Kategoriarkiv: _Degenerative arthritis in the hip joint

Baker cyst

_Degenerative arthritis in the hip joint

SYNOVIAL FLUID IN THE POPLITEAL SPACE

Diagnosis: SYNOVIAL FLUID IN THE POPLITEAL SPACE
(Baker’s cyst)


Anatomy: If an excess of fluid is formed in the knee joint, the synovial fluid will be pressed through the weakest point of the rear of the joint-capsule, and accumulate in an outpouching in the hollow (popliteal space) of the knee (Baker’s cyst).
Cause: Injuries in the knee that bring about inflammation of the synovial membrane (synovitis), causing formation of an excess of synovial fluid in the knee. The fluid is pressed out through the joint-capsule and accumulates in the popliteal space (Baker cyst). The Baker cyst is consequently a symptom of something not right in the knee. The connection from the joint to the Baker cyst can in some cases become strangulated, meaning that the Baker cyst can still be present even thought he injury in the knee has healed.

Symptoms: A sensation of the popliteal space being filled up, and difficulty in flexing the knee completely. There is often also discomfort from the changes in the knee that provoked the Baker cyst.

Examination: As the presence of a Baker cyst is usually a symptom of an injury in the knee, anyone with a Baker cyst or discomfort in the knee should undergo a medical examination. It will often prove difficult to diagnose even a large Baker cyst from a normal examination, and the diagnosis is made easiest and swiftest from an ultrasound scan (Ultrasonic image).

Treatment: Treatment is naturally dependant upon the injury in the knee joint that has provoked the Baker cyst. The accumulation in the knee and the Baker cyst can be treated with rheumatic medicine (NSAID) or more effectively by injection of corticosteroid in the knee (or the Baker cyst), preceded by draining of the fluid which can advantageously be performed under ultrasound guidance. Synovial fluid can be drained from the Baker cyst if there is a connection between the knee joint and the Baker cyst, and ultrasound scanning will show the injected corticosteroid spread through the knee joint as well as the Baker cyst (article). The content of the Baker cyst is often quite thick (gelatinous) if the Baker cyst does not communicate with the knee joint.

Rehabilitation: Treatment is completely dependant upon the provoking cause of the Baker cyst.
Also read rehabilitation, general.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct. Amongst others, the following should be considered:

The bursa can become infected with bacteria in rare cases. This is a serious condition where the bursa becomes red, warm and increasingly swollen and tender. This condition requires immediate medical examination and treatment. If relief and medicinal treatment (including ultrasound guided injection of corticosteroid) does not produce any progress, a surgical removal of the bursa can be attempted.

Outer collateral ligament rupture

_Degenerative arthritis in the hip joint

OUTER COLLATERAL LIGAMENT RUPTURE

Diagnosis: OUTER COLLATERAL LIGAMENT RUPTURE
(Ruptura ligamentum collaterale laterale/fibulare)


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the kneecap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius and ligamentum cruciatum posterius).

  1. Ligamentum cruciatum posterius
  2. Ligamentum collaterale mediale/tibiale
  3. Meniscus medialis
  4. Insertio anterior menisci medialis
  5. Ligamentum transversum genus
  6. Tibiae
  7. Fibulae
  8. Ligamentum cruciatum anterius
  9. Ligamentum collaterale laterale/fibulare
  10. Meniscus lateralis
  11. Femur

KNEE FROM THE FRONT

  1. M. gastrocnemius
  2. Caput fibulae
  3. B. subtendinea m. bicipitis femoris inferior
  4. M. biceps femoris
  5. Ligamentum collaterale laterale/fibulare
  6. M. plantaris

OUTER LOWER LEG

Cause: When the shin bone is pressed inwards in relation to the thigh bone the outer side-ligament is stretched. If the load becomes sufficiently powerful (as is the case when the load is sudden, so that the thigh muscles do not have time to tighten and stabilize the joint) the ligament can rupture.

Symptoms: Sudden pain on the outside of the knee. Occasionally a snap is felt when the ligament ruptures. In severe cases the athlete complains about a sense of looseness in the knee.

Acute treatment: Click here.

Examination: If a total or partial rupture of the ligaments in the knee is suspected, you should seek medical attention for a diagnosis. The doctor can perform various knee tests to examine the stability of the knee (external side-instability-test) . If the knee is stable the injury is called a “sprain” of the outer side-ligament. If the knee is loose the injury is called a “rupture” of the ligament. The diagnosis is usually made from a normal medical examination. If there are any doubts surrounding the diagnosis, an ultrasound scan can be performed which will reveal the rupture and the bleeding along the ligaments (Ultrasonic image).

Treatment: The treatment of a partial or total rupture of the outer side-ligament involves relief and rehabilitation. If the knee is markedly loose, you can, for a short period, use a support splint (Don Joy). With pronounced sideways looseness surgery can be considered (article). (However if the rupture of the outer side-ligament is combined with other ligament ruptures, as is often the case, surgery is recommended).

Bandage: Hinge bandages can be used initially (Don Joy). Tape treatment of ligament ruptures in the knee have no sure effect.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Supplementary examinations (X-ray, ultrasound, MR scan or arthroscopy) will often be required. The following should be considered:

An inflammation by the ligament fastening is sometimes seen later in the course of the injury, and in some cases bursitis at the ligament fastening is seen. The inflammation and bursitis can possibly be treated with medication (rheumatic medicine (NSAID) or the injection of corticosteroid), if further relief has no effect (article).

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Inner collateral ligament rupture

_Degenerative arthritis in the hip joint

INNER COLLATERAL LIGAMENT RUPTURE

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Diagnosis: INNER COLLATERAL LIGAMENT RUPTURE
(Ruptura ligamentum collaterale mediale/tibiale)


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius and ligamentum cruciatum posterius).

  1. Ligamentum cruciatum posterius
  2. Ligamentum collaterale mediale/tibiale
  3. Meniscus medialis
  4. Insertio anterior menisci medialis
  5. Ligamentum transversum genus
  6. Tibiae
  7. Fibulae
  8. Ligamentum cruciatum anterius
  9. Ligamentum collaterale laterale/fibulare
  10. Meniscus lateralis
  11. Femur

KNEE FROM THE FRONT

  1. Tendo m. adductoris magni
  2. Retinaculum patellae mediale
  3. Meniscus medialis
  4. Ligamentum collaterale mediale/tibiale
  5. Bursa anserina
  6. Bursa subtendinea m. sartori
  7. Ligamentum patellae
  8. Patella

KNEE FROM THE FRONT

Cause: When the shin bone is pressed outwards in relation to the thigh bone the inner side-ligament is stretched. If the load becomes sufficiently powerful (as is the case when the load is sudden, so that the thigh muscles do not have time to tighten and stabilize the joint) the ligament can rupture.

Symptoms: Sudden pain on the inside of the knee. Occasionally a snap is felt when the ligament ruptures. In severe cases the athlete complains about a sense of looseness in the knee.

Acute treatment: Click here.

Examination: If a total or partial rupture of the ligaments in the knee is suspected, you should seek medical attention for a diagnosis. The doctor can perform various knee tests (internal side-instability-test) to examine the stability of the knee. If the knee is stable the injury is called a “sprain” of the inner side-ligament. If the knee is loose the injury is called a “rupture” of the ligament. The diagnosis is usually made from a normal medical examination. If there are any doubts surrounding the diagnosis, an ultrasound scan can be performed which will reveal the rupture and the bleeding along the ligaments (Ultrasonic image) .

Treatment: The treatment of a partial or total rupture of the inner side-ligament involves relief and rehabilitation. If the knee is markedly loose, you can, for a short period, use a support splint (Don Joy). Surgical treatment previously considered has today largely been abandoned in uncomplicated ruptures of the inner side-ligament (article). (However if the rupture of the inner side-ligament is combined with other ligament ruptures, many would recommend surgery).

Bandage: Hinge bandages can be used initially (Don Joy). Tape treatment of ligament ruptures in the knee have no sure effect.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Supplementary examinations (X-ray, ultrasound, MR scan or arthroscopy) will often be required. The following should be considered:

An inflammation by the ligament fastening is sometimes seen later in the course of the injury, and in some cases bursitis at the ligament fastening is seen. The inflammation and bursitis can possibly be treated with medication (rheumatic medicine (NSAID) or injection of corticosteroid), if further relief has no effect.

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Inflammation of the bursa

_Degenerative arthritis in the hip joint

INFLAMMATION OF THE BURSA

Diagnosis: INFLAMMATION OF THE BURSA
(Bursitis)


Anatomy: There are numerous bursas around the knee for the purpose of reducing the pressure on the muscles, tendons and ligaments which lie close to bone projections. Bursas can be present at all muscle fastenings around the knee, externally (i.e. bursa pes anserinus, bursa subtendinea m bicipitis), internally, to the front (i.e. bursae prepatellaris, bursa infrapatellaris profunda) and to the rear of the knee (i.e. bursae m semimembranosus, bursa subtendinea m gastrocnemii medialis & lateralis, Baker cyst).

  1. M. gastrocnemius
  2. M. plantaris
  3. M. soleus
  4. Tendo m. gastrocnemii
  5. Tendo calcaneus (Achillis)
  6. M. popliteus
  7. Bursa m. semimembranosi
  8. M. semimembranosus
  9. Bursa subtendinea m. gastrocnemii medialis

KNEE FROM THE REAR

Cause: The bursas can become inflamed, produce fluid, swell and become painful with repeated over-load or due to blows. Although the condition is termed inflammation of the bursa, there is not often an infection in the bursa.

Symptoms: Pain when applying pressure to the bursa, which sometimes, but far from always, can give the impression of being swollen. The pain is aggravated when the muscle above the bursa is activated.

Acute treatment: Click here.

Examination: Medical examination is usually not required in light cases with only minimal tenderness. With more pronounced pain, or lack of improvement, medical examination should always be performed to confirm the diagnosis and commencement of treatment if required. The diagnosis is usually made from a normal medical examination, however, if any doubts arise an ultrasound scan can be performed which is most well suited to confirm the diagnosis.

Treatment: Treatment is primarily concentrated on providing rest. Treatment can be supplemented with rheumatic medicine (NSAID) or injection of corticosteroid in the bursa preceded by draining, which can be best performed under ultrasound guidance (article).

Rehabilitation: Treatment is completely dependent upon which bursa is inflamed, but the sports activity can usually be cautiously resumed when the pain has diminished, especially if the provoking factor has been identified and removed.
Also read rehabilitation, general.

Complications: If there is not a steady improvement in the condition consideration must be given as to whether the diagnosis is correct, or if complications have arisen:

In rare cases, the bursa can be infected with bacteria. This is a serious condition if the bursa becomes red, warm and increasingly swollen and tender. This condition requires immediate examination and treatment. If relief and medicinal treatment (including ultrasound guided injection of corticosteroid) does not produce any progress, a surgical removal of the bursa can be attempted.

Special: Shock absorbing shoes or inlays will reduce the load. If there is a lack of progress or a relapse after successful rehabilitation, consideration must be given to performing a running style analysis to establish whether a correction of the running style should be recommended.

Inflamed mucous fold (plica synovialis)

_Degenerative arthritis in the hip joint

INFLAMMATION OF THE MUCOUS FOLD

Diagnosis: INFLAMMATION OF THE MUCOUS FOLD
(Plica synovialis)


Anatomy: The joint cavity in the knee joint is covered with a thin synovial membrane (synovialis). Four mucous folds (plica synovialis) can develop in the membrane: one fold in the inner joint chamber (medial plica), outer joint chamber (lateral plica), upper (suprapatellar) and front (anterior plica). A mucous fold is found in the inner joint chamber (medial plica) in almost 50% of all people (article).

Cause: The mucous fold will become inflamed if an entrapment of the fold occurs, or if the fold suffers internal bleeding. This will result in thickening and subsequently cause pain.

Symptoms: The mucous fold in the inner joint chamber (medial plica) will most often give symptoms which are difficult to distinguish from the symptoms of a meniscus lesion. The pain is usually localised on the inner side of the knee cap, in front of the inner joint line. The pain often occurs quite suddenly following certain movements, and can be accompanied by swelling in the knee. The knee can lock if a flap of the mucous fold becomes entrapped (article).

Examination: A medical examination is always necessary to ensure the diagnosis if there is any suspicion of an inflamed mucous fold in the knee. A tender string inside the knee cap can occasionally give a slipping sensation, but often a normal clinical examination is not sufficient. It is often necessary to perform an arthroscopic examination (telescopic examination of the joint) or MR-scan to make the diagnosis (article).

Treatment: Treatment comprises relief and careful rehabilitation of the knee. If the discomfort does not slowly diminish, the treatment can be supplemented with rheumatic medicine (NSAID) or injection of corticosteroidi in the mucous fold. Medial synovial shelf plica syndrome. Treatment by intraplical steroid injection. If this does not give the desired results, the mucous fold can be removed by arthroscopy (telescopic examination of the knee).

Exerting load on the knee can commence as soon as the pain and swelling in the knee has diminished. In the best cases, full activity is possible after a period of a few weeks. In uncomplicated cases, it should be possible to resume a full level of sports activity during the course of a month. Rehabilitation must not be allowed to cause increased swelling (or pain) in the knee.

Complications: If insufficient progress is made prior to an operation it must be considered if the diagnosis is correct. Supplementary examinations will often be required (X-ray, ultrasound or MR scan). In particular the following should be considered:

Following an arthroscopic examination fluid accumulation in the joint (traumatic arthritis/synovitis), should be considered, as well as infection in the scar or knee joint, which will always require medical attention as soon as possible.

Bone membrane tear (periosteal avulsion)

_Degenerative arthritis in the hip joint

BONE MEMBRANE TEAR

Diagnosis: BONE MEMBRANE TEAR
(Perisotael avulsion)


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin-bone (tibia) and the knee cap (patella). A small joint is also formed between the shin-bone and the calf bone (fibula).

  1. Patella
  2. Tibiae
  3. Meniscus lateralis
  4. Femur

KNEE JOINT

Cause: A violent twist in the knee joint can stretch the ligaments and tear a small piece of bone membrane from the ligament attachment point. In the majority of cases the symptoms will diminish after a few weeks, however, in some cases the tears will provoke an inflammation and can be of a longer duration. Bone membrane tears in the knee joint area are common, and can be seen in most cases where the person has played football for many years (“football-knee”). Bone membrane tears can occur on all the bones of the knee where tendons or ligaments are attached, but is most commonly seen on the inner and outer part of the knee joint as a consequence of previous spraining of the collateral ligaments.

Symptoms: Pain when applying pressure, and when stretching the tendon or ligaments which are attached to the bone where the tear has occurred.

Acute treatment: Click here.

Examination: Normal clinical examination is often sufficient. Larger tears can be seen on an X-ray. Many lesser tears can be best seen via an ultrasound scan, from which an inflammation surrounding the tear can also be seen (Ultrasonic image).

Treatment: Minor tears merely require relief from the pain inducing activities. Larger tears can require surgery. Some cases can cause prolonged discomfort with pain that does not recede despite relief. This can be due to the tear causing chronic inflammation in the tissue. In such cases, rheumatic medicine (NSAID) or injection of corticosteroid in the area surrounding the tear can be recommended.

Rehabilitation: Rehabilitation is totally dependent upon the type of tear, and the treatment (conservative or surgical). The tears on the inner side of the knee are usually re-trained in the manner of inner collateral ligaments ruptures, whilst tears externally to the knee are re-trained as outer collateral ligament ruptures.
Also read rehabilitation, general.

Complications: If smooth progress is not achieved it should be considered whether the diagnosis is correct, which will often require supplementary examination (X-ray, ultrasound scanning or MR scanning). The following should especially be considered:

Cartilage damage (osteochondral lesions)

_Degenerative arthritis in the hip joint

CARTILAGE DAMAGE IN THE JOINT

Diagnosis: CARTILAGE DAMAGE IN THE JOINT
(Osteochondral lesion)


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin-bone (tibia) and the knee cap (patella). The articular surfaces of the thigh bone, shin-bone and knee cap are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

Cause: Twists in the knee joint causing the thigh bone and shin bone to collide can cause damage to the cartilage in the knee. In some cases a piece of cartilage can be shed which can wander in the joint (joint-mouse) and become inflamed and increase the production of synovial fluid.

Symptoms: Pain in the joint when under load or strain. Often, periodic swelling of the joint (synovitis).

Examination: Normal medical examination is often not sufficient. To make the diagnosis correctly it is therefore necessary to perform an arthroscopic examination (telescopic examination of the joint (Photo) or an MR-scanning  (Ultrasonic image).

Treatment: Treatment comprises relief from the painful activities until the pain is no longer experienced, after which gradual re-training can be commenced. There is no treatment that can restore the damaged cartilage, which has itself poor restorative ability. Different procedures to enhance the healing can be attempted using arthroscopy, however, the results are generally unsatisfactory. Results from experimental cartilage transplants are still not successful enough to warrant introduction as a routine treatment in the near future (article). Joint-mouse that provokes the symptoms must be surgically removed. Injection of corticosteroid in the knee joint, performed under ultrasound guidance, can be attempted to combat prolonged and pronounced cases of fluid accumulation in the knee joint (synovitis).

Rehabilitation: Rehabilitation is completely dependent upon the type of cartilage damage (size and position in the joint) and treatment (conservative or surgical). It is generally attempted to strengthen the musculature around the knee joint.
Also read rehabilitation, general.

Complications: Large cartilage damage which is positioned on the weight-bearing parts of the joint represents one of the most serious sports injuries, and often results in an end to the sporting career.

Special: As there is a risk that the injury can cause permanent disability, all cases should be reported to your insurance company.

Meniscus lesion

_Degenerative arthritis in the hip joint

MENISCUS LESION

Diagnosis: MENISCUS LESION


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). The articular surfaces on the thigh bone, shin bone and the knee cap are covered with a few mm thick cartilage coating which serves to reduce the strain on the articular surfaces. There is a ring-formed cartilage disk (meniscus) internally and externally in the joint. The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). The internal meniscus is attached to the inner collateral ligament, whereas the external meniscus is not attached to the outer collateral ligament.

  1. Ligamentum cruciatum posterius
  2. Ligamentum collaterale mediale/tibiale
  3. Meniscus medialis
  4. Insertio anterior menisci medialis
  5. Ligamentum transversum genus
  6. Tibiae
  7. Fibulae
  8. Ligamentum cruciatum anterius
  9. Ligamentum collaterale laterale/fibulare
  10. Meniscus lateralis
  11. Femur

KNEE JOINT FROM THE FRONT

 

  1. Ligamentum transversum genus
  2. Meniscus lateralis
  3. Meniscus medialis
  4. Insertio anterior menisci

KNEE JOINT FROM ABOVE

Cause: Meniscus lesions often occur when the knee is stretched at the same time as rotating. The meniscus will consequently be squeezed between the thigh bone and the shin bone. The inner meniscus is more often damaged than the external. Meniscus injuries in children is very rare (article).

Symptoms: Pain along the joint line when applying pressure and when rotating the knee. The pain often occurs suddenly when performing certain movements, and can be accompanied by swelling of the knee. In some instances the knee can lock due to a splinter from the meniscus becoming jammed. In other cases, a small and tender outpouching of fluid can be sensed at the joint line (meniscus cyst). Prolonged discomfort will often cause the thigh muscle to diminish.

Acute treatment: Click here.

Examination: A medical examination is always necessary if there is any suspicion of injury within the knee joint. A normal clinical examination is often not sufficient. The doctor can perform various knee tests (meniscus test), however, there is typically tenderness along the joint line which is aggravated when rotating the knee joint. It is often necessary to perform an arthroscopy (telescopic examination of the joint), MR-scan or ultrasound scan to make the diagnosis (article) (Ultrasonic image).

Treatment: In uncertain cases the treatment comprises relief and rehabilitation of the knee. If the discomfort does not slowly diminish, if there are instances of “locking” or if it is clear that the meniscus lesion is large (e.g. assessed from an ultrasound scan), surgery should be considered. Under an operation, it can be attempted to sew the torn piece of meniscus back (which will require a considerably longer rehabilitation period, but will probably in the long term reduce the risk of degenerative arthritis in the knee) (article). The torn piece of meniscus is usually removed, but in rare cases the whole meniscus is taken out.

Following an operation, exerting load on the knee can commence as soon as the pain and swelling in the knee has diminished. In the best cases, full activity is possible after a period of a few weeks. In uncomplicated cases, it should be possible to resume a full level of sports activity during the course of a month. Rehabilitation must not be allowed to cause increased swelling (or pain) in the knee.

Complications: If insufficient progress is made prior to an operation it must be considered if the diagnosis is correct. Supplementary examinations will often be required (X-ray, ultrasound or MR scan). In particular the following should be considered:

Following an arthroscopy, fluid accumulation in the joint (traumatic arthritis/synovitis) should be considered, and infection in the scar or knee joint, which will always require medical attention as soon as possible.

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Anterior collateral ligament rupture

_Degenerative arthritis in the hip joint

RUPTURE OF THE ANTERIOR CRUCIATE LIGAMENT

Diagnosis: RUPTURE OF THE ANTERIOR CRUCIATE LIGAMENT
(Ruptura ligamentum cruciatum anterius)


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius and ligamentum cruciatum posterius).

  1. Ligamentum cruciatum posterius
  2. Ligamentum collaterale mediale/tibiale
  3. Meniscus medialis
  4. Insertio anterior menisci medialis
  5. Ligamentum transversum genus
  6. Tibiae
  7. Fibulae
  8. Ligamentum cruciatum anterius
  9. Ligamentum collaterale laterale/fibulare
  10. Meniscus lateralis
  11. Femur

KNEE JOINT FROM THE FRONT

Cause: Rupture of the anterior cruciate ligament usually occurs during running with fast changes of direction or as the result of a fall while skiing. Most injuries occur without contact with an opponent.

Symptoms: Usually a snap can be heard or felt and continued sports activity must be aborted. The knee swells within the first few hours, after which the knee can not bend completely. You can subsequently often sense that the leg gives way (knee failure).

Acute treatment: Click here.

Examination: If a partial or complete rupture of the cruciate ligament is suspected, you should seek medical attention (casualty ward) immediately, to obtain a diagnosis. The doctor can perform various tests on the knee (front drawer looseness, Lachmann, Pivot shift) to examine the stability of the knee. It should be noted that the looseness in the knee can often only be demonstrated after two weeks. The fluid in the knee can be drained. Blood in the knee provides a very strong suspicion of a rupture of the anterior cruciate ligament. The bleeding that occurs after a rupture of the anterior cruciate ligament can usually be seen in an ultrasound scan (Ultrasonic image) (article) or MR-scan. Arthroscopy (a telescopic examination of the knee) is the best suited examination if there is any doubt in the diagnosis.

Treatment: Young athletes or others with physically demanding work will usually be advised surgery with the insertion of a new cruciate ligament (article).

An intensive rehabilitation period of at least six months is to be expected. It is important that the knee is stretched completely at least twice a day. The surgeon should be consulted if problems occur with stretching the knee completely.

Bandage: Hinge bandages (Don-Joy) can be utilised the first few weeks. Tape treatment of cruciate ligament ruptures in the knee has no sure effect.

Complications: In case of lack of progress you should consider various complications to the surgery:

In cases where the knee cap tendon is used as a new cruciate ligament an inflammation, is often seen where the knee cap tendon has been removed. With prolonged discomfort which does not diminish following relief, medical treatment in form of rheumatic medicine (NSAID) or injection of corticosteroid along the inflamed part of the knee cap tendon can be attempted (article).
Less than half the athletes suffering a rupture of the anterior cruciate ligament are able to resume sports activity on the same level as prior to the injury (article).

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Bursitis

_Degenerative arthritis in the hip joint

DEGERATIVE ARTHRITIS

Diagnosis: DEGERATIVE ARTHRITIS
(Osteoarthritis)


Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin-bone (tibia) and the knee cap (patella). The articular surfaces of the thigh bone, shin-bone and knee cap are lined with a cartilage covering of a few millimetre’s thickness which serves to reduce the load or strain on the joint surfaces.

  1. Patella
  2. Tibiae
  3. Meniscus lateralis
  4. Femur

KNEE JOINT

Cause: Repeated and uniform loads can cause damage to the cartilage, and subsequently the bone beneath the cartilage (degenerative arthritis). of the synovial membrane (synovitis), which will cause formation of fluid, swelling, reduction in mobility and pain in the knee joint. Degenerative arthritis in the knee joint is often seen after a previous rupture of the anterior cruciate ligament, rupture of the posterior cruciate ligament eller meniscus lesion, where it has been necessary to remove the whole or part of the meniscus.

Symptoms: Pain in the joint with movement under load or strain. Difficulties in the start up phase are often experienced, alleviated after warm-up, but with pain again after a prolonged period under load. Swelling of the joint (synovitis) in occasional cases. With pronounced swelling, a fluid filled bursa can develop in the hollow (popliteal space) of the knee (Baker cyst).

Examination: Normal medical examination is usually sufficient to make the diagnosis, however, it is also often necessary to perform an x-ray (or ultrasound scan or MR scan) to make the diagnosis.

Treatment: Treatment comprises relief from the pain inducing activities until the swelling has gone down, after which training can commence with the primary aim to strengthen the muscles surrounding the joint and retain joint mobility (article). There is no treatment which can restore the damaged cartilage (and bone). Cartilage transplants are, as yet, not suitable for general degenerative arthritis. In cases of swelling in the joint (and popliteal space), inflammation of the synovial membrane (synovitis) can be attempted subdued by using rheumatic medicine (NSAID), or by draining the fluid and injecting corticosteroid. The injections can be performed to advantage by utilising an ultrasound guided method (Ultrasonic image). Pain without swelling of the joints is best treated with paracetamol. In severe cases of degenerative arthritis where there is pain when resting (at night), it may be necessary to replace the joint.

Rehabilitation: Rehabilitation is primarily aimed at strengthening the thigh muscles, whereby the joint can be stabilised and relieved to a certain extent.

Complications: Degenerative arthritis which is positioned on the weight-bearing parts of the joint surfaces represents one of the most serious sports injuries, and often results in an end to the sporting career. It is usually possible to participate in sports with lesser knee straining activity (i.e. swimming), whereas sports with great knee straining activity (i.e. running, football) should be treated with reservation.

Special: Shock absorbing shoes or inlays will reduce the load on the knee.