ABNORMAL CONDITIONS OF THE KNEE-JOINT. 



49 



articulation, and are associated with some form 

 of inflammatory action, either acute or chronic. 



Simple acute inflammation of the knee-joint, 

 or acute art/iritis genu, may be the result of a 

 contusion, a sprain, or a wound; or there may 

 be no assignable cause. In the latter case it 

 may have been preceded by rheumatic fever, 

 erysipelas, or diffuse inflammation, which had 

 previously engaged distant organs and other 

 structures. The symptoms are usually strongly 

 marked. Considerable pain, which comes on 

 very suddenly, is felt in the knee ; the leg in 

 most cases soon becomes flexed and reposes on 

 its outside ; and the patient cannot bear the 

 slightest movement to be communicated to the 

 knee-joint. There is considerable increase of 

 temperature in the skin over the affected arti- 

 culation, together with tension of it from in- 

 ordinate effusion of synovial fluid into the 

 joint. Although the usual phenomena of red- 

 ness as an accompaniment of phlogosis may not 

 be observed externally, there can be but little 

 doubt that the capillary vessels pervading the 

 different structures of the interior of the joint 

 are in a state of hyperaemia. The patient has 

 but little sleep, and this is frequently inter- 

 rupted by unpleasant dreams and painful spas- 

 modic starlings of the affected extremity. O2de- 

 ma of the lower part of the limb now occurs, 

 and in severe cases sometimes extends up the 

 whole leg and thigh, even to the groin. The 

 sympathetic fever may run so high, and the 

 swelling and other local symptoms proceed so 

 rapidly as to deprive the surgeon of any oppor- 

 tunity of proposing or performing amputation 

 to save the patient's life. 



The fever in well-marked cases of acute ar- 

 thritis genu is sometimes symptomatic of the 

 local disease ; sometimes it has preceded the 

 local affection, and has been ushered in by a 

 very severe rigour followed by profuse perspi- 

 ration. Like the disease, the fever will vary in 

 its character. Erysipelas, rheumatic fever, and 

 diffuse inflammation, as has been mentioned, 

 will each occasionally present in their progress 

 examples of the disease of the knee-joint now 

 under consideration, and the accompanying 

 fever will bear the character of the disease with 

 which the inflammatory affection of the joint is 

 associated. The local phenomena presented 

 by an acute arthritis genu do not, however, 

 vary so much, except in degree and severity. 



Acute arthritis genu may supervene as 

 a consequence of wounds. Sometimes these 

 wounds are very small. We have known one 

 case in which a puncture made with a fine sew- 

 ing needle, which was accidentally driven with 

 force into the knee-joint, at the inside of the 

 patella, was the cause of a fatal inflammation 

 of the joint : the point of the needle probably 

 penetrated the bone. The patient, a young 

 woman, was under the care of Mr. Colles 

 many years ago, in Steevens's Hospital. In 

 some instances we have known inflammation of 

 the synovial membrane of the knee to have 

 been the result of a wound of the subcruraal 

 bursa. A countryman had received a trans- 

 verse wound by the cut of a broadsword 

 just above the patella, and fatal inflammation 



VOL. III. 



extended from this bursa, which was opened, to 

 the synovial sac of the knee-joint. 



Acute inflammation of the knee-joint has 

 been the result of surgical operations, such, for 

 instance, as that occasionally undertaken for the 

 extraction of moveable bodies which form in 

 the joint and interfere with the due perform- 

 ance of its functions. This operation, we be- 

 lieve, is now very seldom recommended. We 

 have heard and read of many cases in which 

 it has been performed with complete success ; 

 on the other hand, we have reason to know 

 that many have died of the inflammation con- 

 sequent on it, and that others have narrowly 

 escaped with their lives, having ever after- 

 wards an anchylosed knee-joint. It is rather 

 singular, but we believe it to be true, that 

 the inflammation resulting from a valvular 

 opening having been made in the knee-joint 

 has not come on for six or seven days after the 

 moveable cartilage has been extracted ; but in- 

 flammation being once set up, its course is ge- 

 nerally acute and dangerous. 



We consider the observations and experience 

 of Mr. Guthrie on the subject of wounds of 

 the knee-joint to be too valuable to be here 

 passed over. " Wounds of the knee-joint," he 

 remarks, " however simple, should always be 

 considered of a dangerous nature, infinitely 

 more so than of the shoulder, the elbow, or the 

 ankle." " I could," he adds, " relate an infi- 

 nite number of cases on these points, termi- 

 nating fatally or in amputation, where the in- 

 jury was severe, or apparently at first but slight, 

 and but few cases where the capsular ligament 

 was opened into by a musket-ball, where the 

 patient has preserved the use of the limb. In 

 every case where the wound was known to be 

 serious, I have invariably been disappointed in 

 the hope of saving the limb." He then adduces 

 the following case as an instance of apparent 

 simple injury that frequently occurs. " This 

 case," he adds, " will shew the danger of all 

 these wounds, and the very great care and at- 

 tention that are necessary for their cure. Co- 

 lonel Donellan, of the forty-eighth regiment, 

 was wounded at the battle of Talavera in the 

 knee-joint by a musket-ball, which gave him so 

 little uneasiness, that when a roller had been 

 put on his leg, with some simple dressing, he 

 could scarcely be persuaded to proceed to the 

 rear. At a little distance from the fire of the 

 enemy we talked over the affairs of the mo- 

 ment, when, tossing his leg about on the 

 saddle, he declared he felt no inconvenience 

 from the wound, and would go back, as he saw 

 his corps was very much exposed. I explained 

 to him the dangerous nature of the wounds of 

 the knee-joint, and after he had staid with me 

 a couple of hours, I persuaded him to go into 

 the town. This injury, although at first to all 

 appearance so trifling, and under the best sur- 

 gical care, caused the death of this officer in a 

 very short time, and proceeded so rapidly as to 

 prevent any relief at last being obtained by 

 amputation." 



Some years ago MM. Larrey and Garriques, 

 in France, recommended the amputation of the 

 leg immediately below the tuberosity of the 



