver and protected under -80 degrees are used.


How are meniscus injuries treated?

There are 4 treatment methods applied when meniscus is torn.
The first one is the removal of the torn part, which is preferred by most of the athletes. Because the other treatment method is repairing the meniscus, in other words suturing the torn part, is a tougher and longer road for the athlete. In case of suturing the meniscus, weakening occurs at the muscles due to the limitation of their knee movements. Even the treatment is successful, returning period is longer when compared to the removal of the meniscus. Both the athlete and the trainer do not like this situation. When later ages of people are taken into account, it is always the preference of us, the orthopedists, to protect meniscuses and not removing them but sport life is not that long and achievements are very important. Suturing the meniscus is a decision that has to be given between the athlete and the doctor. It must not be left alone either to the athlete or to the doctor. Meniscus of a willing athlete can be sutured appropriately. The third treatment method is meniscus implant. Since the gap occurring after removing the torn part is impossible to be filled by the body itself, we can place meniscus implants with which we aim to provide the meniscus function. When we place these implants, the person or the athlete is required to use crutches for 6 to 8 weeks. This is not an acceptance period generally for an athlete. Therefore we cannot prefer implants for the athletes. The fourth treatment method is meniscus transplantation. When we have to remove more than 80% of a meniscus, it is likely that cartilage abrasions and joint arthritis occurs in meniscus tears. In this case, meniscus transfer from a cadaver upon mutual decision to be made with the person, is one of the treatment methods. These treatments may not be suitable treatment method generally for the athletes since returning period can take one year.Other important problems seen in the knees are the ligament injuries. There are 4 main ligaments in the knee. Two of them are medial and lateral collateral ligaments and other two are anterior and posterior cruciate ligaments aligned cruciately in the middle. Frequently injured ones are anterior and medial collateral ligaments. In case of 1ST and 2ND degree medial collateral ligament tears, no surgical treatment is necessary. Because this ligament self-repairs and heals. Physical support is suggested in these situations. In case of the 3RD degree ligament injuries, surgical treatment may be necessary depending on the situation. If the athlete has a tear on his anterior cruciate ligament, then the situation changes and generally surgical treatment is required. While a footballer without an anterior cruciate ligament cannot perform properly, a cyclist can continue his/her sport for a while without anterior cruciate ligament. But regardless of the type of the sport, it is necessary to ensure stability of the knee for preventing rotation of it again. Therefore anterior cruciate ligament surgeries frequently come to forth. Anterior cruciate ligament tears in an interesting way. This happens in 70 milliseconds. When the person notices this, 140 milliseconds have passed. Therefore anterior cruciate ligaments tear suddenly.


How can they be careful?


The most important advice to be given is that the athlete is not captured on one of his/her sole on the ground. This happens frequently in football carpet fields when the footballers are captured with their one sole on the ground. In other words, 70% of anterior cruciate ligament tears happen without any contact, while the person is changing his/her direction. While changing direction suddenly, if the sole is on the ground, the knee may turn and anterior cruciate ligament may tear. Athletes who are on their fingertips can jump and escape from the position. The most important point here is the trainings that prevent tearing anterior cruciate ligaments. Trainers must know these and practice them regularly in some part of the training. These trainings ensure escaping from a dangerous position and preventing injuries.


How is the process ahead of an athlete when his/her anterior cruciate ligament is torn?


When anterior cruciate ligament is torn, many different situations appear. When anterior cruciate ligaments tear, the athlete may feel a severe pain or no pain at all. The knee may or may not swell after the tear.


What does a person feel after tearing his/her anterior cruciate ligaments?


The knee may or may not be painful, swell. A person, whose anterior cruciate ligament was torn, feels more comfortable after 3-4 weeks, pain usually goes away feels a gap inside his/her knee. The gap is felt better on the stairs and while running. A sense of disbelief emerges for his/her knee. He/she starts to protect his/her knee and thus muscles become weaker. When muscles become weaker, this sense of disbelief increases more and the person starts to stay away from sport. If he/she continues to exercise or makes any reverse motion in his/her daily life, his/her knee rotates again and this time his7her meniscus is torn. When meniscus is torn, pain starts. It must be noticed that 10-15% of torn meniscuses can be saved by suturing them.


What kinds of ligament problems encountered in athletes?


While some of them continue their lives normally, some of them may feel discomfort as the result of pain from a small cartilage problem. Therefore, although cartilage problems generally cause problems in the knees, athletes can continue doing sport without complaining much about them.


Is there a different approach in our country with this regards?

Turkish orthopedists do not have any weaknesses when compared to our colleagues abroad. We are in information age now, the important thing is to desire obtaining information. We do not have any weaknesses from the orthopedists abroad in surgical aspect. We can do the same surgeries performed in America, which is one of the most advanced countries in orthopedics. We can do some of them even better. In my opinions, athletes do not need to go abroad.