Road to Recovery: Hurdling the Unhappy Triad

In the world of sports, few conditions are as debilitating as getting your knee torn–in three places all at once. Dubbed the “unhappy triad” by the father of sports science Don O’Donoghue in the 1950s, this type of knee injury commonly occurs in sports with rough contact, like rugby or football, and sports that require a significant amount of pivoting on your knees, like soccer or basketball. Around 25% of athletes who sustain knee injuries suffer from the unhappy triad.

How does it happen?

The unhappy triad is an injury that is sustained when an outside force collides with your knee, or when your weight-bearing foot is forced to twist and change directions while it is firmly planted on the ground.

What are the symptoms?

True to its moniker, the unhappy triad comes with a slew of unpleasant symptoms. The injury is marked by extreme pain in the knee area, swelling, the inability to walk, and the sensation of the knee “giving out” or locking. Bruises also surface two to three days after the injury.

You may also want to read other common sports injuries, their treatment and prevention. Read it here.

The Unhappy Triad: Anterior Cruciate Ligament (ACL)

Along with the posterior cruciate ligament (PCL), the anterior cruciate ligament (ACL) functions as the knee’s primary stabilizer. People with a torn ACL often need surgery to fully recover, as a torn ACL seriously impedes movement and makes it painful to walk. In the world of sports, few injuries are as common as a torn ACL. In the US alone, $500 million a year is spent on treating ACL-related injuries. It is also one of the common injuries in the NBA, and puts athletes out of commission for more than a year. At its worst, ACL injuries can even be career ending.

The Unhappy Triad: Lateral or Medial Meniscus

The meniscus lies at the intersection of the femur, tibia, and patella–the three bones that meet together to make up your knee. It is a rubbery cartilage that functions as your knee’s “shock absorbers”, helping it distribute force and stabilize the knee. Like ACL tears, meniscus tears usually have to be treated surgically. A large part of menisci have poor blood flow, meaning that the tears cannot heal on their own, and must be surgically snipped away to prevent any pieces from getting stuck in the knee joint and further locking up the knee.

The Unhappy Triad: Medial Collateral Ligament (MCL)

The medial collateral ligament (MCL), runs along the inside of the knee, and prevents the knee from overextending backwards Unlike ACL tears and torn menisci, MCL tears can be treated without surgery. This type of injury usually takes an average of 6 weeks to heal on its own. But surgeons may choose to surgically repair a torn MCL in patients with the unhappy triad, since they are already cutting open the knee to repair the ACL and meniscus.

Treating the unhappy triad: The first few hours

Similar to common severe knee injuries, pain management and preventing further harm should be top priorities. In the event of a knee injury, patients should:

  • Apply ice therapy to reduce pain and inflammation
  • Elevate the knee so as to reduce blood flow to the area
  • Secure the knee using a compression bandage or a knee brace
  • Avoid walking; if you absolutely must, use crutches or some form of support
  • Immediately consult with a doctor about your next course of action

Treating the unhappy triad: Undergoing surgery

As a severe knee injury, the unhappy triad requires surgical intervention. Depending on the severity of your tears, the doctor might recommend different treatments.

  • Keyhole surgery (arthroscopic surgery): A keyhole surgery is minimally invasive procedure done with the help of a tiny, 5mm camera. Surgeons make small incisions and uses the camera to guide thin, specialized instruments. Because surgeons do not make large cuts, patients experience in less pain and faster recovery times.
  • ACL reconstruction: Ligament reconstruction is done by taking a graft–a tissue sample–from a donor or the patient’s own hamstring or tendon, and using that piece of tissue as a replacement ligament.
  • MCL repair: The MCL responds well to non-surgical treatments. However, surgeons may recommend surgical treatment because of the simultaneous ACL and meniscus repairs. Surgeons treat a torn MCL by re-attaching it to the bone from which it tore away.
  • Meniscus repair or removal: Depending on the damage to the meniscus, a surgeon may either repair or have to remove portions of the meniscus that have been damaged beyond repair in a process called a meniscectomy. In younger patients, a meniscus repair is generally preferred as the rates of success are high. The goal is to save as much of the cartilage as possible, because the absence of portions of the meniscus can lead to arthritis 10 to 20 years after the injury.

Recovering from the unhappy triad

It takes time to recover from one serious knee injury, let alone three. The average recovery period from the unhappy triad is anywhere from 6 to 9 months. Your surgeon might prescribe going to physical therapy, or a set of exercises to be done at home to help the knee heal and to strengthen the muscles that support it. 

During the recovery period, patients are advised to avoid any stressful activities. Athletes should not engage in their sport unless given a clean bill of health by their surgeon. Going back to the field, or the court, before a knee is fully-healed can lead to the knee not healing properly, and put the patient at risk for future injuries. The unhappy triad is a severe knee injury that will not go away with the standard PRICE therapy. 

Dr. Dutton of the Dr. Andrew Dutton Orthopaedic and Sports Clinic will gladly answer questions about how to nurse your knee back to health. Dr. Dutton has been in the medical practice since 1996, and completed his subspecialty on hip and knee surgery at the Massachusetts General Hospital and Harvard Medical School before opening a practice in Singapore. Book an appointment today by calling (+65) 6836 8000, or by sending a message through our inquiry form.