WORLD cup winner Juninho is finally back to match fitness after his devastating knee injury.

Of course, the Brazilian international and Premiership star has enjoyed the best care in the world.

But North-East orthopaedic surgeon Gavin DeKiewiet is anxious that the legions of ordinary footballers who risk anterior cruciate ligament injuries every week should protect themselves.

Mr DeKiewiet, who combines his work at the BUPA Hospital in Washington with his role as Sunderland FC's orthopaedic surgeon, sees so many cases of cruciate ligament damage that he strongly advises amateur footballers to think seriously about getting insured.

"It worries me they may be seen in their local hospital and told you have cruciate ligament damage, go away and have some rehabilitation," said Mr DeKiewiet.

In many cases this may be appropriate, but if your livelihood depends on making strenuous demands on your knees, such as a builder, you would do well to consider surgery.

"You will get back to near normality providing you are not climbing ladders on a building site, but if you don't modify your lifestyle you will almost certainly need surgery," he said.

Waiting for surgery on the NHS could take a long time, but private surgery will allow a relatively quick recovery. "Given the current circumstances of the NHS if you are doing sport on a serious basis get yourself insured," he said.

"You also need to chose your surgeon; it's not an operation that every Tom, Dick and Harry should be doing," he added.

While the operation will fix instability in the knee it will not prevent premature arthritis.

Surgical techniques are progressing all of the time, adds Mr DeKiewiet. The technique of using part of the kneecap tendon to replace the ligament, which was used in Juninho's case, is now being overtaken by an alternative approach which uses a combination of bone and tendon from the kneecap and calf which is fixed in place with screws.