Ronaldo’s Knee

Did you hazard a guess?

I’m sure many of you saw the incident that caused Cristiano Ronaldo’s exit from the 2016 European Cup finals. For those who didn’t here’s a couple of stills form the game, courtesy of kinetmd and the Sun Newspaper, respectively.
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What you can clearly see is that at the point of impact, his foot is planted firmly on the ground, the knee is bent a little, he’s also weight bearing on this leg and, the force and direction of the tackle causes the knee to collapse inwards (valgus). If you look even more closely, especially at the first picture, you can see that the tibia is externally rotated relative to the femur (thigh bone).

First, this was a pretty nasty injury, shown by Ronaldo’s inability to play on. Read out the description above to a physio or orthopaedic surgeon and they’ll probably say it’s likely to be an ACL (anterior cruciate ligament) injury. The mechanism is almost entirely consistent with an ACL injury … apart from a couple of things:

1. He managed to play on for a short while, albeit with strapping and very, very hesitantly
2. There didn’t appear to be a huge swelling (admittedly though visibility form a television screen isn’t likely to be the best)

All things taken into consideration, this incident caused much speculation about the structures he could have injured.

My first guess on seeing the footage replayed during the match was a partial tear to the ACL, with potential damage to the MCL (medial collateral ligament) and maybe to the meniscus too (commonly called cartilage). I thought this because with a complete tear of the ACL, it’s unusual immediately after injury to be able to hobble about without the knee collapsing.

Apparently, the diagnosis has been confirmed, according to
…. partly torn MCL

I was wrong, well, partly. Ronaldo is lucky to get away without an ACL injury. Or is he? Perhaps he’s been a very good boy and done all his prehabilitation focussed on developing the speed of response and strength of his hamstrings, which are the major protector of the ACL!

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