Due to its anatomical structure and multitude of functions, the knee joint needs soft tissue support to remain in balance and perform its functions. Soft tissue supports of the knee joint are examined in 2 groups: intra-articular and extra-articular.
1-Intra-articular structures:
Anterior cruciate ligament
Posterior cruciate ligament
Internal meniscus
External meniscus
2-Extra-articular structures:
Internal lateral ligament
External lateral ligament
Muscles
Injury in one or more of these structures It may impair the functions of the knee joint as well as disrupt the anatomical integrity of the joint. Knee injuries are generally in the form of sports injuries, but they also occur in the form of traffic accidents, falls from height, direct blows and knee sprains. The severity of the injury is generally directly proportional to the damage to the joint. Treatment should be considered in two stages: First of all, emergency treatment; What to do immediately after injury. In the second stage, the treatment that will ensure the structural and functional integrity of the knee.
Emergency Treatment: In the first stage, it should be checked whether there is a dislocation or fracture in the joint, and if there is, urgent treatment should be performed. Vascular and nerve injuries are frequently seen in knee injuries, especially in dislocations. These must be evaluated and treated urgently. If there is no vascular or nerve injury, the damaged joint should be rested (with a cast, bandage or knee pad) and the joint should be allowed to calm down with ice application and medication. During this period, the patient should avoid stepping on his leg and use crutches if necessary. After the joint has calmed down, the knee should be re-evaluated by the orthopedist and the degree of ligament injury in the joint should be determined.
Stage I: There is an incomplete tear in the ligament. There is continuity of the ligament and the findings are usually mild. In the first stage, rest, ice and medication are sufficient. Stage II: The ligament is not completely torn, but there is elongation and stretching in the neck. They can usually be treated by fixing the joint for 3-4 weeks, but if there is no complete recovery, surgical treatment may be required. Stage III: The ligament is completely ruptured. There is a feeling of emptiness in the joint. Non-surgical treatments can be applied in such injuries, but if there is not sufficient recovery, A permanent feeling of emptiness and subluxation (semi-dislocation) may develop in the joint. In this case, the ligament will need to be repaired or restructured.
The most frequently injured ligaments of the knee joint are the internal lateral ligament, anterior cruciate ligament and external lateral ligaments. The posterior cruciate ligament is rarely torn and usually occurs as a result of direct blows to the knee. Ligament injuries can be single or multiple ligament injuries. This usually results in knee dislocation and is a serious injury. Surgical treatment is often required after emergency treatment.
Internal collateral ligament injuries: Since the internal collateral ligament prevents the opening of the inner part of the knee, it can be injured due to excessive tension in side impacts to the knee while standing. In this case, the inner part of the knee opens while the outer part narrows. This injury may occur alone or in combination with other ligament injuries. The most commonly injured structures, along with the medial collateral ligament, are the anterior cruciate ligament and meniscus. It is important whether there is any additional injury in the treatment. While non-surgical treatments are generally sufficient for isolated injuries, surgical treatment may be required if accompanied by cruciate ligament and meniscus injury.
External collateral ligament injury: In the external collateral ligament, it works exactly opposite to the mechanism. With a blow to the inner side of the knee, the outer side opens while the inner side closes, and increased tension in the outer collateral ligament may lead to injury. Healing is slower and more difficult than the internal collateral ligament. For this reason, the fixation period of the knee should be longer than the internal collateral ligament. Its treatment is similar to the internal collateral ligament in stage I and II injuries. Surgery is required in Stage III injuries.
Anterior cruciate ligament injuries: They mostly occur as sports injuries. Especially in sports performed on artificial turf, the ligament is torn as a result of the foot remaining fixed on the ground and the thigh turning outwards during reverse movements due to the non-slip nature of the field. Treatment of anterior cruciate ligament injuries is generally determined by the patient's needs, knee instability, and the presence of additional injuries. Surgical treatment should be applied if the patient is active in sports and wants to continue, if he is young, if the feeling of emptiness in the knee negatively affects his daily life or professional life, and if there is additional meniscus or ligament injury. Ligament repair in surgical treatment increases the healing potential of cruciate ligaments. Reconstruction of the ligament is preferred due to its failure due to inadequacy. Generally, the kneecap tendon or posterior muscle tendon taken from the person is used. Cadaveric beams can also be used.
Physical therapy is essential for knee ligament injury, whether the treatment is surgical or non-surgical. Maintaining the range of motion of the joint and strengthening the muscles during and after the treatment affects the success of the treatment.
Meniscus injury: menisci have very important functions in the knee joint. These are load transmission, ensuring the harmony of the femur and shin bone during movements, and ensuring the stability of the joint (the joint remains in place). The mechanism of injury usually occurs when the thigh is forced to externally rotate while the foot is fixed on the ground. In older patients, if there is wear on the meniscus, it may occur with simpler strains (such as kneeling, going down stairs, stepping down). Injury history and examination are usually sufficient for the diagnosis of meniscus tears. If additional injury is suspected and the clinic is not clear, diagnosis can be made by MRI. The patient's complaints and the degree of tear are important in deciding the treatment. Generally, the preferred treatment is to clean the torn parts of the meniscus with a closed method by imaging the joint with a camera. Meniscus repair can be performed in suitable patients and tears.
Muscle injury: Injury to the muscles around the knee joint occurs when the muscles are exposed to excessive tension as a result of not doing enough warm-up exercises before sports. Serious injuries are rare and usually occur as minor muscle tears. Treatment mostly consists of rest, ice and medication followed by physical therapy. Rarely, the muscles may rupture completely from their attachment points to the bone. In this case, depending on the function of the muscle, it may need to be surgically stitched.
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