Knee Injury | Aurora, CO

Puncture Wounds – Podiatry, Orthopedics, & Physical Therapy

Overview of Puncture Wounds

Dr. John Goodner DPM

    Puncture wound injuries are common work place injuries for adults and playground injuries in children. The most common mechanism of injury is stepping on a sharp object, nail or stick, penetrating the foot through the sole of a shoe, sock, or directly due to walking barefoot. Early medical attention is critical, approximately 10% of patients will develop soft tissue infections and 2% will develop infection of the bone. Clinical signs can often present weeks to months after initial puncture injury, so proper treatment and wound care should not be neglected even if the foot appears not to be infected initiallly. Co-morbidities, such as Diabetes Mellitus and other immune system suppressing conditions, increase the risk of spreading infection without visible clinical signs and symptoms until a much later stage of infection is present.

When should I be concerned and seek medical attention?

• The foot is painful, swollen and tender
• A wound can be visualized
• A sinus tract can be seen where the sharp object initially penetrated the foot
• Diffuse skin redness surrounding the wound, foot and/or ascending up the leg
• Swollen or palpable lymph nodes behind the the knee or in the groin
• If Fever, Nausea, Vomiting, Chills, or Shortness of Breath become present

Treatment:

• An X-Ray and/or MRI may be necessary to evaluate the extent of the infection in the soft tissues and bone.
• Tetanus booster is advised, especially, if the patient is not up to date on their vaccination schedule.
• Wound debridement and antibiotic infused irrigation is advised for most wounds
• Oral or IV antibiotics will often be given in accordance with depth of infection, level of contamination, wound cultures taken and patient health condition
• The foreign material can become enveloped in the soft tissue and a chronic inclusion cyst may form, requiring removal if painful or if it causes a recurrent infection.

Intraop Pics of Excsion of Inclusion Cyst from Prior Puncture Wound

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Thorn injury mimicking a septic arthritis of the knee

Ulster Med J. 2007 Sep; 76(3): 164–165.

Department of Trauma and Orthopaedics, Altnagelvin Area Hospital, Glenshane Road, Londonderry, United Kingdom

Copyright © The Ulster Medical Society, 2007This article has been cited by other articles in PMC.

INTRODUCTION

An 8 year old boy was admitted via the accident and emergency (A&E) department with a painful swollen right knee. He described sustaining an injury to the knee some four hours previously when he had crawled under a tree and knelt on a sharp twig, which pierced his trousers and the soft tissues of his right knee. He described also removing the offending twig from his knee.

On examination in the A&E department he had a swollen, generally tender right knee with decreased range of movement. There was a large effusion with a positive patellar tap. There was also evidence of a small puncture wound in the supero-medial aspect of his right knee. He was apyrexic (36.2°C) and systemically well. The knee was aspirated under aseptic technique, and 8ml of turbid fluid was sampled. This was sent for direct microscopy and Gram stain as well as for culture for organisms and sensitivities, which ultimately failed to show the presence of organisms. Routine blood testing revealed Haemoglobin of 11.6g/dL, White Cell Count of 14.5×10³/mL, and significantly, a normal C-reactive protein (CRP) level of <5mg/L. The possibility of a septic arthritis was raised, but it was felt that on balance, given the clinical condition of the patient, the rapid onset of the effusion, his temperature, routine laboratory results and the results of the aspirate direct microscopy and Gram stain, this diagnosis was less likely. The patient was commenced on intravenous co-amoxiclav and admitted to the ward for observation.

Overnight the patients’ symptoms failed to settle and the following day he underwent arthrotomy and washout of his right knee under general anaesthetic. The incision included the puncture wound and followed the track made by the plant material into the joint. Upon opening the joint there was further turbid fluid which was swabbed and sent for culture. Careful examination of the joint revealed a small piece of thorn within the joint, which was removed (). The knee joint was thoroughly washed out and closed in layers. Post-operative recovery was unremarkable. The patient was discharged home two days later on oral antibiotics.

Foreign body removed from knee joint at arthrotomy, measuring approximately 2.5mm.

The direct microscopy from the original aspirate revealed 3+ pus cells, occasional epithelial cells, and no organisms and the bacteriological culture yielded no growth after 48 hours. The swab taken at arthrotomy also failed to show any growth at 48 hours.

DISCUSSION

Thorn injury to joints is uncommon, but should be thought of in cases of acute monoarticular arthritis. In this case, the most salient feature of the history was that of a penetrating injury to the knee with plant material, which was readily volunteered by the patient, but is often overlooked. Additionally, the patient had removed the twig at the time of his injury, however removal had been incomplete, leaving a small piece of plant material behind. Also of worthy consideration was the rapid onset of symptoms from the time of injury (less than four hours). In a case of this type, where a history of penetrating injury is present, then arthroscopic washout or formal arthrotomy is mandatory since there are numerous examples in the literature of cases of recurrent episodes of isolated joint sepsis/synovitis. Washout of a joint but leaving plant material behind is likely to cause recurrent symptoms which can result in multiple presentations and ultimately require extensive treatments including synovectomy.

Foreign body synovitis may simulate an acute septic arthritis¹. A history of penetrating injury to a joint may not be readily forthcoming, or may be overlooked in the history taking with consequences for long-term sequelae.

In cases of missed diagnosis, the typical presentation may often be of a transient synovitis followed by a relatively asymptomatic period and later by a chronic arthritis long after the thorn injury has been forgotten. In one report a 14 year old boy admitted to hospital 6 weeks after a palm tree injury was shown to have a foreign body on ultrasound scan (USS), with treatment subsequently including repeated arthrotomies².

Suspicion of, or history of thorn injury around a joint should be treated by thorough washout of joint and inspection of the joint (with removal of any foreign body), which may be via arthroscopy or arthrotomy. Arthroscopy in theory affords the best view with lower morbidity compared with arthrotomy^3,4. Although much of the published work comparing arthrotomy with arthroscopy in children is condition specific (for example septic arthritis, osteochondritis dessicans, diagnostic)⁵, there is overwhelming evidence in the current literature favouring arthroscopy over arthrotomy. Potential disadvantages of arthroscopy of the knee include the increased technical demands and the small risk of damage to the articular surface. Additionally, the operating time of the procedure will be increased with arthroscopy⁵. However, numerous published studies have shown clearly that there is decreased morbidity with improved outcomes, as well as better visualisation of the joint using arthroscopy over arthrotomy in cases of both plant thorn injuries and true septic arthritis. Effective early treatment can also be achieved with the arthroscopic route³. A further consideration regarding the decision to proceed arthoscopically or via arthrotomy will be surgeon preference and familiarity. Other imaging modalities, such as USS, computed tomography, and magnetic resonance imaging (MRI) may be employed in cases where intra-articular foreign bodies have not been identified. Examples of this type of case may be where there has been a delay in diagnosis or the foreign body is extra-articular⁶. Furthermore, cases have been reported where a plant thorn synovitis was diagnosed after MRI was initially used to exclude other differential diagnoses for example septic arthritis of an elbow joint⁷.

The commonest organism isolated from positive cultures (synovial fluid, blood cultures) is Pantoea agglomerans, a gram negative bacterium found in human and animal faeces, as well as plants⁸. It is interesting to note historically that in cases diagnosed as aseptic, the inflammatory response was attributed to plant toxin⁹. It is possible that aseptic cases are in fact Pantoea agglomerans septic arthritis with negative cultures. Negative cultures can be due to inappropriate culture media, or inaccuracies in the identification of organisms². Awareness of the possibility of a plant thorn injury should be borne in mind, and if suspected treatment as outlined above be instigated, to avoid the possibility of long term complications.

CONCLUSION

The possibility of penetrating injury with plant material should always be considered and excluded in cases of an apparent rapidly developing effusion, and careful attention to the history of injury must be made. A normal CRP result, as in this case, adds further weight to this differential diagnosis, as it would be considerably elevated in true infection. If an injury of this type is present then the treatment must be formal arthrotomy or arthroscopy and washout since simply washing out the joint but leaving plant material behind may lead to recurrent problems.

Notes

The authors have no conflict of interest

REFERENCES

1. O’Connor CR, Reginato AJ, DeLong WG., Jr Foreign body reactions simulating acute septic arthritis. J Rheumatol. 1988;15(10):1568–71. [PubMed] [Google Scholar]2. Kratz A, Greenberg D, Barki Y, Cohen E, Lifshitz M. Pantoea agglomerans as a cause of septic arthritis after palm tree thorn injury; case report and literature review. Arch Dis Child. 2003;88(6):542–44. [PMC free article] [PubMed] [Google Scholar]3. Taskiran E, Toros T. Chronic synovitis caused by a date palm thorn: An unusual clinical picture. Arthroscopy. 2002;18(2):E7. [PubMed] [Google Scholar]4. Eiskjaer S, Larsen ST. Arthroscopy of the knee in children. Acta Orthop Scand. 1987;58(3):273–6. [PubMed] [Google Scholar]5. Birr R, Wuschech H, Kundiger R, Heller G. Complications in 4,000 arthroscopies. Beitr Orthop Traumatol. 1990;37(11–12):620–6. [German] [PubMed] [Google Scholar]6. Pai VS, Tan E, Matheson JA. Box thorn embedded in the cartilaginous distal femur. Injury Extra. 2004;35(5–6):45–47. [Google Scholar]7. Stevens KJ, Theologis T, McNally EG. Imaging of plant thorn synovitis. Skeletal Radiol. 2000;29(10):605–8. [PubMed] [Google Scholar]8. De Champs C, Le Seaux S, Dubost JJ, Boisgard S, Sauvezie B, Sirot J. Isolation of Pantoea agglomerans in two cases of septic monoarthritis after plant thorn and wood sliver injuries. J Clin Microbiol. 2000;38(1):460–1. [PMC free article] [PubMed] [Google Scholar]9. Karshner AG, Hanafee W. Palm thorns as a cause of joint effusion in children. Radiology. 1953;60(4):592–5. [PubMed] [Google Scholar]

First Aid Treatment for a Puncture Wound

How do you best treat a puncture wound and how do these differ from lacerations and other types of injuries? What do you need to be aware of and watch for if you suffer one of these injuries?

stocksnapper / Getty Images

Definition and Description of Puncture Wounds

Puncture wounds and lacerations can look the same at the surface of the skin. It’s really the depth below the surface and what internal organs or tissues are damaged that matters most.

Puncture wounds can be deep or shallow and large or small. Treatment depends on the severity of the puncture wound, and the size and speed of the object creating it. Also, treatment is different based on whether the object that created the puncture is still in the body or was removed. An object that is sticking out of the skin is called an impaled object. A bullet wound is a type of puncture wound created at high speed and often leaves the object still under the surface.

Animal bites can also be in the form of a puncture wound and bring with them the additional complication of potential infection. For all puncture wounds, bleeding control and infection are the priorities.

Steps For First Aid Treatment of a Puncture Wound

If you encounter a person with a puncture wound the first step is to protect yourself.

Stay safe. If you are not the victim, practice universal precautions and wear personal protective equipment if available.

Once you determine that you are safe to be near the victim, and after you have protected yourself with gloves and eyewear protection if indicated, follow these steps.

1. Control bleeding before anything else. Putting pressure directly on the puncture wound while holding it at a level above the heart (if possible) for 15 minutes should be enough to stop bleeding. If not, try using pressure points. Pressure points are areas where blood vessels lie close to the surface of the skin and include the brachial artery (between the shoulder and elbow), the femoral artery (in the groin along the bikini line), and the popliteal artery (behind the knee). Tourniquets should be avoided unless medical care will be delayed for several hours.
2. Know when to call 911. Call 911 right away for puncture wounds of any depth in the neck or if a deep puncture wound (or one of unknown depth) occurs to the abdomen, back, pelvis, thigh, or chest. Puncture wounds in other regions, even if shallow, should prompt you to call 911 if the bleeding will not stop. Holes in the chest can lead to collapsed lungs. Deep puncture wounds to the chest should be immediately sealed by hand or with a dressing that does not allow air to flow. Victims may complain of shortness of breath. If the victim gets worse after sealing the chest puncture wound, unseal it.
3. When bleeding is controlled, wash the wound. Once bleeding has been controlled, wash the puncture wound with warm water and mild soap (see illustration). If bleeding starts again, repeat step two.
4. Determine if the wound needs stitches. Wide puncture wounds may need stitches. If the victim needs stitches, proceed to the emergency department
5. Properly dress the wound. For smaller puncture wounds that do not require stitches, use antiseptic ointment and cover with adhesive bandages.
6. Watch for signs of infection. When you change the bandages, or if the victim develops a fever, chills, or is feeling poorly, check for signs of infection. Increased redness, swelling, or drainage, especially pus-like drainage is a sign that you should contact a healthcare provider. If redness begins to radiate or streak away from the puncture wound, contact your healthcare provider right away.
7. Clean and change bandages daily. Clean and change the dressings (bandages) over a puncture wound daily. Each time you change the dressing you should clean the wound and look for signs of infection.
8. Give pain relief if needed. Use acetaminophen or ibuprofen for pain relief as needed as long as there are no reasons why these should not be used (such as kidney disease).

Risk of Contamination With Puncture Wounds/Tetanus Prophylaxis

If the puncture wound is contaminated, the victim should consult a healthcare provider as soon as possible for a tetanus vaccination or booster shot. Wounds of the feet, those that cannot be cleaned right away, and wounds made by animals all carry a high risk of contamination.

Caused by Animal Bites

Puncture wounds caused by animal bites may also cause rabies. Rabies is a preventable disease but is almost always fatal if you wait until symptoms are present. Always consult a healthcare provider for wounds caused by animal bites.

Caused by Human Bites

Human bite wounds carry a very high incidence of infection, much more than bites such as dog bites. Always seek out medical care for a human bite wound.

Caused by Bullets

Gunshot wounds are unpredictable and can be much more serious than they appear at first glance. Always call 911 as soon as you are in a safe position to do so. The chance of a person surviving a bullet wound is related to how long it takes to get emergency medical care. Apply the principles of a puncture wound care above but if the wound is above the chest, do not elevate the victim’s legs as this can increase bleeding.

A Word From Verywell

Puncture wounds differ from lacerations in a few ways. Sometimes it can be uncertain whether an object is still present within the wound and it also very hard to tell the depth of the wound at first glance. With a puncture wound to the chest, back, or pelvis, it’s best to call 911 if the puncture is deep or you can’t tell the depth. With a neck wound call 911 regardless of the depth.

Basic first aid strategies for controlling bleeding and knowing when to all 911 or seek medical attention are discussed above. If you are taking care of someone who has received a puncture wound make sure to practice universal precautions and practice safety for yourself first. An injured rescuer does little to help an injured victim and can result in two victims.

Puncture wounds should be monitored closely. If there is a risk of rabies, vaccinations should be done right away as waiting for symptoms is usually fatal. Bite wounds of any form often become infected and medical care should be sought out for any of these.

Skin Trauma | Pediatric and Young Adult Medicine

Cuts and Scratches 

Most cuts are superficial and extend only partially through the skin.  The cuts that need sutures are deep and leave the skin edges separated.  Another rule of thumb is that cuts need sutures if they are longer than 1/2 inch (1/4 inch if on the face).

Scrapes (Abrasions) 

An abrasion is an area of superficial skin that has been scraped off during a fall, such as a floor burn or a scraped knee.

Puncture Wounds 

The skin has been completely punctured by an object that is narrow and sharp, such as a nail.  The wound is not wide enough to need sutures.  Since puncture wounds usually seal over quickly, there is a greater chance of wound infection with this type of skin injury.  Puncture wounds of the upper eyelid are especially dangerous and can lead to a brain abscess.  A deep infection of the foot can begin with swelling of the top of the foot 1 to 2 weeks after the puncture.  Tetanus is also a risk if your child is not immunized.

Bruises

Bleeding into the skin from damaged blood vessels gives a black and blue mark, or a bruise.  Since the skin is not broken, there is no risk of infection.  Bruises usually follow injury caused by blunt objects.  Unexplained bruises can indicate a bleeding tendency.  (Exception:  “Unexplained” bruises on the shins are usually not a sign of a bleeding tendency.  Children often bump this area and forget about it.)

Cuts and Scratches 

Most cuts are superficial and extend only partially through the skin.  The cuts that need sutures are deep and leave the skin edges separated.  Another rule of thumb is that cuts need sutures if they are longer than 1/2 inch (1/4 inch if on the face).

Home Care 

Treatment

• Apply direct pressure for 10 minutes to stop any bleeding.
• Wash the wound with soap and water for 5 minutes.
• Cut off any pieces of loose skin using a small scissors.
• Apply an antibiotic ointment and cover it with a Band-Aid or gauze. Wash the wound, apply the ointment, and change the Band-Aid or gauze daily.
• Give acetaminophen or ibuprofen as needed for pain relief.

Common Mistakes in Treating Cuts and Scratches

• Don’t use alcohol or Merthiolate on open wounds, because they sting and damage normal tissue.
• Don’t kiss an open wound because the wound will become contaminated by the many germs in a normal person’s mouth.
• Let the scab fall off by itself; picking it off may cause a scar.

Call our Office IMMEDIATELY if . . . 

• Bleeding won’t stop after 10 minutes of direct pressure.
• The skin is split open and might need sutures. Note:  Lacerations must be sutured within 12 hours of the time of injury, and the infection rate is far lower if they are closed within 4 hours.
• There is any dirt in the wound that you can’t get out.
• The cut looks infected (yellow pus, spreading redness or streaks).

Call our office during regular hours if . . . 

• Your child hasn’t had a tetanus booster in10 years.
• The wound hasn’t healed after 10 days.
• You have other questions or concerns.

Scrapes (Abrasions) 

An abrasion is an area of superficial skin that has been scraped off during a fall, such as a floor burn or a scraped knee.

Home Care 

Cleaning the scrape.  First, wash your hands and then wash the wound vigorously for at least 5 minutes with warm water and liquid soap.  The area will probably need to be scrubbed several times with a wet piece of gauze to get out all the dirt.  You may have to remove some dirt particles with a pair of tweezers.  If there is tar in the wound, it can often be removed by rubbing it with petroleum jelly, followed by soap and water.  Pieces of loose skin should be cut off with sterile scissors, especially if the pieces of skin are dirty.  Rinse the wound well.

Antibiotic Ointments and Dressing. Apply an antibiotic ointment and cover the scrape with a Band-Aid or gauze dressing.  This is especially important for scrapes over joints where the skin is stretched constantly, like elbows and knees.  Cracking and reopening at these sites can be prevented with an antibiotic ointment, which keeps the crust soft.  Cleanse the area once a day with warm water and then reapply the ointment and dressing until the scrape is healed.  Because abrasions can hurt badly, give acetaminophen or ibuprofen for the first day.

Call our office IMMEDIATELY if . . . 

• There is any dirt or grime in the wound that you can’t get out.
• Skin loss involves a very large area.
• The scrape looks infected (yellow pus, spreading readness).

Call our office during regular hours if . . . 

• Your child hasn’t had a tetanus booster in 10 years.
• The scrape hasn’t healed after 2 weeks.
• You have other questions or concerns.

Puncture Wounds 

The skin has been completely punctured by an object that is narrow and sharp, such as a nail.  The wound is not wide enough to need sutures.  Since puncture wounds usually seal over quickly, there is a greater chance of wound infection with this type of skin injury.  Puncture wounds of the upper eyelid are especially dangerous and can lead to a brain abscess.  A deep infection of the foot can begin with swelling of the top of the foot 1 to 2 weeks after the puncture.  Tetanus is also a risk if your child is not immunized.

Home Care 

Cleansing and Trimming.  Soak the wound in warm water and soap for 15 minutes.  Scrub the wound with a washcloth to remove any debris.  If the wound bleeds a little more, that may help remove germs. Cut off any flaps of loose skin that cover the wound and interfere with drainage or removing debris.  Use a fine scissors after cleaning them with rubbing alcohol.

Antibiotic Ointment and Pain Relief.  Apply an antibiotic ointment and a Band-Aid to reduce the risk of infection. Resoak and reapply antibiotic ointment every 12 hours for 2 days.  Give acetaminophen or ibuprofen for any pain.

Call our office IMMEDIATELY if . . . 

• Dirt remains in the wound after you have soaked it.
• The tip of the object could have broken off in the wound.
• The sharp object or place where the injury occurred was dirty.
• The wound looks infected (yellow pus, spreading redness).

Call our office during regular hours if . . . 

Your child hasn’t had a tetanus booster in more than 5 years.

Pain, redness, or swelling increases after 48 hours.

You have other questions or concerns.

Bruises

Bleeding into the skin from damaged blood vessels gives a black and blue mark, or a bruise.  Since the skin is not broken, there is no risk of infection.  Bruises usually follow injury caused by blunt objects.  Unexplained bruises can indicate a bleeding tendency.  (Exception:  “Unexplained” bruises on the shins are usually not a sign of a bleeding tendency.  Children often bump this area and forget about it.)

Home Care 

Apply ice for 20 to 30 minutes.  No other treatment should be necessary.  Give acetaminophen or ibuprofen for pain.  Avoid aspirin because it may prolong the bleeding.  After 48 hours apply a warm washcloth for 10 minutes 3 times a day to help the skin reabsorb the blood.  Bruises clear in about 2 weeks.  If the injury is a blood blister, do not open it, or the risk of infection will be increased.  Blisters will dry up and peel off in a 1 to 2 weeks.

Call Our Office Immediately … 

• Bruises are unexplained and several in number.

Identifying Different Types of Wounds and Bleeding

Injuries that result in bleeding can happen in many ways and you might have heard them referred to in many different ways. Learn the four most common types of injuries and how to best treat them.

Four Most Common Types of Bleeding Injuries

1. Abrasions

Abrasions are usually the result of a rub or scrape on a rough surface, like skinning your knee on the playground or scratching your elbow on a brick wall. Sometimes people call abrasions strawberries or raspberries. Typically, an abrasion will not bleed heavily, but the area should be thoroughly cleaned and washed with soap and water to avoid infection. An abrasion may require a bandage or dressing in extreme cases, but minor abrasions should heal on their own after cleaning.

2. Lacerations

Lacerations are cuts, slices, or tears in the skin. Lacerations are often caused by sharp objects like knives or broken glass. Bleeding may occur quickly in the cases of deep lacerations, so it is important to stop the bleeding by covering the wound and applying pressure. If bleeding is severe or won’t stop, you may need to proceed to an emergency room or call 911 for additional medical attention.

3. Punctures

• Punctures can occur when any type of pointed object, such as a nail, penetrates the skin. Puncture wounds may not bleed much outwardly, but a deep puncture can cause internal bleeding. Apply pressure and rinse the wound with clean water to remove all dirt. Before drying and covering with a bandage, apply antibiotic cream or ointment. Watch the puncture for signs of infection, such as spreading redness, pain, swelling, or fever.
• Tetanus: If the person with the injury hasn’t had a tetanus shot in the past five years, a booster may be needed. It best to get this within 48 hours of the injury.
• Rabies: If the wound is from a cat, dog, or other animal bite, it is important to find out if the animal’s rabies vaccine is up to date, or consult with your doctor on the best way to proceed.

4. Avulsions

Avulsions are severe injuries that can cause uncontrolled, life-threatening bleeding. This type of injury typically occurs when skin or a body part is partially or completely torn away. These injuries often result from serious trauma, such as car or motorcycle accidents, explosions, or gunshots. In avulsions, bleeding will occur instantly and extensively, so you should call 911 immediately and attempt to control the bleeding as quickly as possible. For some avulsions, you may need to apply a tourniquet to stop the bleeding[VL1] [Mh3] . If a body part is severed, it should be brought to the hospital for possible reattachment. Wrap the body part in a clean cloth and pack it in ice, if possible.

How to Stop Uncontrolled Bleeding

If you encounter someone experiencing uncontrolled bleeding, first make sure you are safe. If you are safe, it’s important to remember that any attempt to control bleeding is better than no intervention.

Next, follow the ABCs of Bleeding:

A – Alert – Call 911

B – Bleeding – Find the source of bleeding. Look on the arms, legs, neck, groin, and abdomen areas for bleeding.

C – Compress – Once you find the source of bleeding, apply pressure. You can use a piece of clothing, or anything else available that can help stop bleeding. Cover the wound and apply pressure by pushing directly with both hands. You can also pack the wound with gauze or a clean cloth, and then continue to hold pressure with both hands. If bleeding does not slow or stop, and the injury is located on an arm or leg, a tourniquet can be applied high and tight on the limb to stop the bleeding. Keep holding pressure on the injury until help arrives.

Getting Medical Attention for Wounds

If you are at the scene of an accident and see someone with substantial bleeding, call 911 right away. It is important to get emergency responders to the scene as soon as possible.

For minor wounds, such as abrasions and shallow lacerations, the treatment you can provide at home is often adequate.

• Clean the injured area thoroughly with soap and water to avoid infection
• Elevate the wound and apply pressure to the affected area to slow the bleeding
  • When the bleeding has subsided, apply a sterile dressing.

• Leave it covered and keep it dry for as many as five days
• If you have minor pain, acetaminophen usually will relieve the pain.

Cuts, grazes and puncture wounds

If you have a wound that won’t stop bleeding, see your doctor or go to the emergency department.

If you have very serious bleeding including spurting blood, or you feel faint or light headed then call 111 straight away.

Cuts and grazes

• A clean cut or tear in the skin is called a laceration. Most lacerations are superficial and heal easily with self-care. Deeper lacerations may need stitches by a nurse or doctor.
• A graze (or abrasion) is a scraping or rubbing away of the skin surface. Grazes are superficial and usually heal within 2 weeks with self-care.

Self-care

If you or a family member has a cut or graze, follow these steps to help it heal well.

• Wash your hands with soap and water before and after cleaning any wound.
• If necessary use direct pressure to stop bleeding.
• Clean the wound with tap water. Use sterile saline solution if you have some in your first aid kit.
• Clean, loose flaps of skin may be left in place to form a natural dressing.
• Apply antiseptic ointment (eg, savlon or betadine) only if the wound is dirty – do not use for longer than 2 weeks.
• Cover with a non-stick dressing.
• Keep dry for 24 hours if possible during initial healing.
• Replace the dressing if it becomes dirty or wet.
• Check whether a tetanus injection is needed. A booster is recommended if it is more than 10 years since your last tetanus injection, or 5 years if the wound is dirty, contaminated or deep.

When to seek help

See your doctor or nurse if:

• you can’t fully clean the wound
• the bleeding won’t stop
• the wound is deep and the skin is gaping.

If you have managed to clean and dress the wound, keep an eye on it and see your doctor if:

• you have any new loss of feeling, numbness or inability to move the limb
• there is increased redness, swelling, tenderness and/or it becomes warm to touch
• red streaks develop
• there is a coloured or smelly discharge
• the wound has not healed after 2 weeks.

Call Healthline 0800 611 116 if you are unsure what you should do.

Puncture wounds

A puncture wound is when something penetrates layers of skin, such as a knife, nail or tooth. Bacteria can be carried to the tissue under the skin.

Puncture wounds usually close very quickly and need to be cleaned thoroughly to prevent infection.

Self-care

If you or a family member has a puncture wound, follow these steps to help it heal well.

• Wash your hands with soap and water before and after cleaning the wound.
• Flush the wound with running tap water to remove all dirt.
• Check whether a tetanus injection is needed. A booster injection is recommended if it is more than 10 years since your last tetanus injection or 5 years if the wound is dirty, contaminated or deep.

When to seek help

See your doctor or nurse if:

• there is something stuck in the puncture wound
• you have any numbness or tingling below the puncture.

If you have managed to clean and dress the wound, keep an eye on it and see your doctor if:

• you have any new loss of feeling, numbness or inability to move limb
• there is increased redness, swelling, tenderness or it becomes warm to touch
• red streaks develop
• there is a coloured or smelly discharge
• the wound has not healed after 2 weeks.

Call Healthline 0800 611 116 if you are unsure what you should do.

Treatment of open wounds of the knee joint

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Evgeniya,

August 14, 2021

I have been served in this clinic for two years now, I am happy with everything.I was satisfied with the reception, the specialist is good. The time of admission was quite enough, the doctor was attentive, prescribed the necessary medications. Then I also plan to make an appointment with him.

Igor,

06 August 2021

We liked everything, the doctor examined the child, gave recommendations, consulted.The doctor is attentive, polite, found a common language with the child, was caring and affectionate. I can recommend him as a specialist and, if necessary, we will apply again, I liked everything.

Alexandra,

04 August 2021

The doctor is experienced.He treated me well. The doctor examined me, talked, explained everything in detail and prescribed a pepper plaster, after which the pain disappeared. Before that, I was in another clinic and they did not tell me anything sensible. If necessary, I will refer to him again.

Galibjon,

July 20, 2021

I am very happy with the doctor! He shot my previous pictures, extracts, compared everything,
I did not miss any detail, I clearly, quickly made a diagnosis, determined the cause and prescribed an effective treatment that helps me.The doctor is very competent. He was positively disposed. Does not frighten but says everything that is. Polite specialist.

Oksana,

June 30, 2021

Show 10 reviews of 8,746 90,000 Treatment Prepatellar Bursitis and Other Knee Bursitis

Prepatellar bursitis is a disease of the musculoskeletal system caused by inflammation of the prepatellar bursa.The disease is manifested by edema of the anterior surface of the knee joint – above the patella, pain during extension and flexion in the knee joint, when leaning on the knee joint.

REASONS OF PREPATELARY BURSIT DEVELOPMENT

The causes of inflammation can be different: from a banal trauma to infection. According to the classification, septic (infectious) and aseptic (inflammatory) bursitis are distinguished. For the prepatellar bursa, both types of bursitis are characteristic.
In some cases, the prepatellar bag can be damaged as a result of a direct mechanism of injury, such as impact or falling to the knee. The trauma causes tears of the tissues of the prepatellar bursa and hemorrhage into the cavity of the bursa. In some cases, blood can completely fill the cavity of the prepatellar bursa and the bursa can swell, causing the knee joint to take on a characteristic shape.
It is believed that the blood accumulated in the cavity of the prepatellar bursa triggers an inflammatory reaction.As a result of inflammation, the walls of the prepatellar bursa thicken, become less elastic, and their sliding properties disappear. As a result, prepatellar bursitis develops.

Prepatellar bursitis may result from constant pressure on the patella. Some workers perform work with their knees resting on a hard surface. If the knee is constantly injured, this leads to the development of inflammation and prepatellar bursitis develops.

Prepatellar bursitis can be caused by infection.A small scratch or prick in the area of ​​the prepatellar bursa can lead to infection. Or, after trauma, the infection can enter the damaged tissues of the prepatellar bursa with blood flow from the focus of a chronic infection in the body, for example, a carious tooth. The infection leads to the accumulation of pus in the cavity of the prepatellar bursa. The consequences of infectious prepatellar bursitis can be serious.

SYMPTOMS OF PREPELLAR BURSITIS

Prepatellar bursitis manifests itself as pain and swelling over the patella.When viewed during palpation (feeling), the prepatellar bursa is usually painful. In this condition, it hurts to kneel on a hard surface. If prepatellar bursitis does not go away for a long time, then the inflammation becomes chronic. There may be a feeling of lumps in the inflammatory fluid in the prepatellar bursa. This suggests that the prepatellar bursa in response to chronic inflammation has become even thicker and folds have formed. These folds also feel like lumps.

The prepatellar bag can increase in size several times.This occurs due to the thickening of the walls of the prepatellar bursa and filling the prepatellar bursa with inflammatory fluid. The amount of inflammatory fluid is usually associated with the phase of inflammation. If inflammation is in the active phase, then the amount of inflammatory fluid increases, and the bursa increases in size. When the prepatellar bursa is large, the knee joint, when viewed from the side, takes on a characteristic appearance.

If an infection of the bursa prepatellar occurs, the knee becomes swollen, very painful and warm to the touch.In this case, in addition to local signs of inflammation (pain, redness, an increase in local temperature, edema), general ones develop – an increase in temperature, chills, changes in the blood test. An emergency surgical intervention is required – opening and draining the prepatellar bursa. If you do not go to the doctor and do not open the prepatellar bursa, then the pus can break through on its own, and systemic complications may occur.

DIAGNOSTICS OF PREPATELLAR BURSITIS

Differential diagnosis of bursitis of the prepatellar bursa is carried out with diseases such as gout, rheumatoid arthritis, septic arthritis of the knee joint.

The diagnosis of bursitis of the prepatellar bursa becomes obvious after examining the patient, no special examination methods are required. If, nevertheless, an additional examination is needed, then ultrasound allows you to quickly and confidently confirm the diagnosis of prepatellar bursitis.

If it is not clear to the doctor whether the bursitis is inflammatory or infectious, a puncture of the prepatellar bursa is performed and the resulting fluid sample is sent to the laboratory for examination. Sowing of liquid is carried out to identify microflora and determine its sensitivity to antibacterial drugs.Thus, the doctor receives an answer to two questions: is the bursitis infectious or inflammatory and, if the bursitis is infectious, what antibiotic should it be treated with?

TREATMENT OF PREPATELLAR BURSITIS

Conservative treatment

Traumatic bursitis of the prepatellar bursa can be treated conservatively. If a significant amount of blood has accumulated as a result of an injury, then a puncture with a thick needle is performed or a small incision is made to remove all the accumulated blood from the cavity of the prepatellar bursa.The question of the appropriateness of the puncture is decided by the doctor.

There is a small risk of infection of the prepatellar bursa during these manipulations, so the puncture is performed in the dressing room in compliance with all the rules of asepsis and antiseptics. After the puncture is performed, a sterile bandage is applied.

Chronic bursitis of the bursae is a problem that can reduce disability and quality of life. Swelling and pain are the main manifestations.Normal daily activities can be uncomfortable. Treatment usually begins with an attempt to relieve the inflammatory syndrome. Measures to relieve inflammation are rest in the knee joint and the use of anti-inflammatory drugs. Medications such as diclofenac and ibuprofen are used to relieve inflammation and swelling.

If there is an inflammatory fluid in the bag, then a puncture can be performed in order to remove the fluid and its further laboratory examination. During a puncture (provided that there are no signs of infection in the cavity of the prepatellar bursa and there are no other contraindications), a small amount of a steroid, such as betamethasone salts, may be administered.Steroid medications are powerful anti-inflammatory drugs. Its anti-inflammatory effect can last for several weeks.

Consultation with a physiotherapist is required, who will help you choose physiotherapeutic procedures, taking into account all the features and contraindications.

The use of heat, cold, ultrasound, or UHF usually helps to relieve pain and swelling. Using cold or heat treatments can help improve the condition at home.Cold is usually indicated immediately after injury, thermal procedures – during chronic inflammation; in any case, the use of any methods of exposure should be discussed with a doctor.

If bursitis is infectious, the ulnar bursa must be completely drained, that is, all inflammatory fluid or pus must be removed. A prerequisite is to ensure peace of the knee joint and the appointment of antibacterial drugs. Patients with infectious bursitis are observed by a doctor until the inflammation disappears completely.

Surgical treatment

Drainage of the prepatellar bursa.
If an acute infection develops, or as a result of examination of the fluid obtained from the prepatellar bursa, microorganisms have been seeded, then the prepatellar bursa must be drained. The prepatellar bursa is surgically opened, that is, a small incision is made through which the discharge can be completely drained. Sometimes it is advisable to use a tube or half-tube to improve outflow.After the drainage of the discharge is ensured, the patient is observed until the wound is completely healed. Improvement usually occurs within a few days. With infectious bursitis, antibacterial drugs are necessarily prescribed.

Removal of the bursa (bursectomy).
In chronic bursitis, the walls of the bursa thicken, the bursa increases in size, and folds of the bursa appear. With conservative treatment, it is possible to relieve inflammation, but after a while the inflammatory process is exacerbated again.It becomes difficult to carry out work and daily activities. In this case, it is worth thinking about surgical treatment – removal of the prepatellar bursa.
An incision is made in the projection of the prepatellar bursa. The bag is excised. Determining the boundaries of the bag usually does not cause difficulties, since its walls are significantly thickened. After that, the wound is sutured in layers. After the operation, it is advisable to place the leg in the splint for several days to ensure peace and better healing of the postoperative wound, after which rehabilitation measures can be started.

Since in this area it is necessary to ensure the sliding of the skin over the patella, a new bag of connective tissue is formed in the body. This happens during the rehabilitation process some time after the operation. In order for this process to take place without complications, it is advisable to undergo the prescribed rehabilitation program.

REHABILITATION AFTER TREATMENT OF PREPATELARY BURSITIS

During conservative treatment, no special rehabilitation is usually required.It is necessary to limit motor activity in the knee joint during the period of development of inflammation. After the inflammation begins to resolve, an increase in the load and range of motion in the knee joint is allowed. Some people are not worried about the increased size of the prepatellar bag. Preparative bursitis, which is not associated with an infectious process, can go away on its own without any treatment.

After the operation, for better wound healing, the knee joint is fixed with a splint.If the wound healing takes place without complications, then the splint is removed for 3-5 days and the rehabilitation process begins. The first few sessions are conducted with a physical therapy instructor to guide you through the required exercises.

Usually, rehabilitation does not cause problems and patients, after several sessions, can practice at home without the supervision of an instructor. The recovery is fast enough. If the work is not associated with constant movements in the knee joint and support on the knee, then it is possible to return to daily activities in 3-4 weeks.If knee support is necessary, rehabilitation may take 2-3 months. During this time, knee support must be completely avoided.

TRUST YOUR HEALTH CARE TO REAL PROFESSIONALS!

Protect your elbows and knees

As soon as the snow melts and the ground dries up, an army of cyclists and skateboarders fill the yards and squares, revealing a list of summer injuries, among which broken knees and elbows are in the first place. Although these injuries are classified as lungs, they cause a lot of suffering and inconvenience to children.

First aid: rinse the wound surface with 3% hydrogen peroxide solution, pouring it directly from the bottle, either with furacilin solution (one tablet per glass of boiled water) or with a weak solution of potassium permanganate (potassium permanganate).

If you don’t have an antiseptic at hand, just use boiled water. Use a gauze pad to dry the wound with gentle blotting movements. Thoroughly wash the contaminated skin around the wound with warm water and soap, after protecting the damaged area.Lubricate a dried and non-bleeding wound with a 1-2% solution of brilliant green.

If the wound is dry and superficial, then it does not need a bandage. It is enough to observe hygienic rules and lubricate it with brilliant green 2-3 times a day. A good remedy for such wounds is Novikov’s liquid, created on the basis of brilliant green with the addition of a special colloidal mass. Dries quickly in air, it forms a dense elastic film that protects the wound from dirt.

With bleeding and infected wounds, Novikov’s liquid is contraindicated!

If the wound is deep, and blood or ichor continues to ooze from it, you cannot do without a bandage.Lubricate the skin around the wound with iodine or brilliant green, and apply a napkin moistened with furacilin, rivanol, chlorhexidine or another antiseptic on the surface of the wound, and fix it with a bandage.

Apply the bandage neatly and tightly enough: in a mobile fidget, it can slide off the wound, you will not have time to blink an eye. But do not overdo it: too tight bandaging will cause poor circulation, and even swelling of the underlying soft tissues. To better adhere to the wound, use a properly sized elastic tubular bandage.

Currently, the pharmacy has a huge assortment of modern dressings with hemostatic, antimicrobial, anti-inflammatory, analgesic and wound healing effects. I will name just a few of them: Koletex, Activetex. A drug, such as chlorhexidine and lidocaine, is applied to the gauze layer, and this napkin protects the wound from germs and has an analgesic effect. Thanks to the sticky edges, it is tightly fixed, does not require replacement within 2-3 days, and, most importantly, does not stick to the wound.

If the bandage is applied well, does not slide off, remains dry and does not emit an unpleasant odor, which indicates the well-being of the wound, you can leave it alone for 2-3 days.

When removing the bandage, be careful. Do not tear off the dried napkin, but thoroughly moisten it with any antiseptic solution or boiled water, and only when it gets wet, separate it from the wound.

Is the wound dry and clean? No more bandage required. Lubricate the wound with brilliant green, Novikov’s liquid or liquid plaster [1], keep the skin around it clean and live peacefully.

Why do knocked knees take a long time to heal?

For the epithelialization of any wound, rest is required, and the one located in the joint area is constantly under stress. One has only to form a crust, as it cracks when moving. Often, the child himself tears off the crusts that tighten the skin and interfere with movement in the joint.

What to do? Use for the night dressings with rosehip or sea buckthorn oil, Olazol preparation containing sea buckthorn oil, vinylin ointment, vinisol.From them, the crusts will become soft and elastic, and healing will go faster. At night, the dressing will not interfere with the child, and the drug will freely act on the wound. There are ready-made dressings that have a wound-healing effect: Activetex with sea buckthorn oil, Voskopran with Levomekol ointment – they are applied to the injured knee and accelerate healing, as they contribute to the penetration of air under the dressing, disinfecting the wound and its speedy epithelialization.

Most often, knees and elbows are affected by falls from a bicycle and rollerblading and skateboarding.Protective knee pads and elbow pads, which cushion inevitable falls, will not be damaged for a beginner cyclist and young roller skater.

Another frequent injury associated with a bicycle: rolling the “passenger” on the trunk, ending with the last leg hitting between the spokes of the rear wheel and both falling to the ground. The “passenger” has a fracture of the shin bones or an extensive laceration. And the “driver” often gets off with ripped off knees and elbows.

Liquid patch – a protective agent in the form of a spray or liquid with a brush in a bottle, which forms a thin elastic film on the wound that protects against infection.

Treatment of a bruised knee

Mechanical injuries or bruises of the knee are quite common. Among the causes of this household injury are winter ice, active sports, traffic accidents, and many other circumstances. Most often, children suffer from knee bruises after a fall, because their musculoskeletal system is not yet stable enough.

First aid for bruised knee

Knee contusions can be of varying severity, and not all of them require immediate medical attention.First of all, you need to examine the joint and assess how strong the pain is: gently stand on your feet, move the damaged joint, walk slowly.

The injured joint should be at rest, preferably in an elevated position for better blood flow from the site of injury. If possible, a piece of ice or any refrigerated object should be applied to the injury site (hold for no more than 15 minutes).

If there is a wound at the site of the injury, rinse it with running water, treat it with an antiseptic and apply a clean, dry bandage.Large wounds require immediate medical attention for professional treatment.

When to see a doctor

Within a few days after providing first aid, the patient’s condition should gradually improve, and the pain should subside every day. If the pain does not improve after a week after the bruised knee, you should see a doctor.

Also, immediate consultation with a specialist is needed if the following symptoms appear:

• hematoma, increased in size;
• a bump at the site of the injury;
• Soreness on movement and crunching knee;
• edema, redness;
• numbness of the knee, or, conversely, spontaneous movements;
• joint deformity;
• increase in body temperature after injury;

The doctor will examine the site of the injury, prescribe an X-ray or ultrasound if necessary, determine the risk of complications and prescribe treatment.

Despite the seeming harmlessness, a knee injury can be associated with a crack or bone fracture, a meniscus rupture, tears and inflammation in the tendons, twisting of the ligaments, internal bleeding, hematomas.

Since there are many nerve endings in the area of ​​the knee joint, even a slight bruise can cause severe pain. Also in the knee joint are muscle tissues, ligaments, cartilage, blood vessels, damage to which leads to various disorders. For example, untreated joint injury can cause arthritis (inflammation of the joints) or even osteoporosis (increased fragility of the bone).

Injuries are especially dangerous for children. The child’s body has not yet formed completely, and improperly provided assistance with a bruise can provoke a serious disruption in physical development.

Treatment of the consequences of a bruised knee

After the diagnosis is made, the surgeon or traumatologist will prescribe treatment depending on the severity of the injury.

For cracks and fractures, a plaster cast is applied. If the meniscus ruptures, measures are taken to restore or remove its broken off parts.

In cases of blood accumulation inside the joint, a specialist performs a puncture (medical removal of the accumulated fluid). To relieve pain and inflammation, special medications, physiotherapy procedures and vitamins are prescribed.

Our clinics in St. Petersburg

You can get detailed information and make an appointment by calling
+7 (812) 640-55-25

90,000 The main causes of knee swelling | Koleno

Many of us have repeatedly come across a situation where after a busy workout or an active day, the knee swells.With what this may be connected and what to do in such situations, we will consider further.

Causes of the swollen knee

First of all, you need to find out why the knee swells. Depending on this, treatment is prescribed.

1. Tendon inflammation. The main job of tendons is to attach muscles to bones. If they are inflamed, there is a sharp pain during movement and the soft tissues around them swell.
2. Inflammation of the joint capsule. Pain when bending the leg.Severe redness.
3. Injury of the anterior or posterior knee ligaments. A fairly common phenomenon in which, in addition to the fact that the knee swells, there is a feeling of instability in the leg. Sharp pain in the injured area is sometimes so severe that it is impossible to step on the injured leg.
4. Patella offset. Most often occurs after a blow or fall. Increased pain occurs during the straightening of the leg, and in some cases it is impossible to completely align the leg.
5. Knee injury. In addition to pain, it is accompanied by redness.
6. Rheumatoid arthritis. A chronic condition in which intermittent or permanent knee swelling can occur. The most acute pain is usually in the morning.
7. Osteoporosis. Pain is often dependent on weather conditions.
8. Septic arthritis. In addition to pain and swelling, it can be accompanied by fever.
9. Infection. Sometimes, when the epidermis is damaged, various kinds of infections can get into the wound. Some of these can cause swelling.

First aid

When the knee is swollen, first aid is needed. Sometimes the pain is so severe that it is almost impossible to move. In order to get to a specialist, you need to cope with pain. This will help:

• Painkillers. It is especially important if the pain is too strong to be tolerated.
• Cold. Ice works best. It must be applied to the swollen area for 15-20 minutes.But you need not to overdo it, so as not to lead to hypothermia.
• Rest. In order not to aggravate the situation when the knee is swollen, it is better to give him maximum rest. If the pain is severe, walk less and, if possible, call a taxi or even an ambulance to come to a specialist as soon as possible.

If you managed to cope with pain and reduce swelling on your own, this is not a reason to cancel your visit to a specialist. It is important to understand the cause and take the correct action to address it.This requires consultation with a specialist. We provide a free consultation. You can contact us by phone or using a vibe.

Who is most at risk of knee disease

There are categories of people who are especially at risk of such complications. What can contribute to this:

• Sedentary lifestyle. This is especially true for office workers who do not compensate for sedentary work with additional physical activity.
• Overweight. The knee gets a lot more stress when a person is overweight. The joint gradually deforms and collapses.
• Anatomical features. Sometimes the specificity of the structure of the leg is found, for example, the same flat feet or different lengths of the legs.
• Women after 40 years. Not only are women much more susceptible to ligament ruptures and injuries of the knee joint, but also after 40 years of age, cartilage tissue becomes thinner, which makes them even more fragile.This causes all sorts of diseases like osteoporosis. This complication is especially common among lovers of high heels on a regular basis – this further increases the load on the legs and directly on the articular part.

To prevent complications from developing, do not ignore the need to visit a doctor. To determine the diagnosis, he may prescribe you a CT, MRI, ultrasound or X-ray.

In some cases, a sample of the intra-articular fluid is taken.

Let your life be active enough and without injuries! Take care of your health!

Meniscus restoration by arthroscopic method, meniscus surgery

Information: Meniscus restoration by arthroscopic method

• Duration of stay in the clinic: 3 days
• Outpatient rehabilitation: 4 weeks
• Earliest time of departure home: 7 days after surgery
• Recommended time to fly home: 10 days after surgery
• Showering possible: 5 days after surgery
• Duration of incapacity for work: 2-6 weeks (depending on the type of activity)
• Driving possible: after 6 weeks

1. Meniscus tear: Symptoms and treatment
2. Meniscus function of the knee joint
3. Causes of knee injury: damage, structural abnormalities
4. Trauma features: symptoms
5. Diagnosis: How is the diagnosis made? Clinical examination, X-ray, ultrasound, MRI
6. What are the main types of knee meniscus injuries?
7. Surgical treatment: Resection, arthroscopic suture, transplantation
8. Duration of sick leave after surgery?

Front Knee Anatomy: Menisci surround the knee joint.They form a single bowl containing and supporting the femur. Together with the cruciate ligaments (in the image in the middle in the form of a spiral), it is fixed in the knee joint. © ttsz / istockphoto

Meniscus injury © Viewmedica

Meniscus tear is one of the most common knee diseases. Every accident leading to a painful dislocation or fracture of the knee joint can damage this cartilaginous structure. The more weight falls on the knee at the time of injury, the more likely it is to injure the meniscus.The more the knee bends inward and the larger the X-shaped curvature becomes, the higher the risk of rupture.

Each knee joint has an inner and outer meniscus. In this case, we are talking about cartilaginous C-shaped structures that act as a shock absorber between the tibia and femur. A sharp break immediately causes severe pain, swelling, and significantly limits the mobility of the knee when bending or extending the leg. Sometimes patients experience a so-called blockage in the knee.A worn out meniscus makes itself felt through gradual complaints.

Sometimes knee immobilization and physical therapy can help. In cases where pain and blockages are chronic, surgical treatment helps. …

Meniscus tear: Symptoms and treatment

In the knee, there are two menisci, lateral and medial, in the shape of a crescent. © Viewmedica

Meniscus rupture is a trauma of elastic-elastic C-shaped paired shock absorbers, consisting of fibrous cartilage that protects the knee, ensures its mobility, and also balances the load during walking.

One of the main reasons for this pathology is traumatic overload during sports, primarily due to dislocation or age-related changes.

The range of services of the Gelenk Clinic medical center includes both conservative and surgical treatment of the knee joint. If, after damage to the cartilaginous layers of the knee, the wound does not heal and does not heal, surgeons perform a partial removal operation or apply a special suture in order to restore the shock-absorbing function.

Meniscus rupture is the most common knee pathology that can occur when the knee is stretched or fractured. For such an injury, edema and acute pain are characteristic. In addition, it can speed up the process of destruction of the articular cartilage.

That is why arthroscopy or partial removal is one of the most frequently used knee surgeries practiced by our doctors. In addition, there is a whole range of damage. Some minor injuries go away on their own and do not have any consequences.However, there are injuries that require immediate surgery to stabilize the knee and prevent cartilage wear and arthrosis.

Knee menisci (top view). Clear crescent-shaped image. Mechanical shock absorbers that protect the cartilage surface. They also increase the bony articular surfaces and stabilize the knee. In addition, they reduce friction and limit excessive knee movement. © Alila Medical Media @ Fotolia

What is the role of the knee menisci?

Cartilaginous formations with shock-absorbing functions between the thigh and the lower leg, which are also a C-shaped cartilaginous structure located between the femur and the lower leg bone.

In each knee of the human body there are two such formations: the outer and inner meniscus. The first takes on a significant part of a person’s body weight, as a result of which it is much more likely to be exposed to various injuries.

First of all, during loads on the knee due to falls or jumps, this structure acts as a mechanical shock absorber between the thigh and lower leg. In addition, the meniscus, which is an intra-articular buffer, cushions the joint due to its elastic cartilage structure.When a person walks or runs, the knee carries a load in the amount of eight times the body weight. In this case, the meniscus absorbs most of the body weight, which exerts pressure on the articular surfaces of the knee joint. Without such protection, the process of destruction of the articular cartilage would be much faster. This fact is confirmed by the observations of both doctors and patients of the orthopedic clinic Gelenk Klinik in Freiburg: Earlier, when medicine was not yet at such a high level as at present, the damaged cartilaginous structures were completely removed, and after 2-3 years the patients were diagnosed with arthrosis …

Also, the menisci increase the available articular surface in which the large cylindrical condyles of the femur slide. After its rupture, the contact surface of the femur on the tibial plateau (lower articular surface of the knee) is reduced by 70%. In this regard, the severity on this area of ​​the articular cartilage increases.

By retaining a liquid film on the main part of the cartilaginous surface, the menisci support nutrition and promote lubrication of the articular cartilage.

Both meniscus of the knee joint form a cup-shaped depression in which the cylindrical condyles of the femur are located. By doing this, they stabilize the condition of the knee. Regardless of the position of the knee joint, the thigh is fixed towards the lower leg. Thus, the menisci are able to support the work of the cruciate ligament, the task of which is to center the bones in the knee joint. Degenerative injuries are most often formed after a cruciate ligament rupture, since these components of the knee, in a more mobile state, take on a stronger load as the last remaining tomous pads.

D The outer edge of the meniscus is firmly connected to the tibia. In addition, the internal meniscus is firmly attached to the articular capsule and the tibial collateral ligament. That is why it is not distinguished by high mobility and in case of an accident or other incidents it is damaged much more often than an external one.

The end of the cartilaginous structure in the direction of movement is called the anterior horn. Its end in the opposite direction is referred to as the posterior horn. The first is injured much more often than the second.

Causes of rupture of the knee meniscus

Meniscus injuries gradually appear as degenerative diseases of the knee joint due to long-term overload.

In younger patients, the above injuries occur in connection with past accidents or road accidents: During skiing or playing football, that is, when a person makes circular movements with his knee, the meniscus is most susceptible to various shocks. Patients notice the moment of its rupture immediately when they hear a kind of crunch in the knee.The most common injuries are meniscus tear or fissure.

The likelihood of the above injury increases with age: The older the person, the weaker his joints.

Meniscus injury of the knee joint: Symptoms

Signs of injury

• Loud crunch during rupture
• Swelling and numbness in the knee
• Stitching pain, especially during rotational movements of the knee
• If the patient is unable to fully flex or extend the knee
• Flexion and flexion blocks

Often the gap is accompanied by a kind of click.

Subsequently, the knee swells and becomes less mobile.

After a meniscus rupture, the patient feels pain in the knee while squatting and bending the knee back. In addition, the person has difficulty in fully extending the knee.

At the time of injury, a crackling sound can even be heard in the knee joint. In addition, the patient has difficulty moving the knee in a certain position.

Increasing pain and tingling sensations are a warning signal.Although menisci do not have pain sensors, the inner meniscus fuses with the articular capsule of the knee joint. From this it follows that any damage leads to painful injuries to the joint capsule.

If you have one of the above symptoms, immediately contact a specialist.

In patients with limited or insufficient meniscus function, arthrosis develops more rapidly.

After a knee meniscus rupture, a Baker’s cyst can form in the popliteal cavity.Often, the patient considers this pathology as the cause of his illness.

First aid after rupture of the knee meniscus

Immobilization, cooling, and placing the knee in a high position are recommended as first aid after a rupture or other trauma to the meniscus. If a pressure bandage is applied to the injured limb, it is necessary to pay attention to the fact that the bandage does not strongly adhere to the leg and does not disrupt the blood supply process.

If a patient complains of severe knee pain, he may be prescribed non-steroidal pain relievers to reduce swelling and pain.

How is knee meniscus injury diagnosed?

Clinical examination

During the clinical examination, the doctor conducts an explanatory conversation with the patient and asks the necessary questions regarding the condition of the knee joint and possible pre-existing diseases. In order to make the correct diagnosis and prescribe a suitable treatment, the specialists of our clinic need to know how often the patient complains of knee pain and how often it recurs.In addition, the orthopedic surgeon needs to be aware of any pre-existing injuries. The specialist also checks the mobility of the knee and thus determines the presence of blockages and edema. In addition, the examination allows the orthopedist to determine whether the patient can move the knee in different directions without feeling pain. Qualified examination at Gelenk Clinic helps to determine or exclude the presence of hallux valgus or varus deformity of the legs in a patient

X-ray examination

In order to exclude damage and bone fractures, an X-ray is performed.This examination only shows the condition of the bones. The position of the meniscus or other soft tissue injuries is not visible on the x-ray.

Ultrasound examination

Ultrasound examination helps to identify problems with menisci and associated diseases. In addition, an ultrasound scan may indicate a torn meniscus. Ultrasound also reveals such injuries as rupture of the external collateral and tibial collateral ligaments.

An MRI of a patient with a knee injury (left) clearly shows a horizontal meniscus tear along its longitudinal axis.The other meniscus (right) is intact (dark in color). This injury significantly reduces the mechanical motor properties of the knee. Active sports of the stop-start system are not recommended for such a patient. There is a possibility of surgical treatment of this pathology. Resection is not necessary if the injury does not adversely affect the mechanical function of the knee. © Gelenk-Klinik

Meniscus tear: Magnetic resonance imaging

The definitive diagnosis helps to make an MRI of the knee joint.This examination displays changes in soft tissue and articular cartilage in high resolution. If the doctor does not exclude the need for surgical treatment or when the patient constantly complains of the same symptoms, MRI cannot be avoided. The tomographic image also determines the presence of comorbidities by rupture of the external collateral and cruciate ligaments of the knee joint.

Forms of knee meniscus tears

In medicine, several forms of meniscus rupture are considered, which are distinguished depending on their shape and position.This information is necessary in order to properly plan both conservative and surgical treatment.

Vertical meniscus tear

Separation of the raised outer edge of the meniscus from the flatter inner edge. With the dislocation of the separated fragment, the mechanical functions of the knee joint are impaired.

Horizontal tear of the meniscus

Splitting of the C-shaped cartilaginous structure into the upper and lower parts. Both halves can be stably adhered to each other even after breaking.The injury is oriented horizontally and parallel to the tibial plateau. The prevalence is higher in older people.

Radial-transverse meniscus rupture

One of the most common lesions occurring perpendicular to the main line. As a rule, it is localized in the middle third of the lateral meniscus. Determined in coronary or sagittal projection.

Various forms of meniscus tear. Determined depending on the position, depth and degree of damage.Top row: Vertical, radial-transverse and horizontal breaks. Bottom row: Patchwork, vertically oblique (like a “parrot’s beak”) and a gap in the form of a watering can handle. High-quality treatment is possible if the doctor is fully aware of the form of the rupture. Violation of the mechanical functions of the meniscus can be compensated for by a change in lifestyle, namely, refusal to engage in active sports. A displaced fragment that has a negative effect on the knee is almost always sutured or resected. © Judith @fotolia

A partial meniscus tear may occur suddenly.

Most often, the tear passes through a specific part of the tissue and never fully damages the meniscus.If a stable injury is diagnosed without displacement, the wound heals on its own, and the original functions are restored in a short time.

The blood supply to the knee meniscus is improved depending on its position. In addition, a good blood supply to the damaged area increases the chances of recovery.

Degenerative rupture of the knee meniscus

Degenerative changes in the knee are more common in older people than in young people.

The connective tissues of the cartilaginous structure of the knee lose their elasticity with age and become less mobile.So, minor injuries can cause rupture of the knee meniscus. Unlike acute injuries, degenerative injuries resolve without symptoms and usually without pain.

• Meniscus dysfunction is diagnosed in more than 25% of people aged 50 to 59 years.
• Degeneration of the cartilaginous structure is observed in more than 35% of people over the age of 65.
• More than 45% of people over the age of 70 have pathological changes in the knee
• 95% of patients with arthrosis of the knee joint have a meniscus rupture
  (ESSKA Meniscus Consensus Project: Beaufils, Becker 2016)

Pain or discomfort in the knee rarely indicates degenerative changes in the meniscus.In acute injuries of the meniscus due to trauma or road traffic accidents, the patient feels severe pain if the joint capsule or collateral ligament is damaged. Degenerative changes, in turn, are asymptomatic, despite the fact that the shock-absorbing capacity of the cartilaginous structure is impaired.

Conservative treatment

Therapy of a damaged meniscus always begins with conservative techniques. Thus, our specialists want to speed up the process of curing the symptoms of the disease.

Surgical treatment

Meniscus tears can block the knee completely, especially when debris is anchored in the joint. Since, due to this injury, the naturally smooth articular surface becomes rough, the process of wear of the articular cartilage is significantly accelerated. Not every injury of this nature requires surgical intervention. If conservative treatment, namely physiotherapy and immobilization, helps to reduce pain, surgery will not be necessary.

A person can live calmly and with limited shock-absorbing ability of the knee joint, if he adheres to the doctor’s recommendations and avoids certain situations and types of sports activities.

However, after an accurate diagnosis, the doctor may pay attention to the fact of dislocation of fragments of the meniscus, which disrupts the mechanics and mobility of the knee. In addition, after this injury, sharp angles may appear in the knee, which, with each step of the patient, negatively affect the articular cartilage.In this case, surgery is performed on the knee joint.

Treatment of a meniscus tear of the knee: For trauma in an area with less blood supply, partial removal (resection) can straighten the tear site and prevent both angles and mechanical blockages in the knee. Arthroscopy is useful if there is a rupture at the base of the meniscus. This area is distinguished by good blood supply and the ability to regenerate. © Alila Medical Media @ fotolia.com

Meniscus resection: Partial removal

In the treatment of pathologies of the knee joint, minimally invasive arthroscopic methods are often used.Moreover, resection is one of the most commonly practiced techniques.

E A trained orthopedic specialist will be able to diagnose a ruptured knee meniscus during arthroscopic surgery and, if possible, straighten or suture it.

Earlier, when orthopedics was not yet at a sufficiently high level, a complete removal of the meniscus was carried out, since the doctors did not fully understand what function it performs. Today, experts are trying with all their might to preserve this cartilaginous structure and thus the articular cartilage.

The effectiveness of resection of a destroyed meniscus was questionable in medical circles. However, there are convincing studies that prove that alignment or resection is only beneficial for patients with mild arthrosis of the knee ( Lamplot, Brophy 2016) .

• • If symptoms and pain in the knee persist after three months after conservative treatment
• If MRI shows a grade 3 rupture
• If the patient complains of painful blockages in the knee joint

When surgery of the above injury is still not makes sense? The group of such patients includes people who have been diagnosed with a progressive stage of arthrosis and related complaints.In this case, a partial removal or leveling operation will not help improve the situation. The younger the patient, the easier it is for the orthopedist to determine the benefits that this surgery can bring to preserve the articular cartilage and prevent arthrosis.

How long does the patient stay in the clinic after the surgery?

Postoperative treatment is not particularly difficult. After two or three days in the hospital, the patient should keep the leg at rest for one week.Sometimes people are allowed to fully load the knee. Office workers can start their professional activities in a week. Patients whose work is related to physical labor are on sick leave for about 2-3 weeks.

Arthroscopic suture

In addition to smoothing the cartilaginous surface, it is possible to carry out an orthoscopic suture in order to heal the knee. This technique is recommended in cases of localization of a rupture in the area of ​​a well-supplied base of the meniscus.An optimal blood supply helps to heal injured structures. In addition, this technique helps to prevent the dislocation of fractured fragments. The advantage of this operation is to restore the functions of the meniscus without losing the structure-forming substance.

How long is the patient on sick leave?

In contrast to resection, the postoperative treatment after suture is quite complex. After a 4-day hospital stay, the patient must use elbow crutches for six weeks.In order for the seam to heal, a special orthosis is put on the knee. Office workers can start working in 3 weeks without removing the orthosis. Physically working patients are on sick leave for about eight weeks.

The most important goal of both conservative and surgical treatment is to preserve the articular cartilage and function of the damaged knee meniscus. However, this does not always work, and therapy begins to work too late. Sometimes the injuries are so severe that preservation is no longer possible.In addition, there are cases when, during resection, the surgeon removed much more of the cartilaginous structure than was actually required.

This situation is an indication for transplant surgery, which will help restore the shock-absorbing capacity of the knee joint.

Specialized orthopedic clinics offer two types of transplant techniques. In the presence of a donor meniscus, the donor’s biological material is implanted.

Synthetic transplantation involves the use of artificial material.

Both cases are not standard knee treatments. Each case is carefully checked by the health insurance fund and requires a special authorization.

Skeptical opinions regarding this method of treatment are associated with the lack of positive long-term results.

Therefore, it is very important to consider all the possibilities of therapy and choose the most appropriate one. First of all, you need to contact a qualified orthopedic specialist.

An experienced physician can initially plan treatment to preserve the knee joint.Thus, you can prevent unnecessary tissue loss, resection or misdiagnosis of existing damage.

Meniscus Surgery: Postoperative Treatment and Rehabilitation

After resection, the knee can be loaded almost immediately, namely every other day. The stitches are removed two weeks later. After the final healing of the wound, the patient is allowed to ride a bicycle and swim in a crawl style.

After suturing the meniscus, it should usually take 8 weeks for the patient to be able to move the knee as before.The aim of the operation is to fully restore the athletic ability and load capacity of the knee joint. After the operation, the patient should not feel any discomfort in the knee. Long-term damage and arthrosis can be prevented by restoring meniscus function.

Knee Arthroscopy | CDC “Ultramed”

Arthroscopy of the knee joint is a modern high-tech minimally invasive method of surgical examination and treatment of injuries and diseases of the knee joint, in other words, it is an operation that allows you to perform the entire required volume of surgery after 2-3 skin punctures and after which you are allowed to get up and walk the next day.

This operation is shown for:

• tears and other damage to menisks,
• rupture of the ligaments of the knee joint,
• inflammation of the synovial (inner) membrane of the joint,
• the presence of intra-articular bodies,
• patellar dislocation,
• diseases of the joint cartilage,
• deforming arthrosis of the joint,
• rheumatoid arthritis,
• necrosis of the femoral condyles and other diseases.

Often, arthroscopy is used to more accurately diagnose the condition of the joint when the clinical picture is unclear, for example, when conservative treatment is ineffective.

It is clear that arthroscopy has many advantages over conventional (open) surgery, which is why arthroscopy is currently the gold standard in the diagnosis and treatment of diseases and injuries of the knee joint.

Arthroscopy of the joint is performed using a special device – arthroscopic, which is a thin tube 4 mm in diameter with a special optical system at the end and an illuminator.

The device is connected to a video camera, so the image is displayed on the monitor. To insert the arthroscope into the joint, it is necessary to make a very small incision, only 5-7 mm. An additional access of the same size is made for the surgical instruments used. Rarely, during arthroscopy of the knee, there is a need to widen the incision for instruments or perform a third incision, usually when large intra-articular bodies need to be removed or in complex injuries in the joint.

Despite the low trauma of the operation, there are contraindications for arthroscopy of the knee joint: contraindications to anesthesia, infected wounds or inflammatory diseases of the skin and subcutaneous tissue in the knee joint and lower extremities, pronounced adhesive process in the joint cavity.

Preparation for surgery

Preparation for arthroscopy is easy for the patient. The main condition is the tolerance of anesthetic agents, the absence of absolute contraindications from other organs and systems of the body.If the patient takes special drugs that affect blood clotting, then taking these drugs on the eve of the operation is a separate issue for discussion with the doctor.

The preoperative examination of the patient usually includes a physical examination, blood and urine tests, an electrocardiogram, an X-ray of the knee, an MRI or ultrasound of the knee, sometimes more in-depth examination is required to safely administer anesthesia.

Conducting transaction

After the onset of anesthesia, the patient’s knee joint is filled with liquid through a skin puncture, an arthroscope is inserted into the joint and a special thin probe is inserted through a separate puncture.First, the diagnostic stage is always performed, during which the joint is examined, all accessible internal structures of the joint are palpated: menisci, cartilage, ligaments, and the inner (synovial) membrane of the joint. After completing the diagnostic stage, when the picture of changes in the joint is clear, the required amount of therapeutic actions is determined, depending on the identified pathology. The healing phase takes 5-60 minutes. At the end of the operation, the joint is washed with fluid, and sutures are applied to the wounds.

After a successful knee arthroscopy, the patient can go home even on the day of surgery.Although this operation is performed with minimal incisions and usually does not cause complications, patients still require a recovery period.

Analgesics may be needed on the first day after surgery. Usually painful sensations of varying intensity can last up to 3 days. The need for analgesics may not arise. The day after the operation, the dressing is performed, the further dressing schedule is drawn up individually. If necessary, in addition to bandaging, a puncture of the knee joint is performed to remove fluid from the joint.Do not wet the operated area and dressings until the stitches are removed. In the postoperative period, an elevated position of the limb is recommended for 1-3 days (until the edema subsides). The stitches are usually removed on the 8-14th day, depending on the volume of the operation. The load and movement in the first days after the operation should be limited – ask the surgeon about your movement regime. Also, from the third day, physiotherapy, physiotherapy exercises and massage are shown. The purpose of these procedures largely depends on the volume of the operation performed and is assigned individually.If all the instructions are followed, the patient returns to his usual way of life and can engage in physical activity in full within 3-5 weeks after arthroscopy.

Complications of arthroscopy

Like any other surgical intervention, some complications may occur, albeit rarely, during arthroscopy:

• caused by anesthesia are not associated with arthroscopic surgery per se;
• hemarthrosis (accumulation of blood in the joint), requires puncture;
• synovitis (non-infectious inflammation of the inner lining of the joint), often appears when vigorous activity is resumed too quickly after surgery, requires puncture and anti-inflammatory treatment;
• Complications from the nervous system: they are manifested by the appearance of a zone of “anesthesia” or a feeling of creep in the joint area and are associated with damage to the nerve branches.Over time, these manifestations disappear.
• Internal Lateral Ligament Stretching: Can be obtained through increased manipulation to increase the distance between the femur and tibia during the examination and treatment of the menisci, this is required to preserve the cartilage from damage
• Thromboembolic complications: they are extremely rare, their prevention is mandatory for everyone: at least elastic bandages, in the presence of risk factors, medications are required.
• purulent arthritis – associated with an infection in the joint, most often appears after inflammation of the skin in the area of ​​postoperative wounds if the regimen is not followed (water gets on the wounds when washing).

The main thing for the prevention of complications after arthroscopy is strict adherence to all the prescriptions of the attending physician.

Meniscus rupture is a common pathology that occurs with injuries or sudden movements (the most typical mechanism of injury is a twisting load on the knee joint with a fixed foot), sometimes meniscus damage can be obtained when squatting or jumping even from a low height.

As a rule, the patient is worried about pain in the joint, appearing or worsening with movements or exertion, while the knee often increases in size due to edema and fluid inside the joint, often there are “blockages” of the joint, which sharply limit the range of motion and are accompanied by a feeling of instability in it (the leg is “tucked”).

In such situations, you should create rest for the knee joint, fix it with an elastic bandage or knee pad, and as soon as possible appear for an examination by an orthopedic traumatologist.The doctor examines the damaged joint and prescribes an examination. Radiography in case of damage to the menisci is absolutely not informative, but it can be performed if there is a suspicion of the presence of any bone pathology, ultrasound is a screening method, which in most cases allows confirming the study conducted by the traumatologist. The most informative method of non-invasive diagnosis of meniscus injury is MRI.

Conservative treatment for meniscus rupture is ineffective.

Arthroscopy of the knee joint is the only correct solution in this case, since it allows you to clarify the nature of the damage in the joint and perform a full treatment of the revealed pathology.Arthroscopic knee surgery is usually performed under spinal anesthesia, lasts about 15-40 minutes, and – in most cases – involves removing only the damaged part of the meniscus. In rare cases, and only with fresh paracapsular tears, suturing of the meniscus is possible.

You can fully lean on your leg 12 hours after the operation, crutches and walking sticks are not required in the vast majority of cases, a cast is not applied. The load is gradually – within 4 weeks it is brought to the usual one, however, do not forget that all this time it is required to carry out certain rehabilitation measures for the most complete restoration of the function of the damaged knee joint.All these recommendations after the operation can be given to you by the operating surgeon. On the part of the patient, their strict implementation is required under the supervision of the attending physician. The ability to work can be restored, depending on the nature of the work, in 2-4 weeks. Sports can be practiced 6 weeks after surgery.

Rupture of the anterior cruciate ligament (ACL) of the knee joint – injury that occurs during torsional load on the knee joint, during a fall with a turn, a strong blow to the knee joint; often, along with the cruciate ligament, the menisci and the internal lateral ligament are injured.As a rule, with a rupture of the ACL, hemarthrosis occurs (blood in the joint), while the joint rapidly and significantly increases in size, pain increases.

Diagnosis of rupture of the anterior cruciate ligament in the early period after trauma is not very simple: examination due to swelling and pain does not always reveal instability in the joint, only bone lesions are visible on the X-ray, and it is almost impossible to examine the anterior cruciate ligament with ultrasound. The only reliable method is MRI.

Often, patients with ACL rupture are treated conservatively in the hope that the disease will subside without surgery.

Indeed, in most cases, the edema decreases, the inflammation subsides, the pain becomes weak, however, as a rule, the most important symptom of ligament damage persists: instability. Someone really feels it as instability, when the lower leg “pulls out” from under the knee, someone notes “twisting” in the joint, someone talks about a sharp pain that occasionally occurs during awkward movement and further try to avoid repetition situations like this.However, anterior instability inside the joint always remains and this manifests itself in the collision of the cartilage of the articular surfaces during walking and more serious loads, which ultimately leads to rapidly progressive arthrosis of the knee joint with its constant pain and irreversible destruction of the cartilage. The anatomy of the knee joint is such that the damaged ACL has no chances to recover, moreover, even a partially damaged ligament may be completely incompetent due to a rupture of the vessel feeding the ligament: with old ACL injuries, arthroscopy often finds only fragments of the ligament or states its complete absence.

Surgical treatment for ACL rupture is performed to stabilize the knee joint by performing arthroscopic plasty of the anterior cruciate ligament. During the operation, first of all, a diagnostic stage is performed, during which the state of the intra-articular structures is assessed and the volume of necessary procedures during the treatment stage is determined (resection or suture of the menisci, treatment of cartilage, etc.). Suturing of the ligament is impossible, therefore a graft is required for the plasty.Most often, tissues of the body’s own are used: the tendon of the semitendinosus muscle, the tender or even peroneal muscles, part of the tendon of the 4-headed femoris muscle or part of the patella’s own ligament, less often allografts or synthetic materials are used. In our practice, we prefer the ACL autograft from the hamstring and tender muscles tendons, since it corresponds to the strength characteristics of the real ligament, there are various options for its fixation, and – today it is the least traumatic way to restore the anterior cruciate ligament.

After preparing the graft, using special guides, channels are formed in the femur and tibia through which the graft is passed and fixed in the chosen way. We prefer fixation with Endobutton systems (in various modifications) and interference screws.

After the operation, the knee joint is fixed with an orthosis with limited range of motion in the knee joint; walking is allowed from the next day after the operation with additional support on crutches.Do not step on your foot completely for at least three weeks after the operation.

The period of stay in the clinic of the clinic is 2 days, when the observation of the patient in dynamics is required and the treatment is carried out in the required volume. From the 3rd day, when the pain is significantly reduced, it is possible to continue treatment on an outpatient basis. At this stage of treatment, it is necessary to reduce swelling, heal skin wounds, and gradually restore the range of motion in the joint. After 3 weeks, the full load on the leg is allowed, the development of movements in the joint continues, however, for normal physical activity, approximately 2 more months of rehabilitation will be required.Sports can be practiced 8 months after the operation, devoting all this time to the active restoration of joint function.

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