Knee injuries are commonly caused by contact or non-contact injuries in sports (including knee meniscal injuries, knee ligament injuries, both often occurring in combination), patellar dislocation, tendon tears and a range of other injurious conditions.
I. Meniscal injury of the knee?
1.1 Clinical manifestations of knee meniscus injury
Only some acute injury cases have a history of trauma, chronic injury cases without a clear history of trauma.
Most of them are seen in athletes and manual workers, more men than women.
After the injury, the knee joint has severe pain, limited extension and rapid swelling, and is often accompanied by intra-articular blood accumulation. After the acute phase, the swelling is no longer obvious and the joint function has been restored, but the joint is always painful and there is a popping sound when moving, and sometimes a sudden “click” is heard when moving. The joint cannot be straightened normally, but the joint can be straightened again by waving the calf a few times and then hearing the “click” sound. This phenomenon is clinically known as “joint interlocking” and can occur occasionally or frequently. Frequent episodes of interlocking can significantly interfere with daily life and movement.
Signs of the chronic phase include pressure pain in the joint space, popping, knee flexion contracture and decreased strength of the medial femoral muscles. The pressure points can be examined by palpating along the joint space. Depending on the site of the pressure point, it can be roughly determined whether it is an anterior, body, or posterior horn tear. A horizontal transfer-like split of the anterior horn can be seen as the knee eye pops during flexion and extension of the knee, and the flexion contracture side of the knee suggests that the torn meniscus is embedded under the femoral condyle for a long period of time and is difficult to unlock. The atrophy of the medial femoral muscle is disuse and the sign is suggestive of internal structural and architectural disorders of the knee joint.
Test examinations.
(1) Hyperextension test: When the knee is fully extended and mildly hyperextended, the meniscus rupture is stretched or squeezed to produce severe pain.
(2) Hyperextension test: When the knee joint is flexed extremely, the ruptured posterior horn is stuck and causes severe pain.
(3) Meniscus rotation test (also called Mcmurry test): The patient lies on his back with the affected hip and knee fully flexed. The examiner places one hand on the extra-articular space for palpation, while the other hand holds the heel and then performs a large circular rotation movement of the lower leg. The lateral meniscus is tested with the internal rotation loop, and the medial meniscus is tested with the external rotation loop. The knee is gradually extended to 90 degrees while maintaining the rotated position, noting the joint angle at which the ringing occurs. If the sound is heard when the joint is in full flexion, it indicates a posterior meniscal horn injury; if the sound occurs when the joint is extended to about 90 degrees, it indicates a body injury. If the joint is extended to about 90 degrees, this indicates a body injury. If the joint is gradually extended to a slightly flexed position while maintaining the rotational position, a sound is obtained at this time, indicating a possible anterior meniscal horn injury.
(4) Apley test: the patient is lying prone, the knee joint is flexed to 90 degrees, the examiner presses the lower leg down and makes internal and external rotation movements, causing friction between the femur and the tibial joint surface. If external rotation produces pain, it suggests a lateral meniscus injury. Thereafter, the calf was lifted and internal and external rotation was performed, and if external rotation caused pain, it suggested medial collateral ligament injury. This test has some practical significance when examining the meniscus of patients with hip ankylosis.
(5) Squat and walk test: It is mainly used to check whether there is injury to the posterior horn of the meniscus. The method is as follows: ask the patient to squat and walk a duck walk, and change direction from time to time, either left or right. If the patient is able to perform these various movements well, posterior meniscal horn injury can be excluded. If the knee joint cannot be fully flexed because of pain and there is a rattling sound and painful discomfort in the knee when squatting and walking, this is a positive finding. In cases of posterior meniscal horn rupture, the popping sound during squatting and walking is obvious. This test is only indicated for the examination of adolescent patients and is particularly useful in mass physical examinations to check for meniscal damage.
It is important to note that no single test is the only criterion for diagnosing meniscal injury in the knee. A combination of clinical symptoms, pressure points and positive findings should be used to make a final diagnosis.
1.2 Examination of meniscal injuries of the knee.
X-ray plain film examination cannot show the meniscus pattern and is mainly used to exclude other lesions and injuries of the knee. MRI is now commonly used to clarify the condition of the knee (MRI provides a good visualization of the ligaments and meniscus). Ultrasound can be used to detect fluid in the knee joint. High resolution MRI films can clearly show meniscal deformation and rupture, and can detect joint effusion and ligament damage, but they are not as accurate as arthroscopy. Arthroscopy is a new technology. In recent years, the widespread use of endoscopic techniques has provided further insight into intra-articular disorders of the knee. It can detect not only meniscal injuries that are difficult to detect on imaging, but also the presence or absence of lesions of the cruciate ligament, articular cartilage and synovium at the same time. It can be used not only for diagnosis but also for surgical procedures such as biopsies and meniscal repair and partial resection through endoscopy.
1.3 Treatment of meniscal injuries of the knee.
In acute meniscal injuries, a long-leg plaster brace can be used for 4 weeks. If there is blood accumulation, it can be pumped out under local anesthesia and then bandaged with pressure. After the acute phase has passed and the pain has subsided, you can begin to do quadriceps exercises to avoid muscle atrophy.
Knee meniscus injuries can be classified as complete or partial tears. For patients diagnosed with partial tears, conservative treatment methods such as acupuncture, Chinese herbal medicine or ointment dressings can be used. In the past, meniscectomy was performed for complete meniscus tears, but osteoarthritis can easily develop in the removed knee joint. In other words, the meniscus can be sutured together under the arthroscope, the ruptured meniscus flap that is prone to interlocking can be partially removed or repaired if sutures are available, and the broken meniscus can be removed under the mirror. The endoscopic surgery has a small incision, little interference with the joint, quick recovery, and the ability to get up and move around early. It has become a common treatment method nowadays.
Knee ligament injury
2.1 Clinical manifestations of knee ligament injuries.
All have a history of trauma, more common in adolescents, more males than females.
Athletes are the most common.
Injury can sometimes hear the sound of ligament rupture, and soon due to severe pain and can no longer continue to exercise or work. There is swelling, pressure and fluid (blood) accumulation at the knee joint, and spasm of the knee muscles. The patient is afraid to move the knee, and the knee is in a forced position, either straight or flexed. There are obvious pressure points at the rupture of the lateral collateral ligaments of the knee, and sometimes the severed ends of the curled ligaments are felt.
(1) Lateral stress test. The lateral stress test is painful in the acute phase and can be performed after waiting several days or after local anesthesia at the painful site. Passive knee inversion and knee valgus are performed with the knee in full extension and 20-30 degrees of flexion and compared to the opposite side. If there is pain or if the inversion and valgus angles are found to be outside the normal range and there is a bouncing sensation, it suggests a lateral collateral ligament sprain or rupture.
(2) Drawer test. The knee is flexed at 90 degrees, the lower leg is lowered, and the examiner holds the upper tibia with both hands for pulling forward and pushing backward, and pays attention to the magnitude of anterior and posterior movement of the tibial tuberosity. Increased anterior movement indicates an anterior cruciate ligament rupture and increased posterior movement indicates a posterior cruciate ligament rupture. Since the tibia can also have mild anterior-posterior passive motion in the normal knee with the knee flexed at 90 degrees, it is necessary to compare the healthy side with the affected side. The anterior tibial translation is only slightly greater than normal when the ACL is torn alone, but if the anterior translation increases significantly. This indicates that there may also be a combined medial collateral ligament injury, and the drawer test is very painful in the acute phase and should be performed after anesthesia.
2.2 Examination of knee ligament injuries.
Imaging examinations and arthroscopy. Plain radiographs can only show avulsed fracture fragments. To show the presence or absence of medial and lateral collateral ligament injuries, stress radiographs can be taken. This is a painful position and is performed under local anesthesia. The medial and lateral gap openings are compared on x-ray. It is generally considered that a gap difference of 4mm or less between the two sides is a mild sprain, 4-12mm is a partial rupture, and 12mm or more is a complete rupture, and may be combined with an anterior cruciate ligament injury.
MRI examination can clearly show the anterior and posterior cruciate ligaments and can also detect hidden fracture lines. Arthroscopy is important to diagnose cruciate ligament injuries.
2.3 Treatment of knee ligament injuries.
Medial collateral ligament injury. A sprain or partial rupture of the medial collateral ligament can be treated conservatively with immobilization in a long-legged tubular cast for 4-6 weeks; complete ruptures should be repaired early. If there is meniscal injury with ACL injury, it should also be treated at the same time of surgery.
Lateral collateral ligament injury. A rupture of the lateral collateral ligament should be repaired immediately.
Anterior cruciate ligament injury. Any anterior cruciate ligament rupture less than 2 weeks old should be pursued with surgical sutures.
Posterior cruciate ligament injury. Whether or not to suture the ruptured posterior cruciate ligament has been debated in the past, but current opinion favors early repair under arthroscopy.
Other injuries of the knee joint
(a) Knee fracture Such as intercondylar fracture of femur, tibial condyle fracture, etc. The possibility of knee ligament and meniscus as well as neurovascular injury should be noted. Dislocation of the knee should also be a concern. Careful examination is required to avoid missed diagnoses.
(2) Traumatic patellar dislocation with no specific abnormality of the knee joint can cause serious soft tissue injury around the knee, especially the torn joint capsule should be repaired and sutured in time to prevent the formation of habitual dislocation in the future.
(iii) Rupture of patellar tendon or quadriceps tendon caused by indirect violence during sports. Sudden pain above the knee (quadriceps tendon rupture) or below the knee (patellar tendon rupture), and a rattling sound of the tendon rupture can be heard. On physical examination, the knee is swollen, unable to actively extend the knee, and the knee extension resistance test is positive. There is obvious pressure pain above (quadriceps tendon rupture) or below (patellar tendon rupture) the patella, local hollowing, and the severed end of the tendon can be palpated, and the patella is shifted down (quadriceps tendon rupture) or up (patellar tendon rupture) compared with the healthy side, which should be promptly repaired surgically.
(iv) Tibial tuberosity epiphysitis Prevalent in adolescents with a history of trauma or strain. Limited tibial tuberosity pain, soft tissue swelling, insignificant dysfunction, and significant pain on kneeling. On examination, the tibial tuberosity is elevated (higher than the contralateral side), not red, hard to touch, and painful to palpation. A knee extension resistance test, a bent knee half-squat rise test, and a single leg support test can be performed. Treatment includes strict suspension of training and rest, local closure or conservative treatment such as acupuncture and Chinese medicine. If conservative treatment is not effective in June, tibial tuberosity drilling can also be used.
(E) Chronic running Long-term running and jumping sports cause repeated friction between the iliotibial bundle and the femoral epicondyle, resulting in local sterile inflammation. There is local pain, swelling, and pressure, which is aggravated by activity, and the inversion deformity of the knee is most prone to this disease. Treatment includes elevation of the outer sole of the shoe, local closure, appropriate anti-inflammatory and analgesic drugs and conservative treatment with Chinese herbal medicine.