BEM4D: Portal Toto Slot Online Berbasis Teknologi Modern – Knee Injuries – The anterior cruciate ligament (ACL) is probably the most commonly injured ligament of the knee. In most cases, the ligament is injured by people participating in athletic activity. The most common method of injurying the ACL is with a “plant and pivot” maneuver, occuring is sports such as football, soccer, and basketball. This injury has received a great deal of attention from orthopedic surgeons over the past 15 years, as the amount of sport related injuries have increased.
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Anterior Cruciate Ligament Injuries
Anatomy
Where is the ACL, and what does it do?
How do ACL injuries occur?
The major cause of injury to the ACL is sports. The types of sports that have been associated with ACL tears are numerous. Those sports requiring the foot to be planted and the body to change direction rapidly (such as basketball) carry a high incidence of injury. Football is also frequently the source of an ACL tear. Football combines the activity of planting the foot and rapidly changing direction or pivoting thus leading to a torn ACL. Downhill skiing is another frequent source of injury, especially since the introduction of ski boots that come higher up the calf. These boots move the impact of a fall to the knee rather than the ankle or lower leg. An ACL injury usually occurs when the knee is forcefully twisted or hyperextended. Many patients recall hearing a loud “pop” when the ligament is torn, and they feel the knee give way or buckle when weight is applied
Symptoms
What does a torn ACL feel like?
The symptoms following a tear of the ACL can vary. Usually, the knee joint swells within a short time following the injury. This is due to bleeding into the knee joint from torn blood vessels in the damaged ligament. The instability caused by the torn ligament leads to a feeling of buckling and giving way of the knee, especially when trying to change direction on the knee. The knee may feel like it wants to slip backwards. Many times, even with a complete tear of the ACL, normal every day activities and even straight ahead sports such as jogging, biking or swimming that do not involve changing direction quickly can be performed without difficulty.The pain and swelling from the initial injury will usually be gone after two to four weeks, but the knee may still feel unstable. The symptom of instability and the inability to trust the knee for support are what require treatment. Also important in the decision about treatment is the growing realization by orthopedic surgeons that long-term instability leads to early arthritis of the knee
Diagnosis
The history and physical examination are probably the most important ways to diagnose a ruptured or deficient ACL. In the acute (sudden) injury, the swelling is a good indicator. A good rule of thumb that orthopedic surgeons use is that any tense swelling that occurs within 2-4 hours of a knee injury usually represents blood in the joint, or a hemarthrosis.Draining the swollen joint or aspirating the knee gives relief from the swelling and provides useful information. If blood is found when draining the knee, there is about a 70 percent chance it represents a torn ACL. This fluid can also show if the cartilage on the surface of the knee joint was injured.During the physical examination, your doctor will determine how badly the ACL was injured and whether other knee ligaments or joint cartilage were injured.X-rays of the knee will be performed in the office to rule out a fracture. Ligaments and tendons do not show up on X-rays, but bleeding into the joint can result from a fracture of the knee joint, or when portions of the joint surface are chipped off. Magnetic resonance imaging (MRI) is probably the most accurate test for diagnosing a torn ACL without actually looking into the knee. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. This machine creates pictures that look like slices of the knee. The pictures show the anatomy, and any injuries, very clearly. This test does not require any needles or special dye and is painless.In some cases, arthroscopy may be used to make the definitive diagnosis if there is a question about what is causing your knee problem.
Treatment
NONSURGICAL Treatment:Initial treatment for an ACL injury focuses on decreasing pain and swelling in the knee. Rest and mild pain medications, such as acetaminophen (Tylenol®), can help decrease these symptoms. You may need to use crutches until you can walk without a limp. Most patients are instructed to put a normal amount of weight down while walking. The knee joint may need to be drained with a needle (mentioned earlier) to remove any blood in the joint.Most patients receive physical therapy after having an ACL injury. Therapists treat swelling and pain with the use of ice, electrical stimulation, and rest periods with your leg supported in elevation. Exercises are used to help you regain normal movement of joints and muscles. Range-of-motion exercises should be started right away with the goal of helping you swiftly regain full movement in your knee. This includes the use of a stationary bike, gentle stretching, and careful pressure applied to the knee by the therapist. Exercises are also given to improve the strength of the hamstring and quadriceps muscles. As your symptoms ease and strength improves, you will be guided in specialized exercises to improve knee stability.An ACL brace may be suggested. This type of brace is usually custom-made and not the type you can buy at the drugstore. It is designed to improve knee stability when the ACL doesn’t function properly. An ACL brace is often recommended when the knee is unstable and surgery is not planned. As mentioned, a torn ACL that isn’t corrected often leads to early knee arthritis. There is no evidence that an ACL brace will prevent further damage to the knee due to wear and tear arthritis. The ACL brace may help keep the knee from giving way during moderate activity. However, it can give a false sense of security and won’t always protect the knee during sports that require heavy cutting, jumping, or pivoting. Many orthopedists will also recommend wearing a brace for at least one year after a surgical reconstruction, so even if you decide to have ACL surgery, a brace is probably a good investment.
SURGERY treatment:If the symptoms of instability are not controlled by a brace and rehabilitation program, then arthroscopic surgery may be suggested. Symptoms of instability include recurrent giving way, swelling and/or pain. The main goal of surgery is to keep the tibia from moving too far forward under the femur bone and to get the knee functioning normally again.Even when surgery is needed, we ideally like patients to attend physical therapy for several visits before the surgery. This is done to reduce swelling and to make sure you can straighten your knee completely and gain strength. This will speed recovery after surgery.Arthroscopic MethodReconstruction of the ACL is performed using a piece of tendon to replace the torn ACL. This surgery is always done with the aid of the arthroscope. Tiny incisions are made around the knee, but the surgery doesn’t require the surgeon to open the joint. The arthroscope is used to view the inside of the knee joint as the surgeon performs the work.
Allograft ReconstructionAn allograft is tissue that comes from someone else. This tissue is harvested from tissue and organ donors at the time of death and sent to a tissue bank. The tissue is checked for any type of infection, sterilized, and stored in a freezer. When needed, the tissue is ordered by the surgeon and used to replace the torn ACL. The allograft (your surgeon’s choice of graft) can be from the tibialis tendon or Achilles tendon (the tendon that connects the calf muscles to the heel). The advantage of using an allograft is that the surgeon does not have to disturb or remove any of the normal tissue from your knee to use as a graft. The operation also usually takes less time because the graft does not need to be harvested from your hamstring.
REHABILITATION / RECOVERY
Nonsurgical rehabilitationfor a torn ACL will typically last six to eight weeks. Therapists apply treatments such as electrical stimulation and ice to reduce pain and swelling. Exercises to improve knee range of motion and strength are added gradually. If your doctor prescribes a brace, your therapist will work with you to obtain and use the brace.You can return to your sporting activities when your quadriceps and hamstring muscles are back to nearly their full strength and control, you are not having swelling that comes and goes, and you aren’t having problems with the knee giving way.Post-operative Rehabilitation:You will take part in a formal physical therapy after ACL reconstruction. You will be involved in a progressive rehabilitation program for four to six months after surgery to ensure the best result from your ACL reconstruction. At first, expect to see the physical therapist two to three times a week. If your surgery and rehabilitation go as planned during the first six weeks, you may only need to do a home exercise program and see your therapist every few weeks over the four to six month period.
Meniscal Injuries
Meniscus Tear
The meniscus is a commonly injured structure in the knee. The injury can occur in any age group. In younger people, the meniscus is fairly tough and rubbery, and tears usually occur as a result of a forceful twisting injury. The meniscus grows weaker with age, and meniscal tears can occur in aging adults as the result of fairly minor injuries, even from the up-and-down motion of squatting.
Anatomy
What is a meniscus, and what does it do?
There are two menisci between the shinbone (tibia) and thighbone (femur) in the knee joint. (Menisci is plural for meniscus.)
The C-shaped medial meniscus is on the inside part of the knee, closest to your other knee. (Medial means closer to the middle of the body.) The U-shaped lateral meniscus is on the outer half of the knee joint. (Lateral means further out from the center of the body.)
These two menisci act like shock absorbers in the knee. Forming a gasket between the shinbone and the thighbone, they help spread out the forces that are transmitted across the joint. Walking puts up to two times your body weight on the joint. Running puts about eight times your body weight on the knee. As the knee bends, the back part of the menisci takes most of the pressure
Articular cartilage is a smooth, slippery material that covers the ends of the bones that make up the knee joint. The articular cartilage allows the surfaces to slide against one another without damage to either surface.
By spreading out the forces on the knee joint, the menisci protect the articular cartilage from getting too much pressure on one small area on the surface of the joint. Without the menisci, the forces on the knee joint are concentrated onto a small area, leading to damage and degeneration of the articular cartilage, a condition called osteoarthritis.
The menisci add stability to the knee joint. They convert the surface of the shinbone into a shallow socket, which is more stable than its otherwise flat surface. Without the menisci, the round femur would slide on top of the flat surface of the tibia.
Causes
How do meniscal problems develop?
Meniscal injuries can occur at any age, but the causes are somewhat different for each age group. In younger people / athletes, the meniscus is a fairly tough and rubbery structure. Tears in the meniscus in patients under 30 years old usually occur as a result of a fairly forceful twisting injury. In the younger age group, meniscal tears are more likely to be caused by a sport activity. The entire inner rim of the medial meniscus can be torn in what is called a bucket handle tear. These tears usually occur in an area of good blood supply in the meniscus. When treated early (within 3 weeks) these can generally be repaired
The meniscus can also have a flap tear from the inner rim. These tears usually involve a small percentage of the meniscus and do not have the ability to heal because they occur in an area that does not have blood supply. These are usually “trimmed out” or “shaved”. The earlier these tears are treated, the less meniscus that has to be trimmed.
Displaced Bucket Handle Tear
Reduced Bucket handle Tear
The tissue that forms the menisci weakens with age, making the menisci prone to degeneration and tearing. These changes generally begin in the early 30’s. People of older ages often end up with a tear as result of a minor injury, such as from the up-and-down motion of squatting, stairs, or even a misstep walking. Most often, there isn’t one specific injury to the knee that leads to the degenerative type of meniscal tear. These tears of the menisci are commonly seen as a part of the overall condition of osteoarthritis of the knee in aging adults. Degenerative tears cause the menisci to fray and become torn in many directions.
With more advanced degenerative changes in the knee the roughness and irregularity of articular cartilage cap on the bone can actually be the cause of the meniscus tear. Particularly in these cases, physical therapy and strengthening and not arthroscopic surgery will lead to the active person’s best knee.
Moderate Meniscal Flap Tear
Trimmed Meniscus
Anatomy
What does a torn meniscus feel like?
The most common problem caused by a torn meniscus is pain. The pain may be felt along the edge of the knee joint closest to where the meniscus is located. Or the pain may be more vague and involve the whole knee
The knee may swell, causing it to feel stiff and tight. This is usually because fluid accumulates inside the knee joint. This is sometimes called water on the knee. This is not unique to meniscal tears, since it can also occur when the knee becomes inflamed.
The knee joint can also lock up if the tear is large enough. Locking refers to the inability to completely straighten out the knee. This can happen when a fragment of the meniscus tears free and gets caught in the hinge mechanism of the knee, like a pencil stuck in the hinge of a door.
A torn meniscus can cause long-term problems. The constant rubbing of the torn meniscus on the articular cartilage may cause the joint surface to become worn, leading to chondromalacia (softening of the cartilage) which is a precursor to Osteoarthritis.
Torn Meniscus Without Chondromaicia
Torn Meniscus With Chondromaicia
Diagnosis
How do doctors identify this problem?
Diagnosis begins with a history and physical exam. Your doctor will try to determine where the pain is located, whether you’ve had any locking, and if you have any clicks or pops with knee movement. X-rays will not show the torn meniscus. X-rays are mainly useful to determine if other injuries are present.
Magnetic resonance imaging (MRI) is very good at showing the meniscus. The MRI machine uses magnetic waves rather than X-rays to show the soft tissues of the body. This machine creates pictures that look like slices of the area. Usually, this test is done to look for injuries, such as tears in the menisci or ligaments of the knee. This test does not require any needles or special dye and is painless.
MRI of Meniscus without Tear
MRI of Meniscus with Tear
Treatments
Non-surgical
Initial treatment for a torn meniscus focuses on decreasing pain and swelling in the knee. Rest and anti-inflammatory medications, such as aspirin, can help decrease these symptoms. You may need to use crutches until you can walk without a limp.
Some patients may receive physical therapy treatments for meniscal problems. Therapists treat swelling and pain with the use of ice, electrical stimulation, and rest periods with your leg supported in elevation. Exercises are used to help you regain normal movement of joints and muscles.
Surgery
If the knee continues to be painful, keeps locking up, giving out or can’t be straightened out, surgery may be recommended as soon as reasonably possible to remove the torn part that is getting caught in the knee joint. But even a less severely torn meniscus may not heal on its own. If symptoms continue after nonsurgical treatment, surgery will probably be suggested to either remove or repair the torn portion of the meniscus.
Surgeons use an arthroscope (mentioned earlier) during surgery for an injured meniscus. A small incision (about 5 mm) is made in the knee to allow the insertion of the camera into the joint. A second small incision is made to insert small instruments such as shavers, probes and biters to perform any necessary procedures.