...'of the knee'. That was the diagnosis from the dressing room for a player taken off injured during today's MLS match between the Metrostars and DC United. The ESPN commentators (veteran soccer folks) had never heard that term before, but had quite a good laugh about it.

Question for Dr. Bill, or any other doctor/sports injury types....what in the world is "Interior Derangement"? Or did something get lost in the translation? Just to be safe we might want to make sure Farcelino doesn't hear about it. He may find himself with a season-ending case of it by Weds night. ;-)

-- Anonymous, July 21, 2001

Answers

Hmm - I thought Interior Derangement was something to do with brain fade. An alternative explanation can often be found on those bliddy house-makeover programmes seen on telly.

-- Anonymous, July 21, 2001

That's an interesting thought Screach. Perhaps we could do a "Changing Rooms" thread where we go into The Stadium of Light and redo the interior for them. I think if it was all painted black and white it would look (as Carol Smillie would say) "reelly reelly nice". I think Softie will be good at the Llewelyn-Bowen bits (ooh-er missus) but we'll have to wait a few months for him to get the hair right obviously.

-- Anonymous, July 22, 2001

Interior derangement, hmmm, can be as nasty as it sounds I'm afraid.

The knee is a ridiculously complicated joint considering it's basically just a hinge. However, it has to withstand some very large forces that try to make it bend in the other plane (ie sideways), move backwards or forwards on itself, or twist, while still flexing and extending smoothly in the correct plane with lots of kilograms of weight bouncing up and down on it. To try to keep everything in order, there are at least three different systems within the joint capsule (the bit that keeps the joint lubricated): anterior and posterior cruciate ligaments, medial and lateral collateral ligaments and medial and lateral menisci (cartilages).

Any force in a 'wrong' direction that is sufficiently great will cause disruption of one or more of these systems - ruptured ligaments or torn menisci. That would include rotation injuries where the foot gets planted and the body weight (or somebody else's) keeps turning, as well as direct impacts and lateral (sideways) forces. It's often not clear at the time exactly what inappropriate force has caused the damage, nor exactly what the resulting problem is. Interior derangement is one of the terms used to describe this situation: some catastrophic disruption has occurred withind the joint capsule, but the exact nature isn't yet clear. Funnily enough, I thought it was a term in more common use in the US, so am surprised your ESPN guys hadn't heard of it.

If torn, cartilages can be taken out with little resultant limitation. Internal ligaments have to be repaired - used to mean serious limitation of movement in the past, end of sporting careers very commonly - now more successful, but still career-threatening.

Btw, contrary to popular belief in some circles, all of this has virtually nothing to do with the kneecap, which is just a bit of bone in the quadriceps tendon that acts as some protection against an impact from the front.

Next week: total devastation of the little finger joint - a case- report from SJP.

PS Ask me about the cranial nerves next time, go on - I can still do the mnemonic...

-- Anonymous, July 22, 2001

So they really weren't handed a report from the Dr on the Simpsons(as they were starting to think). ;-)

Thanks for the explanation. In the replay, it did look as though the player's knee bent a little strangely. I shrieked and covered my eyes pretty quickly, so didn't get a good look at what really happened.(Yes, I'm incredibly squeamish about these things.) Hope his injury isn't too serious.

-- Anonymous, July 22, 2001