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GUIDE TO CRUCIATE LIGAMENTS 31-5-05
If you think way, way back to the olden days, when a pocket calculator was too big for your pocket? No before then, back in the days when cartoons weren't just to sell kids stuff, Boro had a cracking young player called Gaizka Mendieta.
Only the older fan, grey of beard and rheumy of eye remember his silky midfield skills. But they will also tell you that he was taken from us by a tear of his cruciate ligament. To be fair they're more likely to say "he buggered his knee or summat, I dunno, leave me alone I'm drinking".
So, the more inquisitive of you may ask, why has Mendi, like Nathan Jones, been gone so long. I mean winters passed and spring since his fall. He never wrote me, he never called... those not au fait with the work of the Supremes can rest a while here, for big words are on the horizon.
It was after the Portsmouth game in October, when he packed his bags as I recall, and he walked slowly down the hall. So why has he been away for ages? What is a cruciate ligament? Why do we have knees? What are you doing in my bedroom? Are peanuts soluble? I hope to answer at least one of these questions if you will continue to have the good grace to indulge me a little further.
So what is a cruciate?
The knee joint is supposedly the most complex joint in the human body. Stick your own funny-fag joke in here, I tried three variations and none of them worked. But this complexity can be summarised quite easily by someone who used the watching ER method to get through medical school.
Basically, your femur or thighbone has a curvy surface at the bottom end. Your tibia, the main bone of the shin, has a flat surface on the top end. These two meet to form the knee joint. Curve surface on flat surface is great for movement, but shite when it comes to stability, that is not falling apart after movement.
For stability we have a load of ligaments. The collaterals stop your knee falling apart to the sides, and the cruciates stop it falling apart front and back. You have two cruciates which cross over each other, hence the name cruciate, from the latin crux meaning cross, which might start getting us into conspiracy theorist territory.
Interestingly (or perhaps not) the knights Templar, who are thought to have been the chamber militant of the Prieure du Sion, had much of their land taken by the Knights Hospitalier de St John, who eventually became the Saint John's Ambulance Service. So expect Dan Brown's next book to look at the occult imagery of the first aid manual.
But I digress, the two cruciate ligaments are called the anterior, the one at the front, and the posterior, the one at the back. The point of the anterior cruciate is to stop your knee moving too far forward, the posterior too far backwards. At this point I'm fed up with typing cruciate all the time, so, we're going to have to start abbreviating to ACL for anterior and PCL for posterior, UCL is a University in London, KCL is potassium chloride and MCL is 1150 in Roman numerals.
How do you injure them then?
More often than not, your footballing type damages his ACL. This occurs when the knee joint is forced too far forward. This often occurs when the foot is planted firmly on the floor and the knee is held steady but the body continues to move forward. Usually there is also an element of twisting going on simultaneously.
So this could occur to the foot on the floor when kicking at goal or after a 30 yard sprint towards goal and the opposition spoil your run by suddenly playing Jive Bunny. Due to this tactic FIFA banned twist and shout from all grounds in 1968.
Alternatively a blow directly to the knee-cap could force the knee to hyperextend and the ligament gets torn that way. Fortunately this is becoming less frequent as Roy Keanes' anger management therapy has finally started to succeed. I personally feel that once he becomes comfortable with his sexuality... but again I digress.
PCL injuries are much rarer, but can occur when sliding on one's knees say as part of a goal celebration, which would explain why Maccarone has never had one. Alternatively it can happen in a car crash, though this most often occurs by smashing your knee against the dashboard. So if you were getting a lift home off Michael Ricketts rather than stupidly crossing the road after Man U's under 19 youth team's home-time bell has gone...
Have we nearly finished yet?
When a cruciate ligament is damaged, one of the first things a patient will notice is that it hurts and will often pass comment on the pain. Next, as the ligament is torn it will bleed into the joint causing it to swell up. Again the patient will comment on this and will probably also try to draw your attention to the pain that they mentioned earlier.
When they go on to see a doctor, he (or she) will often get the patient to sit up on a bed. This stops the knee moving about and often the pain will get a little better. Unfortunately all doctors are bastards by nature - accident and emergency doctors quadrupally so - and the first thing they do is make the patient move his knee to see how far it will go. This will cause the patient to gently remind the doctor of the pain that I'm pretty sure I may have pointed out earlier.
This will usually get an apology from the doctor, and often a smile which the patient will take as reassurance, but is actually anticipation, for the only way to test to see if a cruciate is damaged is to grab the thigh in one hand and the calf in the other and start pulling.
If the knee joint can be dragged unnaturally far forward the ACL has gone, too far back and the PCL is knacked, which is a medical term meaning worse than buggered not as bad as fucked.
The patient will refer the doctor to his previous statements regarding pain, occasionally in a more insistent tone and/or at a higher volume. Often they will look towards a nurse for help. Unfortunately nurses are also bastards, however they are devious bastards who will pretend to be on the patients' side against the doctor, but really they are just pissed off that the doctor is getting to do all the hurting and just want to hurry things up so they can start sticking needles in the patient's arse. Anyway, with a cruciate tear diagnosed we need to get it fixed.
Look really, I've got a dentist's appointment can I not just go now?
Mild injuries in real people will be fine if you sit with your feet up with a bit with a bandage on, popping a bag of frozen peas - or sweetcorn but never lettuce - for five minutes every hour. This is referred to as RICE (rest, ice, compression, elevation) to make the medical profession sound all dynamic and American which is important in the twenty-first century.
Similarly we have to say RTA rather than car crash, it just sounds more ER, saying gee-ess-double-you takes longer than gunshot wound which is what it stands for so it is a shit abbreviation but is soooo much cooler than "he were shot" which is possibly why I fail to progress. But as always I do digress.
Physiotherapy can sort the mild ones, but in bad tears and tears in professional sportspeople - interestingly the renowned taxpayer-robbing chav millionaire who needs legal aid for defending his vileness, El-Radj Piouff fails to fulfil any of the three categories professional, sporting or person, wanker - the next step is proper repair.
For this they pop a camera into the joint and replace the torn part of the ligament with a bit of tendon from the hamstring or the quadriceps. This is the pleasant doctory way of describing an operation where you get a bloody great hole in your leg and on top of a cruciate that can disintegrate if you even look at it wrong you've now got a bloody great hamstring tear as well (grade II probably), so it's gonna hurt like buggery and you're looking at months of physio.
But at least you can spend the time off the pitch reading Dan Brown's theories on how putting a broken wrist in a triangular bandage proves that John the Baptist was the true Messiah but it's all been hushed up by the Vatican.
Dr Vits is a real doctor and once saw a lady he never met before's bare belly button, just cos he asked to.
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