Knee 膝

Dr. Adrian Leung > Knee 膝

Anatomy 結構

Knee is a joint made of 4 bones, Femur (the thigh bone), Patella (the knee cap), Tibia (the shin bone), Fibula (the smaller shin bone).

Two strong ligaments, Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL), linked the femur and the tibia at the joint center, constraining abnormal translation front and back, as well rotation.

Another two ligaments, Medial Collateral Ligament (MCL) and Lateral Collateral Ligament (LCL), lie at inner and outer side of the knee , preventing the knee from opening up at side.

The knee cap travel at the valley of the femur, called Trochlea. A small ligament called Medial PatelloFemoral Ligament (MPFL) helps guiding its track. The tracking of the patella requires muscle coordination, congruent trochlea with sufficient depth, and an intact MPFL.

There are two meniscus inside the joint. Both are C shaped when view above, and triangular in cross section. Medial Meniscus locates at the inner and Lateral Meniscus is at the outer half of the knee. They make the curved articulating surface of femur having tight fit with the flat tibia surface. Without their prescence, it will be a point or line contact rather than a surface contact. 

knee
Knee model 膝關節模型
ACL
Anterior Cruciate Ligamentt　前十字韌帶
膝關節是由4根骨頭組成。它們分別是股骨（大腿骨），臏骨（膝蓋骨），脛骨（小腿骨），腓骨（細小腿骨）。膝關節有數條韌帶。膝關節中央有兩條很粗的韌帶，前十字韌帶（ACL）和後十字韌帶（PCL），它們連接股骨和脛骨，限制了異常的前後平移以及內外旋轉。膝關節還有另外兩條韌帶，內側副韌帶（MCL）和外側副韌帶（LCL）位於膝蓋的內側和外側，以防止膝關節向內外折曲。臏骨在股骨谷溝滑行，該位置稱為Trochlea。臏骨內側有一條小韌帶，內側髕骨股骨韌帶（MPFL）。它有助於引導臏骨以正常軌道滑行。髕骨<的正常滑動軌道需要內側肌肉協調，股骨谷溝具有足夠深度和無損的內側髕骨股骨韌帶。膝關節內有兩個半月板。俯視時均為C形，橫截面為三角形。內側半月板位於膝內半，外側半月板位於膝關節的外半。它們使股骨的彎曲關節表面與平坦的脛骨表面緊密配合。沒有正常的半月板，兩骨的銜接將是點接觸或線接觸而不是表面接觸，壓力大增。

Pathology 毛病

Disease 病變

The followings are common pathologies in knee
以下是常見膝病變

  • ACL tear 前十字韌帶撕裂
  • Meniscal tear 半月板撕裂
  • Degenerative knee 膝關節退化
  • Osteochondral lesion 軟硬骨病變
  • Patella dislocation  臏骨脫位
  • MPFL tear　內側髕骨股骨韌帶撕裂
  • Subchondral bone marrow edema 軟骨底骨髓水腫
  • Varus knee 膝內曲
  • Osgood-Schlatter disease 脛骨粗隆骨骺炎

Investigation 評估

MRI is usually required to review soft tissue status. Occasionally, standing X-ray would be needed.

磁力共震片能夠提供軟組織情況，所以很多時會是醫生的選擇。某些情況需安排站立受力X光。

Management 治療

Conservative treatments are indicated for majority of cases. They included,

  • Physiotherapy
  • Chiropractor
  • TCM practitioner
  • Prescribed Exercise
  • Medication

For cases failed conservative treatments, or when the injury is unstable, then surgical intervention would be indicated.

For patients with witnessed deterioration, surgical intervention might be advocated.

Chiropractor
Physiotherapist

絕大多數病人只需採取保守治療。他們包括

  • 物理治療
  • 脊醫
  • 中醫
  • 處方運動
  • 藥物（口服及外敷）

對於保守治療無效的病例，或受傷位置不穩定，醫生會改為介入治療，例如打針甚至手術。

對於持續惡化的患者，醫生往往會建議手術，以保肢體功能。

Common Interventions include

Knee Arthroscopic Meniscus Repair 膝關節頸半月板修復常見的介入性治療包括