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Injuries of Knee Cartilage


Autor: dr sci.med. Milorad Jerkan    

injuries-of-knee-cartilage

Injuries of knee catrilige are one of the most usual injury in the praxis of sport medicine. Mechanism of this injury ( meniscus injury) is quite complex. It happens mostly due to the rotation forces, flexion, extension, abduction and compression. Actually, it is about sudden sharp rotations, direct blows, restrained movements of back medial capsule due to stretching of semimembranous or frontal  lateral capsule with tibia flexion and forward movement of femur, i.e. with forced flexion of the knee.  


Meniscal fracture may be :
  • longitudal
  • horizontal
  • sidelong
  • radial

Injuries May Be One of Those Basic Fractures or Combined

Longitudal meniscus fracture is characteristic for its place which is vertical on the surface of plateau tibia and occurs mostly with younger people. The most usual is in  sport. It happens as a complete or incomplete injury of meninscus and is parallel with the long edge of meniscus and separates circumferent fibers. We meet fractures along periphery of meniscus or in the middle of it itself.

Horizontal fracture is characteristic for the elderly people with degenerative changes on meniscus. The place of the fracture is parallel to the upper and lower surface of the meniscus. It is possible to separate the meniscus in two parts – upper and lower when it comes to the injury.

Case History :

Various symptoms dominate the case history. The initial injury itself is followed with the flow that a sportsman may not notice immediately, but the day after. Pain is constant and present along medial or lateral part of meniscus fracture.
 

Four main symptoms of meniscus injury are:

  • pain
  • swelling
  • instability
  • blocade
Instability is characterized by intermittent changes (a sportsman feels instability during one game, and the other day they have an impression that everything is ok), it is localized between femur and tibia (interponate). This instability differs from instability caused by knee lesion of ligaments.  

Blocades that are caused by meniscus lesion are of chronic nature, they last for couple of minutes and cannot be taken away by an ordinary movement. They occure due to meniscus rupture and are shaped in “arm of a basket”.

Tearing of knee cartilige is usually caused by strong twist or blow in the knee. The injury occurs in meniscus cartilage, one of the two semicircle stripes of the elastic tissue, placed next to tibia in meniscus. Pain occurs in meniscus as a symptom, knee may be restrained or to joggle, one may hear crunch or it may swell. Along with training of cartilage (meniscus injury) it is quite often to have tearing of ligament apparatus as well. Meniscus injury occurs in rugby, football, skiing, fighting sports. Recently due to the existence of arthroscopy, cartilage injuries are delt with quickly and sportsmen go back to the field in the shortest possible period.     

Atypical signs of meniscus injury are :
  • posttraumatic flow that may occur even with the rupture of joint bursae, with connection damage at intraarticular fracture                        
  • recurrent flow after a physical ballast, we often meet the same symptoms even with nonspecific synovitis, hondropathia, rheumatic illnesses and the like                         
  • characteristic pain in the joint due to a longer walk or enforced knee position on longer time interval (sitting in the cars) this phenomenon may look like hondropathy.         
  • atrophy of the frontal and medial group of upper leg muscles    
  • radiographical snapshot in four directions however this analysis rarely signals meniscus injury.     
          

Diagnosis

Making a diagnosis of meniscus injury is very simple even when we have taken a good case history (which is the most important), physical examination, artrophy as well as Murray, De Palma, Stewart, Appley tests and  Payer’s sign which really help with diagnostic purposes of meniscus injury.

Mc Murray test  is performed in the way that a patient lies on the back. Examined leg is folded in hip and heel touches upon tigh. Examiner holds feet with one hand and the knee with the other. They rotate foot in the field, abducate lower leg and extend the knee. If they feel disruptive discharge under their hand it is probably a medical meniscur departure.        

De Palma test (compressive  test) is performed with a knee in full extension, lower leg is abducated for examining the medial meniscus. Extension test is performed when the knee is in extension position, a knee is forced and brought in hyperextension, if the meniscus is injured pain occurs on joint line of the hurt side.

Stewart test is performed in the way that the sportsman stands with their feet and lower legs in total inward rotation, and after that in total outward rotation. If pain rises in the examined knee during a squat in inward rotation, it signals a possible injury of inward meniscus. In the care of otherwise rotation we are probably talking about lateral meniscus injury.  

Apley test is performed in the way that a sportsman lies pronely with the knees flexed under  the angle of 90 degrees and upper legs are fixed for the bad. Examiner presses the lower leg with both hands and rotates the foot about inward and in the field changing the degree of flexion. If we notice disruptive discharge or a sportsman complains to pain it is about meniscus lesion. The second part of the test is performed in the same position, but now examiner pulls the lower leg upward, and the tigh is frim to the bad. If pain occurs  while feet are rotated inside the field and inward it signals for the ligament lesion.

Payer’s sign – we cause the maximum flexion and pain occurs in the back part of joint either medially or leterally it depends on meniscus injury.

Artography   is still important as a helping diagnosing measure, especially if posteromedial part of the knee lasia is in question   
 
Arthroscopy   was used for a long time in diagnostical purpose with meniscus lesia, today it is used in operation purposes in dealing with meniscus injuries.

Treatment

Experiences  with meniscus extraction did not give good results so far. Johnson et al. researches point out that around 60 % of all examined meniscus extraction were not successful. For this purpose a new way and operation method  are being used where arthroscopy gained the first place, and the operation success and going back at the field is 95 %.


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