I. Anterior cruciate ligament injury.
Anterior cruciate ligament injury of the knee is a common acute sports injury. Can occur in any sports, especially gymnastics, skiing, soccer, wrestling, basketball, volleyball and other projects. The degree of injury varies with the size of the external force and can range from a minor strain to a complete rupture; from a single ligament injury to a multi-structural compound injury. Most patients seriously affect training and life.
Diagnosis: At the time of injury, the athlete mostly feels a tearing sensation in the joint. At that time, pain, swelling, limited movement, some patients can not support walking. Protective muscle spasm. After pain relief some patients have no obvious symptoms of laxity for a short period of time, usually after a period of time patients have symptoms of joint laxity and instability, pain, playing softness, and loss of power downstairs off the knee feeling. Lachman test (+), anterior drawer test (+), axial shift test (+) of the right knee. MRI has diagnostic value.
Treatment: If only a partial rupture of the anterior cruciate ligament does not injure other structures, most patients with good muscle training can be asymptomatic and do not need to be treated. If the joint laxity and instability are obvious, the ACL must be reconstructed by arthroscopic surgery. Autologous materials are mostly used, such as patellar tendon, thin femoral tendon, semitendinosus tendon, and iliotibial bundle. The patellar tendon is generally considered the most ideal. For fresh ACL rupture, the rate of excellent arthroscopic surgical reconstruction of the ACL is 88% in foreign data and 40% in conservative treatment. In old cases, the excellent rate of surgical efficacy is 67% in foreign data.
II. Posterior cruciate ligament injury.
The injury of the posterior cruciate ligament of the knee joint is easily missed and incompletely diagnosed in the early stage because the swelling and pain are not very serious after the trauma, and there is no obvious obstacle to the activity after the swelling and pain are reduced. If improperly treated, it leads to late joint instability. The main function of the posterior cruciate ligament is to prevent posterior misalignment of the lower leg and to prevent hyperextension and flexion of the knee. Posterior cruciate ligament rupture can be combined with other tissue injuries, such as anterior cruciate ligament and lateral collateral ligament.
Diagnosis: There is a history of acute injury, a tearing sensation in the joint, pain and swelling at that time, limited movement, and the patient may have a feeling of joint instability and laxity. Later on, the knee joint hit softness in walking and loss of power downstairs off the knee feeling symptoms. At about 90 degrees of knee flexion, subluxation of the tibial tuberosity is seen, and the Lachman test (+) and the posterior drawer test are positive. MRI has diagnostic value.
Treatment: Early surgical treatment is effective, with excellent rates of up to 80% reported abroad and only 9% with conservative treatment. Late repair with decreased efficacy, about 50%. If the anterior and posterior cruciate ligament rupture at the same time should be fully repaired, otherwise the efficacy is very poor and the joint is unstable. Fresh ruptures should be operated early. The upper and lower stop rupture can do stop refixation, if there is avulsion bone piece, the effect is better. The mid-segment rupture is often difficult to suture, and arthroscopic surgery to reconstruct the posterior cruciate ligament is the most effective treatment.
Third, meniscal injury of the knee joint
The meniscus is the semilunar cartilage plate between the femoral and tibial joints, one on the medial and one on the lateral side. The inner and outer edges of the meniscus are thin and thick. The inner meniscus is “C” shaped and the outer meniscus is “O” shaped. Meniscal tears are the most common sports injuries. It is most common in the three major ball games, gymnastics and wrestling.
Diagnosis: Generally, there is a history of acute injury, but in some cases, the history of injury is not obvious or is ignored. In acute injuries, there are mostly joint pain and swelling, except for those with obvious interlocking, it is not easy to confirm the diagnosis. At this time, there is no urgency to confirm whether the meniscus is damaged, other injuries such as ligament rupture and osteochondral fracture should be excluded first. The characteristics of meniscus injury are revealed only after the acute phase. Pain: fixed on one side, is caused by abnormal activity of the injured meniscus pulling on the synovial membrane.
The meniscus itself is painless. The swelling of the joint effusion is caused by the pulling and irritation of the synovial membrane. Rattling: The meniscus ruptures and rattles from abnormal activity. Constant on one side. Joint interlocking: sudden jamming, joint cannot be extended and flexed, constant on one side. Mostly can be unlocked on their own or with the help of others. Positive rocking test, positive McSweeney’s sign, positive Apley’s lifting and grinding test, positive Kollegg-Speed sign.
Treatment: Meniscus injury can no longer heal on its own. Early surgical treatment is an important measure to prevent secondary damage to the articular cartilage. The type of meniscus surgery is generally preferable to partial resection. With the development of arthroscopy in recent years, the meniscus can be resected and repaired under the microscope, and recovery after surgery is rapid. Those with marginal tears can be sutured under the microscope, and recovery takes 3-4 months.
Chondromalacia patellae
Chondromalacia patellae is mainly due to local strain and trauma. The knee hemiplegia develops, the patellofemoral joint is repeatedly flexed and twisted, overload friction, plus abnormal misalignment, impact and twisting resulting in injury.
Diagnosis: Generally there is a history of knee hemiplegia overstrain or trauma, early knee tenderness, obvious after exercise, weakness to go up and down stairs, relieved by rest. Later develop knee pain, aggravated after exercise, activity open without pain, can be trained normally. Further progress is semi-squatting power pain, such as jumping, emergency stop, etc. The activity is not open, so that the jump is weak. Further, walking and going up and down stairs are painful. Half squat pain is an important symptom of this disease. Patellar pressure pain accounts for more than 90%; peripatellar acupressure pain more than 90%, mostly at the inner edge of the patella. The resistance knee extension test is positive in about 78% of cases; the leg half squat test is positive (pain); the unevenness of the joint surface and friction sounds are usually found in more advanced cases.
Treatment: Massage the joint, physiotherapy with ultra-short wave is better, and the efficiency of Chinese herbal medicine external application is about 80%. Recipe: 50g each of safflower, peach kernel, gweiwei, natural copper, raw Sichuan wu, raw grass wu, licorice, 30g of strychnine, 5 slices of ginger. Preparation: Soak in equal amount of white wine (or 50% alcohol) for 7 days. Filter the liquid for use. Usage: Take 6~8 layers of gauze, soak wet liquid and put it on the front of patella. Externally wrap with plastic sheeting. Daily 2~6 hours (gradually increase the time). Do not overflow too much when the solution is wet. Discontinue immediately in case of allergic skin reaction. Surgical treatment may be considered if conservative treatment is ineffective and symptoms are severe. Specific to each patient’s situation is different, the choice of surgical modality is formulated according to the characteristics of the patient.
Five, athletes patellar tendon tendinopathy patellar tip end disease
This injury is mostly seen in jumping, basketball and volleyball players, so it is also called jumping knee. The main lesions are in the patellar tendon, tendon periphery and the infrapatellar pole tendon stop. If the patellar pain is predominant, it is called patellar endopathy; if the tendon pain is predominant, the common type is called patellar tendon periapical tendonitis. Or both.
Diagnosis: History of training or trauma. The main symptoms are jumping pain, semi-squatting power pain, up and down pain, heavy thickening and hypertrophy, and positive pressure pain. Resistance knee extension pain is positive (mostly around 90°).
Treatment: Conservative treatment and adjustment training are mostly used.
(1) External application of Chinese herbal medicine: the efficiency of external application of Shuangbai San in the treatment of these lesions can reach 85%.
(2)Physiotherapy.
(3) Massage: scraping, pinching and pressing at each tendon circumference of the patellar rim.
(4) Acupuncture treatment: the patella-tip type is effective, acupuncture stabbed into the patella-tip stop, and the tail needle smoked with moxa.
(5) Surgery: conservative treatment is ineffective, long duration of the disease and seriously affects training can be operated.
Surgical modalities should be combined with the lesion to select.
a.Tendon peripheral dissection;
b.peritendinous anger vessel ligation;
c, partial resection of the tendon periphery and tendon;
d. Longitudinal dissection and release of the tendon;
e, V-shaped lengthening of the tendon;
f, partial resection of the patellar tip.