Signs of meniscus disease. Treatment of the meniscus of the patella. What is the meniscus of the knee

Damage to the meniscus of the knee joint, symptoms and treatment is a problem for people who are not used to sitting in one place and those who are actively involved in sports. The meniscus plays a very important role in the knee joint system, and its injury can seriously affect a person's motor abilities. Any damage to the internal meniscus of the knee joint requires emergency measures and effective treatment. Poorly healed injuries can cause the development of various articular pathologies and early disability of a person.

Anatomical and physiological features

The meniscus of the knee joint is a trihedral cartilaginous lining that separates the femur and tibia. The main tasks of such pads are to absorb sharp shocks, redistribute emerging loads, reduce contact stress in the area of bone articulation and stabilize the joint. With flexion movement in the joint, more than 80% of the load is perceived by the menisci, and with leg extension - up to 70% of the load.

In any knee joint there are 2 types of elements: internal (medial) and external (lateral) meniscus. The C-shaped inner meniscus connects the tibia to the outer capsular border of the joint. The tibial ligament is fixed in its middle. Such fastening of the medial meniscus reduces its mobility, which is the reason for its more frequent damage (destruction). The outer meniscus covers almost the entire top of the lateral region of the joint of the tibia. Due to the fact that the lateral meniscus is not limited to the joint capsule in mobility, its injuries are recorded 8-9 times less often than injuries of the internal element.

Both types of menisci have the following main components in their structure: the body, as well as the anterior and posterior horns. The composition of the meniscus is almost 75% formed by collagen fibers with multidirectional orientation. The interlacing and orientation of the fibers provides a very high strength of the structure. The outer end of the meniscus is composed of a thickened layer of collagen and is firmly attached to the joint capsule, while the inner end is slightly pointed and oriented into the joint cavity. The increased elasticity of the meniscus is provided by a small amount of a specific protein (elastin). This structure makes the menisci almost 1.5 times more elastic than cartilage, which determines the functions of reliable shock-absorbing elements.

If we consider the blood flow system, then the menisci have a specific character. The following zones are distinguished in them: a red area in contact with the capsule and having its own circulatory network; the intermediate zone, which is fed by the red zone, and the white zone, in which there are no blood vessels, and nutrition occurs as a result of the diffusion of nutrients from the synovial fluid. In the meniscus attachment system, the following main ligaments are distinguished that strengthen the structure: the transverse ligament connecting the menisci to each other, the frontal and dorsal femoral ligaments.

The essence of the problem

Despite the significant loads on the menisci, in a normal state they are able to perform their functions. Another thing is the appearance of excessive loads that exceed the strength of the fibers. Such efforts occur, as a rule, with abnormal rotation of the lower leg at the knee, when landing after a jump from a great height or squats with a large load. In general, damage to the meniscus of the knee, especially damage to the medial meniscus, is a fairly common phenomenon, most often affecting men. The most common type is a sports injury.

Damage to the meniscus has the form of a rupture along its body or a complete separation at the point of attachment to the capsule or bone ending. One of the most common is damage to the posterior horn of the medial meniscus, however, ruptures of the anterior horn and body can be observed, both in the medial and lateral elements. Damage to the meniscus can be completely isolated, but is often combined with damage to other articular elements. As a rule, the lateral and cruciate ligaments, the articular capsule suffer. Almost half of the pathologies are combined with a fracture of the condyles of the tibia. Body rupture can occur with complete separation and displacement of the detached part, or in the form of a partial rupture, when the connection between the elements is not completely broken.

Etiological features of pathology

In the etiology of meniscal injuries, 2 main mechanisms are distinguished: traumatic and degenerative type. The traumatic mechanism causes damage to an absolutely healthy joint at any age of a person when an excessive load occurs. The most common injuries are: damage to the internal meniscus - a sharp turn of the lower leg with a significant amplitude in the outward direction, and the lateral meniscus - when it rotates inward.

Traumatic destruction of the medial meniscus often occurs in the longitudinal direction with destruction in its central area. A watering can handle is considered typical when the middle of the body is destroyed, but both horns are not destroyed. At the same time, lesions of the anterior and posterior horns are often observed. Transverse ruptures occur much less frequently. Rupture of the lateral fibers in an adult is not a typical lesion due to the high mobility of this meniscus. Such an injury is more common in adolescence, when the tissues are not yet strong enough.

The degenerative mechanism of joint destruction is associated with chronic processes that reduce the strength of colloidal fibers. It develops in people older than 48-55 years. When the structure of the menisci is weakened, their destruction can occur under loads that are not normally critical. The provoking causes that trigger the degenerative mechanism are the following factors:

rheumatism;
polyarthritis;
gout;
age factor;
hypothermia;
metabolic disease.

Symptomatic manifestation of pathology

If an injury such as a meniscus lesion is received, the symptoms depend on the extent of the lesion and the involvement of other articular elements. The most characteristic symptom is pain. It can be localized at the point of rupture, more often felt throughout the joint space. If the damage is not too great and the parts have not dispersed, then pains are felt in the form of clicks and discomfort appears.

In case of complete destruction, the detached fragment migrates into the joint and blocks its mobility. There is an intense painful symptom.

In the case when destruction occurs in the red zone, a hematoma develops as a result of internal bleeding. The process is accompanied by swelling slightly above the kneecap. If a piece of the anterior horn is torn off, then the function of the joint to extend the leg is disrupted, and if the posterior horn is destroyed, it is to flex the joint. Gradually, effusion can accumulate in the joint - exudate as a result of the inflammation process.

The presence of a torn meniscus is determined by performing certain tests to establish the following symptoms:

Baykova: when the leg is bent at a right angle, with the help of a doctor, intense pain should appear;
Shteiman: rotation of the lower leg by a doctor while bending the leg at a right angle. To determine the localization of the injury, the rotation is carried out in different directions. If the pain occurs during the rotational movement of the lower leg inward, the medial element is affected, when it appears in the opposite direction of rotation, the external meniscus is affected.
Chaklin: detection of a click in the articular zone during flexion and extensor movements (click symptom) and a tailor's symptom - thinning of the wide femoral muscle.
Polyakova: pain occurs when lifting a healthy limb from a lying position, while lifting the body based on the shoulder blades and heel of the affected limb.
Landau: pain syndrome occurs when taking the “Turkish sitting” position.
Perelman - 2 types are identified: "ladder" - increased pain when walking up the stairs or any hill down; "galosh" - the pain manifests itself when turning the lower leg.
McMurray: pain and crunching are detected during the rotational movement of the knee in a supine state with bent limbs.

Symptoms of damage to the meniscus of the knee joint, most often, appear quite clearly (pain, swelling, impaired mobility), but for the final clarification of the type of pathology, it is necessary to differentiate these signs from articular diseases.

Diagnostics

The primary diagnosis is based on the results of the examination and testing. The next step in clarifying the pathology is radiography and ultrasound of the knee joint. However, it should be borne in mind that X-ray does not give a clear picture of the meniscus lesion, but helps to establish the involvement of bone tissues in the process. An accurate diagnosis is based on the results of computed tomography and MRI.

0 degree - the meniscus is in a normal state;
1 degree - the origin inside the meniscus of the lesion without reaching its surface;
2 degree - a linear type signal is detected inside the meniscus without reaching the surface;
Grade 3 - the exit of the lesion to the surface of the meniscus or a complete rupture of the body.

Principles of therapeutic measures

The treatment regimen for a damaged meniscus is determined by the type and extent of the lesion. For small lesions, conservative therapy can be used, but the most common method is surgery. Which method to apply, only the doctor can decide after receiving the results of ultrasound and MRI.

Conservative therapy aims to eliminate the blockade of the joint. For this purpose, fluid is removed from the joint cavity by puncture and Procaine is injected. An important stage of treatment is the reduction of the meniscus in its place. If the procedure is carried out correctly, then the blockade of the joint is removed. Further treatment includes the following procedures: UHF exposure, physiotherapy according to an individual program, therapeutic massage, the appointment of chondroprotectors to restore cartilage (Glucosamine, Chondroitin, Rumalon). If necessary, drugs are used to relieve pain and relieve inflammation.

Surgery is performed in the following circumstances:

flattening of the body of the meniscus;
damage to blood vessels with bleeding;
rupture (separation) of the horn;
complete break;
destruction of the meniscus with displacement;
recurrence of joint immobilization after conservative therapy.

There are more than 200 bones in the human body, which are connected to each other motionlessly, semi-flexibly and movably. The last connection is called a joint. Among all constantly exposed to stress, there is a high risk of injury.

The joint is formed by bones, numerous ligaments and formations that serve for cushioning - menisci. Most often, knee pain is caused precisely by their pathologies. In people under the age of forty, injuries occupy a leading place, and after 50, degenerative changes in the skeletal system already affect. The most serious pathology is the rupture of symptoms, we will analyze the treatment in the article.

What is a meniscus?

The meniscus is a cartilaginous plate located between the bones of the thigh and lower leg, which serves to cushion while walking. It consists of a body and horns. The meniscus looks like a crescent, the horns of which are attached to the intercondylar eminences. There are two types of menisci:

The causes and symptoms of a meniscus tear will be discussed next.

The purpose of the menisci

These cartilaginous formations perform the following functions:

The lateral parts of the meniscus receive blood supply from the capsule, and the body from the intracapsular fluid. There are several areas of meniscus supply with nutrients:

The red zone is located in the immediate vicinity of the capsule and receives maximum blood supply.
The intermediate zone receives little nutrition.
The white zone is deprived of blood supply from the capsule.

If there is a rupture of the medial meniscus of the knee joint, the treatment is selected depending on the area of damage.

Causes of a meniscus injury

The most common causes of a meniscus tear are:

traumatic impact.
Sharp abduction of the leg.
Sharp and maximum extension in the knee joint.
Knee hit.

After 50 years, a meniscus tear can be triggered in the composition of the bones.

Types of meniscal injuries

A torn medial meniscus of the knee joint is one of the most common injuries. It is most often found in athletes, professional dancers, and those who are engaged in heavy physical labor. Depending on the type of damage, there are:

vertical gap;
oblique;
degenerative rupture, when there is a large-scale destruction of the meniscus tissue;
radial;
horizontal gap;
injury to the horns of the meniscus.

As a result of injury, damage to the outer or inner meniscus, or both, can occur.

Symptoms of a torn meniscus

If we take into account the nature of the cause of the gap, then they are divided into two types:

Traumatic rupture of the meniscus of the knee joint has characteristic symptoms and is acute.
A degenerative rupture is characterized by a chronic course, so the symptoms are smoothed out and there are no bright clinical manifestations.

Acute injury to the meniscus is manifested by:

Sharp and severe pain.
Edema.
Impaired joint mobility.

But only a doctor can make a correct diagnosis, because such symptoms can indicate many injuries, for example, a dislocation or torn ligaments. If you do not take any measures, then after a couple of weeks the rupture of the meniscus of the knee joint symptoms, the photo demonstrates this, shows already secondary ones, which include:

Accumulation of fluid in the joint cavity.
The knee is locked in a bent position.
The thigh muscles lose their tone.
Sometimes a meniscus can be felt in the joint space.

If a knee meniscus tear occurs, treatment will depend on the severity of the injury.

The severity of a meniscus tear

Depending on how serious the meniscus injury is, the doctor will prescribe therapy. And the degrees of damage are as follows:

1 degree, when a small gap occurs, the pain is insignificant, there is swelling. Symptoms disappear on their own after a couple of weeks.
2 degree of moderate severity. Manifested by acute pain in the knee, swelling, movement is limited. At the slightest load, pain in the joint appears. If there is such a rupture of the meniscus of the knee joint, it can be cured without surgery, but without appropriate therapy, the pathology becomes chronic.
Grade 3 rupture is the most severe. There is not only pain, swelling, but also a hemorrhage appears in the joint cavity. The meniscus is almost completely crushed, this degree requires mandatory surgical treatment.

Establishing diagnosis

If you suspect a meniscus injury, you should definitely consult a doctor. After a detailed examination, the surgeon will determine the severity of the injury, its location, but in order to accurately recognize a meniscus rupture, it is necessary to undergo a series of studies:

X-ray examination is the easiest way to diagnose. Due to the fact that the menisci are not visible in the picture, the study is carried out using a contrast agent.
Arthroscopy allows you to look inside the joint and determine the severity of the damage.

After confirming the diagnosis, the doctor can prescribe an effective treatment.

Types of therapy for meniscus injury

If the diagnosis is confirmed, a meniscus tear without surgery includes the following areas:

conservative therapy.
Treatment with folk methods.

If there is an extensive tear in the meniscus of the knee joint, treatment without surgery will not help. Without the help of competent surgeons can not do.

Conservative treatment

This type of therapy includes the following:

1. First aid, which is as follows:

Ensuring complete rest.
Use of a cold compress.
The use of painkillers.
If fluid accumulates, then you will have to resort to puncture.
Putting on a plaster cast, although some doctors find this inappropriate.

2. Compliance with bed rest.

3. Superimposed for a period of at least 2-3 weeks.

4. Remove the blockade of the knee joint.

5. Application in the treatment of physiotherapeutic methods and therapeutic exercises.

6. Inflammation and pain syndrome are relieved with the help of non-steroidal anti-inflammatory drugs: Diclofenk, Ibuprofen, Meloxicam.

7. Chondroprotectors: "Glucosamine", "Chondratin sulfate" help the speedy restoration of cartilage tissue.

8. The use of external agents in the form of ointments and creams will help you recover faster after an injury. Most often they use "Ketoral", "Voltaren", "Dolgit" and others.

If the treatment is chosen correctly, then after 6-8 weeks recovery occurs.

Surgical intervention

If a rupture is obtained, some symptoms may become an indication for surgical intervention:

meniscus tissue is crushed;
there was a displacement of the meniscus or its rupture into parts;
the presence of blood in the joint cavity;
no results from treatment.

Surgical intervention can be carried out in several ways:

1. If the rupture of the meniscus of the knee joint shows symptoms acutely due to the almost complete decomposition of the cartilaginous tissue, then the removal of the meniscus or part of it is indicated. The operation is quite traumatic and can relieve pain only in 50-60% of cases.

2. Restoration of the meniscus. Surgeons usually undertake such a manipulation when they perform an operation on young people, and then under certain conditions:

longitudinal gap;
peripheral rupture;
if the meniscus has come off the capsule;
peripheral rupture with displacement;
in the absence of degenerative changes.

With such an intervention, it is important to consider the location of the gap and the prescription of the injury.

3. The arthroscopic method is less traumatic and modern. With this intervention, there is minimal disruption of neighboring tissues. To sew up the meniscus, special needles are used, the seam is strong.

4. The use of special clamps to fasten the meniscus. This method allows you to perform the operation without additional incisions and devices. For this method, second-generation fixators are used, which quickly dissolve and reduce the risk of complications.

5. A meniscus transplant is performed when nothing else can be done. There are some contraindications for this method:

degenerative changes;
elderly age;
general somatic diseases;
knee instability.

Which method of surgical intervention to prefer is decided in each case by the doctor.

Rehabilitation after surgery

Not only is it important to perform the operation correctly, but success will depend on the recovery period. After the operation, it is important to follow some recommendations:

Under the guidance of an experienced mentor, perform special exercises that will contribute to the development of the joint.
It is mandatory to take chondroprotectors, anti-inflammatory drugs.
Physiotherapy and massage will greatly help in recovery.
No physical activity for at least six months, and preferably all 12 months.

Folk methods of treatment

If the symptoms of a meniscus rupture of the knee joint are not so acute, treatment with folk remedies, along with conservative methods of therapy, may well provide effective help. Here is a list of the most popular recipes:

In the first hours and days after injury, apply ice to the sore spot.
Be sure to complete rest and the leg should be located above the level of the heart.
You can use a warm compress using honey, it will not only remove the inflammatory process, but also relieve pain. You can prepare it like this: combine the same amount of alcohol and honey, mix well, moisten a napkin and apply to a sore spot. Wrap a warm scarf on top and keep for several hours.
Grind a fresh onion with a blender, mix the gruel with 1 teaspoon of sugar and apply on a napkin to the injured knee. Wrap with plastic wrap on top and secure. Leave it in this state overnight. Such a manipulation must be done every day, if the meniscus is not displaced, then it should recover.
Burdock can also help if crushed and applied to the sore spot. Secure with a bandage and hold for 3 hours, then change.

If the meniscus rupture of the knee joint shows symptoms seriously enough and treatment does not help, then you will have to resort to surgical intervention.

Consequences of meniscus injury

If there is a rupture of the meniscus, then such an injury is considered quite serious. Most often, joint pathologies do not disappear without a trace, even with appropriate treatment. If a knee meniscus tear has been diagnosed, the consequences may be as follows:

Repeat break. This is quite common even after surgery. That is why, after the rehabilitation period, you still have to take care of your knees, you need to limit active sports.
Hematoma formation. They can remain after surgery and cause pain. Such consequences need urgent elimination, the patient will have to undergo a long period of rehabilitation and complex drug treatment.
The development of an inflammatory process, which often occurs if you do not try to eliminate the remaining hematomas or there was an unsuccessful surgical intervention. Even if the treatment was successful, this does not guarantee the absence of problems in the future, so it is necessary to periodically visit a doctor for an examination.
It is also necessary to remember that after the operation there will be swelling of the joint, but after a while all this will pass, if not, then you need to inform the doctor.
Discomfort after discharge from the hospital remains for some time, but it becomes less as medication is taken. But if it does not subside, but becomes more intense, then this may indicate that a complication is developing in the form of a hemorrhage into the joint or a purulent inflammatory process. In such situations, the help of a doctor is indispensable.

How to prevent meniscus injury?

Absolutely anyone can get such an injury, but it is better to prevent a meniscus tear or reduce its likelihood. This is great for knee training. But it does not mean the use of large loads, it is enough to regularly ride a bike, walk, run so that the meniscus strengthens, then the likelihood of a rupture will be minimal.

We examined how the symptoms of a meniscus rupture of the knee show, what methods of therapy are used, but it is better to avoid such injuries. Take good care of yourself and your health.

The meniscus is a crescent-shaped elastic formation of fibrocartilaginous tissue, similar in properties to the tendon. There are two menisci in the knee joint: inner and outer. They are located in the joint space on the surface of the tibia, attached to its surface by ligaments. In the knee joint, they perform the functions of shock absorption, stabilization, weight distribution.

As a result of injury, the outer or inner meniscus can be damaged. Damage can affect both menisci, destroy it in isolation, or destroy part of the joint. The cause of the injury can be a blow to the knee, twisting, bending the leg, any abrupt unsuccessful movement, degenerative changes in cartilage tissue.

The latter often happens in old age, even for no apparent reason. With severe degenerative changes, it may be enough just to sit down unsuccessfully to get injured. The following meniscal injuries are possible:

complete detachment is the most severe and rare injury that requires surgical intervention;
pinching - occurs quite often, manifests itself in the blockade of the knee joint;
gap - the most common in practice.

If left untreated, the torn part of the meniscus gradually turns into a foreign body, disrupting the functioning of the joint. A piece of the meniscus moves freely in the articular bag and may end up at the place of articulation of the bones. Here, it destroys cartilage tissue, which causes acute pain and a number of changes in the appearance of the knee.

The structure of the patella

Symptoms of an injury to the meniscus of the patella

You can understand that a meniscus rupture has occurred by your own feelings. A sign of rupture is a characteristic crackling, cotton. In the first minutes, pain is not felt, a person may not even understand that he was injured. When moving, there is no pain, even with full support on the injured leg. And if the load does not weaken, for example, the athlete continues training, then the risk that a fragment will fall into the joint space increases.

Symptoms increase gradually and appear about 2 days after the injury. The patient in the initial phase has a significant limitation in the extension of the diseased limb. Edema is a characteristic sign of injury, then other signs of damage join it:

restriction of freedom of movement of the joint, stiffness, inability to straighten the leg;
sudden complete blockade of knee mobility;
instability of the knee joint;
increased edema;
increased sensitivity in the area of injury;
pain.

By the nature of the pain, you can determine the localization of the injury. When the inner meniscus is torn, there is a shooting pain on the inside of the knee. In addition, there is a point discomfort over the place of its attachment. Pain also occurs when turning a bent knee, with excessive effort when bending the leg. There is a weakening of the thigh muscles on the anterior surface. With partial or complete destruction of the external meniscus, severe pain is felt in the outer part of the cup, when the knee is turned inward. In addition, there are special symptoms specific to such injuries.

When lifting a leg straightened at the knee, atrophy of the quadriceps femoris muscle on the inside and a strong tension of the sartorius muscle (otherwise, a sartorial symptom) become clearly visible.
Pressing on the leg bent at the knee at a right angle with its passive extension causes increased pain - this is how Baikov's symptom manifests itself.
Discomfort and increased pain is noted during the usual unhurried descent from the stairs. This phenomenon is called the "staircase symptom" (or otherwise - Pelman's symptom).
Even with normal walking at a calm pace, a “click” symptom may be observed, and an attempt to sit cross-legged causes discomfort and increased pain.
Rauber - is detected on x-rays 2-3 months after the injury and consists in the growth of styloid formations on the condyles of the knee joint.
Polyakova - pain in the patella region appears when trying to raise a healthy leg from a prone position, leaning on the heel of the diseased leg and back.

Changes also occur within the joint. Synovial fluid accumulates in the joint cavity, the articular cartilage is gradually destroyed, exposing the surface of the bones in the joint.

Diagnostics

The symptoms of a torn meniscus are similar to those of other knee problems. X-ray helps to exclude diseases that have similar symptoms.

The diagnosis is confirmed by magnetic resonance imaging data - it makes it possible to obtain a good picture of the soft tissues of the knee;
ultrasound research.

In addition, pain and sound tests are carried out.

Treatment of the meniscus of the knee joint

The release of the meniscus, sandwiched between the cartilages of the knee joint, is trusted by a traumatologist, orthopedist or chiropractor. Usually, several procedures are enough to restore normal joint mobility. In an unfavorable case, the patient is prescribed joint traction.

After the damage can be repaired, therapeutic treatment is prescribed with injections of corticosteroids and anti-inflammatory drugs. To restore cartilage tissue, the patient is given intra-articular injections of hyaluronic acid, prescribe chondroprotectors, physical therapy exercises.
The rupture is complete or partial. The choice of method of treatment depends on the nature of the gap, the age of the patient, his state of health and the degree of deterioration of the joint. First aid for a patient with a torn meniscus consists of standard recommendations:

peace;
wearing compression underwear;
applying cold;
elevated position of the sore leg;
anti-inflammatory ointments and tablets - ibuprofen, aspirin.

The doctor prescribes the method of treatment based on the results of the examination and x-ray. As a rule, they try to avoid surgery, using methods of conservative therapy.

Non-surgical treatment

The patient is given a puncture of the knee joint, the accumulated blood is cleaned out. The joint is fixed, bed rest is prescribed, physical activity is completely excluded for 15 days. Assign massage, warming up, physiotherapy exercises. If the measures do not give a therapeutic effect, an operation is prescribed.

Folk methods of treatment

Folk methods of treatment are resorted to only for injuries without displacement. If the movement of the limb in the knee is partially or completely blocked, then you need to see a traumatologist. Compresses are applied to reduce pain and swelling.

Warm up medical bile, apply to the knee, wrap with a warm scarf for 2 hours. Repeat the procedure for 10 days. The course of treatment can be repeated.
Mix alcohol and honey melted in a water bath in equal proportions, apply on the injured knee for 2 hours.

Surgical intervention. The suture of the meniscus is performed in the outer zone, which is well supplied with blood and capable of regeneration. The operation is done with a fresh injury, no later than 10 days in case of a longitudinal rupture of the meniscus. After the intervention, a long recovery period is required. The patient is restricted in movement for six months, the use of crutches is prescribed for 8 months.
Arthroscopic resection (meniscectomy). The operation consists in the complete replacement of the damaged meniscus or the removal of damaged tissues. With the help of an arthroscope, surgical instruments and a mini video camera are introduced into the joint cavity through micro incisions, allowing the surgeon to examine the joint from the inside. Meniscus implantation is done at a young age, on a joint that does not show signs of destruction. This method gives good results, serves as a prevention of arthrosis.

After the operation to remove the meniscus, the patient will have to use crutches for 1-2 weeks. During the recovery period, the patient should wear a plaster cast and perform exercises aimed at increasing the amplitude and freedom of movement in the operated joint. Full recovery of knee function occurs in 30-40 days. After the meniscus surgery, you will have to walk on crutches for 45 days.

Why does the meniscus of the knee joint hurt, and what to do? Even a qualified doctor will not be able to answer this question unambiguously. The causes preceding the onset of pain are varied.

How does the meniscus hurt?

The knees can be safely attributed to the most important joints in the human skeleton, and the most vulnerable at the same time. This largest connection of bones is designed to support the weight of the entire body, and endure significant loads. Menisci - internal and external - are a kind of shock absorbers, elastic bands in the cup of the joint, which allow you to move, squat, run gently, not like robots.

The knee cartilage maintains the shape of the joint and protects it from wear and tear. Pain in the knee meniscus can be sharp and acute, or it can increase gradually. It is noteworthy that in young people the disease is more acute and painful than in older people. Worn joints dull perception. The external or lateral meniscus is extremely rarely damaged, most often it is a disease of the internal or medial meniscus. Rezi in the knee area is most often accompanied by swelling, which is a kind of protection. What to do if your knee hurts?

First of all, contact a medical institution. The doctor during the examination will help determine the cause and prescribe the appropriate treatment.

Pain on exertion

It is widely believed that diseases of elastic cartilage are the fate of athletes and people involved in heavy physical labor. Indeed, this category of persons is the main one in the risk group, but not the only one.

Pain in the knee can overtake someone who, without constant training, loads the leg once. We played football at a picnic, had a blast at a disco, walked along a mountain path and our knees were already swollen, my menisci hurt and my movements were constrained. In this way, the meniscus reacts to sprains, bruises and unusual loads.

What to do? Most often, special treatment in such cases is not required, pain and swelling go away on their own at home, it is enough to give the legs a rest, apply a compress or anoint with ointment.

It should be remembered that without training, such loads are very harmful to the knee joint and can cause injuries and chronic inflammation.

After injury

A common cause of knee pain is a meniscus injury. This concept refers to the rupture of the protective cartilage. Meniscus tears of a traumatic nature haunt both young people and the elderly. The second reason for ruptures is degenerative changes, which, in turn, can occur in the absence of proper damage treatment, as a neglected option.

The main signs of a meniscus tear are:

Severe pain is felt if the torn fragments of cartilage fall between the tibia and femur. In this case, the victim cannot bend the knee and move around. Most often, discomfort is not acute in the initial stage. Soreness can also appear after a long period. The resulting injury reminds of itself with a slight load, even after six months.
Swelling. A fresh injury is always accompanied by edema of varying degrees, which disappear during treatment after 2-3 days. Degenerative changes may be accompanied by chronic swelling.
Violation of functionality. Immediately after the injury, bending and unbending the knee, stepping on the sore leg, becomes problematic. Sometimes movement, in addition to pain, can be accompanied by characteristic clicks in the joint.

What to do in case of injury

It will not be original, but always relevant advice - contact the clinic. Meniscal tears rarely go away on their own. Even if the first symptoms have disappeared, the insidious disease will manifest itself in a chronic form after a while. And this is more serious, the final stage is complete immobility.

First aid for a sore leg:

Give immobility.
Use a crutch if necessary to move.
To relieve pain, use painkillers, both internally and externally.
Fix the diseased joint with a bandage, knee pad or even a splint.

What will the doctor prescribe

If therapeutic measures do not bring the desired result, and the pain makes itself felt for more than three weeks, surgery becomes necessary. The type of operation on the knee meniscus can be different: stitching together torn particles, complete or partial removal of cartilage, endoprosthetics.

Medical measures can be effectively combined with the methods of alternative and traditional medicine, physiological procedures, and spa treatment.

Pain when running

Running is the most favorite and common exercise for those who love physical activity. Sometimes non-traumatic pain in the meniscus, which occurs when running, or immediately after class, interferes with this activity. With what it can be connected? Its reasons are:

Wrong shoes.
Overweight.
The onset of inflammation, stretching.
Running on uncomfortable terrain, or in the wrong technique.

What to do?

Loads should be moderate. All professional runners sooner or later experience all the "charms" of knee wear.
An easy and safe run, in which the support is transferred to the forefoot, the supporting leg is slightly bent, the movements of the arms and body are synchronous with the movements of the legs.
Properly choose shoes that fit your foot tightly.
It is most convenient to run on a dirt trodden path. For paved surfaces, sneakers with special soles are needed.
Before the race, you need to stimulate and warm up the muscles with special exercises.

If the pain continues for more than three days, this is a reason to take action.

Diseases of the knee joint

Pain in the menisci with arthritis, arthrosis, polyarthritis, rheumatism and other joint diseases do not occur acutely. This is a long and gradual process, which at first is not paid attention to. Gonarthritis in the first degree can be asymptomatic, with rare discomfort, which is attributed to simple fatigue. Serious changes and dull periodic pain disturb the patient in the second stage, when the cartilage tissue is deformed.

What to do? Do not ignore the first signs. In the beginning, all joint diseases can be cured without resorting to surgical intervention, using medication and folk methods.

Knee pain is a problem that can affect anyone, regardless of age. It is always easier to prevent a disease than to treat it. What do orthopedists and trainers advise?

Perelman's symptom - pain and instability of the knee joint when descending the stairs.

McMurray's symptom - with maximum flexion of the knee joint, the posterior-internal part of the articular line is palpated with one hand, while the other hand leads and maximally rotates the lower leg outward, after which the lower leg is slowly extended - at the moment when the internal condyle of the femur passes over the damaged area of the internal meniscus, a click or crunch is heard or felt by palpation. To study the state of the external meniscus, the posterior part of the joint space is palpated, the lower leg is retracted and rotated inwards as much as possible, after which it is slowly extended.

From additional examination methods, valuable information can be obtained using various arthroroentgenography with contrast - arthropneumography, positive arthroroentgenography, "double contrast", which allow, based on the distribution of the contrast agent or gas through the joint, to establish the presence of a meniscus rupture and suggest its anatomical type.

MRI of the knee joint is highly accurate; this non-invasive method can detect more than 90% of cases of meniscal injuries.

On MRI, the meniscus tissue is homogeneous, dark, without additional internal signals. Manifestations of degenerative changes in the meniscus consist in the appearance of areas with an increased signal. The most common sign of a meniscus tear is a horizontal split in the projection of the shadow of the meniscus or a defect in the meniscus tissue in its normal location with the presence of one in an atypical location. The first type is typical for degenerative meniscal tears, and the second for traumatic injuries.

MRI can easily be used in patients with acute knee injuries. It replaces the need for examination under anesthesia, X-ray examination techniques with contrast, and in some cases arthroscopy, since the resulting contrast image of soft tissue structures allows in vivo assessment of the stage of internal meniscal degeneration, which can lead to rupture. Perimeniscal cysts are well defined and differentiated from other liquid formations.

The final stage of the examination is diagnostic arthroscopy. With the help of arthroscopy, a variety of types of meniscal injuries have been proven, which cause various clinical symptoms. By direct examination, endoscopy allows you to determine the luster, density of the meniscus tissue, establish the shape, size and localization of the rupture, its type, extent, the presence of concomitant injuries, depending on this, clarify the indications for non-surgical and surgical treatment, plan the stages of its implementation and rehabilitation therapy.

Compliance with the technique of endoscopic intervention provides up to 98.6% accuracy in the diagnosis of meniscus lesions. Performed technically competently, arthroscopy is associated with a minimal risk of complications and leads to a rapid recovery of patients.

Thus, in order to increase the reliability of diagnosing meniscal injuries, it is necessary to use the entire arsenal of tools available to an orthopedic traumatologist.

Treatment

To date, the discussion continues about the indications for surgery and the timing of its implementation for meniscus ruptures.

Most domestic and foreign traumatologists in the "acute" period recommend non-surgical treatment, including puncture of the joint and evacuation of the outflowing blood, elimination of the blockade, immobilization and exclusion of the load on the limb for 1-3 weeks, a set of physiotherapy procedures, exercise therapy. This tactic is based on experimental studies and clinical experience that have proven the possibility of fusion of meniscus ruptures localized in the blood-supplying zone.

Indications for surgical intervention in the "acute" period are unresolved or recurrent blockades and ruptures of both menisci of one joint.

The question of indications for surgery in chronic injuries remains unresolved. Previously, it was believed that a diagnosed meniscus tear should lead to early surgical treatment. This tactic was justified by a high degree of correlation of cartilage damage detected during the intervention and poor long-term results, and the destruction of articular cartilage was associated with a long-term negative effect of damaged menisci on all articular structures. Currently, another point of view prevails, which is that both meniscus injury and meniscectomy significantly increase the risk of deforming arthrosis, therefore, the diagnosed injury is not a direct indication for surgical treatment, both in the acute and in the long-term periods. Indications for surgical treatment of patients with meniscus ruptures are:

repeated blockade of the joint with the development of synovitis;

joint instability;

pain and dysfunction that cause discomfort during household and professional activities or when playing sports.

The totality of these manifestations, corresponding to objective data and the results of additional research methods, gives grounds to assert the presence of meniscus damage and put indications for surgical intervention.

Total meniscectomy has long been the most commonly performed orthopedic surgery. The main steps of an open meniscectomy are as follows:

medial or lateral arthrotomy;

mobilization of the anterior horn of the meniscus;

clipping it paracapsularly within the meniscus tissue to the posterior horn without damaging the collateral ligaments;

movement of the mobilized meniscus into the intercondylar space;

transection of the posterior horn and removal of the meniscus.

Further study of the function of the menisci proved the feasibility of saving tactics in the treatment of their injuries, and partial meniscectomy and suturing are increasingly being used as an alternative to complete removal.

The menisci contribute to a uniform distribution and transformation of up to 30-70% of the load on the articular surfaces of the femur and tibia. After a partial resection, the contact area between the articulating surfaces is reduced by about 12%, and after a total meniscectomy, by almost 50%, and the pressure in the contact zone between the articular surfaces increases to 35%. After partial resection, the remaining section of the meniscus continues to perceive and evenly distribute loads on the articular surfaces, while the integrity of the peripheral circular fibers is very important. Thus, the meniscus is an important structure in the distribution and absorption of loads in the knee joint, its absence contributes to the progression of degenerative-dystrophic processes in the joint, and their severity is directly proportional to the size of the removed part of the meniscus.

A comparative analysis of the results of partial and total meniscectomy performed with arthrotomy showed that the advantages of resection are in the rapid rehabilitation of patients, reducing the number of complications, and reducing the duration of treatment with better functional results. It is indicated for patchwork tears or watering can handle injuries if the peripheral edge of the meniscus is intact.

The development of arthroscopy both abroad and in our country has made it possible to almost completely abandon arthrotomy during interventions on the menisci. The technique of arthroscopic surgery has undoubted advantages, consisting in significantly less trauma and a reduction in the period of rehabilitation of patients.

Disadvantages of arthroscopic surgery include:

technical difficulty of the operation;

the need for extensive experience in the field of endoscopy;

the complexity of using arthroscopic instruments and the possibility of their breakdowns;

high cost of arthroscopic equipment.

The general principles of arthroscopic meniscus resection are as follows:

only unstable fragments are removed, which are displaced into the joint when they are palpated with a hook;

it is necessary to achieve a smooth contour of the edge of the meniscus, without sharp transitions, since the sharp edges left after resection of the damaged fragment are often subsequently torn;

on the other hand, it is not necessary to achieve the ideal smoothness of the contour of the free edge of the meniscus, since this is impossible due to its fibrous structure; after 6-9 months, it smoothes out on its own;

it is often necessary to use an arthroscopic hook in order to assess the degree of displacement and structure of the remaining part of the meniscus and determine the usefulness of the resection;

it is useful to focus on your own tactile sensations - degeneratively altered tissue is softer than normal, therefore, if its density has changed during meniscus resection, it is necessary, by palpating with a hook, to determine the stability and integrity of the preserved part of the meniscus;

it is necessary to avoid deepening the resection into the area of the meniscocapsular attachment, since the separation of the meniscofemoral and meniscotibial ligaments significantly reduces the stability of the joint;

if there is uncertainty about the sufficiency of resection, it is preferable to leave more of the peripheral part of the meniscus than to remove normal tissue, this is especially important in the posterior third of the external meniscus in front of the hamstring;

if an arthroscopic meniscectomy cannot be completed within an hour, then it is reasonable to re-skin and perform an arthrotomy.

Interest in more gentle methods of meniscectomy led in the late 70s of the last century to the development and introduction into practice of arthroscopic operations of laser and electric knives, which have such advantages as painless intervention, more accurate tissue dissection, less risk of postoperative bleeding and synovitis.

The developed methods of open and arthroscopic suture have shown their high efficiency, proven by repeated arthroscopy in the long-term period. DeHaven and Warren achieved healing of the meniscus after suturing in 90% of patients with a stable knee joint, while in unstable conditions, fusion did not occur in 30-40% of patients.

Less encouraging data are provided by Scott, who studied the long-term results of meniscus suture in 178 patients using arthrography and arthroscopy, he noted complete fusion in 61.8% of cases.

Currently, the operation of open or arthroscopic suturing of the meniscus is considered indicated for longitudinal paracapsular and transchondral ruptures and for a patchwork rupture of the width of the meniscus with a length of more than 7-10 mm with instability of the damaged part, determined by hook palpation. Some traumatologists prefer to resort to it only with fresh damage in young patients, while others do not attach importance to these factors. There is also a different attitude towards the need to refresh the edges before suturing.

Stitching of a torn meniscus is performed by arthrotomy or under endoscopic control. In the first case, access is made to the site of the rupture in the projection of the injury, the edges of the rupture are refreshed, and interrupted or U-shaped sutures are applied through both fragments, tying them on the fibrous joint capsule. Three different techniques are used for arthroscopic meniscal suture:

"outside-in";

"from inside to outside";

"everything inside".

For arthroscopic suturing of the meniscus, additional instruments are required: straight and curved needles with mandrin, mandrin with a metal loop at the end, straight and curved thread guides, rasp. The first two techniques differ in the direction of the needle and thread, the knots are tied on the fibrous joint capsule after access to it. The “all inside” technique involves performing all stages of the operation intraarticularly without surgical access to the joint capsule.

To stimulate the fusion of the meniscus, it is proposed to fix a flap from the synovial membrane on the feeding pedicle to the suture area or to introduce an exogenous fibrin clot into the rupture site.

Meniscal injuries do not always cause clinical symptoms, so some of them may heal on their own. Such injuries include cracks that do not penetrate the entire thickness of the meniscus, short ruptures that include its entire thickness, vertically or obliquely, if the peripheral part of the meniscus is stable and does not move when palpated with a hook. Short radial ruptures can also be assigned to this group; most of these injuries are accidental arthroscopic findings. It is not difficult to determine the possibility of self-healing of the rupture with these injuries, however, if the rupture identified during arthroscopy is the only pathological finding, the surgeon must make the right choice of treatment method by comparing the totality of both clinical data and the results of arthroscopy.

After completion of arthroscopy of the knee joint, having treated the skin again with an antiseptic solution, it is recommended to inject 2 ml of ketorolac, which belongs to the group of non-steroidal anti-inflammatory drugs and has predominantly analgesic activity with less pronounced anti-inflammatory and antipyretic properties, into the upper torsion of the knee joint. In most cases, a single intra-articular injection of 60 mg of ketorolac provides a sufficient level of analgesia during the first day, without the need for additional parenteral or oral pain medication.

The problem of treatment of meniscus injuries accompanied by ACL rupture remains a subject of discussion. Acute ACL injury is accompanied by damage to the meniscus in 25% of cases, and chronic injury - in 62%, and the internal meniscus suffers 8-10 times more often than the external one.

ACL reconstruction in case of acute injury is recommended in young active patients under 30 years of age, especially in athletes. Physically less active persons are more often prescribed a course of non-surgical treatment and dynamic monitoring. If a patient with an acute rupture of the ACL is indicated for reconstructive surgery, then to assess the condition of the menisci, it is preceded by diagnostic arthroscopy. Initially, depending on the nature of the damage, a meniscectomy or suture is performed, and then the ligament is reconstructed.

If the recovery of the ACL in the acute period is not shown, then the condition of the menisci is assessed using MRI or arthrography with contrast, only if there is a possibility of damage to the meniscus, arthroscopy is performed, then suturing the meniscus or meniscectomy. Some orthopedists recommend combining meniscus surgery with ACL reconstruction in young patients, especially after meniscal suture.

In patients with chronic ACL injury, careful evaluation of clinical symptoms is critical to diagnosing meniscus injury. Meniscal tears may be the dominant cause of knee dysfunction or may only exacerbate the clinical manifestations of ACL failure. In each case, the surgeon should take into account the age of the patient, the level of his physical activity, the severity of the damage to the knee joint. Although the menisci stabilize the knee joint, a good outcome of surgery to repair meniscus injury in cases of severe ACL deficiency cannot be expected. In such a situation, an operation on a damaged meniscus and ligament is indicated.

Summarizing the experience of treating such patients, specialists consider it necessary first of all to establish whether the clinical symptoms are associated with damage to the meniscus alone or with ACL insufficiency, or with a combination of both. The first option shows the intervention on the meniscus. If the patient is concerned about the symptoms of ACL insufficiency and concomitant meniscus injury can be assumed, then repair of the ligament and, if necessary, intervention on the meniscus is recommended.

Features of postoperative management

Although most traumatologists believe that arthroscopic resections or removals of the menisci should be performed in a day hospital setting, postoperative management of patients is of paramount importance for treatment outcomes. Inadequate postoperative care leads to a poor outcome even with brilliantly performed surgery. Most authors indicate the need for immobilization of the operated limb after arthrotomy with partial or complete meniscectomy lasting from 5 to 10 days, walking on crutches without support - up to 12-15 days. To prevent muscle hypotrophy and the development of contracture, isometric contractions of the quadriceps muscle are shown from the 2nd day, and active movements in the joint are shown from the 6-7th day. After a meniscectomy or meniscus resection performed arthroscopically, immobilization is not required. When the patient is in bed, the operated limb should be given an elevated position about 10 cm above the level of the heart. 2-3 hours after arthroscopy, patients are allowed to get up and walk with additional support on crutches and a dosed load on the lower limb. Excessive axial load on the operated limb and high motor activity in the early postoperative period adversely affect the recovery time of the knee joint function. Therefore, depending on the severity of the pain syndrome, synovitis and swelling of the knee joint, the load on the lower limb should gradually increase to full only by the 3-7th day after the operation.

Cold on the area of the knee joint is used continuously during the first day, and then 3-4 times a day for 20 minutes, up to 72 hours after the operation. The analgesic effect of cold therapy is realized by reducing muscle spasm and reducing the conductivity of nerve fibers. In addition, vasoconstriction increases and the intensity of metabolism in tissues decreases, which helps to reduce edema and prevents the development of hematomas and hemarthrosis.

The first dressing is made the next day. With the accumulation of effusion in the joint cavity, as evidenced by the smoothing of the contours of the knee joint and a positive symptom of balloting of the patella, it is advisable to perform a puncture of the knee joint under local anesthesia with evacuation of the exudate. Sutures are removed after healing of skin wounds on the 7-10th day after arthroscopy. In the future, for 3 weeks after the operation, when walking, it is recommended to use an elastic bandage of the knee joint or wear a soft knee brace.

The postoperative period after suturing the meniscus is characterized by prolonged immobilization and walking with additional support, without load on the operated limb. Dosed load is recommended after removal of the plaster cast, full - after another 2 weeks.

After meniscectomy, exercise therapy must be combined with PTL from 1-2 days after the operation. After removing the sutures, patients are prescribed electromyostimulation, ozocerite applications, hydrocortisone phonophoresis, and other procedures.

Total meniscectomy

First stage.

Contraction of the muscles that form the crow's foot: sartorial, semitendinous and tender. Starting position - sitting or lying on your back, the knee joint is bent at an angle of 170 °. Resting both heels on the floor, the muscles of the back of the thigh are strained for 5 s, followed by their relaxation. The exercise is performed 10 times without movements in the knee joint.

Contraction of the four head muscles of the thigh. Starting position - lying on the stomach with a roller under the ankle joint. By pressing the ankle joint on the roller, the lower limb is maximally unbent and held for 5 s, after which it is returned to its original position - 10 repetitions.

Raising a straight leg, lying on your back. The starting position is lying on the back, the contralateral knee joint is bent, the operated one is maximally extended. The operated leg is slowly raised by 15 cm and held for 5 s. With each subsequent rise, the height is increased by 15 cm. After reaching the maximum height, the exercise is repeated in reverse order until returning to the starting position - 10 times. As the strength of the thigh muscles increases, a weight is added to the ankle joint - a load of 450-500 g. By the 4th week after the operation, the load is gradually increased to 2 kg.

Contraction of the gluteal muscles. In the initial position - lying on your back with bent knee joints - the muscles of the buttocks are strained for 5 seconds, then their relaxation follows - 10 repetitions.

Standing straight leg raise. In a standing position, if necessary, holding the handrail with the opposite hand, the leg unbent at the knee joint is slowly lifted up, and then returned to its original position. Repeat 10 times. As the strength of the thigh muscles increases, a weight of 450-500 g is added to the ankle joint area. By the 4th week after the operation, the load is gradually increased to 2 kg.

Intermediate stage.

Ultimate knee extension in supine position. Starting position - lying on your back with a roller under the back surface of the knee joint. The knee joint resting on the roller is slowly unbent as much as possible and held in this position for 5 s, after which it is slowly returned to its original position - 10 repetitions. As the extension increases, a weight of 450-500 g is added to the ankle joint area. By the 4th week after the operation, the load is gradually increased to 2 kg.

Straight leg raise lying on back. The starting position is lying on the back, the contralateral knee joint is bent, the operated one is maximally extended due to the tension of the quadriceps femoris muscle. Slowly raise your leg 30 cm from the floor, then slowly lower it to the floor and relax your muscles - 5 sets of 10 repetitions. As the strength of the thigh muscles increases, a weight of 450-500 g is added to the ankle joint area. By the 4th week after the operation, the load is gradually increased to 2 kg.

Partial squat with additional support. Starting position - standing on your feet, holding on to the back of a chair or a handrail at a distance of 15-30 cm from the support. Squats are slowly performed, while the back must be kept straight and, having reached the flexion of the knee joint at a right angle, stop for 5-10 seconds, then slowly return to the starting position and relax the muscles. Repeat 10 times.

Stretching the four heads of the thigh muscles while standing. Starting position - standing on a healthy leg, bend the operated limb at the knee joint to an acute angle and, gently helping with your hand, pull the toe, trying to press the heel to the buttock. Having reached a feeling of light stretching along the front surface of the thigh, hold for 5 s. Repeat 10 times. When performing this exercise, the other hand should rest against the wall.

The final stage.

Dosed flexion in the knee joint while standing on one leg. Starting position - standing on your feet with support on the back of the chair. The healthy leg is bent, to maintain balance, the big toe can touch the floor. Slowly perform a partial squat on the operated limb, without lifting the foot from the floor, followed by a return to the starting position - 10 repetitions.

Step one step forward. From the starting position, standing on your feet, the sore leg takes a step forward on a step, 15 cm high, followed by a return to the starting position - 10 repetitions. Gradually, the height of the step can be increased.

Side step step. From the starting position, standing on your feet, a step with the sore leg to the side is performed, on a step 15 cm high, followed by a return to the starting position - 10 repetitions. Gradually, the height of the step can be increased.

Seated terminal knee extension. From the initial position, sitting on a chair with the operated limb lying on a bench of lower height, the knee joint is extended and the leg is lifted up with fixation at the top point for 5 s, after which a slow return to the starting position is performed - 10 repetitions.

: tailoring, semi tendinous and tender, supine. Starting position - lying on your back. The limb is bent at the hip and knee joints and wrapped around the lower third of the thigh with hands. The knee joint is slowly unbent until a stretch is felt along its posterior surface and held for 5 s, followed by a return to its original position. It is advisable to alternate repetitions with a similar exercise for a healthy leg. The sensation of stretch increases with increased flexion in the hip joint. It is important to perform this exercise smoothly and slowly, without jerking.

Stretching the muscles that form the crow's foot: tailoring, semi tendinous and tender, lying on the back with support against the wall. Starting position - lying on your back at the doorway, the heel of the operated leg, bent at the knee joint, is placed on the wall, after which, leaning on a healthy leg, the pelvis is moved closer to the wall. The bent leg is slowly unbent at the knee joint with support on the wall, until a stretch is felt along the back surface of the knee joint and held for 5 s, then returning to its original position. The closer the pelvis is moved to the wall, the more pronounced stretching can be achieved. Repetitions should be alternated with a similar exercise for the opposite limb - 10 times.

Exercise bike. When exercising on an exercise bike, the seat should be raised to such a height that the foot of the operated limb, when performing a full turn, could hardly touch the pedal in its lowest position. You should always start with a light resistance and gradually increase it. The initial duration of the exercise is 10 minutes per day, then the duration is increased by 1 minute per day up to 20 minutes.

Dosed walking without additional support is shown on average 2 weeks after arthroscopy, in shoes with a well-cushioned sole.

The criteria for the transition to the next stage of exercise therapy are the complete mastery of the set of exercises by the patient, the achievement of the planned number of repetitions, the positive dynamics of increasing the range of motion in the knee joint and the strength of the muscles of the lower limb, and the reduction in the severity of pain.

Comprehensive rehabilitation treatment allows you to quickly restore muscle tone and full range of motion in the knee joint. The terms of temporary disability during endoscopic intervention on the knee joint in comparison with arthrotomy are reduced by 2.5-3 times. Sports activities can be started after 6-8 weeks in the absence of pain and swelling of the knee joint.

The problem of early diagnosis and adequate treatment of local damage to the hyaline cartilage resulting from injuries and diseases of the knee joint still causes difficulties in clinical traumatology and orthopedics. This is due to the fact that hyaline cartilage, being a unique tissue capable of withstanding intense repeated mechanical loads throughout the life of an individual, has a very limited reparative potential. Back in 1743, Hunter noted that even with minimal damage to the articular cartilage, it is not fully restored.

Area-limited cartilage damage is a common cause of pain and dysfunction of the knee joint and is detected both in isolation and in combination with other pathological changes in 14-26% of patients. Chondromalacia was first described by Budinger in 1906, and the term "chondromalacia" was used by Aleman in 1928 when describing patellar cartilage degeneration.

Structure and regeneration of articular cartilage

Like other mesenchymal tissues, hyaline cartilage is composed of cells and an extracellular matrix. In normal hyaline cartilage, there is only one type of cell - these are highly specialized chondrocytes, which make up about 1% of the total tissue volume. Chondrocytes synthesize macromolecules such as collagens, of which 90-95% is type II collagen, proteoglycans and non-collagen proteins, then assemble and organize them into a highly ordered three-dimensional structure - the matrix. In addition, by producing the appropriate enzymes, chondrocytes control matrix remodeling. Proteoglycans are presented in the form of both monomers and aggregates connected to hyaluronic acid macromolecules through special proteins. The proteoglycan monomer consists of a central protein associated with sulfated glycosaminoglycans. Chains of glycosaminoglycans are negatively charged, as a result of which they easily bind cations and are highly hydrophilic. In addition, due to the same charge, they repel each other, which causes the molecules to be in a "bloated" state. In hyaline cartilage, proteoglycans are compressed by the collagen scaffold and are only partially hydrated; however, water makes up from 60% to 80% of the mass of native tissue. This determines the mechanical properties of the fabric - strength and elasticity. For comparison, it should be noted that the volume of proteoglycans in solution is several times greater than in articular cartilage. Theoretically, damage to collagen fibers allows proteoglycans to expand and bind more water molecules, resulting in cartilage edema similar to that seen in chondromalacia patellae.

Normally, during exercise, the interstitial fluid leaves the matrix, and after the termination of the load, it returns back. The low permeability of the articular cartilage prevents its rapid extrusion from the matrix, resulting in the protection of collagen fibers, proteoglycans and other glycoproteins from high-intensity and rapidly occurring loads. During the first seconds, up to 75% of the load is absorbed by the bound liquid. After a long period of loading, the fluid begins to come out and the load begins to be carried by the collagen framework with proteoglycans.

The movement of water provides nutrition to chondrocytes, which occurs due to diffusion, therefore, if the elastic properties of the tissue are violated, the metabolism in them is disturbed. In turn, the composition of the matrix and its renewal depend on the functional state of chondrocytes.

It is known that as the body ages, the proliferative and metabolic activity of chondrocytes decreases.

Usually, four zones are distinguished in the articular cartilage:

superficial;

intermediate;

deep;

area of calcified cartilage.

Chondrocytes from different zones differ in size, shape, and metabolic activity. The structure of the matrix varies zonally and depending on the distance to the cell.

There are two main options for the response of cartilage tissue to damage.

The first variant is noted in the formation of a partial-thickness defect, perpendicular or tangential to the surface of the cartilage. Necrosis of the wound edges develops, which leads to a short-term burst of mitotic activity of chondrocytes and an increase in the biosynthesis of the structural components of the matrix. However, since chondrocytes are enclosed in a dense collagen-proteoglycan matrix, they cannot migrate from the edges of the defect, and as a result, its recovery does not occur.

The second variant of the reparative reaction occurs when a full-thickness cartilage injury extends into the subchondral bone zone. In this case, a classical reparative reaction develops, conditionally including three phases: necrosis, inflammation, and remodeling. In the necrotic phase, the resulting defect is filled with a fibrin clot. The source of the cells of the newly formed tissue is undifferentiated pluripotent progenitor stem cells migrating from the bone marrow in response to platelets and cytokines released. Proliferation and differentiation of migrating cells, as well as vascular invasion, occur sequentially. During the inflammatory phase, vasodilation and an increase in the permeability of the vascular wall develop, which leads to extravasation of fluid and proteins, as well as to the release of cells from the bloodstream into the damaged area. A dense fibrin network is formed, containing predominantly inflammatory and pluripotent cells. During the remodeling phase, the fibrin network is replaced by granulation tissue, followed by its maturation and metaplasia into hyaline-like chondroid tissue. In the deep layers, the subchondral bone plate is restored. After 2 weeks, chondrocytes appear that produce type II collagen, however, in the future, unlike intact cartilage, the content of type I collagen remains very significant, the amount of proteoglycans is reduced, and tangential collagen layers in the surface zone are not formed. The collagen fibers of the new tissue remain poorly integrated into adjacent cartilage. Chondrocyte lacunae in the areas of cartilage adjacent to the area of injury remain empty. Between 6 and 12 months after damage, the cells and matrix become completely similar to fibrous cartilage.

The structural features of the newly formed tissue listed above negatively affect its mechanical properties, superficial fibrillation and other degenerative changes develop over time.

The healing process is affected by:

defect size;

passive movements in the joint contribute to the formation of morphologically and histochemically more complete tissue;

Thus, articular cartilage is a highly organized and complex three-dimensional structure that provides the performance of specific tasks. Therefore, for the successful functioning of the restored area, any tissue filling it should have a structure similar to normal cartilage.

Numerous classifications have been developed to assess the severity of acute and chronic damage to the articular cartilage. Due to their simplicity, the systems proposed by Outerbridge and Bauer and Jackson have received the greatest distribution in clinical practice.