Diagnosis and treatment of knee meniscus injuries in athletes. Ankle ligament damage
> Meniscopathy
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One of the functional elements knee joint is the meniscus (cartilage pad). Each joint includes two menisci - lateral (outer) and medial (inner). Their main tasks are to ensure congruence (correspondence) of the articular surfaces to each other and stabilize the joint. In addition, the menisci play the role of a kind of shock absorbers.
Causes of meniscopathies
Pathology of the meniscus is called meniscopathy. The main causes of meniscopathies are injuries to the knee joints and excessive stress on them. The risk group for the development of this pathology is professional athletes (weightlifters, runners, hockey players, football players). Particularly dangerous in the knee joint are movements with a twisting moment when the shin is fixed. They lead to acute injury meniscus, which manifests itself as severe pain.
Clinical signs of the disease
As already mentioned, the main symptom of meniscopathy is pain. Based on the nature of the development of the lesion, one can distinguish acute injury with meniscopathy, which is often called a knee block, as well as chronic meniscopathy, in which the damaging factor is of low intensity, but lasts for a long time (in professional runners). In acute meniscopathy, the pain is accompanied by a pronounced limitation of the function of the knee joint (block), and there is no opportunity to fully straighten the leg. In the next few minutes after the injury, severe swelling develops.
Methods for examining the knee joint
Although knee block may resolve without qualified assistance, if it occurs, you should consult a traumatologist for an examination that will help avoid complications. At the emergency room, the doctor will examine the injured limb, prescribe an X-ray examination and, based on the data obtained, either send the victim to ambulatory treatment, or recommend that he be hospitalized in the trauma department. In case of hospitalization, a detailed examination will be carried out: all the necessary tests will be taken, an ultrasound of the joint will be performed. The most reliable way to diagnose meniscopathy is arthroscopy - examination of the joint cavity using an endoscope. Occasionally, doctors prescribe an MRI of the knee joint.
Therapeutic manipulations for meniscopathy
For minor damage to the meniscus, conservative treatment is allowed. Rest for the injured limb, painkillers, and compresses to reduce swelling are recommended. In case of meniscus rupture, fragmentation or in case of meniscopathy with chronic course Traumatologists recommend meniscectomy (removal of the meniscus). This is due to the fact that the damaged element of the joint is not able to properly perform its function. In addition, it has a damaging effect on the articular surfaces, which can lead to a serious complication - post-traumatic deforming osteoarthritis, accompanied by sharp decline or complete loss of function of the knee joint.
Disease prognosis
Prognosis for meniscopathy with timely treatment quite favorable. Done on time surgical intervention can completely restore mobility to the joint. In advanced cases, in addition to deforming arthrosis, contracture may occur - fusion of the articular surfaces of the tibia and femur, which leads to complete immobility of the leg in the joint.
Prevention of meniscopathies
Prevention of meniscopathies is of great importance. When playing sports, it is not recommended to put excessive stress on the knee joints. This is especially true for people involved in kettlebell lifting, barbell lifting, football and hockey. When a block of the knee joint occurs for the first time, it is recommended a long period rehabilitation, during which all stress on the knee should be excluded. The patient must walk on crutches for 4–6 weeks. The speed of restoration of joint function depends on the correct implementation of the traumatologist’s recommendations.
Ticket number 34.
35. Dislocations in the knee joint: dislocation of the tibia and patella. Diagnosis, treatment.
PATELLA DISLOCATIONS
Causes: falling on the knee joint or sudden tension of the quadriceps femoris muscle with simultaneous abduction of the lower leg outward; the internal section of the fibrous capsule of the joint is torn, and the patella is displaced by the force of the blow or the thrust of the extensor apparatus outer surface joint Dislocation of the patella is facilitated by congenital valgus alignment of the tibia, due to previous rickets, as well as underdevelopment of the lateral condyle femur. Sometimes dislocations become habitual, arise from minor violence and are easily adjusted by patients without the help of medical workers.
Signs. A typical displacement of the patella to the outer surface of the joint, a semi-bent position of the lower leg, and movements in the joint are impossible. The patella is palpated on the side of the lateral femoral condyle, the quadriceps tendon and the patellar ligament are sharply tense. The diagnosis is confirmed by x-ray examination.
Treatment. Reduction of the dislocation is carried out under local anesthesia. The leg is fully extended at the knee joint, and the patella is moved into place with the fingers. The limb is then fixed for 2-3 weeks with a splint plaster cast in the position of extension in the knee joint. Subsequently, exercise therapy, massage and thermal procedures are prescribed. Working capacity after a traumatic dislocation is restored after 4-5 weeks.
For frequent habitual dislocations of the patella, surgical treatment is indicated.
SHIN DISLOCATIONS
Causes: sudden forced adduction, abduction or hyperextension of the leg. Moreover, the traumatic violence is so great that, following damage to the collateral and cruciate ligaments the joint capsule ruptures and the articular surfaces of the femur and tibia are displaced.
Signs. A pronounced deformation of the knee joint, an unusual position of the lower leg relative to the thigh, and a mismatch of their axes are revealed. Sharp pain in the joint does not allow the patient to change the position of the limb. The lower leg can be displaced in any direction depending on the traumatic force. Dislocations may be complicated by compression of the popliteal vessels or damage peroneal nerve Therefore, you should always check the pulsation of the peripheral vessels of the foot and the possibility of active extension of the foot. X-ray examinations are mandatory even with a clear clinical picture of dislocation, in order to exclude collateral damage bones.
Treatment. Dislocations must be reduced under anesthesia by traction along the length and pressure on the displaced bones.
After successful bloodless reduction of the dislocation, 2-3 days later it is necessary to operative recovery damaged ligamentous apparatus and fibrous capsule of the joint. If the operation cannot be performed for any reason, then they are limited to fixing the limb with a circular plaster cast from the fingers to the gluteal fold (when bending the knee joint to an angle of 150-160°) for 2 months. Subsequently, if incompetence of the ligamentous apparatus of the knee joint is revealed, its plastic restoration is performed.
37.Degenerative-dystrophic diseases of the joints. Classification, etiology, pathogenesis.
There are primary and secondary degenerative-dystrophic lesions of joints. If the cause of secondary degenerative-dystrophic lesions of the joints is considered to be injuries, joint dysplasia, nervous diseases, endocrine systems, blood diseases, metabolism, past inflammatory processes, static chronic overloads, biomechanical abnormalities in joints and bones, and the like, then the cause of primary diseases remains unknown.
At the core primary cause The occurrence of a degenerative-dystrophic process in the joint is due to biochemical and microcirculatory disorders in the cartilage and bone tissue of the epiphysis. Mechanical and static loads additionally destroy defective chondrocytes and bone tissue of the epiphysis with the development of clinical and X-ray picture diseases.
Based on clinical and morphological data, there are three forms of degenerative-dystrophic joint lesions: deforming osteoarthritis, cystic restructuring and aseptic necrosis.
The first form is deforming osteoarthritis, in which five stages are distinguished: I - prearthrosis; II - arthrosis; III - osteoarthrosis; IV - deforming osteoarthritis; V - arthrosis-arthritis.
The second form of degenerative-dystrophic lesion - aseptic necrosis - has three stages: I - radiological clearing (sequestration); II - demarcation; III - pushing through the necrotic area, deforming osteoarthritis.
The third form is cystic restructuring, in which three stages are distinguished: I - the appearance of single subchondral cysts; II - generalization, or fusion of single cysts; III - breakthrough of cysts into the articular cavity, deforming osteoarthritis.
The first stage is prearthrosis. Patients complain of discomfort in the joint or vague pain during heavy work or prolonged standing on their feet. Clinical and radiological signs are missing. Only during a careful examination can it be stated that when checking passive movements in the joint, hyperextension disappears or is limited (Sklyarenko’s symptom).
Such patients must be registered at a dispensary and undergo preventive treatment, which consists of limiting static and physical activity, prescribing balneotherapy, massage, acupuncture, a course of mumiyo, and multivitamins with microelements.
The second stage is arthrosis. Patients complain of pain in the joint during severe physical labor, long stay on your feet, which goes away after rest and unloading of the limb, but reappears over time. The pain stops, and after an overnight rest, the maximum range of motion is limited, and the usual range of motion (working) in the joint is not limited. The contours of the joint are not painful, the muscles are not hypotrophic.
An x-ray of the joint reveals moderate patchy osteoporosis and moderate narrowing of the joint space. The latter indicates a thinning of the cartilaginous cover, in which degenerative-dystrophic processes occur, and spotted osteoporosis indicates trophic disorders in the bone structure of the epiphysis
The third stage is osteoarthritis. Pain in the joint occurs during movement, but does not go away after rest. The contours of the joint appear more prominent as a result of muscle wasting, active and passive movements are limited, there is flexion or adducted contracture, diffuse pain during palpation of the periarticular tissues.
The radiograph reveals diffuse osteoporosis of the epiphysis, significant narrowing of the joint space, subchondral sclerosis, alternating zones of compaction and clearing bone structure epiphyses, single subchondral cysts (Fig. 4).
Increasing narrowing of the joint space indicates progressive destruction of articular cartilage, and radiographic changes in the epiphyses - for the presence of organic processes in the bone structure. Consequently, during the third stage, cartilage destruction continues and organic lesion bone structure, which reflects the name of the stage - osteoarthritis. There is no deformation of the articular ends at this stage.
The fourth stage is deforming osteoarthritis.
The intensity of pain increases during standing, walking, standing for long periods of time, physical activity. Flexion and extension contracture in the joints is pronounced. In the hip joint, flexion-adduction contracture, significant wasting of the muscles of the limb, functional shortening of the limb, and pelvic distortion are determined. As a result of muscle wasting, the contours of the joint are prominent and appear deformed. Diffuse pain in the periarticular tissues during palpation, crunching when moving the joint. There is a positive Gaglund's sign in the knee joint (during passive movements of the relaxed patella, a crunching sensation is felt under it in the joint). There is a pronounced limitation of active and passive movements in the joint.
Radiographs show a significant narrowing of the joint space, which in some places may even break, and deformation of the articular surfaces due to osteochondral growths. Subchondral sclerosis, mosaic alternation of zones of sclerosis and clearing of the epiphyses, hyperplastic layers
The second form of degenerative-dystrophic joint damage is aseptic necrosis. In the dynamics of the development of the pathological process, three stages are distinguished.
The first stage is x-ray clearing.
For no apparent reason, patients begin to limp their legs. Sometimes moderate pain in the joint is detected.
Closed joint injuries
Due to their complex anatomical and functional properties, joints are injured quite often, but most often those that have the greatest load (knee, shoulder, etc.) are damaged. Depending on the mechanism of injury, tissue damage may occur and structural elements joint Joint injuries occur mainly in people of working age.
Joint clogging occurs with a direct blow, resulting in damage to the periarticular tissues, joint capsule, synovial membrane, and sometimes articular cartilage.
Clogging of the periarticular tissues is clinically manifested by local swelling due to interstitial hematoma and edema, sometimes by a bruise, and a slight limitation of joint function. Palpation reveals local pain, tissue infiltration, and time fluctuation. A more detailed examination makes it possible to exclude intra-articular injuries.
Treatment. To create rest, the injured limb is fixed in a plaster cast. From the third day, UHF therapy is prescribed, and after the splint is removed (6-7 days), exercise therapy and muscle massage are prescribed. For minor impacts, they are limited to applying a tight bandage for several days.
Hemarthrosis is characteristic of damage to the synovial membrane of the joint; it can occur either as a result of direct trauma or pinching of the membrane. Hemarthrosis of the knee joint is most often observed.
Immediately after the injury, the joint increases in size, its contours are smoothed, and pain appears (baroreceptors). The limb is in the floor bent position(protective balancing of the tension force of the antagonist muscles), in which the volume of the joint cavity becomes largest, and thereby intra-articular pressure and pain are reduced. When palpated, fluctuation is determined, and when pressed, increased pain is detected. Movement in the joint is limited and painful. The diagnosis is clarified by puncture of the joint (under local puncture). Drops of fat in the extracted blood indicate damage to the fat pads or intra-articular fracture. Therefore, radiography must be taken in two projections.
During the examination, the integrity is also checked ligamentous apparatus joint Damage to the meniscus acute period injuries can be difficult to determine even after puncture.
Treatment. The diagnostic puncture is completed with suction from the joint maximum quantity blood to reduce intra-articular pressure and pain. This also prevents the formation of adhesions in the joint and stiffness after the formation of a hematoma. In case of significant hemarthrosis, punctures are performed several times, sometimes with washing of the joint with a solution of novocaine until complete reorganization synovial fluid.
To prevent adhesive arthritis (sticking of the leaves of the upper inversion), after each puncture, 40-50 ml of a 0.5% solution of novocaine with an antibiotic is injected into the joint. Intramuscular administration of antibiotics is mandatory. After the first puncture, the limb is fixed in a plaster splint with a cotton-gauze “donut” tightly bandaged on the front surface of the knee.
The plaster cast is removed only when the swelling subsides and the joint becomes calm (after 10-14 days). Once again the condition of the ligamentous apparatus and menisci is checked and a new treatment is prescribed - active and passive physical therapy, muscle massage, thermal procedures, lidases, desensitizing therapy, etc.
Post-traumatic reactive synovitis
Post-traumatic reactive - a direct consequence of hemarthrosis or stroke, is one of the stages of clinical manifestations and the course of the pathological process. Sometimes synovitis can develop later, after the so-called clinical recovery, which forces the patient to consult a doctor again.
Causes and pathogenesis of post-traumatic synovitis have not yet been fully revealed. It does not occur in all people after injury. It has been experimentally proven in animals that post-traumatic synovitis develops only after sensitization by a foreign protein; in nonsensitized animals, regardless of the severity of the injury, reactive synovitis does not occur.
Clinical symptoms of synovitis the same as hemarthrosis, only the pain is insignificant, since patients seek help before excessive effusion and pressure in the joint arise.
Joint puncture is both diagnostic and remedy. Macroscopic view of the collected fluid and laboratory test it (quantity and nature cellular elements, specific reactions, etc.) make it possible to clarify the diagnosis and monitor the progress of synovitis over time. Freeing the articular cavity from exudate prevents the loss of coarse protein fractions into clots that layer on the surface articular cartilage, disrupt his nutrition. Effect of lysosomal exudate enzymes and deficiency hyaluronic acid is the cause of degenerative changes and the occurrence of deforming diseases.
In order to create rest, the limb is fixed in a functionally advantageous position with a posterior plaster splint. Drug anti-inflammatory and desensitizing therapy is carried out. Adhering to the principles of asepsis, after puncture, corticosteroids (hydrocortisone, Kenalog-40) are injected into the joint cavity at intervals of 5-7 days, always with an antibiotic diluted with a 0.5% solution of novocaine. Steroid drugs reduce exudation, suppress the fibroblastic reaction and inhibit development connective tissue. For the same purpose, electrophoresis of chymotrypsin, paratrypsin, etc. is used.
Physiotherapeutic treatment is carried out in the reverse stage of the inflammatory process, although quartz irradiation is also useful in the acute period of synovitis. After the elimination of synovitis, the plaster splint is removed and prescribed complex treatment which restores the function of the limb (physical therapy, massage, etc.).
Damage to the fat pad and pterygoid folds of the knee joint are rare and are identified rarely, as a rule, due to constant trauma to the anterior surface of the knee (in women, miners, SUVs), as well as chronic inflammatory processes(rheumatoid arthritis). The fat body, which is located under the patellar ligament and the pterygoid folds of the synovial membrane on the sides, hypertrophy, and then periodically become pinched between articular surfaces, are even more injured. Due to constant hemorrhages and reactive inflammation, chronic sometimes occurs - sclerosis and induration of fatty bodies. This pathological condition is called Hoffa's disease, who first described it. There are also acute cases of direct trauma to fat pads.
Diagnosis diagnosed on the basis of medical history, patient complaints and clinical symptoms. The patient complains of pain in the area own ligament patella, difficulty or discomfort when walking. Sometimes full extension of the leg is limited. When the patient is asked to stand on his toes, the pain intensifies and swelling is visible on the sides of the patellar ligament, which decreases with free standing. The patient feels better if he sits. Could be the thigh muscles. An elastic-hard hypertrophied fat body is felt by palpation, which can be painless. The pain intensifies sharply if you straighten your leg with a jerk. The induced fat pad is contoured on a lateral radiograph of the knee joint.
Treatment. In acute cases of injury or pinched fat pad, the patient is given a posterior plaster splint and heat (a heating pad) is recommended. After 5-7 days the patient can start working.
At chronic process with frequent pinching and pain, which reduces the patient’s performance, surgery is recommended - removal of the pathologically altered fat body. Complete extirpation of the fat pad is an operation technically simpler and less traumatic than resection, which is accompanied by significant hemarthrosis, despite drainage of the joint. After the operation, a plaster splint is applied for 5-7 days, and then exercise therapy is prescribed, and when the stitches are removed, thermal procedures and massage are prescribed. Performance is restored after 3-4 weeks.
Meniscal damage
Damage - common species knee joint injuries account for about 50% of all intra-articular injuries.
Mechanogenesisand types of damage. The medial meniscus is most often damaged (94%), since it is fused along the entire edge with the articular capsule, which is less mobile and larger in size. The distance between its horns is almost 2 times greater than that of the lateral meniscus.
Distinguish three mechanismsoccurrence of meniscus damage:
1) during a sharp squat, it is sandwiched between the articular surfaces of the condyles, sliding (more often - the posterior horn);
2) during sharp turn the torso and thighs with the lower leg fixed due to the force that mutually counteracts the meniscus;
3) when falling or jumping onto your feet (a transchondral rupture or crushing of the meniscus occurs). If during rotation the tension of the meniscus exceeds its elasticity, then it ruptures (most often - paracapsularly, less often - the anterior horn).
Symptoms anddamage diagnosis. Important in a reliable diagnosis is a detailed anamnesis - elucidation of the mechanogenesis of the injury. Patients may feel a crunch, dislocation or pinching in the joint at the time of injury. While walking, they feel instability in the joint, uncertainty, and limp.
The pain that occurs in the joint is localized by the patient in the projection of the damage. The block of the knee joint is caused by the displacement of the torn part of the meniscus and its pinching between the condyles, which limits the range of motion in the knee. A block that occurs at the time of injury can be stable, but can accidentally be removed spontaneously during muscle relaxation and during certain movements. It should be remembered that a block can occur when a free osteochondral piece (“articular mouse”) is pinched, as with Koenig’s disease or with. A pseudoblock also occurs with excessive hemarthrosis and synovitis, when the joint gains the greatest volume with the limb bent at the knee.
When pressing with the first finger of one hand on the area of the anterior horn of the meniscus and sharply extending the shin with the second hand, it sharply increases local pain. This is Baykov's symptom.
After damage to the meniscus, Perelman, Turner, and Chaklin symptoms occur. Perelman's, or staircase, sign is when going down stairs is more difficult than going up, due to variable soreness due to muscle relaxation and tension during walking. Turner's symptom is hyperesthesia of a small area of the knee joint in the area of damage due to irritation of the branch of the saphenous nerve. Chaklin's symptom occurs when the sartorius muscle is tense and the medial hypotonia vastus muscle hips.
Of the given data, the most reliable signs Meniscus damage should be considered a characteristic history and block of the knee joint. All other symptoms are always pathognomonic; also occur with other joint pathologies. Turner's symptom occurs in fresh cases, and in stale cases there is hypoesthesia or normal sensitivity. Chaklin's symptom is expressed in old cases. Therefore, to diagnose meniscal damage they use helper methods studies - contrast arthrography, arthroscopy, etc.
Contrastingarthrography- radiography after introducing oxygen, air or contrast agent with limb placement according to Yu. M. Mitelman. The manipulation is carried out under local anesthesia with a 0.5% novocaine solution with strict adherence to the rules of asepsis. To prevent reactive synovitis (reaction to iodine preparations), after radiography, the contrast from the joint should be sucked off or an X-ray should be taken immediately before surgery. The information content of contrast X-ray diagnostics is small (up to 42%) due to imperfections in technology.
Arthroscopy- visual examination of the joint cavity in an operating room using an arthroscope, which is inserted through a tissue incision. It allows you to clearly examine all parts of the joint, with the exception of the posterior one.
When diagnosing meniscal injuries, which is based on anamnesis, clinical and radiological examination, in 3% of cases there are diagnostic errors - both under- and over-diagnosis. Only allows you to accurately establish an accurate diagnosis.
Treatment. In fresh cases of primary pinching of a damaged meniscus, conservative treatment is permissible, since the possibility of its fusion cannot be excluded. It consists of repositioning the displaced meniscus after anesthesia (1% novocaine solution, anesthesia) with the application of a plaster splint for a period of 2-3 weeks. After that, the splint is removed and exercise therapy, massage and physiotherapy are prescribed. Conservative therapy also carried out if the patient refuses surgery or if there are contraindications to it. In cases where there is all the evidence of damage to the meniscus, it is more advisable to do a meniscectomy - removal of the meniscus, since this the only organ, which regenerates, and the transaction is minimally traumatic.
Unresolvedknee block is absolute indication to surgery, because otherwise the function of the limb suffers, and incongruity of the articular surfaces leads to degenerative changes in cartilage and deforming arthrosis. Reactive synovitis is not a contraindication to surgery. The operation can be performed under local anesthesia with a 0.5% novocaine solution, but most effectively under general anesthesia. The use of a tourniquet has both positive (clean surgical field) and negative sides(inadequate hemostasis, pain at the site of its application).
More often, arthrotomy is performed using an oblique Jones section or a parapatellar Barker section. These methods are convenient because, if revision of the joint is necessary, they can be expanded up and down. The Mathieu transverse incision rarely avoids damage to the saphenous nerve and is therefore not used in cases of medial meniscus tear. When opening, you should spare the fibers of the vastus medialis muscle, bypassing them through the aponeurosis. Damage to the muscle slows the recovery of movement.
The meniscus is cut off along its entire length, retreating from the articular capsule by 1 mm. Extirpation of the meniscus, that is, its radical separation from the capsule, reduces the possibility of regeneration or slows it down. The joint capsule is sutured with interrupted sutures, injecting with a needle directly under the synovial membrane and without grasping it, because iodized catgut in the joint cavity leads to All tissues are sutured in layers so as not to connect the superficial and deeper layers with each other. This may affect the speed at which knee motion is restored.
After surgery, a posterior plaster splint is applied for 47 days, and then active physical therapy begins. Some surgeons do not apply splints after surgery. The patient performs pulse exercises of the quadriceps femoris muscle from the first day after surgery. Puncture of the knee joint after surgery is indicated only if the joint is full and the patient complains of pain. The occurrence of reactive synovitis in postoperative period, as a rule, is associated with significant trauma to the synovial membrane with hooks during surgery or with iodized catgut, which penetrates into the joint cavity when suturing the capsule. Average duration disability after meniscectomy for 4-5 weeks.
Damagejoint ligaments arise, as a rule, as a result of indirect injury - with sudden excessive movement, which goes beyond the physiological volume characteristic of each joint.
Ligaments are more often damaged ankle joint(calcaneofibular and medial) and collateral ligaments of the knee joint. The ligaments of other joints are rarely injured. The mechanism of injury is typical - twisting of the foot or leg while walking on a slippery or uneven road. All dislocations are also accompanied by partial or complete rupture of the ligaments.
Distinguishsprain and rupture of the ligament. By stretching we mean the rupture of rare fibrous fibers of the connection different levels. After a sprain, the ligament never, even under ideal conditions for scarring, restores its length, and therefore, to compensate for its functional insufficiency, protective mechanisms are subconsciously developed.
The time of insufficient connection is so significant that it leads to habitual twisting of the foot, lower leg, etc. Since the ligaments are strong enough, they tear at the place of their attachment, and sometimes tear off the periosteum or a piece of bone.
Ankle ligament damage
When the foot rolls inward, the calcaneofibular ligament is first pulled and then stretched, torn, or torn from the heel bone. The diagnosis is made on the basis of anamnesis and clinical manifestations - subcutaneous hemorrhage and swelling at the lateral malleolus, local pain and limitation of movements in the joint, mainly with supination and flexion of the foot. The examination must be completed with an x-ray of the ankle joint to exclude a fracture of the lateral malleolus.
Treatment. First, the ankle joint is bandaged. In a trauma center, a plaster boot is applied to the upper third of the shin for 3 weeks. After this, the patient is prescribed rehabilitation treatment and recommend wearing pronators for 6 months. If, after the plaster boot is removed, functional insufficiency of the connection is expressed, plastic restoration is recommended.
Pronation-abduction twisting of the foot usually causes an avulsion fracture of the medial malleolus, but ruptures of the medial (deltoid) ligament are rare. There are practically no breaks tibiofibular syndesmosis no broken ankles.
Damage to the patellar ligament is rare and occurs as a result of a direct blow (falling on a bent leg). More often, the ligament is torn off from the patella, less often - from the tibial tuberosity.
Symptoms. The contours of the knee are smoothed, the patella is located slightly higher than at healthy leg, the patient in the supine position cannot actively lift the leg straightened at the knee. Local pain and weakening of the connection are determined by palpation. Be sure to take x-rays in two projections to exclude separation of the lower edge of the patella.
Treatment. In case of incomplete rupture, when the lateral fibrous tissue, the patient’s straightened limb is fixed with a plaster splint for 3 weeks. Next, a massage is prescribed, paraffin applications and exercise therapy. If there is a complete rupture of the ligament, surgery is indicated - stitching or plastic strengthening of the stitched connection.
Damage to the collateral ligaments of the knee joint
A sprain, tear, or rupture of the collateral ligaments occurs due to excessive lateral deviation of the tibia. The tibial collateral ligament is most often damaged when releasing a slightly rotated tibia. Sometimes damage to the ligament is accompanied by hemarthrosis and combined with a rupture of the medial meniscus. The fibular collateral ligament is rarely injured due to excessive adduction of the tibia.
Symptoms. In the area of damage, swelling and sometimes subcutaneous bruising are visible. Sharp local pain is determined by palpation. The degree of insufficient connection is checked by deflecting the straightened leg in the opposite direction, although in the acute period this is not always possible due to pain. Be sure to take an x-ray of the knee joint, since with a fracture of the tibial condyle there are similar symptoms, as well as a tearing off of a piece of bone at the site of its attachment.
X-ray diagnostics rupture of collateral ligaments with the help of spacers (between the ankle joints) and compression of the knees with a belt (for rupture of the tibial ligament) is practically not used for pain in the acute period.
Treatment. If there is hemarthrosis, the joint is punctured and 20 ml of a 1% novocaine solution is injected. The limb is fixed with a plaster splint in a slightly bent (15-20°) position to relax the ligaments (bring the points of its attachment closer together). When modeling with a splint, the shin is kept tilted (adducted or abducted) towards the damaged connection. In 5-6 weeks plaster cast remove and check the degree of its insufficiency. If there are no lateral pathological movements, then active physical therapy, muscle massage, and thermal procedures are prescribed. Performance is restored after 1.5-2 months.
In cases where there is pain and shaky lateral movements in the knee of a straightened leg, the patient is recommended to undergo surgery to restore the collateral ligament.
If there is fluid in the joint, the knee can sometimes become somewhat bowed, which causes the ligaments to relax. Then you can make a mistake with the conclusion. Only after the puncture is it possible to straighten the leg and reveal the lateral pathological mobility of the lower leg.
Injuries to the crossed ligaments of the knee joint are relatively rare and are combined mainly with damage to the tibial collateral ligament, and sometimes with damage to the meniscus. The anterior crossed ligament is most often damaged, rarely the posterior one, and sometimes all the ligaments of the knee joint (in case of dislocation of the lower leg).
Mechanogenesisinjuries. The anterior cruciate ligament is damaged during the moment of forced abduction and rotation of a hyperextended leg at the knee or a blow to the shin from behind. Depending on the intensity of the acting force, it can stretch, rupture or tear off from the place of attachment, and sometimes tear off the intercondylar elevation of the tibia.
A blow from the front to the shin, which is bent at the knee, damages the posterior crossed ligament.
Symptoms. Immediately after an injury, it can be very difficult to determine even minor damage to the crossed ligaments. and clinical symptoms overlap with symptoms of other injuries - rupture of the collateral ligament, meniscal damage, hemarthrosis.
The diagnosis is clarified after the pain and reactive swelling of the knee decrease.
A characteristic symptom for damage to the crossed ligaments is the drawer and drawer symptom. The patient sits on a chair, bends the shin at the knee to 90°, rests the foot on the floor. The surgeon covers with both hands upper third shin, pulls it towards him and back. If the anterior cruciate ligament is torn, then the tibia moves forward relative to the condyles of the femur (drawer sign), and if it is torn posterior ligament, - back (symptom of a sliding drawer). If there is insufficiency of the cruciate ligament, instability in the knee joint when walking, some hyperextension and rotation of the lower leg also appears over time, the patient spares the leg and limps.
Treatment. If there is hemarthrosis, the knee joint is punctured, the blood is sucked out and 20 ml of a 1% novocaine solution is injected. The limb is fixed with a circular plaster cast in a slightly bent position (15-20°) of the knee for 4-6 weeks. During this time, the patient does impulse gymnastics, walks on crutches without putting any weight on his legs.
When the bandage is removed, the degree of functional insufficiency of the ligamentous apparatus is checked. In the absence of pathological mobility in the knee, active physical therapy, muscle massage, thermal procedures, and then tight bandaging of the knee and dosed loading of the leg are prescribed. Performance is restored in 2-2.5 months. When conservative treatment is unsuccessful and functional insufficiency of the ligament manifests itself, plastic restoration surgery is indicated (according to Land, Zarechny, lavsan tape, etc.). The operation is also performed in fresh cases, when the symptoms of a complete rupture of the ligaments are clearly expressed, and the effectiveness of conservative treatment cannot be counted on.
Clinical signs, treatment tactics. Definition of the concept of “knee block”. The cause may be a direct blow to the knee on a hard object or crushing of the meniscus between the articular surfaces when jumping from a height. More often observed indirect mechanism damage. With a sharp uncoordinated flexion or extension of the leg at the knee joint with simultaneous rotation of it inward and outward, the meniscus does not keep pace with the movement of the articular surfaces and is crushed by them. The meniscus associated with the joint capsule, with a sharp movement of the articular surfaces, is torn away from it, torn along or across, sometimes shifting into the intercondylar space. Damage to the medial meniscus occurs 10 times more often than to the external meniscus. Signs. Pain and dysfunction of the knee joint. The leg is often half-bent at the joint, and it is usually not possible to straighten it. Later, hemarthrosis occurs and the clinical picture resembles that of a joint bruise. Typical circumstances of injury sharp pain in the area of the joint space, blocking of the joint in a half-bent position of the limb, relapses of blockades allow us to establish the correct diagnosis with a significant degree of certainty. If there is a suspicion of meniscus damage, an X-ray examination is mandatory to exclude other diseases and injuries of the knee joint. For more accurate X-ray diagnostics, air, liquid contrast agents, or both are injected into the joint. The development of deforming arthrosis, especially pronounced on the side of injury, can serve indirect sign pathological condition meniscus Application in last years arthroscopy and MRI have significantly improved the diagnosis and treatment of meniscal injuries. Treatment. The joint is punctured and accumulated blood is removed, followed by immobilization of the limb with a plaster cast from the toes to the gluteal fold. The blockade is removed under local anesthesia with novocaine, which is injected into the joint cavity. The meniscus, pinched between the articular surfaces or displaced into the intercondylar space, is straightened by bending the leg at a right angle at the knee joint, traction of the shin along the length with its simultaneous rotation and abduction to the healthy side. In this case, a gap is formed between the articular surfaces and the meniscus falls into place. Immobilization of the limb continues until the hemarthrosis disappears and the phenomena of secondary synovitis subside, which takes an average of 10-14 days. Then thermal procedures, muscle massage and exercise therapy are prescribed. Usually after 3-4 weeks the patient can begin to work. Early surgical treatment for fresh meniscus injuries is rarely performed and only in cases where the diagnosis is beyond doubt. More often it is performed with repeated joint blockades. The operation is performed under conduction or local (intra-articular) anesthesia. The damaged meniscus is removed completely or partially (only the torn part). After the operation, a plaster splint is applied for 7-10 days, followed by exercise therapy, massage and thermal procedures. Working capacity is restored after 6-8 weeks. With the help of arthroscopic techniques, the trauma of the intervention and the period of disability are significantly reduced.
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More on topic No. 39 Damage to the menisci of the knee joint:
- No. 40 Damage to the ligamentous apparatus of the knee joint
- No. 38 Hemarthrosis of the knee joint - causes, clinical signs, differential diagnosis of hydrarthrosis, treatment.
As you know, sport is health. But excessive loads big sport They certainly do not benefit the body of the person doing it, disrupting the activity of many of its systems. So many professional athletes face problems with their knees...
Such pathologies are especially typical for weightlifters, football players, as well as hockey players and runners. Not only is upright walking a dangerous thing in itself, but we also aggravate everything ourselves... As a result, in the absence of timely correction and continued stress, our “stubbornness” in achieving our goals can provoke quite serious complications. One of the most common problems of this kind is considered to be meniscapopathy, which is also called meniscal pathology. Let's try to understand the features clinical picture and treatment methods of this disease a little more detail.
Clarification
Meniscopathy is not one disease, but a generalizing term for all degenerative-dystrophic lesions of the meniscus of the knee.
How does knee meniscopathy manifest? Symptoms
Meniscopathy develops due to injuries of the knee joint, as well as against the background of constant and excessive load to this area. Main symptom similar pathology it is generally accepted painful sensations. Depending on the nature of the development of the lesion, we can talk about two types of such pathology - acute injury accompanied by meniscopathy (in this case we talk about a knee block), as well as chronic meniscopathy, in this case the damaging factor is of low intensity, but has a negative effect in for quite a long time (typical of professional runners).
If the patient has developed acute meniscopathy, then it is accompanied by a significant limitation of the function of the knee joint, called a block. In this case, the patient simply cannot fully straighten the injured limb. Literally a few minutes after the injury, severe swelling develops.
How is knee meniscopathy corrected? Treatment of the condition
The knee block may well go away on its own without providing the patient with qualified assistance. However, the appearance of such a symptom is a serious reason to consult a doctor. The specialist will examine the patient and advise necessary measures to prevent complications. At the emergency room, the doctor will carefully examine the affected limb and then refer the patient for an x-ray examination. Based on the data obtained, outpatient treatment is prescribed, or hospitalization in an inpatient traumatology department is recommended.
Conservative treatment
If the damage to the meniscus is minor, the patient can easily cope with it using conservative methods. In this case, the affected limb needs maximum rest. The patient should take painkillers selected by the doctor and apply compresses to reduce swelling. The rehabilitation period can last up to one and a half months, and during this time the patient will have to move exclusively on crutches.
Many experts argue that treatment of meniscopathy can be carried out using joint reduction, as well as using hardware traction of the knee, which is hardware traction of the joints. In this case, the affected meniscus is freed from pinching, which ensures it further recovery.
Reduction can be carried out by a qualified orthopedist, traumatologist or chiropractor, with the final positive result can be achieved in one to four sessions. Hardware traction is carried out over a longer period of time and requires significant amount treatment sessions. However, such manipulation in most cases effectively relieves the patient of the need for surgical intervention.
After the root cause of meniscopathy has been eliminated, various physiotherapeutic agents can be used - laser, ultrasound with hydrocortisone, as well as magnetotherapy. Such techniques will help speed up the healing process.
To consolidate the positive result, the patient is prescribed chondroprotectors and special exercises are selected. Injections of hyaluronic acid also provide good results.
How is knee meniscopathy corrected surgically? Operation
If the injured meniscus is torn or fragmented, and also if the meniscopathy is characterized by a chronic course, conservative treatment will be completely ineffective. In this case, traumatologists insist on implementing surgical treatment– meniscectomy, which involves complete removal injured meniscus. The main indication for such an intervention is the inability of the affected joint element to perform its functions. normal functions. In addition, the injured meniscus has an aggressive damaging effect on the surface of the joint, which is fraught with the development of a rather serious complication - post-traumatic deforming osteoarthritis, which is accompanied by a significant decrease in the functions of the knee joint or their complete loss.
If meniscopy was treated in a timely manner, the prognosis for the patient is very favorable. With timely surgical intervention, full recovery joint mobility. If the disease has been advanced, then in addition to deforming arthrosis, the patient may also encounter a problem such as the development of contracture - complete immobility of the leg in the knee joint.
