How to treat an old horizontal rupture of the medial meniscus. Damage to the posterior horn of the internal meniscus. Treatment of the meniscus with folk remedies

In its structure, the knee joint is complex, since in addition to numerous components, it includes menisci. These elements are necessary to divide the articular cavity into two parts.

During movements, the meniscus plays the role of an internal stabilizer - together with the articular surfaces, it moves in the right direction.

When walking or running, menisci are needed as shock absorbers, as they soften shocks, as a result of which the human body practically does not feel shocks.

However, it is this ability of the menisci that causes their frequent injuries. In 90% of cases of injury, damage to the internal or medial meniscus occurs.

The meniscus is a dense cartilage plate located inside the joint cavity. The knee has two such elements - the lateral and medial menisci. Their appearance resembles a semicircle, and in the context they have the shape of a triangle. The meniscus consists of a posterior section (horns) and a central section (body).

The structure of these plates differs from the tissue of ordinary cartilage. It contains a huge amount of collagen fibers arranged in a strict order. The horns of the meniscus contain the largest accumulations of collagen. This explains the fact that the inner and central parts of the meniscus are more prone to injury.

These structures do not have specific attachment points, therefore, during movements, they are displaced inside the joint cavity. Restrictions in mobility exist at the medial meniscus, they are provided by the presence of an internal collateral ligament and fusion with the joint membrane.

These features often lead to degenerative or traumatic damage to the internal meniscus.

Meniscus injury and its characteristic features

This pathology occurs as a result of an injury to the knee joint. The injury can be direct, such as a sharp blow to the inner surface of the knee joint or a jump from a height. The joint cavity at the same time sharply decreases in volume, and the meniscus is injured by the end surfaces of the joint.

Injury by indirect variant is predominant. A typical mechanism for its occurrence is a sharp flexion or extension of the knee, while the leg is slightly tucked inward or outward.

Since the medial meniscus is less mobile, its separation from the collateral ligament and capsule occurs from a sharp displacement. When displaced, it is subjected to bone pressure, as a result of which it breaks and turns out.

The severity of the symptoms of pathology depends on the degree of damage to the cartilage plate. Displacement of the meniscus, the size of its rupture, the amount of blood flowing into the joint - these are the main changes that an injury entails.

There are three stages of rupture:

  1. The mild stage is characterized by mild or moderate pain in the knee joint. Movement disorders are not observed. The pain is aggravated by jumping and squatting. Slightly noticeable swelling above the kneecap.
  2. The middle stage is expressed by severe pain in the knee, which is similar in intensity to a bruise. The leg is always in a bent position, and extension is impossible even by force. When walking, lameness is noticeable. From time to time there is a "blockade" - complete immobility. Puffiness increases, and the skin becomes cyanotic.
  3. In the severe stage, the pain becomes so acute that the patient simply cannot tolerate it. The most painful area is the kneecap area. The leg is in a motionless half-bent state. Any attempt at displacement leads to increased pain. The swelling is so severe that the affected knee can be twice the size of a healthy one. The skin around the joint is bluish-purple in color.

If the injury occurred in the medial meniscus, the symptoms of injury are always the same, regardless of its degree.

  • Turner's symptom - the skin around the knee joint is very sensitive.
  • Bazhov's technique - if you try to straighten your leg or press it on the patella from the inside - the pain intensifies.
  • Land's sign - when the patient lies in a relaxed position, the palm freely passes under the knee joint.

To confirm the diagnosis, the doctor prescribes an x-ray to the patient, in which a special fluid is injected into the cavity of the diseased joint.

Today, MRI is widely used to diagnose meniscal injuries, where the degree of damage is determined by Stoller.

Degenerative changes in the meniscus

Changes in the posterior horn of the medial meniscus are often based on various chronic diseases and prolonged microtraumas. The second option is typical for people of hard physical labor and professional athletes. Degenerative wear of the cartilage plates, which occurs gradually, and a decrease in the possibility of their regeneration provokes a sudden damage to the internal meniscus.

Common diseases that cause include rheumatism and gout. With rheumatism, the blood supply is disturbed due to the inflammatory process. In the second case, uric acid salts accumulate in the joints.

Since the nutrition of the menisci occurs due to intra-articular exudate, the processes described above cause them to "starve". In turn, due to damage to collagen fibers, there is a decrease in the strength of the menisci.

This damage is typical for people over forty years of age. Pathology can occur spontaneously, for example, a sharp rise from a chair. Unlike trauma, the symptoms of the disease are rather mild and may not be determined.

  1. A constant symptom is a slight aching pain, which increases with sudden movements.
  2. A slight swelling appears above the patella, which slowly but gradually increases, while the color of the skin remains unchanged.
  3. Mobility in the joint is usually preserved, but from time to time "blockades" occur, which can be provoked by sharp flexion or extension.

In this case, it is difficult to determine the degree of degenerative changes in the medial meniscus. Therefore, X-ray or MRI is prescribed for diagnosis.

Diagnostic methods

For a correct assessment of the changes that have occurred in the cartilaginous plates, the identification of symptoms and the collection of detailed complaints are insufficient measures. The meniscus is inaccessible for direct inspection, as it is located inside the knee joint. Therefore, even the study of their edges by palpation is excluded.

To begin with, the doctor will prescribe a radiography of the joint in two projections. Due to the fact that this method only demonstrates the condition of the skeletal apparatus of the knee joint, it provides little information to determine the degree of damage to the meniscus.

To assess the intra-articular structures, the introduction of air and contrast agents is used. Additional diagnostics is carried out using MRI and ultrasound.

Despite the fact that Stoller MRI is today a completely new and expensive method, its expediency in terms of studies of degenerative changes is undeniable. The procedure does not require special preparation. The only thing that is needed from the patient is patience, since the study is quite lengthy.

There should be no metal objects on the patient’s body and inside (rings, piercings, earrings, artificial joints, pacemaker, etc.),

Depending on the severity of the changes, according to Stoller, four degrees are distinguished:

  1. Zero - a healthy, normal meniscus.
  2. The first is that a point signal appears inside the cartilaginous plate, which does not reach the surface.
  3. The second is a linear formation, but it does not yet reach the edges of the meniscus.
  4. Third - the signal reaches the very edge and violates the meniscus integrity.

The technique of research by ultrasonic waves is based on different tissue densities. Reflecting from the internal knee structures, the sensor signal demonstrates degenerative changes in the cartilage plates, the presence of blood inside the joint and detached fragments. But this signal cannot see through the bones, therefore, when examining the knee joint, the field of its visibility is very limited.

Signs of rupture in case of damage are the displacement of the meniscus and the presence of heterogeneous zones in the plate itself. Additional symptoms include violations of the integrity of the ligaments and joint capsule. The presence of inclusions in the synovial fluid indicates a hemorrhage into the cavity.

The choice of treatment method is based on changes in the meniscus plate. With a mild and moderate degree of degenerative changes (without violating integrity), a complex of conservative therapy is prescribed. In the event of a complete rupture, surgical treatment is carried out to preserve the function of the limb, in particular, arthroscopy is prescribed - an operation with minimal trauma.

Rupture of the posterior horn of the lateral meniscus or its anterior counterpart occurs as a result of trauma. This happens in people who are in the following risk groups:

  • professional athletes (especially football players);
  • people who lead a very active lifestyle and engage in various extreme sports;
  • elderly men and women suffering from various types of arthrosis and similar diseases.

What is an injury to the anterior or posterior horn of the internal meniscus? To do this, you must at least in general terms know what the meniscus itself is. In general terms, this is a special cartilaginous structure consisting of fibers. It is needed for cushioning in the joints of the knees. There are similar cartilaginous structures in other places of the human body - they are provided with all its parts, which are responsible for flexion and extension of the upper and lower extremities. But damage to the posterior or anterior horn of the lateral meniscus is considered the most dangerous and most common injury, which, if not treated in time, can lead to various complications and make a person disabled.

Brief anatomical description of the meniscus

The knee joint of a healthy organism incorporates the following cartilage tabs:

  • external (lateral);
  • internal (medial).

Both of these structures are shaped like a crescent. The density of the first meniscus is higher than that of the posterior cartilaginous structure. Therefore, the lateral part is less exposed to injury. The inner (medial) meniscus is rigid and most often the injury occurs when it is damaged.

The very structure of this body consists of several elements:

  • cartilaginous body of the meniscus;
  • anterior horn;
  • its rear counterpart.

The main part of the cartilaginous tissue is girdled and permeated with a network of capillary vessels, which form the so-called red zone. This whole area has an increased density and is located on the edge of the knee joint. In the middle part is the thinnest part of the meniscus. There are no vessels in it and it is called the white zone. In the initial diagnosis of an injury, it is important to determine exactly which area of ​​the meniscus has been damaged and torn. Previously, it was customary to completely remove the meniscus if damage to the posterior horn of the inner layer was diagnosed, which allegedly contributed to the relief of the patient from complications and problems.

But at the current level of development of medicine, when it is precisely established that the internal and external meniscus perform very important functions for the bones and cartilage of the knee joint, doctors try to treat the injury without resorting to surgical intervention. Since the meniscus plays the role of a shock absorber and protects the joint, its removal can lead to the development of arthrosis and other complications, the treatment of which will require additional time and money. Damage to the anterior horn of the meniscus is rare, since its structure has an increased density and better resists various loads.

For such injuries, conservative treatment or surgery is usually prescribed if damage to the anterior horn of the lateral meniscus has led to the accumulation of blood in the knee joint.

Causes of cartilage rupture

Damage to the posterior horn of the medial meniscus is most often caused by an acute injury, since when a force is applied to the knee joint, it does not always lead to a rupture of the cartilage tissue, which is responsible for the cushioning of this area. Doctors identify a number of factors that contribute to getting a cartilage rupture:

  • excessively active jumping or running over rough terrain;
  • twisting the human body on one leg, when her foot does not come off the surface;
  • frequent and prolonged squatting or active walking;
  • the development of degeneration of the knee joint in certain diseases and limb injury in this condition;
  • the presence of congenital pathology, in which there is a weak development of ligaments and joints.

There are different degrees of damage to the meniscus. Their classification is different in different clinics, but the main thing is that they are all determined by generally recognized signs, which will be discussed below.

Symptoms of damage to the posterior horn of the internal meniscus

Signs of such an injury to the medial meniscus are as follows:

  • sharp, sharp pain occurs when an injury occurs. It can be felt within 3-5 minutes. Before that, a clicking sound is heard. After the pain has disappeared, the person will be able to move around. But this will cause new bouts of pain. After 10-12 hours, the patient will feel a sharp burning sensation in the knee, as if a sharp object had penetrated there. When bending and unbending the knee joint, the pain intensifies, and after a short rest it subsides;
  • blockade of the knee (“jamming”) occurs when the cartilage tissue of the inner meniscus is torn. It can manifest itself at the moment when a torn piece of the meniscus is clamped between the tibia and femur. This results in the inability to move. These symptoms also bother a person if the ligaments of the knee joint are damaged, so the exact cause of the pain syndrome can only be found out when a diagnosis is made in the clinic;
  • when blood enters the joint, traumatic hemarthrosis may occur. This occurs when a meniscus rupture occurs in the red zone, when blood vessels are damaged;
  • after several hours from the moment of injury, swelling of the knee joint may occur.

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Chronic damage to the posterior horn of the medial meniscus of the 2nd degree from an acute injury should be clearly distinguished. This is possible today using hardware diagnostics, which allows you to carefully examine the state of cartilage and fluid in the knee joint. A grade 3 meniscus tear leads to a pool of blood in the inner parts of the knee. At the same time, the edges of the cliff are even, and in case of a chronic disease, the fibers are scattered, there is edema, which occurs from damage to the nearby cartilage, and the penetration into this place and the accumulation of synovial fluid there.

Treatment of an injury to the posterior horn of the internal meniscus

The rupture of the tissues of the knee joint should be treated immediately after the injury, because over time, the disease from the acute stage can turn into a chronic disease. If treatment is not started on time, meniscopathy may develop. This will lead to changes in the structure of the knee joint and degradation of cartilage tissue on the bone surfaces. This situation is observed in half of the cases of rupture of the posterior horn of the internal meniscus in patients who, for various reasons, started the disease and sought medical help late.

The rupture can be treated by the following methods:

  • conservative way;
  • surgical intervention.

After making an accurate diagnosis, the doctors eliminate the primary rupture of the meniscus horn with the help of a therapeutic course. In most cases, conservative treatment gives good results, although about a third of such injuries require surgery.

Treatment with conservative methods consists of several, fairly effective stages (if the injury is not started):

  • manual therapy and traction with the help of various equipment, which are aimed at repositioning, that is, repositioning the knee joint during the development of blockade;
  • the use of anti-inflammatory drugs that doctors prescribe to the patient to eliminate swelling of the knee;
  • rehabilitation course, in which treatment is carried out using therapeutic, restorative gymnastics, physiotherapy methods and massage;
  • prescribing a course to the patient, in which treatment is carried out with chondroprotectors and hyaluronic acid. This lengthy process can last from 3 to 6 months over several years, but is essential for restoring the structure of the menisci;
  • since an injury to the posterior horn of the meniscus is accompanied by severe pain, the doctors continue the treatment using painkillers. For this purpose, analgesics are usually used, for example, Ibuprofen, Paracetamol, Indomethacin, Diclofenac and other drugs. They can only be used as prescribed by the attending physician in a dosage that is determined by the course of therapy.

The knee joint has a rather complex structure. It consists of the femur and tibia, the patella (patella), as well as the ligament system that ensures the stability of the bones of the joint. Another part of the knee joint is the menisci - cartilage between the femur and tibia. When moving, a large load is placed on the knee, which leads to frequent injury to its elements. A tear in the posterior horn of the medial meniscus is one such injury.

Injuries to the knee joint are dangerous, painful and fraught with consequences. Rupture of the posterior horn of the meniscus, which can occur in almost any active person, is the most common and dangerous injury. It is dangerous primarily due to complications, therefore, it requires timely detection and treatment.

What is a meniscus

Menisci are very important structural units of the knee joint. They are curved strips of fibrous cartilage that sit between the bones of a joint. The shape resembles a crescent with elongated edges. It is customary to divide them into zones: the body of the meniscus (middle part); elongated end parts - the posterior and anterior horns of the meniscus.

There are two menisci in the knee joint: medial (inner) and lateral (outer). They are attached to the tibia with their ends. The medial is located on the inside of the knee and is connected to the internal lateral ligament. In addition, it is connected along the outer edge with the capsule of the knee joint, through which partial blood circulation is provided.

The cartilaginous section of the meniscus, adjacent to the capsule, contains a significant number of capillaries and is supplied with blood. This part of the medial meniscus is called the red zone. The middle region (intermediate zone) contains a small number of vessels and is very poorly supplied with blood. Finally, the inner region (white zone) has no circulatory system at all. The lateral meniscus is located in the outer region of the knee. It is more mobile than the medial, and its damage occurs much less frequently.

Menisci perform very important functions. First of all, they play the role of shock absorbers during the movement of the joint. In addition, the menisci stabilize the position of the entire knee in space. Finally, they contain receptors that send operational information to the cerebral cortex about the behavior of the entire leg.

When the inner meniscus is removed, the area of ​​contact of the knee bones decreases by 50-70%, and the load on the ligaments increases by more than 100%. In the absence of an external meniscus, the contact area will decrease by 40-50%, but the load will increase by more than 200%.

meniscal injury

One of the characteristic injuries of the menisci is their rupture. Studies show that such injuries can occur not only in people involved in sports, dancing or hard work, but also in casual activities, as well as in the elderly. It has been established that a meniscal tear is diagnosed in an average of 70 out of every 100,000 people. At a young age (up to 30 years), the damage is acute; with increasing age (over 40 years), the chronic form begins to predominate.

The cause of a torn meniscus can be an excessive lateral load along with twisting of the lower leg. Such loads are typical when performing certain movements (cross-country running, jumping on uneven surfaces, rotation on one leg, prolonged squatting). In addition, ruptures can be caused by joint diseases, tissue aging, or pathological abnormalities. The cause of damage can be a sharp strong blow to the knee or a quick extension of the leg. According to the nature and location of the damage, several types of ruptures can be distinguished:

  • longitudinal (vertical);
  • oblique (patchwork);
  • transverse (radial);
  • horizontal;
  • rupture of the anterior horn of the lateral or medial meniscus;
  • rupture of the posterior horn of the menisci;
  • degenerative rupture.

Degenerative rupture is associated with changes in tissues due to diseases or due to aging.

Symptoms of a meniscus injury

In case of damage to the meniscus of the knee joint, two characteristic periods are distinguished - acute and chronic. The acute period lasts 4-5 weeks and is characterized by a number of painful symptoms. The moment of damage to the meniscus, as a rule, is determined by the sound, resembling a crack, and a sharp pain in the knee area. In the first period after an injury, cracking and pain accompanies a person during exertion (for example, walking up stairs). Swelling develops in the knee area. Often, a meniscus tear is accompanied by hemorrhage into the joint.

In the acute period, the movement of the leg in the knee joint in a person is limited or completely impossible. Due to the accumulation of fluid in the knee area, the effect of a “floating patella” may occur.

The chronic period of meniscus rupture is less painful. Attacks of pain occur only with sudden movements of the leg or increased loads. During this period, it is quite difficult to determine the fact of a meniscus rupture. To diagnose an injury, methods based on characteristic symptoms have been developed.

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Baikov's symptom is based on the detection of pain when fingers are pressed on the outer side of the knee with simultaneous extension of the lower leg. Land's symptom determines the injury by the degree of straightening of the leg in the knee joint, when the leg lies freely on the surface (in case of injury, the palm of the hand is placed between the surface and the knee). Turner's symptom takes into account the increased sensitivity of the skin on the inner surface of the knee joint and the upper part of the lower leg from the inside. The symptom of the blockade establishes a gap in the jamming of the knee joint when a person moves up the stairs. This symptom is characteristic of a torn posterior horn of the internal meniscus.

Typical symptoms of a medial meniscus tear

Rupture of the medial meniscus of the knee joint has a number of characteristic symptoms. Injury to the internal posterior horn of the meniscus causes intense pain in the knee area from the inside. When you press your finger in the area where the meniscus horn attaches to the knee ligament, a sharp pain appears. A tear in the posterior horn causes blockage of movement in the knee joint.

You can determine the gap by making flexion movements. It manifests itself in the form of a sharp pain when the leg is extended and the lower leg is turned outward. The pain also pierces with strong bending of the leg at the knee. According to the severity of damage to the meniscus of the knee joint are divided into small, moderate and severe. Small tears (partial), including the horns of the meniscus, are characterized by pain and slight swelling in the knee area. Such signs of injury cease to appear after 3-4 weeks.

With a moderate degree of injury, all the considered symptoms of the acute period appear, but they are limited and manifest themselves during physical exertion, such as jumping, moving up inclined planes, and squatting. Without treatment, this form of injury becomes chronic. This degree is characteristic of some ruptures of the anterior and posterior horns of the medial meniscus.

With a severe degree of injury, pain and swelling of the knee become obvious; hemorrhage occurs in the joint cavity. The horn is completely detached from the meniscus, and its parts are inside the joints, which causes a blockade of movements. Independent movement of a person is difficult. Severe injury requires surgical intervention.

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Mechanism of rupture of the posterior horn

A very dangerous longitudinal tear (complete or partial), as a rule, begins to develop from the posterior horn of the medial meniscus. With a complete rupture, the separated part of the meniscus horn can migrate into the cavity between the joints and block their movement.

On the border of the middle of the body of the meniscus and the beginning of the posterior horn of the inner meniscus, oblique tears often develop. This is usually a partial tear, but the edge may be embedded between joints. This produces a crackling sound and painful sensations (rolling pain).

Often, the rupture of the posterior horn of the internal meniscus is combined in nature, combining different types of damage. Such gaps develop simultaneously in several directions and planes. They are characteristic of the degenerative mechanism of damage.

A horizontal rupture of the posterior horn of the medial meniscus originates from its inner surface and develops in the direction of the capsule. Such damage causes swelling in the joint space (pathology is also characteristic of the anterior horn of the lateral meniscus).

Conservative treatments

Treatment of a tear in the posterior horn of the medial meniscus (similar to that of the anterior horn of the medial meniscus) depends on the site of injury and its severity. Based on this, the method is determined - conservative or surgical treatment.

The conservative (therapeutic) method is applicable for small ruptures and a rupture of moderate severity. Such treatment is based on a number of therapeutic interventions and is often effective.

The first step is to provide assistance in case of injury. To do this, it is necessary to provide the victim with peace; apply a cold compress on the inside of the knee; inject an anesthetic; apply a plaster bandage. If necessary, fluid should be punctured.

Usually the conservative method involves long-term treatment for 6-12 months. Initially, reduction (reposition) of the knee joint is performed in the presence of a blockade. Manual methods can be used to remove the blockade. For the first 3 weeks, rest should be ensured, and the knee joint should be immobilized with a plaster splint.

When cartilage is damaged, it is necessary to repair and repair them. For this purpose, a course of taking chondroprotectors and hyaluronic acid is prescribed. As protectors, the use of drugs containing chondroitin and glucosamine is recommended. Painful symptoms and inflammatory processes must be eliminated by taking non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, indomethacin) and others.

To eliminate puffiness and accelerate healing, external agents are used in the form of ointments (Amzan, Voltaren, Dolgit and others). The treatment process includes a course of physiotherapy and special therapeutic exercises. A therapeutic massage gives a good effect.

Surgical treatment

With severe damage, there is a need for surgical intervention. With crushing of the cartilage, severe rupture and displacement of the meniscus, complete breakage of the anterior or posterior horns of the meniscus, a surgical operation is necessary. Surgical treatment is divided into several types: removal of a meniscus or detached horn; recovery; suturing the place of the rupture; fastening detached horns with clamps; meniscus transplant.

Menisci are cartilaginous layers inside the knee joint, which mainly perform shock-absorbing and stabilizing functions. There are two menisci of the knee joint: internal (medial) and external (lateral)

Meniscal tears are the most common knee problem. Basically, meniscal tears are traumatic, which often occur as a result of trauma in young people, and degenerative, which are more common in older people and can occur without injury against the background of degenerative changes in the meniscus, which are a variant of the course of arthrosis of the knee joint. If left untreated, a traumatic tear will eventually become degenerative.

A doctor can diagnose a meniscus tear. Magnetic resonance imaging (MRI) may be needed to confirm the diagnosis of a meniscus tear. Less commonly, an ultrasound examination (ultrasound) may be used to confirm the diagnosis.

Meniscus tears occur in the posterior horn, in the body and in the anterior horn of the meniscus.

A rupture of the meniscus can lead to the fact that its torn and dangling part will serve as a mechanical obstacle to movement, cause pain and, possibly, block the joint, restrict movement. Moreover, the dangling part of the meniscus destroys the adjacent cartilage that covers the femur and tibia.

The main method of treatment of ruptures of the meniscus of the knee joint is surgical. But this does not mean that you always need to do an operation if a meniscus tear is detected on an MRI. Operate only those tears that are the cause of pain and mechanical obstruction of movement in the knee joint.

Currently, the "gold standard" for the treatment of ruptures of the meniscus of the knee joint is arthroscopy - a low-traumatic operation that is performed through two incisions one centimeter long. There are other techniques (meniscus suture, meniscus transplantation), but they give less reliable results.

During arthroscopy, the dangling and torn part of the meniscus is removed and the inner edge of the meniscus is aligned with special surgical instruments. Note that only part of the meniscus is removed, not the entire meniscus. The torn off part of the meniscus no longer fulfills its function, so it makes little sense to save it.

After arthroscopic surgery, you can walk on the same day, but full recovery may take from several days to several weeks.

Anatomy

In the knee joint, between the femur and tibia, there are menisci - crescent-shaped cartilage layers that increase the stability of the joint by increasing the area of ​​​​contact of the bones.


Both the outer (lateral) and inner (medial) meniscus are conditionally divided into three parts: the back (posterior horn), the middle (body) and the anterior (anterior horn).

The shape of the inner (medial) meniscus of the knee joint usually resembles the letter "C", and the outer (lateral) - the correct semicircle. Both menisci are formed by fibrous cartilage and are attached anteriorly and posteriorly to the tibia. The medial meniscus is also attached along the outer edge to the capsule of the knee joint by the so-called coronary ligament. The thickening of the capsule in the region of the middle part of the body of the meniscus is formed by the tibial collateral ligament. The attachment of the medial meniscus to both the capsule and the tibia makes it less mobile than the lateral meniscus. This lesser mobility of the inner meniscus causes its tears to occur more frequently than those of the outer meniscus. The lateral meniscus covers most of the upper lateral articular surface of the tibia and, unlike the medial meniscus, has the shape of an almost regular semicircle. Due to the more rounded shape of the lateral meniscus, the anterior and posterior points of its attachment to the tibia lie closer to each other. Slightly medially from the anterior horn of the lateral meniscus is the site of attachment of the anterior cruciate ligament. The anterior and posterior meniscofemoral ligaments, which attach the posterior horn of the lateral meniscus to the medial femoral condyle, run anterior and posterior to the posterior cruciate ligament and are also called Humphrey's ligament and Wriesberg's ligament, respectively. Lateral menisci, extending to the articular surface more than normal, are called discoid; they occur, according to reports, in 3.5-5% of people. In simple terms, a discoid lateral meniscus means that it is wider than the normal lateral meniscus of the knee joint. Among the discoid menisci, one can distinguish the so-called continuous discoid (entirely covering the external condyle of the tibia), semi-disc and Wrisberg variants. In the latter, the posterior horn is fixed to the bone only by the Wrisberg ligament.

On the posterior surface of the joint, through the gap between the capsule and the lateral meniscus, the tendon of the popliteal muscle penetrates into the joint cavity. It is attached to the meniscus by thin bundles that apparently perform a stabilizing function. To the joint capsule, the lateral meniscus is fixed much weaker than the medial one and therefore is more easily displaced. The microstructure of the meniscus is normally represented by fibers of a special protein - collagen. These fibers are predominantly oriented circularly, i.e. along the meniscus. A smaller part of the collagen fibers of the meniscus is oriented radially, i.e. from edge to center. There is another option for fibers - perforating. They are the least, they go "randomly", connecting the circular and radial fibers.

a - radial fibers, b - circular fibers (there are most of them), c - perforating, or "random" fibers Radially, the fibers are oriented mainly at the surface of the meniscus; crossing, they form a network, which is believed to provide the resistance of the meniscus surface to the shear force. Circular fibers make up the bulk of the core of the menisci; this arrangement of fibers ensures the distribution of the longitudinal load on the knee joint. On a dry matter basis, the meniscus is approximately 60-70% collagen, 8-13% extracellular matrix proteins, and 0.6% elastin. Collagen is mainly represented by type I and in a small amount by types II, III, V and VI. In newborns, the entire tissue of the menisci is permeated with blood vessels, but by the age of 9 months, the vessels completely disappear from the inner third of the menisci. In adults, the vascular network is present only in the outermost part of the meniscus (10-30% of the outer edge), and with age, the blood supply to the meniscus only worsens. It is worth noting that with age, the blood supply to the meniscus deteriorates. From the point of view of blood supply, the meniscus is divided into two zones: red and white.

Cross section of the meniscus of the knee joint (in the section it has a triangular shape). Blood vessels enter the thickness of the meniscus from the outside. In children, they penetrate the entire meniscus, but with age, the blood vessels become smaller and in adults there are blood vessels only in 10-30% of the outer part of the meniscus adjacent to the joint capsule. The first zone is the border between the joint capsule and the meniscus (red-red zone, or R-R). The second zone is the border between the red and white zones of the meniscus (red-white zone or R-W zone). The third zone is white-white (W-W), i.e. where there are no blood vessels. Relatively poor in blood vessels is that part of the lateral meniscus, near which the tendon of the popliteal muscle penetrates into the knee joint. The cells of the inner two-thirds of the meniscus receive nutrients through diffusion and active transport from the synovial fluid.

Photograph of the blood vessels of the lateral meniscus (a contrast agent was injected into the bloodstream). Note the lack of vessels at the site where the hamstring tendon passes (red arrow). The anterior and posterior horns of the meniscus, as well as its peripheral part, contain nerve fibers and receptors that are presumably involved in proprioceptive afferentation during movements in the knee joint, i.e. signal to our brain about the position of the knee joint.

Why are menisci needed?

At the end of the 19th century, the menisci were considered the "non-functioning remnants" of muscles. However, as soon as the importance of the function performed by the menisci was discovered, they began to be actively studied. The menisci perform different functions: they distribute the load, absorb shocks, reduce contact stress, act as stabilizers, limit the range of motion, participate in proprioceptive afferentation during movements in the knee joint, i.e. signal to our brain about the position of the knee joint. Among these functions, the first four are considered to be the main ones - load distribution, shock absorption, contact stress distribution and stabilization. When flexing and extending the leg at the knee by 90 degrees, the menisci account for approximately 85% and 50-70% of the load, respectively. After removal of the entire medial meniscus, the area of ​​contact of the articular surfaces decreases by 50-70%, and the tension at their junction increases by 100%. Complete removal of the lateral meniscus reduces the contact area of ​​the articular surfaces by 40–50% and increases the contact stress by 200–300%. These changes, caused by a meniscectomy (i.e., an operation in which the meniscus is completely removed), often lead to narrowing of the joint space, the formation of osteophytes (bone spikes, growths) and the transformation of the condyles of the femur from rounded to angular, which is clearly visible on radiographs. Meniscectomy also affects the function of articular cartilage. Menisci are 50% more elastic than cartilage and therefore play the role of reliable shock absorbers during shocks. In the absence of a meniscus, the entire load during impacts without shock absorption falls on the cartilage. Finally, the medial meniscus prevents the tibia from moving forward relative to the femur when the anterior cruciate ligament is injured. With a preserved anterior cruciate ligament, the loss of the medial meniscus has little effect on the anteroposterior displacement of the tibia during flexion and extension of the leg at the knee. But with damage to the anterior cruciate ligament, the loss of the medial meniscus by more than 50% increases the displacement of the tibia forward when the leg is flexed at the knee by 90°. In general, the inner two-thirds of the menisci are important for increasing the contact area of ​​the articular surfaces and shock absorption, while the outer third is important for distributing the load and stabilizing the joint. How common is a meniscus tear in the knee?

How common is a meniscus tear in the knee?

Meniscus tears occur at a frequency of 60-70 cases per 100,000 population per year. In men, meniscus tears occur 2.5-4 times more often, with traumatic tears predominating at the age of 20 to 30 years, and tears due to chronic degenerative changes in the meniscus at the age of 40 years. It happens that a meniscus rupture occurs at the age of 80-90. In general, the inner (medial) meniscus of the knee joint is most often damaged.

Photos taken during arthroscopy of the knee joint: a video camera (arthroscope) was introduced into the joint cavity through a 1 cm incision, which allows you to examine the joint from the inside and see all the damage. On the left - a normal meniscus (no fibrillation, elastic, even edge, white), in the center - a traumatic meniscus rupture (the edges of the meniscus are even, the meniscus is not torn). Right - degenerative rupture of the meniscus (the edges of the meniscus are torn)

At a young age, acute, traumatic ruptures of the meniscus occur more often. An isolated rupture of the meniscus may occur, however, combined injuries of intra-articular structures are also possible, when, for example, a ligament and a meniscus are damaged at the same time. One of these combined injuries is the rupture of the anterior cruciate ligament, which is accompanied by a rupture of the meniscus in about every third case. At the same time, the lateral meniscus is torn approximately four times more often, more mobile, like the entire outer half of the knee joint. The medial meniscus, which becomes the limiter of the anterior displacement of the tibia when the anterior cruciate ligament is damaged, is more often torn when the anterior cruciate ligament has already been damaged earlier. Meniscus ruptures accompany up to 47% of tibial condyle fractures and are often observed in fractures of the femoral shaft with concomitant effusion into the joint cavity.

Symptoms

Traumatic breaks. At a young age, meniscal tears occur more often as a result of injury. As a rule, the break occurs when twisting on one leg, i.e. with axial load in combination with rotation of the lower leg. For example, such an injury can occur when running, when one foot suddenly stands up on an uneven surface, when landing on one foot with a torsion of the body, but a meniscus tear can also occur with a different mechanism of injury.

Usually, immediately after the rupture, pain in the joint appears, the knee swells. If the meniscus tear affects the red zone, i.e. the place where there are blood vessels in the meniscus, then there will be hemarthrosis- accumulation of blood in the joint. It is manifested by bulging, swelling above the patella (patella).

When the meniscus is torn, the detached and dangling part of the meniscus begins to interfere with movements in the knee joint. Small tears can cause painful clicking or a feeling of difficulty moving. With large tears, blockade of the joint is possible due to the fact that the relatively large size of the torn and dangling fragment of the meniscus moves to the center of the joint and makes some movements impossible, i.e. the joint is "jammed". With ruptures of the posterior horn of the meniscus, flexion is often limited, with ruptures of the body of the meniscus and its anterior horn, extension in the knee joint suffers.

The pain of a torn meniscus can be so severe that it is impossible to step on the foot, and sometimes a torn meniscus manifests itself only as pain with certain movements, such as going down stairs. At the same time, climbing stairs can be completely painless.

It should be noted that the blockade of the knee joint can be caused not only by a meniscus rupture, but also by other causes, for example, rupture of the anterior cruciate ligament, a free intraarticular body, including a detached cartilage fragment in Koenig's disease, knee joint "prick" syndrome, osteochondral fractures , fractures of the condyles of the tibia and many other reasons.

With an acute rupture in combination with damage to the anterior cruciate ligament, swelling may develop faster and be more pronounced. Injuries to the anterior cruciate ligament are often accompanied by rupture of the lateral meniscus. This is due to the fact that when the ligament is torn, the outer part of the tibia dislocates forward and the lateral meniscus is pinched between the femur and tibia.

Chronic or degenerative tears more common in people over 40 years of age; pain and swelling at the same time develop gradually, and it is not always possible to detect their sharp increase. Often there is no history of injury, or only a very minor impact, such as bending the leg, squatting, or even a tear can occur simply when getting up from a chair. In this case, blockade of the joint may also occur, however, degenerative ruptures often give only pain. It is worth noting that with a degenerative meniscus tear, the adjacent cartilage covering the femur or, more often, the tibia is often damaged.

Like acute meniscal tears, degenerative tears can give a variety of symptoms: sometimes it is completely impossible to step on the foot or even move it a little because of the pain, and sometimes the pain appears only when descending stairs, squatting.

Diagnosis

The main symptom of a meniscus tear is pain in the knee joint that occurs or worsens with a certain movement. The severity of pain depends on the place where the meniscus has ruptured (body, posterior horn, anterior horn of the meniscus), the size of the rupture, and the time elapsed since the injury.

Once again, we note that a meniscus rupture can occur suddenly, without any injury. For example, a degenerative tear can occur at night while the person is sleeping and present with pain in the morning when getting out of bed. Often degenerative tears occur when getting up from a low chair.

The intensity of pain is affected by both individual sensitivity and the presence of concomitant diseases and injuries of the knee joint (arthritis of the knee joint, ruptures of the anterior cruciate ligament, ruptures of the lateral ligaments of the knee joint, fractures of the condyles and other conditions that themselves can cause pain in the knee joint) .

So, pain during a meniscus tear can be different: from weak, appearing only occasionally, to strong, making movements in the knee joint impossible. Sometimes it is even impossible to step on the foot because of the pain.

If the pain appears when descending the stairs, then most likely there is a rupture of the posterior horn of the meniscus. If there is a rupture of the body of the meniscus, then the pain increases with extension in the knee joint.

If the knee joint is “jammed”, i.e. the so-called blockade of the joint arose, then most likely there is a rupture of the meniscus, and the blockade is due to the fact that the torn part of the meniscus just blocked the movement in the joint. However, the blockade happens not only when the meniscus is torn. For example, the joint can also “jam” in case of ruptures of the anterior cruciate ligament, infringement of the synovial folds (“plik” syndrome), exacerbation of arthrosis of the knee joint.

It is impossible to diagnose a meniscus rupture on your own - you need to contact an orthopedic traumatologist. It is advisable that you contact a specialist who is directly involved in the treatment of patients with injuries and diseases of the knee joint.

First, the doctor will ask you about how the pain appeared, about the possible causes of its occurrence. Then he starts the inspection. The doctor carefully examines not only the knee joint, but the entire leg. First, the amplitude and pain of movements in the hip and knee joints are assessed, since part of the pain in the hip joint radiates to the knee joint. The doctor then examines the thigh for muscle atrophy. Then the knee joint itself is examined: first of all, it is assessed whether there is an effusion in the knee joint, which may be synovitis or hemarthrosis.

As a rule, effusion, i.e. accumulation of fluid in the knee joint, manifested by visible swelling above the patella (patella). The fluid in the knee joint may be blood, in which case they speak of hemarthrosis of the knee joint, which in literal translation from Latin means "blood in the joint." Hemarthrosis occurs with fresh meniscus ruptures.

If the rupture occurred a long time ago, then effusion is also possible in the joint, but this is no longer hemarthrosis, but synovitis, those. excess accumulation of synovial fluid, which lubricates the joint and nourishes the cartilage.


Swelling of the right knee joint. Please note that the swelling is located above the patella (kneecap), i.e. fluid accumulates in the suprapatellar bag (upper torsion of the knee joint). The left, normal knee is shown for comparison.

A meniscus tear is often manifested by the inability to fully extend or bend the leg at the knee joint.

As we have already noted, the main symptom of a meniscus tear is pain in the knee joint that occurs or increases with a certain movement. If the doctor suspects a meniscus tear, then he tries to just provoke this pain in a certain position and with a certain movement. As a rule, the doctor presses with his finger in the projection of the joint space of the knee joint, i.e. slightly below and to the side (outside and inside) of the patella and flexes and unbends the leg at the knee. If this causes pain, then most likely there is a torn meniscus. There are other special tests that can diagnose a meniscus tear.


The main tests that a doctor performs to diagnose a torn meniscus of the knee.

The doctor must perform not only these tests, but also others that allow you to suspect and diagnose problems with the cruciate ligaments, the patella, and a number of other situations.

In general, if the doctor evaluates the knee joint by a combination of tests, and not by any one of the signs, then a rupture of the internal meniscus can be diagnosed in 95% of cases, and external - in 88% of cases. These figures are very high, and in fact, often a competent traumatologist can accurately diagnose a meniscus rupture without any additional examination methods (radiography, magnetic resonance imaging, ultrasound). However, it will be very unpleasant if the patient gets into those 5-12% of cases when a meniscus rupture is not diagnosed despite the fact that it exists, or is diagnosed erroneously, therefore in our practice we quite often try to resort to additional research methods that confirm or refute doctor's guess.

Radiography. An X-ray of the knee joint can be considered mandatory for any pain in the knee joint. Sometimes there is a desire to immediately perform magnetic resonance imaging (MRI), which "shows more than x-rays." But this is wrong: in some cases, X-rays make it easier, faster and cheaper to establish the correct diagnosis. Therefore, you should not assign yourself research, which can be a waste of time and money.

Radiography is performed in the following projections: 1) in a direct projection in a standing position, including when the legs are bent at the knees by 45 ° (according to Rosenberg), 2) in a lateral projection and 3) in an axial projection. The posterior surfaces of the condyles of the femur in arthrosis of the knee joint usually wear out earlier, and when the legs are flexed 45 ° in the standing position, a corresponding narrowing of the joint space can be seen. In any other position, these changes will most likely not be noticeable, so other radiographic positions are not relevant for examining knee pain. If a patient with complaints of pain in the knee joint radiographically revealed a significant narrowing of the joint space, extensive damage to the meniscus and cartilage is very likely, in which arthroscopic resection of the meniscus (incomplete or partial meniscectomy), which we will discuss below, is useless. To exclude such a cause of pain as chondromalacia of the patella, an x-ray is needed in a special axial projection (for the patella). Plain radiography, which in no way facilitates the diagnosis of meniscus rupture, nevertheless makes it possible to exclude such concomitant disorders as osteochondritis dissecans (Koenig's disease), fracture, tilt or subluxation of the patella, and articular mice (free intraarticular bodies).

MRI (Magnetic resonance imaging) significantly improved the accuracy of diagnosing meniscus ruptures. Its advantages are the ability to image the meniscus in several planes and the absence of ionizing radiation. In addition, MRI allows you to assess the condition of other articular and periarticular formations, which is especially important when the doctor has serious doubts about the diagnosis, as well as if there are concomitant injuries that make it difficult to perform diagnostic tests. The disadvantages of MRI include high cost and the possibility of incorrect interpretation of changes with the ensuing additional studies. A normal meniscus for all pulse sequences gives a weak homogeneous signal. In children, the signal may be enhanced due to a more abundant blood supply to the meniscus. Increased signal in older people may be a sign of degeneration.

According to MRI, there are four degrees of meniscus changes (classification according to Stoller). Degree 0 is a normal meniscus. Grade I is the appearance in the thickness of the meniscus of a focal signal of increased intensity (not reaching the surface of the meniscus). Grade II - the appearance in the thickness of the meniscus of a linear signal of increased intensity (not reaching the surface of the meniscus). Grade III - signal of increased intensity, reaching the surface of the meniscus. Only grade III changes are considered a true meniscus tear.


0 degree (normal), meniscus unchanged.

I degree - a spherical increase in signal intensity, not associated with the surface of the meniscus.

II degree - a linear increase in signal intensity, not associated with the surface of the meniscus.

III degree (rupture) - an increase in signal intensity in contact with the surface of the meniscus.


Magnetic resonance imaging. On the left, a normal, intact meniscus (blue arrow). Right - rupture of the posterior horn of the meniscus (two blue arrows)

The accuracy of MRI in diagnosing a meniscus tear is approximately 90-95%, especially if twice in a row (i.e., on two adjacent slices) a high-intensity signal is recorded that captures the meniscus surface. To diagnose a rupture, you can also focus on the shape of the meniscus. Usually in the pictures in the sagittal plane, the meniscus has the shape of a butterfly. Any other shape could be a sign of a break. A sign of rupture is also the symptom "double posterior cruciate ligament" (or "third cruciate ligament"), when, as a result of displacement, the meniscus is in the intercondylar fossa of the femur and is adjacent to the posterior cruciate ligament.

A torn meniscus can be detected on MRI even in the absence of complaints in the patient, and the frequency of such cases increases with age. This indicates how important it is to take into account all clinical and radiological data during the examination. In a recent study, meniscal tears with no complaints or physical signs (i.e., positive test results when examined by a physician) were found on MRI in 5.6% of patients aged 18 to 39 years. According to another study, 13% of patients younger than 45 years and 36% of patients older than 45 years had signs of meniscal tears on MRI in the absence of complaints and physical signs.

What are knee meniscal tears?

Meniscus tears can be classified according to the cause and the nature of the changes found during the examination (MRI) or during surgery (knee arthroscopy).

As we have already noted, ruptures can be traumatic (excessive load on the unchanged meniscus) and degenerative (normal load on the meniscus changed by degenerative processes).

In the place where the rupture occurred, ruptures of the posterior horn, body and anterior horn of the meniscus are isolated.

Since the blood supply to the meniscus is uneven, three zones are distinguished in it: peripheral (red) - in the area of ​​\u200b\u200bthe junction of the meniscus with the capsule, intermediate (red-white) and central - white, or avascular, zone. The closer to the inner edge of the meniscus the rupture is located, the fewer vessels pass near it and the lower the likelihood of its healing.

The shape of the gaps are divided into longitudinal, horizontal, oblique and radial (transverse). There may be breaks combined in form. In addition, there is also a special variant of the meniscus rupture form: “watering can handle” (“basket handle”).


Classification of meniscal tears according to H. Shahriaree: I - longitudinal tear, II - horizontal tear, III - oblique tear, IV - radial tear


A special variant of the meniscus tear shape: "watering can handle" ("basket handle")

Acute traumatic ruptures that occur at a young age run vertically in a longitudinal or oblique direction; combined and degenerative tears are more common in the elderly. Vertical longitudinal tears, or tears in the form of a watering can handle, are complete and incomplete and usually begin with the posterior horn of the meniscus. With long ruptures, significant mobility of the torn part is possible, allowing it to move into the intercondylar fossa of the femur and block the knee joint. This is especially true for tears of the medial meniscus, possibly due to its lesser mobility, which increases the shear force acting on the meniscus. Oblique tears usually occur at the border between the middle and posterior thirds of the meniscus. More often these are small tears, but their free edge can fall between the articular surfaces and cause a sensation of rolling or clicking. Combined tears run in several planes at once, are often localized in the posterior horn or near it, and usually occur in older people with degenerative changes in the menisci. Horizontal longitudinal tears are often associated with cystic degeneration of the menisci. These tears usually begin at the inner edge of the meniscus and travel to the junction of the meniscus with the capsule. They are thought to be caused by shear forces and, when associated with cystic degeneration of the meniscus, form in the medial medial meniscus and cause localized swelling (bulging) along the joint line.

How to treat a torn meniscus in the knee?

Treatment of meniscal tears is conservative (i.e. non-surgical) and surgical (meniscectomy, i.e. removal of the meniscus, which may be complete or incomplete (partial)).

Meniscus suture and transplantation are special surgical options for meniscal tears, but these techniques are not always possible and sometimes do not give very reliable results.

Conservative (non-surgical) treatment of ruptures of the meniscus of the knee joint. Conservative treatment is usually indicated for small tears in the posterior horn of the meniscus or for small radial tears. These ruptures may be painful, but do not compress the meniscus between the articular surfaces and do not cause any clicking or rolling sensation. Such tears usually occur in stable joints.

Treatment consists of temporarily reducing stress. Unfortunately, it is often possible to come across a situation when in our country, a cast is applied for a meniscus rupture, which completely excludes movement in the knee joint. If there are no other injuries in the knee joint (fractures, torn ligaments), but only a meniscus tear, then such treatment is fundamentally wrong and can even be called crippling. The fact is that large meniscal tears still will not grow together, despite the plaster and complete immobilization of the knee joint. And small meniscus tears can be treated in more gentle ways. Complete immobilization of the knee joint with a heavy plaster cast is not only painful for a person (after all, it is impossible to wash normally, bedsores can occur under the plaster), but it has a detrimental effect on the knee joint itself. The fact is that complete immobilization can lead to contracture of the joint, i.e. persistent limitation of the range of motion due to the fact that non-moving cartilaginous surfaces stick together, and, unfortunately, movements in the knee after such treatment are not always possible to restore. It is doubly sad when the treatment with a plaster cast is used in cases where the gap is large enough, and after several weeks of torment in the cast, an operation still has to be performed. Therefore, it is so important to immediately contact a specialist who is familiar with the treatment of torn menisci and ligaments of the knee joint in case of a knee joint injury.

If the patient is involved in sports, then with conservative treatment it is necessary to exclude situations that can further injure the joint. For example, temporarily stopping sports that require quick jerks, especially turns and movements in which one leg remains in place, can worsen the condition.

In addition, exercises that strengthen the quadriceps femoris and the posterior thigh muscles are needed. The fact is that strong muscles additionally stabilize the knee joint, which reduces the likelihood of such shifts of the femur and tibia relative to each other, which injure the meniscus.

Often, conservative treatment is more effective in the elderly, since in them the cause of the described symptoms is often arthrosis, rather than a meniscal tear. Small (less than 10 mm) stable longitudinal tears, tears of the upper or lower surface that do not penetrate the entire thickness of the meniscus, and small (less than 3 mm) transverse tears may heal on their own or do not appear at all.

In cases where a meniscus tear is combined with an anterior cruciate ligament tear, conservative treatment is usually first resorted to.

Surgical treatment of ruptures of the meniscus of the knee joint. The indications for arthroscopic surgery are a significant size of the gap, causing mechanical symptoms (pain, clicking, blockade, restriction of movement), persistent effusion in the joint, as well as cases of unsuccessful conservative treatment. Once again, we note that the very fact of the existence of the possibility of conservative treatment does not mean that all meniscus ruptures should first be treated conservatively, but then, if it fails, then resort to "operation as a last resort." The fact is that quite often meniscal tears are of such a nature that it is more reliable and more efficient to operate immediately, and sequential treatment (“first conservative, and then, if it doesn’t help, then surgery”) can significantly complicate recovery and worsen the results. Therefore, we emphasize once again that with a meniscus rupture, and indeed with any injury to the knee joint, it is important to consult a specialist.

In meniscal tears, friction and blockage, called mechanical or motor symptoms (because they occur with movement and disappear or are greatly relieved by rest), can be a hindrance both in daily life and in sports. If the symptoms occur in everyday life, then the doctor can easily detect signs of a gap on examination. As a rule, an effusion is found in the joint cavity (synovitis) and pain in the projection of the joint space. There may also be limited movement in the joint and pain during provocative tests. Finally, other causes of knee pain should be ruled out based on the history, physical examination, and x-ray. If these symptoms are present, then this means that a meniscus tear is significant and surgery should be considered.

It is important to know that with meniscus ruptures, you do not need to delay the operation for a long time and endure pain. As we have already noted, a dangling meniscus flap destroys the adjacent cartilage covering the femur and tibia. The cartilage from smooth and elastic becomes softened, loose, and in advanced cases, a dangling flap of a torn meniscus erases the cartilage completely to the bone. Such cartilage damage is called chondromalacia, which has four degrees: in the first degree, the cartilage is softened, in the second, the cartilage begins to loosen, in the third, there is a “dent” in the cartilage, and in the fourth degree, the cartilage is completely absent.


Photograph taken during knee arthroscopy. This patient endured pain for almost a year, after which he finally turned to traumatologists for help. During this time, the dangling flap of the torn meniscus completely obliterated the cartilage down to the bone (grade 4 chondromalacia)

removal of the meniscus or meniscectomy (arthrotomy through a large incision 5-7 centimeters long), was initially considered a harmless intervention and complete removal of the meniscus was performed very often. However, long-term results were disappointing. Recovery or marked improvement was noted in 75% of men and less than 50% of women. Complaints disappeared in less than 50% of men and less than 10% of women. The results of the operation were worse in young people than in older people. In addition, 75% of the operated patients developed arthritis (against 6% in the control group of the same age). Arthrosis often appeared 15 years or more after surgery. Degenerative changes developed faster after lateral meniscectomy. When the role of the menisci finally became clear, the surgical technique changed and new tools were created to restore the integrity of the menisci or remove only part of them. Since the late 1980s, arthrotomic total meniscus removal has been recognized as an ineffective and harmful operation, which has been replaced by the possibility of arthroscopic surgery, which allows preserving the intact part of the meniscus. Unfortunately, in our country, due to organizational reasons, arthroscopy is far from being available everywhere, so there are still surgeons who offer their patients to completely remove a torn meniscus.

Nowadays, the meniscus is not completely removed, since its important role in the knee joint has become clear, but a partial (partial) meniscectomy is performed. This means that not the entire meniscus is removed, but only the detached part, which has already ceased to fulfill its function. What is the principle of partial meniscectomy, i.e. partial removal of the meniscus? The video and illustration below will help you understand the answer to this question.

The principle of partial meniscectomy (i.e., incomplete removal of the meniscus) is not only to remove the torn and dangling part of the meniscus, but also to make the inner edge of the meniscus smooth again.


The principle of partial removal of the meniscus. Different variants of meniscus ruptures are shown. A part of the meniscus is removed from its inner side in such a way as not only to remove the dangling flap of the torn meniscus, but also to restore the smooth inner edge of the meniscus.

In the modern world, the operation of partial removal of a torn meniscus is performed arthroscopically, i.e. through two small holes. An arthroscope is inserted into one of the punctures, which transmits the image to the video camera. Essentially, an arthroscope is an optical system. A saline solution (water) is injected through the arthroscope into the joint, which inflates the joint and allows it to be examined from the inside. Through the second puncture, various special instruments are introduced into the cavity of the knee joint, with which the damaged parts of the menisci are removed, the cartilage is "restored" and other manipulations are performed.

Arthroscopy of the knee. BUT- The patient lies on the operating table, the leg is in a special holder. Behind - the arthroscopic stand itself, which consists of a xenon light source (a xenon light guide illuminates the joint), a video processor (to which a video camera is attached), a pump (injects water into the joint), a monitor, a wiper (a device for ablation of cartilage, the synovial membrane of the joint), shaver (a device that "shaves"). B- an arthroscope (on the left) and a working instrument (nippers, on the right) were inserted into the knee joint through two punctures one centimeter each. AT- Appearance of arthroscopic nippers, clamps.

If cartilage damage (chondromalacia) is detected during arthroscopy, the doctor may recommend that you inject special preparations into the knee joint after the operation (ostenil, fermatron, duralan, etc.). You can find out more about which drugs can be injected into the knee joint and which cannot be found on our website in a separate article.

In addition to meniscectomy, there are methods for repairing the meniscus. These include meniscus suture and meniscus transplantation.It is difficult to decide when it is better to remove part of the meniscus and when it is better to restore the meniscus. It is necessary to take into account many factors that affect the outcome of the operation. In general, it is considered that if the meniscus is damaged so extensively that during arthroscopic surgery it is necessary to remove almost the entire meniscus, then it is necessary to decide whether it is possible to restore the meniscus.

A meniscus suture can be performed in cases where a little time has passed since the rupture. A necessary condition for the successful fusion of the meniscus after its stitching is a sufficient blood supply to the meniscus, i.e. The rupture must be located in the red zone, or at least on the border of the red and white zones. Otherwise, if you perform stitching of a meniscus that has developed in the white zone, the suture will sooner or later become insolvent again, a “repeated rupture” will occur and an operation will be required again. A meniscus suture can be performed arthroscopically.


The principle of arthroscopic suture of the meniscus is "from inside to outside". There are also outside-in methods and meniscus stapling

Photo taken during arthroscopy. Meniscus suture stage

Meniscus transplant. Now there is the possibility of transplantation (transplantation) of the meniscus. Meniscus transplantation is possible and may be appropriate when the meniscus of the knee joint is significantly damaged and completely ceases to function. Contraindications include severe degenerative changes in the articular cartilage, instability of the knee joint and curvature of the leg.

For transplantation, both frozen (donor or cadaveric) and irradiated menisci are used. Reportedly, the best results are to be expected with donor (fresh frozen) menisci. There are also artificial meniscal endoprostheses.

However, operations for transplantation and meniscus arthroplasty are associated with a number of organizational, ethical, practical and scientific difficulties, and this method does not have a convincing evidence base. Moreover, among scientists and surgeons there is still no consensus on the expediency of transplantation and meniscus arthroplasty.

In general, it should be noted that transplantation and meniscal arthroplasty are performed extremely rarely.

Questions to discuss with your doctor

1. Do I have a torn meniscus?

2. What is my meniscus tear? Degenerative or traumatic?

3. What is the size of a meniscus tear and where is the tear located?

4. Are there any other injuries besides a meniscus tear (is the anterior cruciate ligament intact, lateral ligaments, are there any fractures, etc.)?

5. Is there any damage to the cartilage covering the femur and tibia?

6. Do I have a significant meniscus tear? Is an MRI required?

7. Can my torn meniscus be treated without surgery or should I have arthroscopy?

8. What are the chances of cartilage damage and arthrosis if I delay the operation?

9. What are the chances of cartilage damage and arthrosis if I go for arthroscopic surgery?

10. If arthroscopy has a better chance of success than non-surgical method, and I agree to the operation, how long will the recovery take?

The knee is a complex structure, which includes the patella, femur and tibia, ligaments, menisci, etc.

Menisci are a layer of cartilage that is located between two bones. When moving, the knee constantly withstands heavy loads, so most of the injuries occur in this joint. One such injury is a tear in the posterior horn of the medial meniscus.

Injuries to the knee joint are painful and dangerous in their consequences.

A tear in the posterior horn of the meniscus can happen to any active person or athlete, and can lead to severe injury later on.

What is a meniscus

The meniscus is a part of the joint that is a curved band of fibrous cartilage. In shape, they look like a crescent with elongated edges. They are divided into several parts: body, back and front horns.

There are two menisci in a joint:

  • lateral (outer);
  • medial (internal).

Their ends are attached to the tibia.

The medial is located on the inside of the knee and connects to the medial lateral ligament. On the outer edge, it is connected with the capsule of the knee joint, through which partial blood circulation passes.

Menisci perform important functions:

  • cushion the joint during movement;
  • stabilize the knee
  • contain receptors that control leg movement.

If this meniscus is removed, the area of ​​contact between the bones in the knee becomes 50-70% smaller, and the load on the ligaments becomes more than 100%.

Symptoms

There are two periods: chronic, acute.

The acute period lasts about a month and is characterized by a number of painful symptoms. With the injury itself in the knee area, a person feels severe pain and a sound similar to crackling. Swelling quickly appears on the knee. Hemorrhage into the joint also often occurs.

Joint movements are sharply or partially limited.

Typical symptoms of a medial meniscus tear

Such an injury has a number of its characteristic features. If the posterior horn of the internal meniscus is damaged, intense pain appears on the inside of the knee. On palpation, it increases in the area of ​​​​attachment of the horn to the knee ligament.

Also, such an injury blocks the movement of the joint.

It is determined when trying to make flexion movements when turning the lower leg outward and straightening the leg, the pain becomes stronger and the knee cannot move normally.

In terms of severity, there can be small, medium and severe injuries.

Gap types

A longitudinal complete or partial rupture of this part is considered very dangerous. It develops from the posterior horn. With a complete rupture, the part that has separated can move between the joints and block their further movement.

Also, a gap can be between the beginning of the posterior horn and the middle of the body of the meniscus.

Often there are cases when such an injury has a combined character and combines different types of injuries. They are developing in several directions at once.

The horizontal rupture of the posterior horn starts from the side of its inner surface and develops towards the capsule. It causes severe swelling in the joint space.

Treatment

Treatment can be carried out by both conservative and surgical methods.

Conservative therapy is used for mild or moderate injuries.

The operation is performed with severe injuries that block the work of the joint and cause severe pain.

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