Knee Cartilage Damage

OUTLINE

LIVE knee joint Because the surface of the tibial plateau joint is shallow, the condyle of the femur is round and large, so it must have meniscus Midsole padding for added fit. The upper surface of the meniscus is slightly concave, while the lower surface in contact with the tibial plateau is slightly convex. The average thickness of the meniscus is 3 to 5 mm. External meniscus ""O, meniscus in the shape of the letter “OLD". The meniscus is closely related to the joint capsule and surrounding ligaments.

Meniscus has an important role in the function of movement of the knee joint, ensuring the stability of the joint, helping to spread the joint fluid and preventing sudden and abnormal movements of the joint. When doing knee flexion, both meniscus gradually slide up the tibial plateau anteriorly, and vice versa when extending the knee.

The meniscus is an elastic fibrocartilaginous organization that cushions the medial condyle of the femur and the tibial plateau. Injury to the inner meniscus is 9 times more common than the damage to the outer meniscus. When the meniscus injury is new, clinical examination is difficult to detect.

The previous notion that meniscus tear does not heal on its own, so treatment is necessarily surgical removal and post-operative results Rehabilitation Good. Currently, some uncomplicated meniscal tears can be sutured by endoscopic techniques or only meniscalectomy.

Causes and mechanisms of injury

• Indirect mechanism: encountered while playing some sports such as athletics, soccer, skiing, falling, generating rotational force at the knee joint is a very common mechanism. For example, a ski fall causes rotation of the femoral condyle, while the tibial plateau remains immobilized, or in soccer a strong knee flexion tears the meniscus.
• Direct mechanism: strong traumatic force directly affects the knee joint, causing damage to the entire knee joint such as dislocation of the knee, rupture of the tibial plateau, rupture of the femoral condyle and tear of the meniscus. When falling from above, the meniscus in the middle can also be crushed.

Histopathology

Tear site: The meniscus can be torn in the anterior horn, posterior horn, or torn in the trunk.

– Meniscal tear: based on clinical observations, Trillat A. (1962) divided meniscal tears into three main types:

+ Tear line along the body of the meniscus: in this form, the tear line can be long or short, it can tear the entire thickness or only a shallow tear.

+ Transverse tear or tear of the body of the meniscus

+ Racquet-shaped tear: is a combination of the two types of tears above, the damaged meniscus has the shape of a racket that moves freely in the joint, causing joint jamming.

– Combined injury: tearing meniscus inside the body with rupture cruciate ligament before and lateral ligament in because of the same mechanism of injury.

Clinical and Paraclinical SYMPTOMS

Clinical symptoms

• Subjective symptoms:

+ At the stage immediately after the injury, the patient only feels pain in the knee joint, swelling and limited knee movement.

+ The patient can still walk with a limp, then walk normally and the swelling in the posterior knee also subsides, but there is still pain in the knee and sometimes joint stiffness occurs.

+ Patients often describe the situation of entangled and stuck joints as follows: while walking, suddenly the knee joint is stiff, unable to bend or stretch, the patient has to sit and rest for 2-3 minutes, rub in place. then continue as normal. Then the joint stuck again. Newly damaged meniscus has fewer joint entrapments, but the duration of entrapment is longer. Later, the number of joint jams increased, but the time of jamming became shorter. Patients often complain that the knee joint is limited in activities such as difficulty climbing stairs, difficulty squatting.

• Objective symptoms:

+ New meniscus tear: swollen knee joint and mild blood effusion. The range of motion of the knee joint is limited.

+ Tear old meniscus: atrophy of the quadriceps thigh muscle is found, the longer the atrophy becomes clear, the knee joint may have effusion.

+ Press on the joint space just in front of the lateral ligament where there is a sharp pain.

+ Steimann test: patient lies supine, knee flexed, hip flexed, shins turned inward and outward to find pain in the knee joint. When turned outward, if you see a sharp pain, it is an internal meniscus tear, whereas when you turn inward, you see a sharp pain, it is an external meniscus tear.

+ Apley test: the patient lies on the stomach, the knee is flexed 90 degrees, press firmly on the heel from top to bottom, pressing the tibia to the femur. Then, the performer proceeds to rotate the tibia inward or outward. If pain is in the knee joint, the test is positive.

+ Nghiệm pháp Mc Murray: bệnh nhân nằm ngửa, gối gấp, háng gấp, người khám một tay nắm lấy đầu gối, ngón cái đặt vào khe khớp gối trong, tay kia nắm lấy bàn chân giữ ở tư thế xoay ngoài và từ từ duỗi gối. Khi sụn chêm trong bị tổn thương người khám sẽ có cảm giác “lật khật” ở ngón tay cái đặt vào khe khớp bệnh nhân thấy đau chói. Để phát hiện tổn thương sụn chêm ngoài thì giữ bàn chân ở tư thế xoay trong và làm thao tác tương tự.

Subclinical

• Take a shot X-ray Usually does not show meniscal injury, but one should still have both straight and inclined knee arthroplasty to look for associated bony lesions such as tibial plateau fracture, tibial plateau fracture, and assess the condition. osteoarthritis if damage to old meniscus.
• To get an X-ray to clearly see the meniscus tear, you must inflate or contrast the knee joint before taking it.
• Magnetic resonance imaging (MRI) is a modern method that allows to determine the location and nature of meniscus lesions with high specificity, however, sometimes images are not satisfactory.
• Currently, the method arthroscopy The knee is a modern method that allows the diagnosis of the components in the joint socket, helping the surgeon to accurately diagnose the location and image of the meniscal tear injury from which to make an appropriate treatment decision. fit.

DEFINITION AND DIFFERENT DIAGNOSIS

• Definite diagnosis: based on subjective and objective symptoms, especially knee arthroscopy.
• Differential diagnosis:

+ The Hoffa fatty ligament is enlarged due to injury or disease: transient symptoms of joint entanglement when walking and pain points on both sides of the patellar tendon

+ Injury to the lateral ligament: positive sign of internal or external joint opening

+ Injury to the cruciate ligament: positive drawer signs.

• Sick inflammation of the bone - articular cartilage caseation Koenig: inflammatory diseases of bone necrosis, cartilage sheds loose fragments that become foreign bodies in the joint causing joint jamming, this foreign body can be palpable running to the edge of the joint every time the knee is flexed.

PROGRESS AND COMPLAINTS

• Normal progression: most meniscus tears do not heal on their own. The meniscus must be surgically removed or removed. If the meniscus has to be removed, the function of the knee joint will be greatly affected later.
• Complications: If the meniscal tear is not treated, it will cause joint jamming, affecting the patient's movement soon and later causing joint degeneration.

TREATMENT

Stuck in joints due to meniscus tear

• Anesthetize the knee joint with novocaine 1% ´ 20 mL, wait for about 10 minutes, slowly flex, stretch and rotate the leg to clear the joint jam.

Torn meniscus

Treatment methods are based on definitive diagnosis through arthroscopy.

Trước đây, khi phẫu thuật nội soi chưa phát triển thì chủ yếu là mổ mở vào lấy bỏ toàn bộ sụn chêm. Sau mổ cast đùi – cổ chân ba tuần, sau khi bỏ bột cho bệnh nhân tập đứng, tập đi kết hợp điều trị lý liệu. Sau sáu tuần có thể gấp duỗi gối bình thường.

Currently, in places equipped with endoscopic knee arthroscopy for diagnosis, if there is damage to the meniscus, remove the meniscus or suture if only the meniscal tear is at the margin (perfused). By laparoscopic surgery, it is possible to precisely cut the lesion and keep the healthy part.

Patients undergoing laparoscopic surgery only need motionless in the first 3-5 days after surgery, then, put on crutches with increasing pressure on the painful leg, after three weeks can walk normally. Many sports athletes after laparoscopic meniscus removal still retain their old achievements.