Knee Joint Injury

　　Knee joint injuries are traumatic diseases, often caused by twisting external forces. When one leg bears weight, the lower leg is fixed in a semi-flexed abducted position, and the body and thigh are suddenly internally rotated. The medial meniscus is subjected to rotational pressure between the femoral condyle and the tibia, causing meniscus tear. The greater the degree of knee flexion during twisting, the more posterior the tearing site. The mechanism of lateral meniscus injury is the same, but the direction of the force is opposite. The torn part of the meniscus slides into the joint space, causing mechanical obstruction and hindering the extension and flexion of the joint, forming a 'lock'.

　　The structure of the knee joint is complex, with frequent trauma, and the injuries are mostly compound injuries, especially with the complications of tibial collateral ligament injury, which accounts for about 73%, among which grade III injuries combined with injuries to other structures account for about 100%, the common complications include:

　　1. Knee joint effusion.

　　2. Knee joint arthritis.

　　3. Knee joint contracture.

　　The clinical manifestations of knee joint injuries are divided into six categories:

　　Only a partial number of acute injury cases have a history of trauma, while chronic injury cases do not have a clear history of trauma.

　　Ten, more common in athletes and physical laborers, males are more than females.

　　Nine, after injury, the knee joint is extremely painful and cannot be extended, and swelling appears rapidly, and there is blood in the joint.

　　Eight, after the acute stage, it turns into a chronic stage. At this time, the swelling is not obvious, the joint function has also been restored, but there is always joint pain, there are popping sounds during movement, and sometimes you can suddenly hear a 'click' sound when moving, and the joint cannot be extended. After suffering a few swings of the lower leg, the 'click' sound can be heard again, and the joint can be extended again. This phenomenon is called joint locking. Joint locking can occur occasionally or frequently. Frequent occurrence of locking affects daily life and exercise.

　　Seven, signs in the chronic stage include: joint gap tenderness, jump, knee flexion contracture, and weak quadriceps femoris. By palpating along the joint gap, you can find the tender points, and according to the location of the tender points, you can roughly determine whether it is a tear at the anterior horn, body, or posterior horn. The horizontal cleavage of the anterior horn can be seen when flexing and extending the knee, the meniscus is embedded under the femoral condyle on the side of knee flexion contracture, and it is difficult to unlock for a long time, the atrophy of the quadriceps femoris is due to disuse, and these signs indicate internal disorder of the knee joint.

　　Six, several special tests:

　　1. Overextension Test: When the knee is fully extended and slightly overextended, the meniscus rupture site is stretched or compressed, causing severe pain.

　　2. Overflexion Test: When the knee is extremely flexed, the broken posterior horn is caught, causing severe pain.

　　3. Meniscus Rotation Test: The patient lies on their back, the affected hip and knee are fully flexed, the examiner places one hand on the joint external gap for palpation, and the other hand holds the heel and performs a large circular movement of the lower leg, internal rotation for the lateral meniscus and external rotation for the medial meniscus. Under the maintenance of the rotation position, gradually extend the knee to an angle, pay attention to the joint angle when a sound occurs. If a sound is felt when the joint is fully flexed, it indicates posterior horn meniscus injury. If a sound occurs when the knee is extended to about 90 degrees, it indicates body injury. Then, maintain the rotation position and gradually extend it to a slight flexion position (Mouche test), at this time, a sound indicates possible anterior horn meniscus injury.

　　4. Grind Test (Apley Test): The patient lies prone, the knee is flexed to 90 degrees, the examiner presses down on the lower leg with force and performs internal and external rotation movements, causing friction between the femoral and tibial articular surfaces. If pain occurs during external rotation, it indicates lateral meniscus injury. After that, lift the lower leg and perform internal and external rotation movements. If pain occurs during external rotation, it indicates medial collateral ligament injury. This test has certain practical significance in checking the meniscus in patients with hip joint rigidity.

　　5. Gait Test: Mainly used to check for posterior horn meniscus injury, the method is as follows: ask the patient to squat and walk like a duck, changing direction from left to right. If the patient can complete these actions well, it can exclude posterior horn meniscus injury; if the knee cannot be fully flexed due to pain, there will be a sound and discomfort in the knee during gait, which is a positive result. The sound during gait in cases of posterior horn meniscus rupture is very obvious. This test is only suitable for checking adolescents, especially for large-scale physical examinations to check for meniscus injury.

　　It must be noted that no test is the sole basis for diagnosing knee meniscus injury. A final diagnosis can only be made by integrating clinical symptoms, tender points, and various positive test results.

　　Knee injuries are often caused by exercise, so reasonable exercise is an important means of preventing knee injuries, as follows.

　　1. Make sure to warm up thoroughly before training, do not start with high-intensity exercises directly, as injuries often occur during fatigue or insufficient energy.

　　2. Pay attention to keeping the knee warm, especially in summer, do not seek coolness.

　　3. Pay attention to using the muscle group of the thigh, and avoid the knee being directly impacted from below.

　　4. When there are discomfort symptoms in the knee, appropriately reduce the amount and frequency of exercise, and avoid carrying out剧烈 running, jumping and weight-bearing exercises.

　　5. Pay attention to running posture when running, do not land on one side of the foot with only one foot.

　　6. Apply heat to the leg muscles after exercise.

　　7. Avoid knee impact during weight-bearing exercises.

　　8. Developed leg muscles can alleviate the pressure on the knee to a certain extent in certain situations, allowing the knee injury to be minimized. Do more leg muscle exercises in daily life to reduce the pressure on the knee as much as possible. Intentionally strengthen the exercise of the quadriceps femoris (thigh anterior muscle) and cruciate ligament, enhance the strength of the quadriceps femoris medially and the thigh muscles, and combine the use of muscle stretching and elongation, walking, horse-riding posture, or wall exercises, etc., in order to pave the way for the stable movement of the patella in the femoral end groove.

　　9. Before climbing, use your hands to rub the lower edge of the knee, promoting the protection of the knee by the lubricating fluid.

　　10. Stretching and elongating the leg tendons and patellofemoral joint is beneficial to reduce the chance of knee injury.

　　11. Weight-bearing toe raise (toe touch) is mainly to exercise the gastrocnemius muscle of the lower leg, not to exercise the knee, which cannot be exercised. When lifting and lowering the toe, the thigh muscles contract, which is beneficial to the extension and elongation of the thigh muscles.

　　The clinical examination of knee injury mainly checks the injury of the knee meniscus and knee ligaments.

　　1. Examination of knee meniscus injury

　　X-ray film examination cannot show the meniscus shape, and it is mainly used to exclude other lesions and injuries of the knee joint. Arthrogram, iodine solution contrast or air-iodine solution contrast experiment were once auxiliary diagnostic methods, but they have now been replaced by MRI examination. Ultrasound examination is still in the experimental stage. High-resolution MRI images can clearly show whether the meniscus is deformed or ruptured, and can also detect joint effusion and ligament injury, but its accuracy is not as high as arthroscopy. Arthroscopy is a new technology, and in recent years, the extensive use of endoscopic technology has further deepened the understanding of internal knee disorders. It can not only detect meniscus injuries that are difficult to detect by imaging examination, but can also simultaneously detect whether there are cartilage and synovial lesions of the joint, which can not only be used for diagnosis but can also be used for surgical operations through endoscopy, such as biopsy and meniscus repair and partial resection.

　　Second, the examination of knee ligament injury

　　1, Imaging examination and arthroscopy. Plain X-ray film examination can only show avulsed fracture fragments. To show whether there is an injury to the medial and lateral collateral ligaments, a stress position film can be taken. That is, take a film under the position of knee varus and knee valgus, which is very painful and needs to be performed after local anesthesia. Compare the opening of the medial and lateral gaps on the X-ray film, and it is generally believed that a difference of 4mm or less is mild sprain, 4-12mm is partial rupture, and more than 12mm is complete rupture, which may also be accompanied by anterior cruciate ligament injury.

　　2, MRI examination. MRI can clearly show the condition of the anterior and posterior cruciate ligaments, and can also detect hidden fracture lines.

　　3, Arthroscopy. Arthroscopy is very important for diagnosing cruciate ligament injuries. 75% of acute traumatic joint hematomas can be found with anterior cruciate ligament injury, among which 2/3 of the cases are accompanied by medial meniscus tear, and 1/5 of the cases have cartilage surface defects.

　　The diet of knee joint injury patients can include foods rich in protein and can promote bone growth and recovery, such as pork soup, fish soup, braised soybeans, etc. It is recommended to eat less greasy, sour and spicy foods with strong刺激性, eat more vegetables and fruits, eat less refined grains, eat more coarse grains, and pay more attention to rest. The following are several diets that are good for knee joint injuries for everyone to refer to.

　　1, Angelica Sinensis Pork Rib Soup

　　Ingredients and preparation: Take 10 grams of Angelica sinensis, 15 grams of Fracture bone, 10 grams of Dipsacus asper, 250 grams of fresh pork rib or beef rib, boil in water for more than 1 hour, take the soup and meat together, take once a day, for 1-2 weeks. It is helpful for removing blood stasis and continuing the fracture.

　　Note: This dietary formula is mainly suitable for patients in the middle stage (2-4 weeks). At this time, the swelling at the injured site has decreased, but the contusion has not been completely resolved, and callus formation has begun. Treatment should focus on harmonizing the营, relieving pain, removing blood stasis, and promoting new tissue growth, and connecting bones and tendons.

　　2, Peach Kernel Porridge

　　Ingredients and preparation: Take 15 grams of peach kernel, an appropriate amount of brown sugar, crush the peach kernel, soak in water, grind into juice and remove the dregs, add brown sugar and glutinous rice, add 400 milliliters of water, and cook until soft into porridge. Eat twice a day, for 7-10 days continuously, which has the effects of promoting blood circulation and removing blood stasis, and reducing swelling and pain.

　　Note: This dietary method is mainly suitable for early-stage (1-2 weeks) patients. During this period, the injured area is significantly swollen and painful, with meridian blockage and poor Qi and blood circulation. Treatment focuses on promoting blood circulation and removing blood stasis, and promoting Qi and reducing swelling.

　　Knee Joint InjuryImproper treatment may lead to instability or traumatic conditions. Arthritis. The principle of treatment is accurate diagnosis, early treatment, and comprehensive repair. Some injuries can be directly repaired, while severe cases may require repair using adjacent tendons, fascia, and other tissues..

　　Firstly, the treatment of knee meniscus injury

　　Acute meniscus injury can be immobilized with a long leg cast for 4 weeks. If there is blood stasis, it can be aspirated under local anesthesia and then compressed bandaged. After the acute stage passes and the pain subsides, quadriceps exercises can be started to prevent muscle atrophy.

　　For patients with confirmed knee meniscus rupture, meniscectomy was previously performed. Although the symptoms disappeared after surgery, a thin triangular fibrous plate could regenerate at the original site of the meniscus within 3 months after surgery, but the knee joint with excised meniscus is prone to osteoarthritis, so it is not recommended to completely excise the meniscus at present. If there is indeed meniscus injury, it is currently recommended to perform surgery under arthroscopy, where the semilunar meniscus can be sutured, the easily locked broken meniscus flap can be locally excised, and those that can be sutured can also be repaired. The meniscus that is broken and unusable can also be completely removed under arthroscopy. Endoscopic surgery has a small incision, minimal interference with the joint, fast postoperative recovery, and can start early activities, which has become a routine treatment method.

　　Secondly, the treatment of knee ligament injuries

　　1. Medial collateral ligament injury. Medial collateral ligament sprains or partial tears (deep) can be treated conservatively, using a long leg cast for 4-6 weeks. Complete tears should be repaired early. If there is meniscus injury and anterior cruciate ligament injury, the ligament injury should also be treated at the same time as the surgery.

　　2. Lateral collateral ligament injury. Lateral collateral ligament tears should be repaired surgically immediately.

　　3. Anterior cruciate ligament injury. All anterior cruciate ligament tears that occur within 2 weeks should be considered for surgical repair. If the ligament body is torn, it is best to transplant a tendon to enhance the stability of the cruciate ligament, usually selecting the middle third of the patellar ligament as the transplant material. For those with partial tears, the torn part can be sutured, and then the leg cast is fixed for 4-6 weeks. Currently, it is advocated to perform ligament suture surgery under arthroscopy.

　　4. Posterior cruciate ligament injury. There has been controversy in the past about whether to suture the torn posterior cruciate ligament, but the current opinion tends to be early repair under arthroscopy.