söndag 25 mars 2007

Dr Haglunds Knäspecial #3

David Sköld beskriver i sin briljanta novell (v g se tidigare inlägg i Dr Haglunds Spalt) hur han drabbades av främre korsbandsskada och att han har minnesbilder av hur ortopeden under titthålsoperationen även klippte bort trasiga bitar av menisken. Dagens spalt är ägnad just åt meniskskador.



I knät finns två halvmåneformade broskskivor som ligger fast ovanpå skenbenet(Tibia). Dessa broskskivor kallas menisker. Man talar om yttermenisk (meniscus lateralis) och innermenisk (meniscus medialis). Meniskens funktion är primärt att fungera som stötdämpare så att den tar en del av belastningen ifrån benen vid gång och löpning. Annars skulle benbrosken belastas för hårt. Menisken bidrar också till att ge en viss stabilitet i knät. Meniskskador uppstår oftast när man får någon form av vridning av knät medan det är böjt. Därvid kan menisken komma i kläm mellan lårbenet (femur) och skenbenet och bli söndervriden.



Just när man har skadat sitt knä kan det vara svårt att avgöra om det föreligger en meniskskada. Knät kan vara svullet, men det behöver inte vara det. Om knät har låst sig är sannolikheten stor att de rör sig om en meniskskada. De klassiska symptomen fattas dock oftast i början.

De klassiska symptomen på meniskskada är att knät låser sig efter att man har suttit på knä, så att man inte kan sträcka knät igen. Detta beror på att det har blivit en spricka i menisken så att en del av den har kommit i kläm inne i leden. Några gånger kan man då lirka lite på knät och få det sträckt igen. Ett annat symptom på meniskskada kan vara smärta vid belastning och efterföljande större eller mindre svullnad. Vid lateral meniskskada är det ofta mer smärta men mer sällan låsningar än vid mediala meniskskador.

Hur ställs då rätt diagnos? Vid en undersökning av meniskerna känner man över yttre och inre ledspringorna för att se om det är ömt. Sedan finns menisktester som ofta används t ex McMurrays test. När testet utförs känner man ett knäppande över ledspringorna som tecken på att meniskerna är skadade.



För att säkerställa diagnos används ibland magnetkameraundersökning som påvisar mer än 90% av alla mediala meniskskador och något färre andel av de laterala. Helt säker blir man om man tittar efter med titthålsteknik dvs s k artroskopi. Fördelen är då att en eventuell skada kan åtgärdas omedelbart.

I praktiken behandlas de flesta misstänkta lindriga meniskskadorna konservativt med kyla och kompression i akutskedet. Därefter funktionell rehabilitering via sjukgymnast/fysioterapeut. Om ingen förbättring sker bör man träffa en ortopedläkare.

Det finns ingen standardbehandling för meniskskada. Som grundregel försöker man att bevara så mycket av menisken som möjligt. Om det rör sig om en skada som gör att en bit av menisken kan komma i kläm, kan man ta bort denna bit. Dessa behandlingar kan företas i samband med en titthålsundersökning. Om det är en lång spricka i menisken kan det vara möjligt att sy fast menisken igen. Om det finns möjlighet för att sy menisken föredrar man nästan alltid att göra detta. En stor del av menisken är dock utan blodförsörjning och om skadan har skett i det här området är det ingen idé att sy ihop menisken igen, eftersom den då inte kan växa ihop igen. Nedan en bild taget vid artroskopi där man ser en skada i menisken:



Efter titthålsundersökningen, då man har tagit bort en liten del av menisken (meniskektomi), kan man snart gå normalt igen. Om man har sytt menisken ska man använda en skena i cirka 6 veckor, men rehabiliteringen kan ta upp till 6 månader. När det gäller fysisk aktivitet och vardagsmotion under behandlingstiden är det i många fall så att man kan ägna sig åt lätt rörelse som inte ger smärta. Vad händer då om man tagit bort sina menisker? Jo, i många fall går det ganska bra en tid. Men med åren ökar risken för att det övriga bråsket i knät slits ut och att man utvecklar s k artros vilket är en form av förslitning av leden.

Vilka andra i SUS utöver Skölden har haft meniskskador? Skriv gärna frågor i kommentatorsrutan.

54 kommentarer:

Johan seidefors sa...

Du borde få betalt för det här jobbet.

Axel sa...

Den enda betalning som betyder något är positiva kommentarer. Det är det man lever för numera.

Anonym sa...

Jag är hänförd.

Måste läsa igenom allt igen så att man fattar vilket arbete som ligger bakom. Stort.

Stefan sa...

När kommer det nåt om blånaglar?

Anonym sa...

Okej, det var ju ett tag sedan du skrev det här inlägget, men ja råkade googla mig fram till det idag, då jag satt och funderade på knäskador och av ren nyfikenhet vill veta lite mer.

Tack tack !!

Anonym sa...

det känns som att det här just har hänt mig. Mitt knä låser sig och jag har blivit taklad så att mitt knä vred sig. Vad ska man göra då?

Anonym sa...

wow!
det jag just läst är exakt vad som hänt mig!
Efter en skada har mitt knä låst sig och jag blev hänvisad till en ortoped. Han sände mig vidare för magnetröntgen, fick svar idag att jag ska få göra titthålskirurgi och ta bort en bit.
Det beskedet var mycket efterlängtat!

Anonym sa...

Har precis varit på akuten med ett trasigt knä efter en innebandy träning och jag ska opereras för miniskskada i veckan som kommer.
Jag ville då veta mer och hittade den här sidan vilket hjälpte mig enormt att förstå vad läkarna pratade om. Tack för mycket god information.

Hege sa...

Gud va bra skrivet - har just stakat mig genom en läkar-artikel om meniskskador för att bättre förstå vad jag lider av. När jag hittade denna artiklen föll alla bitarna på plats. Tack!

Axel sa...

Hej! Dr Haglund kollar mycket sällan i denna kommentarspalt så förvänta er inte svar på ställda frågor.
Mvh
Dr Haglund

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