Damage to ligaments of the knee joint and meniscus
Last reviewed: 23.04.2024
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Injury to the knee often results in damage to the outer (medial and lateral collateral) or internal (anterior and posterior cruciate) ligaments or to rupture of the meniscus. Symptoms of ligament injury of the knee joint and meniscus include pain, hemarthrosis, instability (for severe injuries) and joint blockade (with certain meniscus lesions). The diagnosis is determined by examination, MRI or arthroscopy. Treatment includes rest, cold, pressing bandage, elevated position and, with severe ruptures, plaster bandage or surgical treatment.
The structures located mainly outside the joint and helping to stabilize it include muscles (for example, quadriceps, semimembranous muscles), places of attachment (for example, a crow's foot), extraarticular ligaments. The lateral collateral ligament refers to the extraarticular formations, the medial (tibial) has a superficial extraarticular and deep part, the latter being part of the capsule of the joint.
The knee joint structures providing stabilization include the joint capsule, the posterior and well vascularized anterior cruciate ligaments. The medial and lateral menisci are intraarticular cartilaginous structures that provide shock absorption to the articular cartilage, as well as those that participate in the stabilization of the joint.
The most common damage is the medial collateral and anterior cruciate ligament. A typical mechanism of damage to the ligaments of the knee joint is a force action directed towards the inside and medially, usually in combination with a moderate external rotation and flexion (as happens with a footboard in football). In such cases, usually the medial collateral ligament is first damaged, then the anterior cruciate, and at the end the medial meniscus. The next most frequent mechanism is external force, often with damage to the lateral collateral ligament, anterior cruciate ligament, or both. Force action in front or behind, as well as over-extension of the knee joint often lead to damage to the cruciate ligaments. Simultaneous weight action and rotation predispose to meniscus lesions.
[Symptoms of ligament injury of the knee joint and meniscus
Edema and muscle spasm progress in the first few hours. With grade II damage, the pain is usually moderate or severe. With grade III pain is negligible and, surprisingly, some patients can move without support. Audible click is not typical; its presence gives reason to think about rupture of the anterior cruciate ligament. The presence of hemarthrosis also indicates damage to the anterior cruciate ligament and, probably, to other intraarticular structures. Nevertheless, with severe ruptures of the third degree of the medial collateral ligament and the anterior cruciate ligament, there may be no hemarthrosis, since the capsule of the joint is damaged and the blood can simply leak out. The zone of greatest soreness often corresponds to structural damage; at rupture of the medial meniscus, tenderness when palpation of the inner surface of the joint, with trauma of the lateral meniscus - external. These injuries can also cause swelling and, sometimes, a restriction of passive movements (so-called jamming).
Where does it hurt?
Diagnosis of ligament injury in the knee joint and meniscus
A patient with severe instability should be suspected of spontaneous dislocation of the knee joint, in this case, an emergency angiography is indicated. In other cases, the knee joint should be fully inspected, first of all, evaluating its extension.
To identify other damage, there are various methods. When performing the test, the doctor folds the knee of the patient lying face down to 90 '. Pain during compression and knee rotation gives reason to think of a meniscus rupture. Pain with distraction and rotation of the knee gives reason to think of damage to the ligaments or capsule of the joint. To assess the condition of the collateral ligaments, the patient is placed on the back, bending the knees to approximately 20 °, achieving complete relaxation of the muscles. The doctor puts one hand on the joint from the side opposite to the test ligament. With the other hand, he grabs the heel, turns the shin to the outside to evaluate the inner collateral ligament, inside - the outer one. Moderate instability after acute trauma gives reason to think about detachment of the meniscus or cruciate ligament. Lahman's test is most sensitive in cases of acute ruptures of the anterior cruciate ligament. The doctor supports the thigh and the tibia of the recumbent patient by flexing the knee joint to 20 °. Excessive passive movements of the pain-sibsters anteriorly from the femoral bone give reason to think of a significant rupture.
If stress testing is difficult (for example, because of pain or muscle spasm), the examination should be repeated after injection of a local anesthetic or under systemic analgesia and sedation, followed by examination 2-3 days (when the edema subsides and muscle spasm decreases), or perform an MRI or arthroscopy. If serious damage can not be ruled out, MRI or arthroscopy is clinically indicated.
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Treatment of ligament injury of the knee joint and meniscus
Evacuation of a large amount of fluid from the joint can reduce pain and spasm. In most cases of grade I and mild / moderate grade II injuries, rest, cold, pressure bandage, elevated position and immobilization of the knee joint, bent at an angle of 20 ° by available commercial devices, can be applied first. Most third-degree injuries, severe damage to grade II, and most of the meniscus lesions require a plaster cast for 6 weeks or more. However, with some injuries to the ligaments of the knee joint and the meniscus of the third degree of the medial collateral ligament, anterior cruciate ligament and meniscus, arthroscopic reconstruction may be required.