The patella and its functions

The patella, or kneecap - this is the biggest sesamoid (sesamoid - a bone of oval, located in the interior of the tendon and is usually lying on the surface of another bone) human bone, located deep in the quadriceps tendon. When the muscles of the knee performs assignment block, whereby the power of the muscles increases. He also warns of the knee injury.

The patella is well detectable through the skin and a bone, the upper rounded edge is called the base and the lower edge of the few stretches and forms the top of the knee pads.

The front surface of the patella is rough, it covers the periosteum, the back or smooth articular surface, covered with cartilage. Vertically Aligned comb back surface of the patella divides into two parts: the lower inner and outer larger, which in turn are attached to the surface of the femur forming a knee joint.

Top to the patellar tendon attaches the quadriceps muscle, below - the patellar tendon, which then attaches to the tibia. In addition to the patellar tendon hold two vertical and two horizontal supporting ligament. Vertical bundles are a continuation of the quadriceps femoris tendon, patella cover on both sides and are attached to the tibia firmly grow together with the joint capsule. Horizontal ligament firmly connected to the lower leg fascia beams and fascia lata.

Blood supply and innervation of the patella by a network of blood vessels and nerves located under the fascia.

Causes of patellar dislocation and their types

Traumatic dislocation of the patella is divided into acute and habitual. In addition, there are full of dislocations and subluxations. There traumatic patellar dislocation is most often a result of falling on one knee when you hit it with a hard object or change the thrust of muscles - the extensor tibia. Great value for the dislocation has a number of predisposing factors: the deviation of the lower leg outwards, a more developed internal condyle of the femur and the wrong direction quadriceps against the patellar tendon.

When traumatic patellar dislocation occurs laterally offset with rupture of the joint capsule. Lateral displacement of the patella promotes bleeding into the joint cavity, stretching of the capsule and a decrease in muscle tone. When patellar dislocation is outward from the outer convexity (condyle) of femur, if it is located anterior subluxation of this condyle.

Acute traumatic patellar dislocation

In acute patellar dislocation knee bent and extended in the transverse direction on the outer side surface of the patella is felt, quadriceps tendon and patellar tendon tense. Patellar dislocation is accompanied by bleeding into the joint (hemarthrosis) or effusion in the joint fluid, sharp pain and restriction of movement. Leg bent at the knee and lower leg rotated outwards.

The presence of dislocation is confirmed by radiological studies.

Once the diagnosis under local or general anesthesia is performed closed reduction of dislocation. For this leg bent at the hip and then grab the edge of the patella thumbs of both hands and slowly pulled his strong front, slipping to its original place. The liquid is removed from the joint syringe. After this limb is fixed in extension for three weeks. From the first days of the victim must be actively exercise the thigh muscles, periodically reducing them and picking up pace. A week later allowed to walk with crutches, slightly stepping on the foot. After two or three weeks, remove the plaster cast, and the victim can walk completely loading the leg.

With rarely a so-called horizontal sprains knee pads when it is located between the articular surfaces of the femur and tibia, shows early surgical treatment. In such cases, the kneecap is removed from the joint, patellar ligament sutured, postoperative limb fixed plaster cast for three weeks.

Familiar traumatic patellar dislocation

Traumatic dislocation of the patella can be repeated and become familiar, especially if the outer protuberance (condyle) of femur as a result of a congenital deformation has a chamfered surface of the joint.

When habitual dislocation Habitual dislocation - that kind of attack you pursue?   patella in the early stages may conservatively (without surgery) treatment - fixing plaster cast, physiotherapy and massage. If habitual dislocation does not give in to conservative treatment, surgery is shown. Performed plastic surgery on the joint capsule and the tendons of the extensor muscles, the purpose of which - the weakening of the thrust of the patella on the outside.

Galina Romanenko

What is arthroscopy

Arthroscopy - a method of visual (eye) the study of the cavity of the knee joint using a special optical device - arthroscope. Arthroscopy refers to endoscopic methods of diagnostic studies. It is used for diagnosis and treatment of injuries and diseases of the joints, sometimes - to monitor the results of treatment.

The first knee arthroscopy Arthroscopy of the knee - will show changes in the bones   on the body using a cystoscope (optical instrument for exploring the inner surface of the bladder), held in 1918, a professor at Tokyo University Takagi. In 1920 he produced using the arthroscope arthroscopy of his own design in a patient with tuberculosis Tuberculosis - a full recovery is not guaranteed   knee. But the method has been recognized only in the 60s of the last century after the creation of pupils Takagi Japanese scientists Watanabe and Takeda convenient model arthroscope.

In modern arthroscope set includes a surgical instrument, allowing to carry out arthroscopy using not only diagnostic tests, but also various manipulation, small in the joint operation (e.g., washing the articular cavity, the partial removal of the meniscus, the removal of loose bodies, and so forth). During arthroscopy possible biopsy (taking a piece of tissue for laboratory testing) synovium under the control of intra-articular structures and photography.

Apparatus for carrying out arthroscopy

Arthroscope - an optical device. The basis of any lens system arthroscope is placed in a rigid metal tube which is connected to a light cable. The light is carried out through a special joint fiber optics, and the image of the joint through a small camera is transferred to the big screen. This allows the physician conducting the study, to consider in detail the structure of intra-articular (cartilage, ligaments, etc.) to find the damage and, if necessary, immediately carry out the treatment. Modern arthroscopes fitted with fiber optics, they can have different viewing angles (available from arthroscopes angle 0˚ 30˚ and 70˚), the field of view from 80˚ to 90˚ and vary the diameter of the tube (arthroscopes have a very small diameter for the study of small joints ).

During the examination, the doctor may increase the field of view by rotating around the axis of the instrument. For example, in the field of view 30˚-th arthroscope can consider what is right and slightly to the side of the lens, and 70˚-of arthroscope - what is more distantly.

How is arthroscopy

Arthroscopy is performed in the operating room under general or local anesthesia. For the most common form of arthroscopy - study knee joint through the skin incision approximately 4 mm in the bent right angle knee special tool joint capsule is pierced, straightened and introduced joint arthroscopy. Joint cavity is filled with sterile saline, and then using the arthroscope exploring its various departments.

This study can be a good look at the changes of articular cartilage, ligaments, meniscus trauma, inflammatory and metabolic diseases. Most often it has done in arthroscopy of the knee joint pathology. In addition, it is used in diseases and injuries of the ankle, hip, shoulder, elbow, wrist joints.

If during the diagnostic arthroscopy revealed some violations, then their treatment is carried out, including with the help of surgery, endoscopic techniques (using tools introduced via arthroscope). But in some cases, surgery is required, drawn through a conventional surgical incision. It can also be carried out immediately after the diagnostic arthroscopy, while the patient is under anesthesia.

The postoperative period after arthroscopic operations is faster than after the usual - small wounds heal in a few days, and full recovery of the joint work occurs within 3-4 weeks.

Sometimes arthroscopy, as with any other surgical procedure, there are complications: damage to blood vessels and nerves in the wound can get infected, the postoperative period may be complicated by inflammation and blockage of veins. Therefore a contraindication for arthroscopy are any purulent inflammatory diseases.

Arthroscopy - a modern low-traumatic method of diagnosis and treatment of diseases of the joints.

Galina Romanenko