Unhappy triad

A complex knee injury

Unhappy triad is a knee injury that results from a chain of separate injuries in the knee joint. As the name suggests, there are three types of injuries involved here – an injury to the medial collateral ligament, the meniscus (a cartilage in the joint), and the cruciate ligament. This combined injury usually occurs when the knee is twisted, something that happens particularly often when skiers get snagged in their skis. Treating an unhappy triad is a difficult process, whereby the exact course of treatment depends on several factors, such as the severity of each injury. Knee orthoses are used here, as they stabilize and reduce pressure on the knee joint during the healing process.Unhappy triad is a knee injury that results from a chain of separate injuries in the knee joint. As the name suggests, there are three types of injuries involved here – an injury to the medial collateral ligament, the meniscus (a cartilage in the joint), and the cruciate ligament. This combined injury usually occurs when the knee is twisted, something that happens particularly often when skiers get snagged in their skis. Treating an unhappy triad is a difficult process, whereby the exact course of treatment depends on several factors, such as the severity of each injury. Knee orthoses are used here, as they stabilize and reduce pressure on the knee joint during the healing process.

Causes of an unhappy triad

Accidents and certain types of athletic activity often lead to combined injuries in the knee joint. An unhappy triad consists of the following injuries:

  1. Tear of the anterior cruciate ligament (ACL)
  2. Tear of the medial collateral ligament. (MCL)
  3. Damage to the medial meniscus

The injuries usually occur when the knee is slightly bent, the leg is in a knock-kneed position, and the knee rotates outwards while the lower leg remains immobile (valgus stress). This unfortunate combination of positions rarely occurs in normal situations, which is why skiers and athletes who play contact ball sports such as football and handball often suffer such injuries. Martial artists also frequently suffer an unhappy triad during matches.

Symptoms of an unhappy triad

Whether it’s skiing or football – challenging athletic activities can cause the knee to twist more quickly then most people realize. Sometimes a loud “pop” is heard – the sound of ligaments tearing. Things happen fast after that: The knee swells up extensively and becomes extremely painful, and the injured person cannot bend or stretch their leg because of all of the pain and swelling. The knee also often twists when the injured person attempts to stand or walk. This twisting under strain is referred to as the “giving-way phenomenon.” A bruise generally develops, although this might not happen until a few days after the injury.

The knee should be elevated and cooled immediately after an unhappy triad occurs. The knee joint should be splinted in the extended position as a provisional measure, and absolutely no stress should be placed upon it.

Diagnosing an unhappy triad

The orthopedist will first ask for an exact description of how the injury occurred. He or she will be able to diagnose an unhappy triad just on the basis of this description. This diagnosis is followed by a physical examination to evaluate knee joint structures. A magnetic resonance imaging examination (MRI) is then conducted to enable the orthopedist to evaluate the condition of the ligaments, the menisci, and the cartilage.

Treating an unhappy triad

An unhappy triad is difficult to treat because it doesn’t involve an injury to a specific structure but is instead a combined injury that affects several structures in the knee joint.

Many medial ligament injuries can be successfully treated conservatively (non-surgically) with medication, physiotherapy, medical supports, knee braces (orthoses), and targeted muscle toning with supports and orthoses. However, cruciate ligament and meniscus tears generally do not heal on their own. In certain circumstances, surgery with subsequent rehabilitation measures may be required.

In the case of meniscus damage, the course of treatment depends on the scope of the injury. Either conservative or surgical treatment measures will be used, depending on how severely the meniscus has been torn. In an unhappy triad operation, the torn cruciate ligament is sutured or replaced and torn portions of the meniscus are removed. The collateral ligament usually heals without surgery being required.
Most unhappy triad operations are conducted using arthroscopy. Only small skin incisions need to be made here, which lowers the risk of infection and reduces the time it takes for surgical wounds to heal. Surgery is followed by a long regeneration phase with physiotherapy and the use of orthoses to stabilize and relieve pressure from the knee joint. The orthosis protects and relieves the knee joint and makes it possible to slowly increase the stress placed upon it.

Complications resulting from an unhappy triad

If structural instability is accompanied by functional instability that muscle buildup cannot compensate for, then surgery will become necessary in order to prevent osteoarthritis from developing in the affected area over the long term. If surgery is not performed, the cartilage will be exposed to excessive strain and wear down. If such cartilage is then no longer available to serve as a protective layer, the bones in the area will rub against each other, which will lead to severe pain and further symptoms of wear. Knee joint instability is often not noticed for some time if the separate injuries in an unhappy triad are only slight. If the orthopedist decides to pursue a conservative course of treatment, it therefore makes sense to re-examine knee joint stability after a few weeks.

Orthoses that support the knee joint

Orthoses play an important role in the treatment of an unhappy triad. SecuTec Genu and SofTec Genu orthoses stabilize the knee joint in the healing phase during conservative treatment or after surgery. SecuTec Genu is made of light aluminum and has skin-friendly, breathable, and comfortable pads. It doesn’t slip and is comfortable to wear. If swelling occurs in the knee joint after an operation, the integrated pressure pads can compensate for it. SoftTec Genu comes with “intelligent” side joints that independently adjust themselves to the knee’s individual axis of rotation. Both orthoses stabilize the knee joint from the outside and provide relief. The side joints can be adjusted in small increments, which makes it possible to gradually increase the strain placed on the knee joint as it heals. The SecuTec Genu and SofTec Genu orthoses thus offer helpful support during the recovery process.