Internal derangement of the knee

Japanese: 膝内障 - しつないしょう（英語表記）Internal derangement of the knee

What kind of disability is it?

Knee dislocation was previously a condition in the knee joint. Incarceration ( Kanton ) It was a comprehensive term for a series of diseases that showed symptoms (a condition in which the meniscus or loose bodies are caught in the joint and the joint cannot bend or straighten). As medical science advanced, the contents of knee joint disorders were analyzed, and several independent diagnostic names were established. Then, knee joint disorders came to be used as a general term for many of these knee joint injuries and disorders.

Clinically, the following are classified: Meniscus ( Half moon ) Damage, 2 Ligaments ( Constitution ) and 3) other damage or impairment.

1. Meniscus injury

The menisci are located on the inside and outside of the knee joint. tibia ( Practice ) It is a fibrous cartilage that covers the margins of the joint surface. It is the most common knee sports injury.

Symptoms include knee joint pain, a feeling of catching, incarceration, joint effusion, etc. In childhood, there is congenital damage to the discoid meniscus, and even without obvious trauma, knee extension disorder is observed.

Diagnosis was previously performed by arthrography, but can now be made with MRI. Treatment involves partial meniscal resection and meniscal suture surgery using a knee arthroscopy. Postoperative outcomes are good and patients are able to play sports.

2) Ligament injury

Please refer to the previous section on knee sprains.

③Other damage or impairment

Intra-articular loose bodies, osteochondritis dissecans, Patellar cartilage ( Pair of bones ) Knee softening, idiopathic Bone necrosis ( Hand tools ) , shelf disorders, intra-articular tumors, Mass ( Production ) , quadriceps tendon rupture, and patellar tendon rupture.

Patellar chondromalacia is common in young women, with the main complaint being pain in the front of the knee. Idiopathic osteonecrosis of the knee is common in women over 60, with the main complaint being pain in the femur of the knee joint. Medial condyle ( Secret turnip ) It occurs most frequently on the joint surfaces, causes nighttime pain, and is diagnosed by characteristic X-ray images or MRI.

Recently, these diseases are treated as independent diseases, and the term "knee joint dysfunction" is gradually being used out of use. It is now used to refer to knee injuries and disorders that have not yet been definitively diagnosed, and once a diagnosis is made, for example, if it is determined that the meniscus is the cause of the pain, the diagnosis is changed to meniscus injury.

Kenji Nakagawa

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな障害か

　膝内障とは、以前は膝関節の嵌頓(かんとん)症状（関節内で半月板や遊離体などが引っかかって屈伸ができない状態）を示す一連の疾患を包括したものでした。医学の進歩とともに膝内障の内容が分析され、いくつかの独立した診断名が確立されました。そして膝内障は、これら数多くの膝関節の損傷・障害の総称として使われるようになりました。

　臨床的に分類すると、①半月板(はんげつばん)損傷、②靭帯(じんたい)損傷、③その他の損傷・障害の3つに分けられます。

①半月板損傷

　半月板は膝関節の内側と外側にあり、脛骨(けいこつ)関節面の辺縁部をおおう線維性軟骨です。膝のスポーツ外傷として最も頻度が高い障害です。

　症状としては、膝関節の疼痛、ひっかかり感、嵌頓、関節水症などがみられます。小児期では先天性の円板状半月の損傷があり、明らかな外傷がなくても膝の伸展障害を示します。

　診断は、以前は関節造影が行われていましたが、現在はMRIで診断可能です。治療は、膝関節鏡を使った半月板部分切除術や半月板縫合術を行います。術後の成績は良好でスポーツをすることも可能です。

②靭帯損傷

　前項の膝関節捻挫(ねんざ)を参照してください。

③その他の損傷・障害

　関節内遊離体(ゆうりたい)、離断性(りだんせい)骨軟骨炎、膝蓋軟骨(しつがいなんこつ)軟化症、膝特発性骨壊死(こつえし)、棚障害、関節内腫瘍や腫瘤(しゅりゅう)、大腿四頭筋断裂、膝蓋腱断裂などが含まれます。

　膝蓋軟骨軟化症は若年の女性に多く、膝の前面の痛みが主訴になります。膝特発性骨壊死は60歳以上の女性に多く、膝関節の大腿骨内側顆部(ないそくかぶ)関節面に好発し、夜間痛があり、特徴的なX線像やMRIで診断されます。

　最近は、これらの疾患は一つひとつが独立した疾患として扱われ、膝内障という病名は次第に使われなくなっています。現在ではむしろ確定診断がまだついていない膝の損傷・障害に使い、診断がついた時点で、たとえば半月板が痛みの原因とわかれば、半月板損傷という診断に変えます。

中川　研二