The unhappy triad , also known as blown knee among other names, is an injury to the anterior ligament, medial collateral ligament, and medial meniscus. Analysis during the 1990s shows that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, medial meniscus medial tears always present with lateral meniscal injury simultaneously. However, the 1990 analysis shows that the lateral meniscal tear is more common than the medial meniscus tears along with ACL sprains.
Video Unhappy triad
Symptoms
- Pain in affected knee
- Stiffness and swelling of the affected knee
- Capture or lock the knee on affected knee
- Instability of knee with twist or side-to-side motion (Knee sensation "ejection").
- Inability to move the knee through full range of motion
Maps Unhappy triad
Cause
An unhappy triad occurs because the lateral blow to the knee causes a rupture in the anterior anterior ligament, the medial collateral ligament, and the meniscus. The injury is most often maintained when the lateral force (from the outside) affects the knee while the foot remains on the ground. The strong valgus or rotary force to the knee tears the ACL, MCL, and medial meniscus all together. This type of injury often occurs in contact sports such as football, rugby, or motocross. During an injury, the leg is rotated laterally and over-abducted. In about 10% of cases, this force is applied to the opposite side of the knee, and the lateral and posterolateral ligaments are torn.
Anatomy
Skeletal components involved in unhappy triads include: patella, femur, tibia. No muscle is directly involved in this injury, only the ligaments; However, strengthening hip flexor muscles and hip extensor muscles can help alleviate injuries.
The medial collateral ligament, the posterior cruciate ligament, the anterior cruciate ligament, and the lateral collateral ligament are the four primary ligaments of the knee. The medial and lateral collateral ligaments mainly provide support for the varus and valgus forces whereas the anterior and posterior cruciate ligaments prevent the anterior and posterior translation of the tibia on the femur. Structure
in triad
The classic O'Donoghue triad is characterized by injury to three knee structures (in order):
- anterior cruciate ligament
- medial meniscus (however, lateral meniscal injuries are more commonly seen among athletes, leading to the most commonly used definition of the O'Donoghue triad currently used.)
- the medial collateral ligament (or "tibial collateral ligament")
Component injuries
Cruciatum anterior cruciate ligament
The anterior cruciate ligament is one of the four important ligaments in the knee. It originates from the lateral condyle of the femur and goes to the tibial interondyloid eminence. Its function is to provide stability in the knee and minimize stress throughout the knee joint. It also withstand excessive forward movement in the legs and restrict rotational movement in the knee.
Injuries
An anterior cruciate ligament injury results from excessive pressure on the ligaments. This can come from motion stopping or kneeling abruptly. Some early symptoms include swelling, knee instability, and pain. The sounds of explosions or sensations may or may not be heard when the first tears of the ACL. The following symptoms usually include a "give" knee feeling. The tearing of the ACL is the most significant injury as it leaves an unstable knee, which also causes the knee to lose its normal function.
Epidemiologi
An estimated 100,000 new anterior ligament injuries occur in the United States each year. About half of the new ACL injuries involve injuries to the affected ligaments, tendons, and/or knee muscles. Women have a greater risk for ACL injuries than men because of their larger Q angles. The angle of Q is the angle formed by the line drawn from the superior anterior iliac spine to the central patella and the second line taken from the central patella to the tibial tubercle.
Meniscus
The medial meniscus is a piece of cartilage shaped like a C-wedge that acts as a "shock absorber" between the femur and the tibia. Each knee has two menisci, one on the outer edge and one on the inside of the knee. Menisci is hard and rubber-like to help protect the joints and help keep them stable.
The lateral martus is also known as the external semilunar fibrocartilase. It is a fibrocartilage band on the lateral side of the knee joint and can be easily injured with torsional stress or direct force.
Each knee has a medial and lateral meniscus, which consists of connective tissue and collagen fibers. Menisci needed to distribute weight in the knee. Without them, weight is distributed unevenly in the femur and tibia, possibly leading to early arthritis in the knee joint. Menisci are preserved by small blood vessels, but each has a large central portion that is avascular and does not get a direct blood supply. This poses a problem in meniscus injury, as blood flow is reduced and the avascular area is less likely to heal.
Injuries
Torn meniscus is one of the most common knee injuries. Usually caused by torsional stress; rotate or rotate the knee too quickly with legs planted on the ground while the knees are flexed. The feeling of "pop" in the knee usually feels when the meniscus is torn. Athletes, especially those who participate in contact sports, are at a greater risk for meniscal tears. Sports-related meniscal tears often occur with other knee injuries, such as anterior cruciate ligament cracks.
Meniscus tear is usually referred to as torn cartilage in the knee. Menisci is torn in different ways and recorded by how they look, as well as where rips occur on the meniscus. Two types of tears include small, which include stiffness and swelling in two or three days but usually disappear within two to three weeks. Then there is the severe, that without treatment, a piece of meniscus can loose and float into the joint space. Tears include elongated, parrot-beak, flap, bucket handle, and mix/complex. The image of meniscal tears
Epidemiologi
The injury to the medial meniscus is about five times greater than the injury to the lateral meniscus due to anatomical attachment to MCL. Lateral meniscal tears are more common in acute ACL injuries, whereas menialal medial injury is more common in chronic ACL knees and easier to repair.
Meta-analysis showed that in ACL acute injuries associated with meniscus tears, 44% were of the medial meniscus, whereas 56% were from the lateral meniscus; in chronic ACL insufficiency, 70% is medial whereas 30% is lateral.
Medial collateral ligament
Injuries
Because the medial collateral ligament refuses the widening of the inside of the knee joint, the ligament is usually injured when the outside of the knee joint is struck. This style causes the outside of the knee to bend, and the inside widens. When the MCL is stretched too far, it is susceptible to tear and injury. This is an injury that was seen by the "clipping" action in soccer matches.
Injury to MCL may occur as an isolated injury, or may be part of a complex injury to the knee. Another ACL ligament, or meniscus, may be torn at the same time as an MCL injury.
Symptoms
The most common symptom after MCL injury is direct pain over the ligaments. Swelling over a torn ligament may appear, and general joint bruising and swelling is common 1 to 2 days after injury. In more severe injuries, patients may complain that their knees feel unstable.
Maintenance
The treatment of MCL tear depends on the severity of the injury. Treatment always begins by letting the pain subside, starting to work on mobility, followed by strengthening the knee to return to sports and activities. Bracing can often be useful for the treatment of MCL injuries. Fortunately, most frequent surgery is not required for the treatment of tearing MCL.
Treatment For Triad Failure Unhappy
An unhappy triad treatment usually requires surgery. ACL surgery is common and meniscus can be treated during surgery as well. MCL is rehabilitated through time and immobilization. Physical therapy after surgery and the use of knee support helps speed the healing process. Typical operations for blown knees include:
- Patellar tendon autograft (Autograft is a patient-derived graft)
- Hamstring tendon autograft
- Quadriceps tendon autograft
- Allograft (taken from the patellar tendon), Achilles tendon, semitendinosus, gracilis, or posterior tibial tendon
The purpose of the reconstruction operation is to prevent instability and restore the function of torn ligaments, creating a stable knee. There are several factors that the patient should consider when deciding for or against surgery.
Epidemiology
A study containing 100 consecutive patients with a new anterior ligament injury was examined with respect to the type of sport activity that caused the injury. Of the 100 ACL injuries respectively, there were also 53 medial collateral ligament injuries, 12 medial, 35 lateral and 11 meniscal bicompartmental lesions. 59/100 injured patients during contact sports, 30/100 on the ski slopes and 11/100 in other recreational activities, traffic accidents or at work.
A corresponding medial collateral ligament collapse is more common in skis (22/30) than during contact exercise (23/59), whereas bicompartmental meniscus lesions are found more frequently in contact sports (9/59) than in skis (0/30). ). Body weight was reported by 56/59 patients with contact sports injuries while 8/30 of them with ski injuries. Non-weightbearing in an injury situation causes the same MCL tear (18/28) level as body weight (35/72) but significantly more intact menisci (19/28 vs 23/72). Thus, contact injury is more commonly maintained during weighting, with joint compression generated from both femuro-tibial compartments as indicated by higher incidence of meniscus bicompartmental lesions. The classic "happy triads" are rare finds (8/100) and Frida  © n T, Erlandsson T, ZÃÆ'¤tterstrÃÆ'¶m R, Lindstrand A, and Moritz U. indicate that this entity should be replaced by "unhappy compression injury ".
History
In 1936, Cambell stated that "crucial ligament damage and important anterior ligaments are associated with internal cartilage injury". In 1950, O'Donoghue described an unhappy triad as: (1) medial collateral ligament rupture, (2) damage to the medial meniscus and (3) anterior cruciate ligament rupture. O'Donoghue estimates the incidence rate in traumatic sports knees to 25%.
In 1991, Shelbourne and Nitz questioned the validity of O'Donoghue's horrific triad studies. A review of all acute acute injuries that are confirmed to arthroscopically second degree or worse on ACL and MCL are performed. Of the 52 knees examined, 80% of group 1 had a lateral meniscal tear and 29% had medial meniscal tears. None of the medial meniscus tears are isolated; medial meniscal tears are absent without the presence of lateral meniscal tears. From this study, it was concluded that structures more often involved in triads are anterior anterior ligaments, medial collateral ligaments, and lateral meniscus (not medial).
Terminology
The term "happy triad" was invented by O'Donoghue in 1950. However, since then, this term and the term "terrible triad" have also been used to describe some other combinations of joint injuries, including terrible elbow triads and shoulders.
The term "terrible triad" is also sometimes used in the popular press to describe pain-related conditions, or even refers to the triad of MacDonald's sociopathic behavior.
See also
- Anterior cruciate ligament injury
- Reconstruction of anterior cranial ligaments
References
External links
- MedlinePlus Encyclopedia Anterior cruciate ligament (ACL) injury
Source of the article : Wikipedia
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