Meniscus injury
The etiology of meniscus injury in the knee joint: Trauma: This disease is a traumatic disease, often caused by twisting external forces. When one leg bears weight, the lower leg is fixed in half
When in flexion or abduction position, the body and thigh suddenly rotate inward, and the medial meniscus is subjected to rotational pressure between the femoral condyle and tibia, causing meniscus tear. For example, the greater the degree of knee joint flexion and the further back the tear site, the same mechanism of lateral meniscus injury occurs, but the direction of force is opposite. The ruptured meniscus partially slides into the joint, causing mechanical obstacles to joint movement, hindering joint extension and flexion, and forming "interlocking". In severe traumatic cases, the meniscus, cruciate ligament, and collateral ligament can be damaged simultaneously. The location of meniscus injury can occur at the anterior, posterior, middle, or edge of the meniscus, and the shape of the injury can be transverse, longitudinal, horizontal, or irregular, and even broken into free bodies within the joint. symptom
Symptoms of meniscus injury in the knee joint: Common clinical manifestations after meniscus injury include localized pain, joint swelling, clicking and interlocking, and femoral pain
Atrophy of quadriceps, softening of legs, and clear tenderness in the knee joint space or meniscus area. 1. Tenderness: Common signs include localized tenderness along the medial and lateral spaces of the knee joint or around the meniscus. 2. McMurray test: The patient is in a supine position, and the examiner presses one hand against the inner edge of the joint to control the internal movement
Side meniscus, with the other hand holding the foot, fully flex the knee joint, rotate the lower leg outward and inward, then slowly extend the knee joint, and you can hear or feel bouncing or bouncing; Then press your hand against the outer edge of the joint, control the lateral meniscus, rotate the calf inward and outward, slowly extend the knee joint, and hear or feel a popping or bouncing sound, which is considered positive for the test.
The popping sound generated by the McMurray test or the sudden pain reported by the patient during the examination often has some significance in locating meniscus tears: the popping sound between complete knee flexion and 90 ° often indicates a tear at the posterior edge of the meniscus; When the knee joint produces a popping sound in a larger extended position, it indicates a tear in the middle or front of the meniscus.
3. Apley grinding test: The patient is in a prone position, bent 90 degrees, with the front of the thigh fixed on the examination table. The foot and calf are lifted upwards to separate the joint and perform a rotational motion. The force tightened during rotation is on the ligament. If the ligament tears, there will be significant pain during the test. Afterwards, when the knee joint is in the same position, the foot and calf press down and rotate the joint, slowly flex and extend. When the meniscus tears, there may be a noticeable popping sound and pain in the knee joint space.
4. Classification of meniscus injuries: The classification of meniscus tears has guiding significance for diagnosis and the selection of appropriate surgical treatment methods.
There are many different classification methods for meniscus tears, with the most common being edge type, center type, longitudinal rupture (i.e. "barrel handle type" rupture), anterior or posterior angle petal like rupture, and rare transverse rupture in the middle of the meniscus. inspect
Examination of meniscus injury in knee joint 1. Tender area: The tender area is generally the site of the lesion, and the diagnosis and determination of meniscus injury
The location of the injury is of great significance. During the examination, the knee is placed in a semi flexed position, in the medial and lateral space of the knee joint, along the upper edge of the tibial condyle (i.e. the edge of the meniscus), and the thumb is used to press point by point from the front to the back until the meniscus is damaged
There is fixed tenderness at the injury site, such as passive flexion and extension of the knee or rotation of the lower leg inside and outside while pressing, which can cause more significant pain. Sometimes abnormal movement of the meniscus can also be felt.
2. McMurray test (gyratory compression test): The patient is lying on their back, and the examiner holds the ankle of the calf with one hand and the knee with the other hand, bending the hip and knee as much as possible. Then, the calf is extended outward, outward, outward, inward, inward, inward, outward, and gradually straightened. If there is pain or noise, it is considered positive. The location of the injury is determined based on the location of the pain and noise.
3. Strong over extension or over bending test: The knee joint is forcefully and passively over extended or over bent. If the anterior meniscus is damaged, over extension can cause pain; If the posterior part of the meniscus is injured, excessive flexion can cause pain.
4. Lateral pressure test: Knee extension position, strong passive adduction or abduction of the knee. If there is meniscus injury, pain may occur in the joint space on the affected side due to compression.
5. Single leg squat test: Use one leg to gradually squat from a standing position, then stand up from the squat position. The healthy side is normal, but when the affected side squats or stands to a certain position, the injured meniscus may be compressed, causing pain in the joint space, and even inability to squat or stand up.
6. Gravity test: The patient is placed in a lateral position, lifting their lower limbs for active knee flexion and extension activities. When the joint space on the affected side is downward, pain is caused by compression of the damaged meniscus; On the contrary, when the joint space on the affected side is upward, there is no pain.
7. Grinding test: The patient is placed in a prone position with the knee joint flexed. The examiner holds the ankle with both hands and presses down on the lower leg while performing internal and external rotation. The injured meniscus is painful due to compression and grinding; On the contrary, if the calf is lifted upwards and then rotated internally and externally, there will be no pain.
8. X-ray examination: Taking X-rays in both frontal and lateral positions, although it cannot show meniscus injury, other bone and joint diseases can be ruled out. Knee joint imaging has little diagnostic significance and can increase patient pain, so it is not suitable for use.
9. Knee arthroscopy: Arthroscopy can directly observe the location, type, and other structures within the joint of meniscus injuries, which is helpful for the diagnosis of difficult cases. diagnosis
The diagnosis of meniscus injury in the knee joint is mainly based on medical history and clinical examination. Most patients have a history of trauma and the affected side
There is fixed pain and compressive energy in the joint space, and based on comprehensive analysis of various examinations, most can make a correct diagnosis. For patients with severe trauma, attention should be paid to checking for the presence of concomitant collateral ligament and cruciate ligament injuries. For late stage cases, attention should be paid to checking for secondary traumatic arthritis.
The diagnosis of this disease can be summarized into the following points: 1. Injury history: Most patients have a relatively accurate history of trauma. 2. Pain: When the meniscus is injured, there is also synovial injury, resulting in severe pain, especially on the injured side. 3. Joint swelling: caused by blood and fluid accumulation. 4. Sound: There may be a crisp sound on the injured side during joint movement. 5. Joint locking: refers to the sudden jamming of a joint during movement, which is caused by a broken meniscus getting stuck between the femoral condyle and tibial plateau. 6. Quadriceps atrophy: usually occurs in chronic medical records. treatment
Treatment of meniscus injury in knee joint 1. Western medicine: Many studies have been conducted on the biomechanical function of meniscus, and it is increasingly recognized that meniscus injury occurs in half a month
The biomechanical function of the meniscus is important, and it is believed that it is not appropriate to simply remove the damaged meniscus. Instead, they should be repaired. However, due to the lack of blood inside the meniscus itself, only blood circulates around it. Therefore, meniscus injuries with only edge tears may heal after long-term cultivation. Difficult to heal after repairing injuries in areas without blood supply to the meniscus
Hehe, this is one of the challenges in the orthopedic field, for which many studies have been conducted. 1. In the acute phase, if there is obvious fluid accumulation (or blood accumulation) in the joints, the fluid should be extracted under strict aseptic operation;
If there is a "cross lock" in the joint, use techniques to release the "cross lock", and then fix the knee joint in an extended position for 4 weeks using a cast tube from the upper one-third of the thigh to the ankle. Gypsum should be properly molded, and patients can walk on the ground with the plaster. During and after fixation, it is important to actively exercise the quadriceps muscle to prevent muscle atrophy.
2. Repair of meniscus blood supply area injury: Injuries in the meniscus blood supply area, especially longitudinal lacerations, can be treated with suture surgery for healing, and the prognosis of this surgery is good, which has been confirmed by many experiments and clinical studies. However, in a 10-year prospective observation, many patients who underwent this surgery were found to have X-ray signs of joint degeneration, indicating that the biomechanical function of the repaired meniscus may not have been fully reconstructed.
3. Repair of injuries in areas without blood supply to the meniscus: Injuries in areas without blood supply to the meniscus are relatively difficult and have become a challenge in knee joint surgery. Small and regular injuries without blood supply to the meniscus, such as barrel like tears, often require partial resection surgery, which can be effective, but this can more or less damage the biomechanical and biophysical functions of the meniscus. At present, although many methods have been found to treat injuries in areas without blood supply to the meniscus, clinical research has been limited, and this area needs to be further explored.
Severe meniscus injury: When the meniscus is severely damaged, a complete resection surgery is necessary. Frozen meniscus and meniscus prosthesis transplantation can be performed at this time. However, there are many difficulties in meniscus prosthesis transplantation, such as the biomechanical function of the prosthesis not meeting the requirements, difficulty in fixing the prosthesis, and significant joint degeneration after transplantation.
Surgical treatment: Surgical treatment often refers to the use of arthroscopy to remove free meniscus fragments or remove damaged meniscus. Among them, removing the meniscus is the last resort. After removing the meniscus, patients will lose or weaken basic physiological functions such as jumping and weight-bearing.
Meniscus regeneration: Compared to surgical treatment, a more ideal therapy is to restore and regenerate the meniscus. Since the 1980s, as an alternative therapy for knee meniscus injuries, the use of pure natural sawtoothed shark cartilage powder has been popularized in advanced countries such as Europe, America, and Japan. Because restoring and regenerating the meniscus is the most ideal method for treating meniscus injuries. And pure natural sawtoothed shark cartilage powder can achieve human cartilage regeneration, completely regenerating the meniscus from the inside, which has become a new attempt in advanced countries and has been gradually promoted to clinical practice around the world. However, the difficulty in selecting materials, high process requirements, and relatively high prices for this therapy are obstacles to its widespread popularity.
2, Traditional Chinese Medicine: Early treatment is suitable for reducing swelling and relieving pain. Take Taohong Siwu Tang orally and apply three colors of medicine externally. For those with severe local redness and swelling, apply Qingying Tuixiang ointment. In the later stage of treatment, it is advisable to warm the meridians, unblock collaterals, and relieve pain. Take Jianbu Zhuanggu Wan or Bushen Zhuangjin Tang orally, and use limb injury washing formula or Haitong Pi Tang to fumigate and wash the affected limb. Healthcare
Health care for meniscus injuries in the knee joint: 1. Strengthen nutrition and eat small meals frequently. 2. Pay attention to rest and exercise appropriately. 3. Take medication according to medical advice and have regular check ups. 2, Diet: Diet is not very helpful for meniscus injury. Eat less greasy and high-fat foods
Eat vegetables and fruits, eat less fine grains, and eat more coarse grains. prevention
Prevention of meniscus injury in knee joint: In order to promote recovery, quadriceps functional exercise should be diligently performed before and after meniscus surgery. The method is,
The patient lies flat on the bed, stretches their lower limbs, lifts their knee bone (patella) upwards with force, then relaxes and repeatedly applies force.
Or straighten and lift the lower limbs, lower them, and repeat the process. After reaching a certain level, you can also hang sandbags of a certain weight on your ankles for practice. The quadriceps muscle that has been exercised is strong and powerful, which is beneficial for maintaining joint stability. Exercise should start before surgery and continue the day after surgery. At this point, the wound is still painful, and patients often have concerns, such as fear of the wound opening and bleeding inside. Be sure to eliminate concerns and exercise with pain. Two weeks after the surgery, lower the ground load and gradually increase the range of joint movement. The degree of exercise is significantly related to the recovery effect, and the better the exercise, the better the effect. complication
Complications of meniscus injury in the knee joint: When meniscus injury occurs in the knee joint, it mainly causes joint pain and functional impairment, and in severe cases, knee pain may occur
The symptom of knee joint interlocking refers to the restriction of flexion and extension of the knee joint in a certain position, accompanied by obvious pain. Therefore, patients with this disease should actively seek treatment to prevent the occurrence of complications.
The Achilles tendon is the longest and strongest tendon in the human body, about 15cm long, originating from the middle of the calf and gradually thickening and narrowing from top to bottom. It is narrowest at the back of the ankle, but thicker, and ends in the lower half behind the calcaneal tuberosity. The main function of the Achilles tendon is to fix the ankle joint during standing, prevent forward leaning, and play an important role in weight-bearing, running, and jumping. There are many causes of Achilles tendon injury, which can be directly caused by trauma or secondary injuries caused by other lesions such as tendinitis, bursitis, and rheumatoid arthritis. Achilles tendon injury is often caused by indirect violence, in addition to direct violence. For example, Achilles tendon injury can occur when the knee joint is extended, the foot is on the ground, or the foot is forcefully stretched or contracted suddenly. Elderly people are more prone to injury due to Achilles tendon degeneration. Under normal circumstances, the muscle tendon bone complex is uniformly stressed. During intense exercise, due to the unpredictable changes in the position of the foot, the lack of complete coordination in active muscle contraction can cause an imbalance in strength bearing, which can easily lead to damage to the weak link of the Achilles tendon. When the ankle joint is in an extreme back extension position (about 70 °), the Achilles tendon must withstand a force of up to 700 kilograms when suddenly jumping off the ground or performing a somersault step under knee extension and weight-bearing conditions. Therefore, this force bearing method is an important factor that makes the Achilles tendon prone to rupture. In addition, due to the local injection of glucocorticoids for tendinitis, although it may alleviate capillary dilation and exudative edema, inhibiting capillary regeneration and compensation can exacerbate ischemia, which is also a factor leading to Achilles tendon injury. Therefore, sports related Achilles tendon injury occurs on the basis of self occurrence of Achilles tendon disease or degeneration, and trauma and accumulated strain are its main triggering factors.
The patient's medical history and age can indicate a diagnosis. Clinical symptoms include: (1) visible fissures in the Achilles tendon; (2) Reduced resistance to plantarflexion of the foot; (3) When performing the plantar flexion resistance test again, there was a lack of "hardness" sensation when compressed laterally at the site of the ruptured Achilles tendon. Soft tissue shadows on X-rays, ultrasound, and MRI examinations all showed a lack of continuity in the Achilles tendon. Reasons for easy missed diagnosis: In addition to the Achilles tendon, there are several other tendons in the calf that also have some Achilles tendon functions. So even though the Achilles tendon is broken, the ankle joint can still perform a few movements with the toe down and the heel raised. In addition, due to the patient's pain and affected examination, it may be mistaken for an acute sprain. Muscles have strong elasticity, and the ruptured Achilles tendon retracts upwards, making it difficult to pull down over time. At this point, other methods can only be used for repair, and the effect is not as good as immediate treatment. Treatment principle: Early surgery is the key to functional recovery
Early surgical treatment for exercise-induced Achilles tendon injury is crucial for the recovery of Achilles tendon function
