The purpose of this article is to help patients with knee injuries understand the rationale for operating or not operating, and the clinical implications of combining minimally invasive surgery with active rehabilitation! It can be a treasure trove for the rehabilitation of knee injury patients.
I. Why does someone need surgery in a knee trauma patient?
Human being is an organism with delicate structure and complex function composed of a mature cell through cell division and cell differentiation. As the old saying goes, you can’t have everything Mom gives you! The good thing is that there are backups when God creates a person, such as two kidneys, two eyes …… At the same time, the human body has adaptive mechanisms that can replace some of the deficiencies under certain conditions.
Life is indefinite, inevitable accidental injuries. The most feared injury lower limbs, especially the knee joint that carries the top and bottom. When a player falls down on the field and rolls around holding his injured knee, the fans in the audience all sigh: Hey! Injured bones, it seems that half a year can not see the face.
The good thing is that modern medical technology can help doctors to form a clear diagnosis through various examinations to determine the condition of the injury at an early stage! The doctor can accurately tell the patient after the injury:Combining your chief complaint and specialist examination, from your X-rays and/or CT, MRI, we can confirm …… that you are advised …….
Okay, now I’ll talk about the knee joint!
The knee is the most complex joint of the human extremities. In terms of its embryogenesis, the process is extremely delicate, delicate and superb! I have been impressed countless times by nature’s masterpieces! The knee joint is the only animal on the planet that walks upright. The human knee joint has a long lever arm and a large moment, so it has a high chance of injury when the human body is accidentally injured. For this reason, clinical medicine has specifically separated the knee joint from orthopedics to deal with its complex trauma in order to avoid or reduce the interference and impact of the injury on the patient’s knee function.
Since the knee is so stunningly beautiful, what kind of patient needs to undergo surgery?
In a word: when the injured knee can’t manage on its own, in order to save the function of the knee and undo the vicious cycle that the injury has brought to the knee, it’s time for the knee surgeon to do it! Our rule of thumb is: first of all, we defend the principle of “never operate if you can do without surgery”!
Based on our respect for natural principles, our surgical goal is to restore function and to provide a suitable anatomical structure and a reasonable biomechanical internal environment for the patient’s early active rehabilitation through reliable domestic and foreign minimally invasive repair and reconstruction surgery.
Therefore, summarizing 20 years of surgical experience in our department, we currently perform knee arthroscopy and its open surgery as follows.
1, trauma causing rupture or failure of stable structures of the knee joint (such as ligaments, meniscus), resulting in joint instability, the patient cannot injure the knee for weight-bearing support, walking or running and jumping; note: clinically, except for simple rupture of the medial collateral ligament, which can repair itself without surgery. Other ligaments and menisci do not have reliable self-repair ability and require repair of the ruptured end according to the condition (e.g., microscopic suture repair after meniscal tear, microscopic internal fixation repair of tibial stop avulsion fracture of anterior cruciate ligament, incisional internal fixation repair of tibial stop avulsion fracture of posterior cruciate ligament, etc.) or reconstruction of ligaments that have disappeared after deficiency or failed after severe scarring (arthroscopic anterior and posterior cruciate ligament reconstruction, incision of medial and lateral collateral ligaments, patellar ligament reconstruction, etc.). Allogeneic meniscus and cartilage transplantation are not carried out in our department due to the safety restriction of the graft source.
2. Mechanical internal disorders of the knee joint (strangulation, knee extension and flexion disorders); meniscal tears, intra-articular free bodies, cartilage exfoliation, creases, fat pad compression, post-traumatic synovial lesions, etc. can all be triggered, which need to be investigated and confirmed by the knee specialist one by one! Once clear, surgery is lifted to avoid sequelae and aggravation of damage.
3, traumatic tear or avulsion fracture of the knee extensor device (including quadriceps tendon, patella, patellar ligament and tibial tuberosity), as well as recurrent dislocation and fixed dislocation of the patellofemoral joint; in our hospital, patellar fractures are treated by our lower extremity trauma department.
Therefore, again, please note that based on the various indications for surgery mentioned above, the overall treatment principles for knee surgery are
When the injured knee cannot be repaired on its own, the surgeon intervenes artificially to save the function of the knee (note that the surgical goals and rehabilitation plans of professional athletes and sports enthusiasts may not be the same as those of the general population due to their different expectations) in order to undo the vicious cycle brought about by the injury to the knee and to promote its functional recovery.
The goal of knee surgery is: to restore function and strive to provide a suitable anatomical structure and a reasonable biomechanical internal environment for the patient’s early start of active rehabilitation through reliable domestic and foreign minimally invasive surgical methods of repair and reconstruction.
II. What does active rehabilitation of knee trauma mean?
Under the condition that the patient fully understands his or her injury and various clinical management modes, the patient accepts the personalized treatment plan formulated by the medical staff, and through the patient’s subjective efforts, while effectively controlling the infection and pain, he or she completes in stages the healing of the joint mobility, muscle strength, proprioception, limb movement coordination and flexibility with self (i.e., conservative treatment) or surgical repair or/and reconstruction of the structure. The rehabilitation process includes: joint mobility, muscle strength, proprioception and limb coordination, and flexibility, in order to resume daily life, work, and special recreational or competitive sports as soon as possible.
Note that this rehabilitation process essentially consists of two concurrent events!
What are the two parallel things?
1, after an accidental injury, the healthy body immediately begins to repair itself (and the focus of work at this time is on a well-documented clinical diagnosis to help doctors as soon as possible to determine whether to operate or not, and the best time to operate!) The most valuable “natural” self-maintenance is the best gift from our mother, and the full use of its repair mechanism will yield far better results than if we had to place our hopes on surgery alone! This is the reason why our department insists on “no surgery if possible”!
2. Another thing that starts at the same time is that after the injury is diagnosed with certainty, regardless of whether it is open or not, the active rehabilitation training that must be completed under medical supervision of the various patients mentioned earlier also starts. This is because the goal of treatment, whether natural repair or surgical repair or/and reconstruction, is that the various functions associated with the injured knee, during the healing process of the injured tissue, should be facilitated by rehabilitation training under scientific medical supervision leading to the recovery of joint mobility, muscle strength, proprioception and lower extremity motor coordination and flexibility of the injured knee, thus advancing the patient’s daily life, work, and special This will enable the patient to resume daily life, work, and recreational or competitive sports as soon as possible. Therefore, our department places great emphasis on outpatient and inpatient specialist consultation, specialist examination and targeted specialist radiography (including X-ray, CT, MRI, etc.), which is the only way to obtain a definite diagnosis! Missed diagnosis and misdiagnosis will definitely be destined to the south, which will be contrary to what you want!
At this point, you may think I still haven’t mentioned how to specifically practice joint mobility, muscle strength, etc. In fact, it depends on each individual injury. In fact, this depends on the specific injury and personal tolerance of each injured person, personal experience and awareness of the injury, etc. What I think you should know more about is exactly what I stated above, and that is the key to a speedy recovery by the power of nature after an accidental injury: How much do you know about your injury? Are the decisions you make for yourself in line with the forces of nature?
I’m sure no one would have undergone surgery in the first place! But when the injury is beyond your own ability to repair, and precise, minimally invasive surgery can assist the forces of nature to restore most, if not all, of the function of the injured knee, it reminds me of the adage: the one who stands against the odds wins! Whoever stands with the truth, he or she will be the brave one.