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Meniscus injury

  Meniscus injury is one of the most common knee injuries, more common in young and middle-aged adults, with more males affected than females. According to foreign reports, the ratio of medial to lateral meniscus injuries is 4-5:1, while in China, the ratio is reversed, at 1:2.5. The meniscus in the human body is a crescent-shaped fibrocartilage, located on the medial and lateral articular surfaces of the tibia plateau. Its cross-section is triangular, with the outer part thicker and the inner part thinner, the upper part slightly concave to fit the femoral condyle, and the lower part flat, connecting with the tibial plateau. The function of the meniscus is to stabilize the knee joint, distribute the load of the knee joint, and promote nutrition within the joint. It is due to the stabilizing load-bearing effect of the meniscus that the knee joint can bear heavy loads for years without injury. Meniscus injuries are often caused by a twisting force, where when one leg bears the weight, the lower leg is fixed in a semi-flexed, abducted position, and the body and thigh are suddenly internally rotated, causing the medial meniscus between the femoral condyle and the tibia to be subjected to rotational pressure, resulting in meniscus tears. In the early stage, knee pain and swelling can be observed, and over time, there may be tenderness on the medial and lateral sides of the knee, atrophy of the thigh muscles, and 'weak legs'. Doctors can also assist in diagnosis through special physical examinations, such as the McMurray sign.

  The acute phase of meniscus injury is characterized by significant pain, swelling, and effusion in the knee joint space, as well as impairment of joint flexion and extension activities. After the acute phase, swelling and effusion can resolve spontaneously, but pain still persists during activities, especially when going up and down stairs, squatting, and jumping. The pain is usually located within the joint space, occasionally in the posterior part, with a sensation of 'tightness'. Severe meniscus injuries can lead to limping or functional impairment of flexion and extension, with some patients experiencing a 'locking' phenomenon, where the fractured part of the meniscus slips into the joint space, causing mechanical obstruction and hindering joint extension and flexion activities, or producing a clicking sound during knee flexion and extension.

  In the acute stage, if there is obvious effusion or hemarthrosis in the joint, the effusion should be aspirated under strict aseptic conditions; if there is a 'lock', the lock can be released manually, but most often surgical treatment is required to release the cause of the lock. Actively exercise the quadriceps femoris muscle, take the knee joint in a straightened and tightened position, with the toes pointing upwards, lasting for 5 seconds as one repetition, 20 repetitions as one set, and do one set in the morning and afternoon to prevent muscle atrophy.

  In the chronic stage, if non-surgical treatment is ineffective and symptoms and signs are obvious, the damaged meniscus should be surgically removed in a timely manner to prevent the occurrence of traumatic arthritis. The patient should apply pressure bandage in the extended knee position after surgery, walk on the second day, and perform functional exercises. Generally, normal function can be restored within 2-3 months after surgery.

  Arthroscopy can treat meniscus injury. Arthroscopic surgery is currently the most recommended minimally invasive surgical method for treating knee injuries. It has minimal trauma, rapid recovery, and can be used for the treatment of meniscus injury.

Table of Contents

1. What are the causes of meniscus injury
2. What complications can meniscus injury easily lead to
3. What are the typical symptoms of meniscus injury
4. How to prevent meniscus injury
5. What laboratory tests are needed for meniscus injury
6. Diet taboos for meniscus injury patients
7. The conventional method of Western medicine for treating meniscus injury

1. What are the causes of meniscus injury

  Meniscus injury is one of the most common knee injuries, more common in young and middle-aged adults, and more common in men than in women. The symptoms of knee meniscus injury include localized pain in the knee joint, and some patients have symptoms such as giving way or locking of the knee joint.

  (I) Etiology

  Caused by rotational external force. The injury is often caused by a twisting external force. When one leg bears weight, the lower leg is fixed in a semi-flexed position, and the body and femur are strongly internally rotated. The medial meniscus between the femoral condyle and tibial condyle is subjected to rotational pressure, causing the meniscus to tear; the mechanism of lateral meniscus injury is the same, but the direction of the force is opposite. If part of the torn meniscus slips into the joint space, it causes mechanical obstruction in joint movement, hindering the extension and flexion of the joint, forming a 'lock'.

  (II) Pathogenesis

  The meniscus is most easily injured when the knee joint moves from flexion to extension while rotating. The injury is mostly on the medial meniscus, and the most common injury is the posterior horn of the meniscus, with the most common type being longitudinal rupture. The length, depth, and position of the tear depend on the relationship between the posterior horn of the meniscus and the femoral condyle and tibial condyle. Congenital abnormalities of the meniscus, especially the lateral discoid cartilage, are more likely to lead to degeneration or injury. Congenital joint laxity and other internal disorders can also increase the risk of meniscus injury.

2. What complications can meniscus injury easily lead to

  Clinical complications of meniscus injury include joint infection, joint effusion, joint pain, and nerve pain, among others. The occurrence of these complications has a significant impact on the patient's normal life and work. Therefore, it is recommended that patients must go to a regular orthopedic hospital for treatment and receive good rehabilitation care after treatment to avoid triggering these complications and affecting the patient's recovery process. The common complications of meniscus injury include:

  Complication 1: Joint Infection

  If the treatment of meniscus injury is not proper, it is likely to appear infection. Therefore, patients with meniscus injury need effective treatment and good rehabilitation care. If the patient has signs of infection, it is imperative to seek medical treatment in a timely manner.

  Complication 2: Joint Effusion

  For joint effusion caused by meniscus injury due to poor hemostasis or improper postoperative rehabilitation, if there is too much effusion, the patient needs to be drained under strict sterile operation and pressure bandaging.

  Complication 3: Joint Pain

  For patients in the rehabilitation period who have joint pain symptoms, physical therapy and exercise therapy can be carried out, which can effectively relieve joint pain.

  Complication 4: Neuralgia

  Neuralgia in meniscus injury is often caused by a neuroma resulting from injury to the hidden nerve patellar branch, so after the tumor is excised, the symptoms of neuralgia can be relieved.

3. What are the typical symptoms of meniscus injury?

  Common clinical manifestations of meniscus injury after injury include localized pain, joint swelling, cracking sound and locking, atrophy of the quadriceps muscle, weak legs, and definite tenderness at the joint space or meniscus area.

  Excessive extension and flexion tests of the knee joint can cause pain, and the rotation and compression test is positive. After injury, the knee joint has severe pain, cannot be extended automatically, and is swollen. The tenderness at the joint space is an important indicator of meniscus injury.

  Many patients have a history of knee rotation and sprains when jumping or landing, some have multiple knee sprains and swelling and pain. When injured, there is a sense of tearing inside the affected knee. Subsequently, the joint becomes painful and swollen, and there is joint effusion. Generally, the pain is on one side or the back of the joint, and the location is relatively fixed. The joint space is tender, and sometimes there is a sound. Some patients may have joint locking (difficulty in extension and flexion), instability, or a sensation of slipping (commonly known as weak legs), which is more obvious when going up or down stairs. In the late stage of injury, the quadriceps muscle atrophy, muscle strength decreases, and the leg becomes thinner. Meniscus injury may be accompanied by cruciate ligament or collateral ligament injury. When combined with ligament injury, there may be manifestations of joint instability.

4. How to prevent meniscus injury?

  Since the lateral meniscus is not connected to the lateral collateral ligament, its mobility is greater than that of the medial meniscus. In addition, the lateral meniscus often has congenital disk-shaped deformity, known as congenital disk-shaped meniscus. Therefore, the chance of injury is also greater.

  Meniscus injuries are common in athletes, miners, and laborers. When the knee joint is fully extended, the lateral and medial collateral ligaments are tense, the joint is stable, and the chance of meniscus injury is low. When the lower limb is bearing weight, the foot is fixed, and the knee joint is semi-flexed, the meniscus moves backward. If there is a sudden excessive internal rotation and extension or external rotation and extension of the knee, the meniscus does not have time to retreat and is squeezed, which can cause injury and tearing. In daily life, to prevent the occurrence of this disease, attention should be paid to the following aspects:

  Firstly, make full use of the tools around you to reduce the risk of meniscus injury caused by accidents. For example, when getting on or off the bus or stairs, do not be too hasty, and you can use the handrails to stabilize your body before stepping forward. People with professional habits should change their working posture and take a break for a while from time to time.

  Second, timely diagnosis and treatment in the early stage, without a large hematoma, symptoms are not severe, without the phenomenon of knee 'locking' or 'locking', no atrophy of the quadriceps muscle, middle-aged and elderly patients or doctors judge according to MRI that patients do not need surgery, can not be operated. Some of these people can participate in sports like normal people, but also after one and a half to two years.

  Third, if the patient is a professional athlete or a patient who must engage in sports, experts do not recommend surgical treatment, but the recovery time is relatively long.

  Fourth, in addition to paying attention to the posture and intensity of exercise, attention should be paid to exercise protection, such as wearing protective equipment to prevent accidental injuries during exercise.

5. What kind of laboratory tests are needed for meniscus injury

  Meniscus injury is one of the most common knee injuries, more common in young and middle-aged adults, with more males than females. The symptoms of meniscus injury include localized pain in the knee joint, some patients may have a feeling of giving way or locking of the knee joint. The diagnosis of this disease can be made clear through the following examinations.

  1. Tenderness Location

  The site of tenderness is generally the site of the lesion, which is of great significance for the diagnosis of meniscus injury and determining the site of the injury. During the examination, the knee is placed in a semi-flexed position, and the patella is pressed along the superior margin of the tibial condyle (i.e., the edge of the meniscus) with the thumb from front to back. Fixed tenderness is found at the site of the meniscus injury. If the knee is passively flexed and extended or internally and externally rotated while pressing, the pain is more pronounced, and sometimes an abnormally moving meniscus can be felt.

  2. McMurray Test (Rotation and Compression Test)

  The patient lies on their back, the examiner holding the lower leg ankle with one hand and supporting the knee with the other hand to fully flex the hip and knee, then external abduct and external rotate the lower leg, or external abduct and internal rotate, or internal adduct and internal rotate, or internal adduct and external rotate, gradually extending straight. Pain or a sound indicates a positive result, and the location of the pain and sound determines the site of the injury.

  3. Forceful Overextension or Overflexion Test

  Passively overextend or overflex the knee joint, if there is a meniscus injury at the anterior part, overextension can cause pain; if the posterior part of the meniscus is injured, overflexion can cause pain.

  4. Side Pressure Test

  With the knee extended, forcibly passively adduct or abduct the knee, and if there is a meniscus injury, pain is caused at the joint space of the affected side due to compression.

  5. Single Leg Squat Test

  Stand with one leg and gradually squat down from a standing position, then stand up from a squatting position. The healthy side is normal, but when the affected side squats or stands up to a certain position, pain in the joint space can be caused by the compressed meniscus, which may even prevent squatting or standing up.

  6. Gravity Test

  The patient assumes a lateral decubitus position, lifting the lower limb to perform active flexion and extension of the knee joint. When the joint space of the affected side is downward, pain is caused by the compressed meniscus. Conversely, when the joint space of the affected side is upward, there is no pain.

  7. Grind Test

  The patient assumes a prone position, with the knee flexed, the examiner holding the ankle with both hands and pressing down on the lower leg while performing internal and external rotation movements. Pain is caused by the compressed and abraded meniscus. Conversely, if the lower leg is lifted upwards and internal and external rotation movements are performed, there is no pain.

  8. X-ray examination

  Take X-ray films of the anteroposterior and lateral positions, although they cannot show the condition of meniscus injury, they can exclude other bone and joint diseases. Arthrography is of little diagnostic significance and can increase the patient's pain, so it is not recommended to use it.

  9. Knee arthroscopy

  Arthroscopy can directly observe the location, type, and other structures within the joint of meniscus injury, which is helpful for the diagnosis of difficult cases.

6. Dietary taboos for meniscus injury patients

  The meniscus of the knee joint is a fibrocartilaginous tissue,呈周缘厚,内缘薄的wedge-shaped, seen from a plane as a crescent shape, known as the meniscus; it fills the space between the femoral condyle and the tibial condyle, and has the function of enhancing the stability of the knee joint. The characteristics of the meniscus structure and function determine that it is one of the most easily injured tissues in the knee joint. The incidence of meniscus injury is higher in people engaged in intense sports and special professions. Diet and health care can promote the recovery of meniscus injury.

  1. Pork kidney and black soybean soup

  Pork kidney 2 (sheep kidney can also be used), black soybean 100g, tangerine peel 5g, fennel 5g, ginger 2 slices, boil together, add seasoning for eating. Take once every other day, for 5-7 times in total.

  2. Eucommia ulmoides pork kidney soup

  Eucommia ulmoides 30g, pork kidney 2, add a little salt to stew the soup and take it. Take once a day, for 7-10 days in a row.

  3. Walnut and Eucommia ulmoides soup

  Walnut meat 30g, Eucommia ulmoides 15g, boil the water and take the decoction. Take once a day, one course of treatment for 7-10 days.

  4. Dog meat and Fuzi soup

  Dog meat 200g, Fuzi 1.5g, and Cuscuta 3g (the two drugs are packed in a cloth bag). Cut the dog meat into slices, stir-fry with ginger, then add water and seasonings to the pot, and cook with Fuzi and Cuscuta until the meat is tender. Eat the dog meat and drink the soup twice a day, one dose per day, for 7-10 days.

  5. Coix seed and Forsythia tea

  Coix seed 30g, Forsythia 10g. Add 500ml of water to the coix seed and Forsythia, boil for 30 minutes, then remove the medicine juice. Add another 500ml of water, boil for another 30 minutes, and remove the medicine juice again. Mix the two batches of medicine juice evenly. Drink as tea, consume in several doses within a month, one dose per day.

  [Action]: Cool heat, promote diuresis, remove wind, and relieve pain. Suitable for meniscus injury.

  6. Black bean congee

  Black soybean 20 grams, glutinous rice 60 grams, and an appropriate amount of brown sugar. Soak the black soybean in warm water overnight, wash it clean, pour it into a pot, and boil it for several minutes with water. Add glutinous rice, brown sugar, and cook until the rice is cooked and the congee is thick. It can be eaten as a side dish.

  [Action]: Remove wind, activate blood circulation, promote diuresis and reduce swelling, used for meniscus injury.

7. Conventional western treatment methods for meniscus injury

  The occurrence of this disease is often accompanied by a clear history of trauma. During the acute stage, the knee joint shows obvious pain, swelling, and effusion, with difficulties in joint flexion and extension. After the acute stage, swelling and effusion can subside spontaneously, but pain in the joint may still occur during activities, especially when going up and down stairs, climbing slopes, squatting, running, and jumping. Severe cases may exhibit limping or dysfunction in joint flexion and extension. Some patients may experience locking phenomena or a cracking sound during knee flexion and extension. The traditional Chinese medicine treatment of this disease mainly adopts different treatment methods according to the different stages of onset.

  1. Early stage

  Treatment method: Activate blood circulation and remove blood stasis, reduce swelling and relieve pain.

  Medicines

  1. Main Party's活血止痛汤

  Prescription: 12 grams of Danggui, 6 grams of Chuanxiong, 6 grams of Ruxiang, 6 grams of Susong, 5 grams of Honghua, 6 grams of Moyao, 9 grams of Tu bie chong, 3 grams of Sanqi, 9 grams of Chishao, 3 grams of Chenpi, 6 grams of Luodeda, 9 grams of Zijingting. Decocted for internal use, one dose per day.

  2. External medicine prescription for Xueyi paste

  Prescription: 1 part of Dahuang, 2 parts of Zhizi, 4 parts of Muli, 4 parts of Jiecaoyu, 4 parts of Jianghuang, 6 parts of Huangbai. Grind into fine powder, mix with half water and half honey, and apply to the affected area.

  Second, those with moderate or chronic injuries

  Treatment method: Nourish blood and activate circulation, relax tendons and meridians.

  Medicines

  1. Main prescription for tonifying tendons and nourishing blood decoction

  Prescription: 9 grams of Danggui, 6 grams of Chuanxiong, 9 grams of Baizhi, 12 grams of Xuanduan, 5 grams of Honghua, 12 grams of Shengdihuang, 9 grams of Niuxi, 9 grams of Mudanpi, 9 grams of Duzhong. Decocted for internal use, one dose per day.

  2. External medicine prescription for Orthopedic External Wash No. 2

  Prescription: 15 grams of Guizhi, 15 grams of Lingxian, 15 grams of Fangfeng, 15 grams of Wujapi, 10 grams of Xixin, 10 grams of Jingjie, 10 grams of Moyao. Decocted for external use to wash the affected knee.

  Third, the later stage

  Treatment method: Warm the meridians and collaterals, tonify the kidneys and strengthen the tendons.

  Medicines

  Main prescription for tonifying the kidney and strengthening the tendons decoction

  Prescription: 12 grams of raw rhizome, 12 grams of Danggui, 10 grams of Niuxi, 12 grams of Shanyao, 12 grams of Fuling, 12 grams of Xuanduan, 10 grams of Duzhong, 10 grams of Baishao, 5 grams of Qingpi, 9 grams of Wujapi. Decocted for internal use, one dose per day.

  Four, other traditional Chinese medicine treatments:

  For those with acute injuries, treatment should be to relieve lock, reduce swelling, and relieve pain. It is advisable to perform the筋手法 once. Instruct the patient to lie on their back, relax the affected limb, and the practitioner holds the knee with one hand, gently massaging the pain point with the thumb, while the other hand holds the ankle, gently flexing and extending the knee joint, and rotating the lower leg gently in and out until the lock symptoms disappear. In the future, massage the upper and lower parts of the affected knee with rubbing and scrubbing techniques 1-2 times a day, for 15 minutes each time, making the local area warm and comfortable as appropriate.

  For those with moderate or chronic injuries, treatment should be to nourish blood and activate circulation, relax tendons and meridians, and perform local massage once a day. The practitioner first presses the acupoint pain in the joint gap with the thumb to have a tingling sensation, and combines it with the acupoint therapy. Acupoints can include Fengshi, Xuehai, Liangqiu, Ganyan, Yanglingquan, Yinxingquan, etc., for 2-3 minutes each, with 3-5 acupoints each time, then perform pushing, kneading, and grasping techniques on the upper and lower parts of the affected knee.

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