knee ligament injury
Introduction
Introduction to knee ligament injury Knee ligament injury is a relatively common disease with more treatments, but the effects are different. The joint capsule of the knee joint is weak, the stability of the joint mainly depends on the ligament and muscle, and the medial collateral ligament is the most important, followed by the lateral collateral ligament and the anterior and posterior cruciate ligament. Knee ligament injury is mostly caused by trauma. The patient suffers from severe pain, joint and surrounding swelling, ecchymosis under the skin, fluid accumulation in the joints and limited activity, which seriously affects the work and life of the patient. basic knowledge The proportion of illness: 45%-65% (the above is a car accident and the incidence of trauma) Susceptible people: no special people Mode of infection: non-infectious Complications: fracture
Cause
Causes of knee ligament injury
Cause
1, medial collateral ligament injury: caused by knee valgus violence. When the knee joint is directly violent and the knee joint is violently everted, the medial collateral ligament will be torn off. When the knee joint is half-buckled, the sudden abduction and rotation of the calf will also cause the medial collateral ligament to rupture. The medial collateral ligament injury is more common. Sports trauma, combined with meniscus and anterior cruciate ligament injuries such as football, skiing, wrestling and other competitive projects.
2, lateral collateral ligament injury: mainly due to knee varus violence, because the lateral iliac crest is more powerful, the lateral lateral collateral ligament injury is rare, easy to merge meniscus and posterior cruciate ligament injury, if the violence is strong, bundle and The common peroneal nerve is difficult to protect from damage.
Pathological changes
1. Anterior cruciate ligament injury: The anterior cruciate ligament can be broken by the varus injury under the knee joint extension and the valgus injury under the knee flexion position. Generally, the anterior cruciate ligament is rarely damaged alone, often with medial and lateral ligament and meniscus injury. However, when the knee joint is overextended, the anterior cruciate ligament may be alone. In addition, the violence comes from the back of the knee. The strength of the upper end can also break the anterior cruciate ligament, and the anterior cruciate ligament injury is also more common in competitive sports.
2, posterior cruciate ligament injury: whether the knee is in the flexion position or the extension position, the violence from the front of the upper end of the humerus can cause the posterior cruciate ligament to break. More common in direct violence and trauma. Patients with knee dislocation can be injured at the same time as the anterior cruciate ligament.
The ligament injury can be divided into sprain (ie partial fiber rupture) partial ligament rupture, complete rupture and joint injury. For example, anterior cruciate ligament rupture can be combined with medial collateral ligament and medial meniscus injury, which becomes a "triple injury" ligament rupture. Part of it can be divided into ligament body fracture, ligament and bone joint fracture and avulsion fracture of ligament attachment. The first type of injury heals slowly and has poor strength, which is the strongest after the third healing.
Prevention
Knee joint ligament injury prevention
Sports enthusiasts or athletes are susceptible to this injury. Proper landing skills are important to prevent knee damage. It is recommended that when the athletes land, they should first land on the front of the foot, bend the knees, and lean forward slightly. Avoid lateral or frontal movements of the knee as much as possible. Remember that the knee joint should not be twisted inward when landing, and the impact force should be minimized.
After the knee joint sports injury, if you can find the right doctor immediately, make a correct diagnosis, perform the correct operation, and cooperate with the doctor and the physiotherapist to complete the rehabilitation program. The expected surgical results are very satisfactory, even professional athletes can return to the competitive state before the injury.
Complication
Complications of knee ligament injury Complications
The structure of the knee joint is complicated and the trauma is many. The damage is mostly combined injury. In particular, the complications of the collateral ligament injury are more than 73%, and the damage of the III injury combined with other structures is about 100%. Common injuries include anterior cruciate ligament injury, posterior cruciate ligament injury, meniscus injury, bone contusion, fracture, joint effusion, and soft tissue blood stasis around the knee joint.
Symptom
Symptoms of knee ligament injury Common symptoms Ligament rupture Knee joint pain Joint pain Knee swelling and pain, ... Knee joint can not fully extend severe pain Can not bend knee and knee joint swelling and blood
When you are injured, you can sometimes hear the rupture of the ligament, and soon you can no longer continue to exercise due to severe pain or swelling at the knee joint, tenderness and effusion (blood), knee tendon, the patient does not dare to move the knee. The knee joint is in a forced position, or straightened, or there is a significant tender point at the fracture of the knee collateral ligament.
Examine
Examination of knee ligament injury
1. Lateral stress test
Lateral stress testing in the acute phase is very painful. You can wait a few days or after the local anesthesia at the pain point, perform passive knee varus and knee valgus in the position of full extension of the knee joint and flexion 20 degrees - 30 degrees, and compare it on the opposite side. Or if the varus angle is beyond the normal range and there is a bouncing sensation, the collateral ligament is sprained or broken.
2, drawer test
The knee flexed 90 degrees and the calf hanged. The examiner held the upper part of the humerus with both hands for the pre- and post-push movements. After restoring the normal position of the tibial tuberosity, the amplitude of the movement of the tibial tuberosity was noted. The increase of the anterior cruciate ligament was observed. Increased posterior ligament rupture of the posterior cruciate ligament, because the normal knee joint knee flexion at 90 degrees, the tibia can also have a slight passive movement before and after, so the contralateral side should be compared with the affected side. When the anterior cruciate ligament is broken, the anterior tibia is only slightly larger than normal. If the advancement is significantly increased, it may be combined with medial collateral ligament injury. It is very painful to test drawers in the acute phase. It should be administered after anesthesia.
3. Axial shift test
This test was used to maintain knee instability after anterior cruciate ligaments. The patient was lying on the side, the examiner stood on one side, and the body held the ankle and flexed the knee to 90 degrees. The other hand exerted a force on the outside of the knee, so that the knee was in the everted position, and then slowly extended the knee joint, and the pain and bouncing when the flexion was 30 degrees was a positive result. This is mainly in the knee-extroversion position, the lateral platform of the humerus is displaced forward, and the lateral femoral condyle slides to the rear of the tibial plateau. During the extension process, the femoral condyle is suddenly reset and pain is generated.
4, imaging examination and arthroscopy
Ordinary X-ray film examination can only show avulsion fracture pieces. In order to show the presence or absence of internal and lateral collateral ligament injury, the stress level can be taken. That is, in the position of knee varus and knee reverse position, this position is very painful. It needs to be performed after local anesthesia. The inner and outer gaps are opened on the X-ray film. It is generally considered that the gap between the two sides is within 4 mm. Mild sprain, 4-12mm is partial fracture, more than 12mm is complete fracture, and may also have anterior cruciate ligament injury.
MRI examinations can be clear. Showing the anterior and posterior cruciate ligaments, you can also find hidden fracture lines.
Arthroscopy is important for the diagnosis of cruciate ligament injury. 75% of acute traumatic joint hematoma can be found in anterior cruciate ligament injury, of which 2/3 cases are accompanied by medial meniscus tear and 1/5 have articular cartilage surface defects. Arthroscopic techniques provide a new understanding of the diagnosis and treatment of knee ligament injuries.
Diagnosis
Diagnosis and identification of knee ligament injury
1. X-ray examination: Under local anesthesia, straighten the knee joint, according to the above inspection method, force the knee to receive or abduct, take a positive X-ray film, if the lateral collateral ligament is completely broken, the injured lateral joint gap increases. width.
2. Magnetic resonance: The anterior and posterior cruciate ligaments can be clearly displayed, and unexpected ligament structural damage and hidden fracture lines can be found.
3. Arthroscopy: It is very important to diagnose the cruciate ligament injury.
4. Special inspection.
