On Hey's 'internal derangement of the knee-joint' / by J.F. Knott.

  • Knott, John, 1853-1921.
Date:
1882
Catalogue details

Licence: Public Domain Mark

Credit: On Hey's 'internal derangement of the knee-joint' / by J.F. Knott. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    same denomination, two distinct varieties of surgical lesion—one, in which the displacement affected the semilunar cartilages only; the other, in which, besides the derangement of the cartilages, there is also a change in the normal relations of the femur and tibia, or, in other words, an incomplete dislocation of the leg. Some cases of the former class were unaccompanied by any prominences or displacement visible externally, as occurred in some of the instances observed by Hey himself. A good example of “ internal derangement” has also been recorded by Bonnet (de Lyon) :—“ A very active man, aged forty-five years, twisted his knee in making a movement of external rotation. I saw him two days after the accident; no physical derangement could be detected in the knee; there was merely a small amount of serous effusion into the synovial cavity. The patient could walk only with extreme pain, he suffered much, and could extend the leg upon the thigh but in a very incomplete manner. This disproportion between the impairment of motion, which was carried to sin-extreme degree, and the inflammation, which was but slight, made me think that a luxation of the semilunar cartilages had probably taken place. I then flexed the knee as much as possible; this flexion was painful. Having done this a first time, I extended the leg, and flexed again. This manoeuvre was followed by immediate relief; the patient was able to walk with less pain, and to extend the leg upon the thigh completely. The inflammation rapidly subsided.” Very valuable evidence with regard to the nature and mechanism of the injury was obtained by this writer from the results of experi- ments performed on the dead body. In the body of an adult male who had succumbed to a chronic malady, and whose articulations in consequence presented a considerable degree of relaxation, Bonnet found that by flexing the leg to form a right angle with the thigh, as the body lay in the prone position, and suddenly rotating the foot outwards, a peculiar snap was felt, after which the limb remained in the position of external rotation, with the leg flexed upon the thigh at an angle of about 45°. At the antero-internal aspect of the knee-joint a prominence could be felt corresponding to the inner tuberosity of the tibia; this prominence projected in front of the inner condyle of the femur; the head of the femur was carried backwards and inwards. The rotation of the leg, measured by the deviation of the foot, amounted to nearly a quarter of.a circle. Lpon extending the leg (for which a slight effort was