Knee ligament injury

　　Knee ligament injury is a relatively common disease. The joint capsule of the knee is loose and weak, and the stability of the joint mainly depends on the ligaments and muscles, with the medial collateral ligament being the most important, followed by the lateral collateral ligament and the anterior and posterior cruciate ligaments. Knee ligament injuries are mostly caused by trauma, with severe pain, swelling of the joint and surrounding area, subcutaneous ecchymosis, joint effusion, and limited movement, which seriously affects the patient's work and life.

　　Knee ligament injuries are often caused by the following reasons:

　　I. Injuries to the medial and lateral collateral ligaments

　　1. Medial collateral ligament injury: Caused by an outward force on the knee, that is, the knee or leg is struck or pressed heavily on the lateral side when the knee is extended, causing the knee to over-externalize, and the medial collateral ligament may be partially or completely ruptured.

　　2. Lateral collateral ligament injury: Mainly caused by an inward force on the knee, that is, the knee or leg is struck or pressed heavily on the medial side, causing the knee to over-internalize, and the lateral collateral ligament may be partially or completely ruptured. In severe trauma, the collateral ligament, cruciate ligament, and meniscus may be injured simultaneously.

　　II. Injuries to the anterior and posterior cruciate ligaments

　　1. Anterior cruciate ligament injury: The anterior cruciate ligament can rupture due to an inversion injury in the extended position of the knee and an eversion injury in the flexed position of the knee.

　　2. Posterior cruciate ligament injury: Whether the knee is in a flexed or extended position, the force from the front that moves the superior end of the tibia posteriorly can cause the posterior cruciate ligament to rupture.

　　Patients with knee ligament injuries should seek medical attention in a timely manner. If the condition is delayed for a long time, it may lead to secondary destruction of the knee cartilage due to knee instability, early osteophyte formation, joint deformity, and ultimately necessitate artificial joint replacement surgery. Therefore, it is reminded that citizens who love sports should always warm up before exercising, maintain correct methods and postures during exercise, and try to avoid injuries. In case of knee injury, seek medical treatment at a regular hospital in a timely manner to avoid missing the treatment opportunity.

　　Due to the occurrence of knee ligament injuries, patients may suffer great harm. Therefore, it is necessary for patients to seek effective treatment as soon as possible to avoid further harm to their health due to the worsening of the condition. Knee ligament injuries may be accompanied by fractures of the fibular head and injuries to the common peroneal nerve. The common peroneal nerve is prone to injury at the popliteal fossa and the fibular head, with manifestations such as foot drop and a gait with a leaping step; inability to dorsiflex and supinate the ankle joint, and inability to dorsiflex the toes; decreased or absent sensation on the lateral aspect of the lower leg and the top of the foot; atrophy of the anterior tibial and lateral lower leg muscles.

　　Knee ligament injuries are more common in adolescents, with more males than females, and athletes are most susceptible. Sometimes, a popping sound can be heard when the ligament breaks, followed by severe pain, making it impossible to continue exercising or working. Swelling, tenderness, and effusion (blood) may occur at the knee joint, with muscle spasm in the knee. Patients dare not move their knees, and the knee joint is in a forced position, either straight or flexed. There is a marked tender point at the site of the lateral collateral ligament rupture, and sometimes the broken ends of the ligament can be felt.

　　Patients with knee ligament injuries may present with the following typical symptoms:

　　The main manifestations of fresh injuries are:

　　(1) Hemarthrosis within the joint leads to joint swelling and pain, with most patients unable to continue their original activities, and even limited in extending and over-flexing movements;

　　(2) During the physical examination, the floating patella test is positive, and the Lachman test shows relaxation and no resistance;

　　(3) The MRI of the knee joint suggests: hemarthrosis within the joint, swelling or continuity interruption of the anterior cruciate ligament, visible residual ends, and bone contusion manifestations on the lateral wall of the intercondylar fossa of the femur or the posterior aspect of the femoral condyle and the corresponding tibial plateau.

　　The main manifestations of old injuries are:

　　(1) The joint is loose and unstable, and the patient has a feeling of dislocation of the knee joint or weak leg during exercise, cannot stop or turn suddenly, and cannot support the affected leg alone;

　　(2) The knee joint is prone to recurrent sprains during exercise, pain, causing meniscus injury, and even recurrent locking after meniscus injury;

　　(3) Physical examination: Lachman test is loose without resistance, and the anterior drawer test is positive

　　(4) MRI of the knee joint suggests: The residual ends can be seen, and the bone contusion of the lateral condyle of the femur and the tibial plateau is manifested. Over time, the morphology of the ligament disappears, and bone hyperplasia appears.

　　(5) Patients with recurrent sprains often have secondary joint cartilage and meniscus injuries.

　　Sports enthusiasts or athletes are prone to this injury. Proper landing techniques are very important for preventing knee injuries. It is recommended that athletes land with the front foot first, bend the knees, and slightly lean the trunk forward. Try to avoid lateral or forward and backward movements of the knees. Remember that the knees should not twist inward when landing, and the impact force should be reduced as much as possible.

　　If the correct doctor is found immediately after the sports injury of the knee joint, the correct diagnosis is made, the correct surgery is performed, and the postoperative rehabilitation plan is completed with the cooperation of the doctor and the physiotherapist, the expected surgical outcome is very satisfactory, even professional athletes can recover to the competitive state before the injury.

　　Knee ligament injury is a relatively common disease. The joint capsule of the knee joint is loose and weak, and the stability of the joint mainly relies on the ligaments and muscles, with the medial collateral ligament being the most important, followed by the collateral ligament and the anterior and posterior cruciate ligaments. Knee ligament injuries are mostly caused by trauma, with patients experiencing severe pain, swelling of the joint and surrounding area, subcutaneous ecchymosis, joint effusion, and limited movement, which seriously affects the patient's work and life. The diagnosis of this disease is generally not difficult. With a history of knee trauma and local symptoms and signs, the diagnosis can be basically established. Common examinations include:

　　1. Lateral Stress Test

　　It is very painful to perform the lateral stress test in the acute stage. It can be waited for several days or performed after local anesthesia at the pain point. Perform passive knee varus and valgus movements in the position where the knee is completely extended and flexed to 20-30 degrees, and compare with the opposite side. If there is pain or if the varus and valgus angles exceed the normal range and have a bouncing sensation, it indicates a sprain or rupture of the collateral ligament.

　　2. Drawer Test

　　With the knee flexed to 90 degrees, the lower leg hangs down, the examiner holds the upper segment of the tibia with both hands and performs a pulling forward and pushing backward action, and pays attention to the range of movement of the patella nodules in front and behind. An increase in anterior displacement indicates a rupture of the anterior cruciate ligament. An increase in posterior displacement indicates a rupture of the posterior cruciate ligament. Since the tibia can also have a slight anterior and posterior passive movement under the 90-degree flexion of the normal knee joint, a comparison between the healthy side and the affected side is necessary.

　　When the patellar ligament is ruptured alone, the anterior displacement of the tibia is only slightly greater than normal. If the anterior displacement increases significantly, it indicates that there may be a concomitant injury to the medial collateral ligament.

　　在急性期作抽屉试验是很痛的。应该麻醉后施行。

　　It is very painful to perform the drawer test in the acute stage. It should be performed after anesthesia.

　　3. Pivot shift test

　　This test is used to maintain knee instability after the toning of the anterior cruciate ligament. The patient lies on their side, the examiner stands on one side, one hand holds the ankle, and the knee is flexed to 90 degrees. The other hand applies force to the outer side of the knee to keep the knee in an external rotation position, then slowly extend the knee until the knee is flexed to 30 degrees, and pain and a pop are felt, which is a positive result. This mainly occurs in the external rotation position of the knee, where the lateral tibial plateau shifts forward, the femoral condyle slides backward to the tibial plateau, and the femoral condyle suddenly resets during the extension process, causing pain.

　　4. KT-1000 joint ligament scale

　　This is used to check and measure the degree of knee joint laxity in patients. The patient lies down, the ligament scale is placed in front of the lower leg, the sensor pad is placed on the patella and tibial tuberosity, and a sound is heard when the handle is pulled with a force of 15 pounds and 20 pounds, and the instrument displays data. The difference in values between the affected side and the healthy side exceeds 3mm can be diagnosed as a rupture of the anterior cruciate ligament.

　　5. Self-test

　　For anterior instability of the knee, the anterior drawer test (ADT), Lachman test, and pivot shift test are used; for posterior instability of the knee, the posterior drawer test (PDT) is used.

　　Due to the occurrence of knee ligament injuries, great harm is brought to patients, therefore, patients should seek effective treatment as soon as possible to avoid further harm to their physical health. Generally, soft tissue injuries have the phenomenon of qi stagnation and blood stasis, and foods with the effects of promoting blood circulation, removing blood stasis, and relieving pain can be selected, such as notoginseng, scallion, tangerine peel, rose, crab, rapeseed, lotus root, eggplant, hawthorn, luffa, pork blood, etc. However, it must be noted that if there is still bleeding, it is not advisable to choose.

　　With the prolongation of the injury, patients often have deficiency symptoms, and it is advisable to choose foods that tonify the liver and kidney, such as grapes, black beans, chicken, beef, pork, mutton, rabbit meat, etc. Natural high-quality plant protein + vitamin C + calcium magnesium tablets will form collagen to help accelerate recovery.

　　Knee ligament injuries are mostly caused by trauma, resulting in severe pain, swelling of the joint and surrounding area, subcutaneous ecchymosis, joint effusion, and limited movement, which seriously affects the patient's work and life. In treatment, traditional Chinese medicine massage therapy is only suitable for partial fiber rupture and sprains, twists, and contusions of the ligament tissue.

　　1. Treatment Principles

　　(1) Acute stage: Stop bleeding and swelling, harmonize the营 and relieve pain.

　　(2) Chronic stage: Strengthen tendons and collaterals.

　　2. Common acupoints and areas

　　Blood sea, Ashi, Yinlingquan acupoints, and the medial side of the knee joint.

　　3. Common techniques

　　Ice massage, palm root kneading technique, finger kneading technique, grasping technique, friction technique, heat application technique, etc.

　　4. Operation method

　　(1) Ice massage: This is a method of using ice for massage. It is not only suitable for this condition but also for acute soft tissue sprains and strains of the limbs with marked swelling. The method is as follows:

　　Choose ice blocks of appropriate size without sharp edges, wrap them in a cloth, and place them on the medial collateral ligament for a gentle and slow massage. After the ice melts, they can be replaced again, about 10 to 20 minutes each time, 1 to 3 times on the day of the injury.

　　Because ice can constrict blood vessels, it can quickly and effectively control bleeding and exudation at the injury site, and at the same time, it can relieve pain. After the ice massage is finished, immediately use an elastic bandage to wrap and immobilize the limb, and elevate it. After the bleeding stops, massage therapy can be started as soon as possible.

　　(2) For non-immediate injuries, where there is no obvious tendency of local bleeding, or the bleeding stops after ice massage treatment, the following method can be chosen for treatment: the patient lies on their back, and the doctor sits or stands on the affected side, first applying the palm root kneading technique to the quadriceps for about 3 to 5 minutes. This method can be used both as a basic technique and to maintain good tension in the quadriceps, playing a positive role in the recovery of knee joint function.

　　Following the above method, massage the blood sea, Ashi point, Yinlingquan, and the medial collateral ligament for about 8 to 10 minutes. This is the main technique for treating the disease. The technique should be gentle and avoid passive movement. There may be some pain at the beginning of the manual therapy, but it is beneficial for the dispersion, absorption, and repair of the hematoma and the injured tissue. If necessary, friction and heat application can be applied to the medial collateral ligament.

　　Precautions

　　1. The affected limb is immobilized and not weight-bearing for 4 to 6 weeks, and the knee joint should be avoided as much as possible from flexing and extending.

　　2. After the acute injury bleeding stops, quadriceps muscle function exercises can be performed.

　　3. Passive joint movements are prohibited during massage therapy.

　　4. If the ligament is completely torn or accompanied by complex injury, early surgical treatment is often required to avoid delaying treatment.

　　5. Use knee pads to protect the knee joint.