Locations

Trauma medical clinic Canazei
Stréda de Cercenà, 8
38032 Canazei (Trento) - ITALY
telephone (+39) 0462 601476
fax (+39) 0462 601607

 

Trauma medical clinic Alta Badia
Strada Boscdaplan 13/b
39030 La Villa (Bolzano) - ITALY
telephone (+39) 0471 1726552
fax (+39) 0471 1726553

 

Trauma medical clinic Riccione
Via Santorre di Santarosa,17
47838 Riccione (RN) - ITALIA
tel. (+39) 0541 1494370
fax (+39) 0541 1494374

THE KNEE

The knee is the largest joint of our body and it consists of the following structures:

  • bones: femur, tibia and kneecap
  • ligaments: anterior cruciate ligament, posterior cruciate ligament, medial and lateral collateral ligament
  • meniscus: medial and lateral
  • cartilage

THE LIGAMENTS 

What are they and what are they for?

The ligaments are fibrous cord structures that connect the bones of the joint, ensuring its stability.

The knee has four major ligaments, two in the periphery of the joint, which are called collateral ligaments, while the other two are exactly in the middle and are called cruciate ligaments. So there is a medial and a lateral collateral ligament, an anterior and a posterior cruciate ligament.

How do they get injured?

The typical mechanism of a ligament injury is a sprain. The patient reports generally that he has fallen during sporting activities such as football or skiing, or that there has been a crack inside the knee during a rotation of it.

What are the symtomps?

The lesion of a ligament causes immediate and acute pain. It may happen, in particular in the lesion of the anterior cruciate ligament that the knee swells, because blood has been collected inside of the joint consequently to the ligament rupture itself.  When this occurrence is accompanied by severe pain and tension felt inside of the knee, it may be advisable to aspirate the effusion.

Another symptom that frequently patients report is the insecurity due to the fact that the knee is not supporting the weight of the body and tends to sag. This symptom is called instability and is the consequence of the fact that the ligament being damaged can no longer perform its stabilizing function.

How should you behave?

When a trauma with the above described features occurs you should go to your orthopedic structure of trust, so that the necessary examination can be executed. A good clinical examination by a specialist can already put the suspicion of a ligament injury. In the presence of this suspicion the execution of a MRI (magnetic resonance imaging) is recommended (unless contraindicated), to confirm the diagnosis and to detect possible injuries associated with load of other ligaments, bone, cartilage or meniscus.

How are ligament injuries treated?

The treatment that the orthopedist may recommend varies depending on the injured ligament, the degree of joint instability, the age of the patient and the type of activities that the patient performs normally.

The medial collateral ligament, for its biological characteristics, tends in the most cases to heal spontaneously with a simple conservative treatment, using an articulated brace for a suitable period of time, without the need of a surgical intervention.

Unlike the external collateral ligament, especially if completely damaged and in combination with other ligaments, imposes very often an urgent surgical indication.

The anterior cruciate ligament never heals spontaneously and tends gradually to “die” and atrophy and the absence of its function can determine over the time the onset of lesions of the remaining articular components and particularly of the meniscus and cartilage. So in selected cases depending on the extent of instability, on the age and functional requirements, it may be appropriate to plan a reconstruction surgery, if possible even quite early.

How do you rebuild the anterior cruciate ligament?

Unfortunately it is not possible to repair the anterior cruciate ligament but you need to replace it using another tissue that is positioned to replace the injured ligament to perform his same function. This tissue is usually taken from the same patient’s knee and consists of a part of the patellar tendon or the semitendinosus and gracilis tendons, taken from the knee in correspondence of the so called “goosefoot”.

In selected cases it is necessary to resort to the use of tissue from the donor or artificial. To place the new ligament within the knee, you run, under arthroscopic vision, a perforation with a diameter of about 1 cm in the tibia and femur. The new ligament is passed through these tunnels and finally set at the same femur and tibia with mostly absorbable systems. At the end of the intervention then, the patient will have two small skin incisions of a few millimeters through which the toolkits were passed and a longer incision, which was necessary for the drawing of the tissue and which varies in its length and location depending on the type of tissue taken. 

THE MENISCUSES 

 Within each knee there are two meniscuses, one medial and one lateral.

What are they and what are they for?

They are crescent-shaped fibro-cartilaginous structures placed between femur and tibia.

The meniscuses play fundamental functions in the balance of the knee joint. In particular they absorb the joints stress, thus acting as a shock absorber, distribute loads evenly from the cartilage of the femur to the one of the tibia and increase joint stability.

How do they get injured?

Meniscal tears in a young patient are typically related to a traumatic sprain event. Unlike in older patients a meniscal tear can result from a simple age-related degenerative process and occurs as a result of minor trauma or no trauma, and is often associated with changes in the cartilage especially in individuals with an axis deviation with varus or valgus (the so called “bow-leg” or “knocked-knee”).

What are the symptoms?

Normally a patient with a meniscal tear complains of pain. Sometimes this symptom is associated with pseudo sagging and joint locks. Sometimes the knee may swell.

What should you do?

It is good that the patient goes to the specialist of confidence so that he can visit him and then establish a diagnosis of suspicion. It will be a MRI to confirm the presence of a possible meniscal tear or detect any other associated injuries (ligament-osteochondral). 

How is a meniscus lesion treated?

In view of the important role that the treatment of a meniscal lesion plays, it should be targeted, if possible, to the preservation of the meniscal function itself. Sometimes, in particular degenerative or small traumatic injuries can be treated conservatively without the need for surgery.

Otherwise the intervention that is performed most frequently is the arthroscopically removal only of the part of the meniscus affected by the lesion (selective menisectomy). Sometimes, in the presence of lesions with well-defined characteristics, mostly in young patients, it is possible, under arthroscopic guide, to suture the meniscus without the need to remove a part of it. In selected cases even where it was necessary to remove the entire meniscus it is possible to perform a transplant surgery with a donor’s meniscus to replace the missing tissue.

THE CARTILAGE

What is it and what is it for?

The cartilage is a few millimeters thick structure formed by connective tissue that lines the bone surfaces inside the joints. It has particular characteristics of mechanical strength and allows distributing loads and reducing the friction inside the articulation.

 How does it get injured?

It is often difficult to determine the cause of a cartilage injury, so it remains hypothetical. However sometimes it is represented by a major trauma. In most cases, however, the damage is caused by micro-repeated trauma or simply by a degenerative process of the articulation, characterized by the progressive wear of the meniscuses and the cartilage surfaces. This process is favored in those patients who for reasons of congenital conformation have an alteration of the axis of the lower limb with a consequent varus (bow-legs) or valgus (knock-knee)  deviation, and so with a medial and lateral overload.

 What are the symptoms?

When the lesion involves simply the cartilage and the damage is of first or second degree the symptoms are often vague and nonspecific.  The patient reports in most cases an intermittent and variable pain and sometimes the articulation can swell. If the cartilage lesion is associated with the suffering of the subchondral bone usually the patient reports severe pain with severe functional limitation with difficulty even to support the foot and to give the load on the limb.

 What to do?

Again it is recommended to have a specialist examination after which the orthopedist will possibly prescribe a MRI, the single instrumental test able to properly assess the cartilage structure. In cases where a deviation of the axis of the lower limbs is suspected, it can be indicate to associate specific x-rays of legs and knee.

 How are cartilages lesions treated?

Cartilage is a non-vascularized structure and this affects its healing. Therefore it is very difficult to conduct a surgical repair. For years they are studying reliable techniques, but the underlying problems of the cartilage are a serious limitation. Granted this, only traumatic injuries, in young patients with no alterations of the axis of the lower limb, are possibly surgically repairable. Lesions of degenerative nature of the elderly patient cannot be repaired.

If there is a deviation of the axis with a consequent mechanical overload, a rectification intervention of the axis itself, called osteotomy, can be indicated. This intervention can be valgisating or varisating with the goal of redistributing the correct load on the articulation. Alternatively it is possible to program solutions aimed for the pain managing as physical therapies, infiltrations with hyaluronic acid or an arthroscopic procedure.

 

ARTHROSIS

The advanced degenerative damage of the meniscuses and cartilage is called arthrosis. So an arthosic knee is characterized by a severe wear of the meniscuses and by an extensive cartilage injury.

 What are the symptoms?

Being a chronic disease, the patient usually reports having pain and swelling often for months or even years, accompanied by a gradual and progressive reduction of the range of motion with difficulty in walking.

 What should you do?

Easily and on the basis of one visit, the orthopedist can suspect the presence of an arthrosic damaged knee. Simple x-rays will confirm the diagnosis.

 How is arthrosis treated?

As already mentioned, degenerative meniscal or cartilaginous injuries cannot be repaired. In the cases where the arthrosic damage is not advanced, it is possible to take in consideration therapeutic solutions simply targeted to pain management, such as physical therapies or infiltrative therapy (for example with the use of hyaluronic acid).

In cases where instead the damage is advanced, it remains the indication for a surgical operation targeted to the replacement of the diseased part of the knee with prosthesis.

This surgery obviously cannot be performed arthroscopically and must be performed by making a skin incision in the anterior part of the knee, through which the surgeon accesses the articulation removing the diseased parts and applying the prosthesis.

Sometimes it is necessary to replace the entire femoral-tibial surface and in this case we speak of complete prosthesis, other times where only a part of the knee has to be removed we speak of mono-compartmental prosthesis.

 

Trauma medical clinic Canazei - Alta Badia

Ambulatorio Specialistico Traumatologico - Ortopedico Privato 
Medical director Dr. Davide Ruffinella
info@traumamedicalclinic.com
VAT ID number: 02040080224

Trauma medical clinic Canazei
Stréda de Cercenà, 8 - 38032 Canazei (Trento) - ITALY
telephone (+39) 0462 601476 - fax (+39) 0462 601607

Trauma medical clinic Alta Badia
Strada Boscdaplan 13/B - 39030 La Villa (Bolzano) - ITALY
telephone (+39) 0471 1726552 - fax (+39) 0471 1726553

Trauma medical clinic Riccione
Via Santorre di Santarosa,17 - 47838 Riccione (RN) - ITALIA
tel. (+39) 0541 1494370 - fax (+39) 0541 1494374