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0KNEE JOINT INJURIES AND THEIR TREATMENT
Botirov N.T.
Botirov Nozimjon Turakhonovich - Senior teacher, DEPARTMENT OF TRAUMATOLOGY, ORTHOPEDICS AND
NEUROSURGERY, ANDIJAN STATE MEDICAL INSTITUTE, ANDIJAN, REPUBLIC OF UZBEKISTAN
Abstract: the knee joint is the biggest joint in your body. It connects your thigh bone (femur) to your shin bone (tibia). It helps you stand, move and keep your balance. Your knees also contain cartilage, like your meniscus, and ligaments, including your LCL, MCL, ACL and PCL.
Keywords: knee joint injures, articulations, the tibiofemoral joint and patellofemoral joint.
UDC 617.616
The knee joint is a synovial joint that connects three bones; the femur, tibia and patella. It is a complex hinge joint composed of two articulations; the tibiofemoral joint and patellofemoral joint. The tibiofemoral joint is an articulation between the tibia and the femur, while the patellofemoral joint is an articulation between the patella and the femur.
The knee joint is the largest and arguably the most stressed joint in the body. The arrangement of the bones in the joint provides a fulcrum that translates the actions of the flexor and extensor muscles of the knee. The arrangement of the extracapsular and intracapsular and ligaments, as well as extensions of muscles that cross the joint, provide the much needed stability that counters the considerable biomechanical stress brought upon the joint. As a hinged joint, the knee joint mostly allows movement along one axis in terms of flexion and extension of the knee in the sagittal plane. It also allows slight medial rotation during flexion and the last stage of extension of the knee, as well as lateral rotation when "unlocking" the knee.
The tibiofemoral joint is an articulation between the lateral and medial condyles of the distal end of the femur and the tibial plateaus, both of which are covered by a thick layer of hyaline cartilage. The lateral and medial condyles are two bony projections located at the distal end of the femur, which have a smooth convex surface, and are separated posteriorly by a deep groove known as the intercondylar fossa. The medial condyle is larger, more narrow and further projected than its lateral counterpart, which accounts for the angle between the femur and the tibia. The roughened outer surfaces of the medial and lateral condyles are defined as medial and lateral epicondyles, respectively. Along the
posterior aspect of the distal femur, there are paired rough elevations above the medial and lateral epicondyles known as the medial and lateral supracondylar ridges.
The tibial plateaus are the two slightly concave superior surfaces of the condyles located at the proximal end of the tibia, and are separated by a bony protuberance known as the intercondylar eminence. The medial tibial articular surface is somewhat oval shaped along its anteroposterior length, while the lateral articular surface is more circular in shape
The articular surfaces of the tibiofemoral joint are generally incongruent, so compatibility is provided by the medial and lateral meniscus. These are crescent-shaped fibrocartilaginous structures that allow a more even distribution of the femoral pressure on the tibia.
The patellofemoral joint is a plane joint formed by the articulation of the patellar surface of femur (also known as the trochlear groove of femur) and the posterior surface of patella. The patellar surface of femur is a groove on the anterior side of the distal femur, which extends posteriorly into the intercondylar fossa.
The patella is a triangular shaped bone, with a curved proximal base and a pointed distal apex. Its articular surface is defined by medial and lateral facets which are concave articular surfaces covered with a thick layer of hyaline cartilage and separated by a vertical ridge. Medial to the medial facet is a third minor facet, known as the 'odd' facet which lacks hyaline cartilage.
Being a sesamoid bone, the patella is tightly embedded and held in place by the tendon of the quadriceps femoris muscle. On the distal part of the patella, an extension of the quadriceps femoris tendon forms a central band called the patellar ligament. It is a strong, thick ligament that extends from the patellar apex to the superior area of the tibial tuberosity.
To solidify your knowledge, take a quiz on the bones contributing to the knee joint!
The ligaments of the knee joint can be divided into two groups; extracapsular ligaments and intracapsular ligaments. These ligaments connect the femur and tibia, holding them in place, providing stability, and preventing dislocation.
Extracapsular ligaments are found outside the joint capsule and include the patellar ligament, fibular (lateral) and tibial (medial) collateral ligaments, and oblique and arcuate popliteal ligaments. Intracapsular ligaments are found inside the joint capsule, with the cruciate ligaments being the most well known of this subgroup.
The tibial collateral ligament is the strong, flat ligament of the medial aspect of the knee joint. The tibial collateral ligament, in addition to its fibular counterpart, acts to secure the knee joint and prevent excessive sideways movement by restricting external and internal rotation of the extended knee. The tibial collateral ligament is sometimes divided the literature into superficial and deep parts:
• Superficial part: originates just proximal the medial epicondyle of the femur. This ligament has two attachment points; a proximal attachment on the medial condyle of the tibia, and a distal attachment on the medial shaft of the tibia. Anteriorly, the superficial part blends with the medial patellar retinaculum and the medial patellofemoral ligament, which courses from the medial femoral condyle to attach onto the medial border of the patella.
• Deep part: a vertical thickening of the knee joint capsule found underneath the superficial part of the tibial collateral ligament. It originates from the area of the distal femur, then attaches to the medial meniscus, and terminates on the proximal tibia.
Common knee injuries include ligament, tendon and cartilage tears, and patella-femoral pain syndrome. Prompt medical attention for any knee injury increases the chances of a full recovery. Treatment options include physiotherapy, arthroscopic surgery and open surgery. Knee injuries involve trauma to one or more tissues that make up the knee joint: ligaments, tendons, cartilage, bones and muscles. These types of injuries may happen due to a fall, forceful twisting of the knee or high impact from a motor vehicle accident or another force. Common knee injuries include fractures, dislocations, tears and sprains.
Anterior cruciate ligament (ACL) tears and meniscus tears are some of the most common sports injuries affecting the knee. Patella (kneecap) fractures are less common in sports but may result from a high-impact trauma. Most knee injuries require immediate medical attention and some may require surgery.
Suggestions for first aid treatment of an injured knee include:
• Stop your activity immediately. Don't 'work through' the pain.
• Rest the joint at first.
• Reduce pain, swelling and internal bleeding with ice packs, applied for 15 minutes every couple of hours.
• Bandage the knee firmly and extend the wrapping down the lower leg.
• Don't apply heat to the joint.
• Avoid alcohol, as this encourages bleeding and swelling.
• Don't massage the joint, as this encourages bleeding and swelling.
Professional help for knee injuries. Mild knee injuries may heal by
themselves, but all injuries should be checked and diagnosed by a doctor or physiotherapist. Persistent knee pain needs professional help. Prompt medical attention for any knee injury increases the chances of a full recovery. Treatment options include:
• Aspiration - if the knee joint is grossly swollen, the doctor may release the pressure by drawing off some of the fluid with a fine needle.
• Physiotherapy - including techniques to reduce pain, kneecap taping, exercises for increased mobility and strength, and associated rehabilitation techniques.
• Arthroscopic surgery - or 'keyhole' surgery, where the knee operation is performed by inserting slender instruments through small incisions (cuts).
• Open surgery - required when the injuries are more severe and the entire joint needs to be laid open for repair.
Prevention tips for knee injuries. You may be able to help to prevent injuries if you:
• Warm up joints and muscles by gently going through the motions of your sport or activity and stretching muscles.
• Wear appropriate footwear.
• Try to turn on the balls of your feet when you're changing direction, rather than twisting through your knees.
• Cool down after exercise by performing light, easy and sustained stretches
• Build up an exercise program slowly over time.
References
1. А.Г. Эйнгорн. Патологическая анатомия и патологическая физиология. Т., «Медицина», 1978.
2. EisingE.H. Willems' Treatment of Knee-joint Injuries. New York Med. Jour., p. 734, May 18, 1921.
