Degenerative rupture of the posterior horn of the medial meniscus treatment. Treatment of rupture of the posterior horn of the lateral (outer) meniscus. Common meniscal injuries

In the article, we will consider in what cases there is a rupture of the posterior horn of the medial meniscus.

One of the most complex structures of the bone parts of the human body are joints, both small and large. Features of the structure of the knee joint allow it to be considered prone to various injuries such as bruises, fractures, hematomas, arthrosis. It is also possible such a complex injury as a rupture of the posterior horn in the medial meniscus.

This is due to the fact that the bones of this joint (tibia, femur), ligaments, patella and menisci, working in a complex, ensure proper flexion when sitting, walking and running. However, excessive loads on the knee, which are placed on it during various manipulations, can lead to a violation of the integrity of the posterior horn of the medial meniscus. This is such a traumatization of the knee joint, which is caused by damage to the cartilage layers located between the tibia and femur.

Anatomical features of the cartilage of the knee joint

Let's take a closer look at how this structure works.

The meniscus is a cartilaginous structure of the knee, which is located between the closing bones and ensures that the bones slide one over the other, which contributes to the unhindered extension of this joint.

The menisci are of two types. Namely:

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

Obviously, the most mobile is the outer one. Therefore, its damage is much less common than damage to the internal.

The medial (internal) meniscus is a cartilaginous lining associated with the bones of the knee joint, located on the side from the inside. It is not very mobile, therefore it is prone to damage. Rupture of the posterior horn of the medial meniscus is also accompanied by damage to the ligamentous apparatus that connects it to the knee joint.

Visually, this structure looks like a crescent, the horn is lined with porous tissue. The cartilage lining consists of three main parts:

• anterior horn;
• middle part;
• back horn.

The cartilages of the knee joint perform several important functions, without which full-fledged movement would be impossible:

• depreciation in the process of walking, jumping, running;
• resting knee stabilization.

These structures are permeated with many nerve endings that send information about the movements of the knee joint to the brain.

Functions of the meniscus

Let's take a closer look at what functions the meniscus performs.

The joint of the lower limb refers to a combined structure, where each element is called upon to solve certain problems. The knee is equipped with menisci, which divide the articular cavity in half, and perform the following tasks:

• stabilizing - the time of any physical activity, the articular surface is shifted in the right direction;
• acts as shock absorbers to soften shocks and shocks while running, walking, jumping.

Traumatization of shock-absorbing elements is observed with various articular injuries, in particular, due to the loads that these articular structures take on. Each knee joint has two menisci, which are made up of cartilage. Each type of shock-absorbing plates is formed by horns (front and rear) and a body. Shock-absorbing components move freely in the process of physical activity. The bulk of the damage is associated with the posterior horn of the medial meniscus.

The causes of this pathology

The most common damage to the cartilage plates is considered to be a tear, absolute or partial. Professional dancers and athletes, whose specialty is sometimes associated with increased loads, can be injured. Injuries are also observed in the elderly, occur as a result of unforeseen, accidental loads on the knee area.

Damage to the body of the posterior horn occurs for the following reasons:

• excessive sports loads (jumping, jogging over rough terrain);
• active walking, long squat position;
• articular pathologies of a chronic nature, in which the development of an inflammatory process in the knee region occurs;
• congenital articular pathologies.

These factors lead to traumatization of the posterior horn of the medial meniscus of varying degrees of complexity.

Stages of this pathology

Symptoms of traumatization of cartilaginous elements depend on the severity of cartilage damage. The following stages of violation of the integrity of the posterior horn are known:

• Stage 1 (mild form) of damage to the posterior horn of the medial meniscus, in which the movements of the damaged limb are normal, the pain syndrome is weak, it becomes more intense during jumps or squats. In some cases, there is a slight swelling in the patella.
• 2 degree. The posterior horn of the medial meniscus is significantly damaged, which is accompanied by an intense pain syndrome, and the limb is difficult to straighten even with outside help. It is possible to move at the same time, but the patient is lame, at any moment the knee joint may be immobilized. Puffiness gradually becomes more and more pronounced.
• Damage to the posterior horn of the medial meniscus of the 3rd degree is accompanied by pain syndromes of such strength that it cannot be tolerated. Most painful in the area of ​​the kneecap. Any physical activity with the development of such an injury is impossible. The knee significantly increases in size, and the skin changes its healthy color to cyanotic or purple.

If the posterior horn of the medial meniscus is damaged, the following symptoms are present:

• The pain intensifies if you press the cup from the back side and simultaneously straighten the leg (Bazhov's technique).
• The skin in the knee area becomes too sensitive (Turner's symptom).
• When the patient is in a prone position, the palm passes under the damaged knee joint (Land's syndrome).

After establishing the diagnosis of damage to the posterior horn of the medial meniscus of the knee joint, the specialist decides which therapeutic technique to apply.

Features of the horizontal tear of the posterior horn

Features are in the following points:

• with this type of tear, injury occurs, which is directed to the joint capsule;
• swelling develops in the area of ​​the joint gap - a similar development of the pathological process has common symptoms with damage to the anterior horn of the external cartilage;
• with partial horizontal damage, excess fluid accumulates in the cavity.

meniscus tear

In what cases does this happen?

Injury to the knee joints is a fairly common occurrence. At the same time, not only active people can receive such injuries, but also those who, for example, squat for a long time, try to spin on one leg, and make various long and high jumps. Tissue destruction can occur gradually over time, with people over 40 at risk. Damaged knee menisci at a young age gradually begin to acquire an old character in older people.

Damage can be very diverse, depending on where the gap is observed and what shape it has.

Forms of meniscus tears

Ruptures of cartilaginous tissue can be different in the form of the lesion and in nature. In modern traumatology, the following categories of ruptures are distinguished:

• longitudinal;
• degenerative;
• oblique;
• transverse;
• rupture of the posterior horn;
• horizontal type;
• tear of the anterior horn.

Rupture of the posterior horn of the medial meniscus of the knee joint

Such a rupture is one of the most common categories of knee injury and the most dangerous injury. Similar damage also has some varieties:

• horizontal, which is also called a longitudinal gap, with it there is a separation of tissue layers from each other, followed by blocking of the movements of the knee;
• radial, which is such damage to the knee joints, with it oblique transverse ruptures of cartilage tissue develop, while the lesions are in the form of tatters (the latter, sinking between the bones of the joint, provoke a crack in the knee joint);
• combined, bearing damage to the (medial) inner section of the meniscus of two varieties - radial and horizontal.

Injury symptoms

How this pathology manifests itself is described in detail below.

The symptoms of the resulting injury depend on the form of the pathology. If this damage is acute, then the symptoms of injury may be as follows:

• acute pain syndrome, which manifests itself even in a calm state;
• hemorrhage into tissues;
• blocking knee activity;
• swelling and redness.

Chronic forms (an old rupture), which are characterized by the following symptoms:

Learn how to treat a torn posterior horn of the medial meniscus.

Therapy for cartilage damage

In order for the acute stage of the pathology not to become chronic, it is necessary to begin treatment immediately. If you are late during therapeutic procedures, the tissues begin to acquire significant destruction and turn into tatters. The destruction of tissues leads to the development of degeneration of cartilage structures, which, in turn, provokes the occurrence of knee arthrosis and complete immobility of this joint.

Therapy for damage to the posterior horn of the medial meniscus depends on the degree of injury.

Stages of conservative treatment of this pathology

Traditional methods are used in acute, not advanced stages in the early stages of the course of the pathological process. Therapy with conservative methods consists of several stages, which include:

• elimination of inflammation, pain syndrome and swelling with the help of anti-inflammatory non-steroidal drugs;
• in cases of “jamming” of the knee, reposition is used, namely reduction by means of traction or manual therapy;
• therapeutic exercises, gymnastics;
• therapeutic massage;
• physiotherapy activities;
• the use of chondroprotectors;
• hyaluronic acid treatment;
• therapy with the help of folk recipes;
• pain relief with analgesics;
• plaster casts.

What else is the treatment for a torn posterior horn of the medial meniscus?

Stages of surgical treatment of the disease

Surgical techniques are used only in the most difficult cases, when, for example, tissues are so damaged that they cannot be restored if traditional methods of therapy have not helped the patient.

Operative methods for restoring torn cartilage of the posterior horn consist of the following manipulations:

1. Arthrotomy - partial removal of damaged cartilage with extensive tissue damage.
2. Meniscotomy is the complete removal of cartilage.
3. Transplantation - moving the donor meniscus to the patient.
4. Endoprosthetics - the introduction of artificial cartilage into the knee joint.
5. Stitching of damaged cartilage (performed with minor injuries).
6. Arthroscopy - a puncture of the knee joint in two places in order to carry out the following manipulations with cartilage tissue (for example, endoprosthesis replacement or stitching).

After the therapy (regardless of what methods it was carried out - surgical or conservative), the patient will have a long course of rehabilitation. It necessarily includes absolute rest throughout the course. Any physical activity after the end of treatment is contraindicated. The patient should take care that his limbs are not supercooled, it is impossible not to make sudden movements.

Tears of the posterior horn of the medial meniscus of the knee joint are a fairly common injury that occurs more often than other injuries. These injuries can vary in size and shape. Rupture of the posterior horn of the meniscus occurs much more often than its middle part or anterior horn. This is due to the fact that the meniscus in this area is the least mobile, and, consequently, the pressure on it during movements is greater.

Treatment of this cartilage tissue injury should begin immediately, otherwise its chronic nature can lead to complete destruction of the joint tissue and its absolute immobility.

In order to avoid injury to the posterior horn, one should not make sudden movements in the form of turns, avoid falls, jumps from a height. This is especially true for people over the age of 40. After treatment of the posterior horn of the medial meniscus, exercise is generally contraindicated.

Damage or rupture of the medial meniscus of the knee usually occurs in athletes and overly active people, this condition requires urgent treatment. In addition to them, people of retirement age are susceptible to this disease, especially those who have arthrosis or arthritis.

What is a meniscus, and where are its horns?

The meniscus is a cartilaginous tissue that consists of fibers and serves as a shock absorber for the knee joint. It looks like two crescents, their ends are called horns.

The small crescent is the outer (lateral) part of the meniscus, and the large crescent is the inner (medial).

Breaks are of different types:

• vertical and horizontal;
• oblique and transverse;
• degenerative;
• ruptures of the posterior and anterior horns of the meniscus.

But most often there is a rupture of the posterior horn of the inner meniscus, since it is less mobile.

What can cause damage to the posterior horn?

This disease always occurs as a result of an injury. The meniscus is not so fragile that it could be damaged by any kind of force. The most common reasons for a break are:

1. Excessive turns of the body, standing on one leg and keeping the foot on the floor.
2. Too vigorous jumping and steeplechase.
3. Very fast walking or, conversely, a long stay in the "squatting" position.
4. An injury received against the background of an already existing degenerative knee joint.
5. Insufficiently good development of joints and ligaments caused by congenital pathology.

In people of retirement and pre-retirement age, a rupture of the posterior horn occurs due to the fact that cartilage tissues are often already destroyed by arthrosis. Therefore, it is much easier to damage it.

How to recognize a gap?

Without a qualified diagnosis, it is impossible to say for sure whether there is damage to the fibrous cartilage tissue. But there are signs that suggest its presence:

1. When injured, a click is clearly heard, pain pierces the knee. Lasts about 5 minutes, then subsides a little. During this period, a person is able to move, overcoming pain. After a significant amount of time, about half a day, pain in the knee again occurs. This time, the sharp pain is accompanied by a burning sensation. Flexion and extension of the knee occurs with increased pain. Rest provides some relief.
2. If, however, there was a rupture of the medial meniscus, then a blockade of the knee joint occurs. Outside of medicine, this is called "jammed." This happens because part of the torn cartilage tissue of the meniscus is fixed by two bones, thereby the movement of the knee becomes limited. But this symptom does not always indicate a meniscus tear. It can also occur due to damage to the ligaments.
3. If in the body of the meniscus, where there are capillaries, then blood accumulates in the knee. They call it hemarthrosis.
4. A few hours after the rupture, swelling of the adjacent tissues occurs.

With the help of hardware research, it is possible to determine whether the gap is chronic or recently acquired. In an acute rupture, the edges are even, there is an accumulation of blood. Chronic rupture has fibrous, uneven edges, edematous tissues. It is not blood that accumulates around it, but synovial fluid.

A degenerative rupture of the posterior horn of the meniscus can be diagnosed by MRI or arthroscopy. Without these methods, this diagnosis is quite difficult to establish, since there are no: acute pain, blockade.

Treatment of rupture of the posterior horn of the medial meniscus of the knee joint

To treat this kind of injury, like any other, it is necessary immediately after the injury.

Important! If left untreated for a long time, the rupture can become chronic.

Treatment not taken in time can lead to destruction of the cartilage of the knee joint, inflammation, changes in its structure and arthrosis. To avoid these troubles, you should immediately visit a doctor as soon as an injury occurs.

A tear in the posterior horn of the knee joint is usually treated without surgery. With the exception of severe trauma that requires prompt assistance. Treatment takes place in several stages:

1. If there is a blockade of the joint, then it must be removed. This is done using manual methods or with hardware traction of the joint.
2. Edema is removed by anti-inflammatory drugs (Diclofenac, Indomethacin).
3. Pain relief with painkillers (Ibuprofen, Paracetamol).
4. After relieving pain and inflammation, it is necessary to start physical therapy, physiotherapy and massage.
5. The longest stage is the restoration of the cartilage that makes up the menisci. For this, preparations containing chondroitin sulfate and hyaluronic acid are prescribed.

It is necessary to take these medicines for a long time, one course can reach up to six months. It is necessary to repeat their intake annually to prevent deterioration of the cartilage.

In some cases, after stretching the joint, plaster is applied. This is done in order to provide the joint with peace and immobility for a certain time. But such a measure is not taken in all cases.

Operative methods of treatment

In the case when the above method of treatment does not have the desired effect on the damaged part, they resort to a surgical method of treatment. If the body of the meniscus itself is damaged, then most often it can be stitched.

There are several types of operations for the treatment of damage to the meniscus horn, but some of them are currently performed extremely rarely, as they are considered ineffective or even harmful. These include, for example, arthrotomy. This is the removal of damaged cartilage tissue, which is carried out with a full opening of the knee.

Surgical methods for the treatment of a torn meniscus of the knee joint are currently aimed at preserving or restoring it. They are of several types:

1. Partial meniscectomy. In this case, the edges of the meniscus are cut off at the site of the lesion, and their remaining part is restored.
2. . The operation, which is performed through three punctures in the knee joint. One of them introduces the tools necessary for manipulation. In the other, saline enters and washes away unnecessary particles of cartilage, accumulated blood, and so on. A camera is inserted into the third puncture, through which the surgeon can see everything that happens inside the knee, and thereby controls the entire process.
3. Transplantation. The donor's meniscus is transplanted to the patient.
4. Endoprosthetics. An artificial organ is implanted into the knee joint.

Regardless of the method of operation, after it, complete rest of the knee joint and protection from the effects of cold are necessary.

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 footballers);
• 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 peculiarity of the knee joint is that it easily adapts to atypical conditions for it. Trauma, damage, meniscus tears, cartilage cracking - all this causes acute pain only at first. Then the symptoms subside, which makes the patient think that everything has passed. He is in no hurry to see a doctor, continuing to live a normal life. That is why a chronic meniscus tear is a fairly common diagnosis. Another reason for this condition is misdiagnosis. If there are no pronounced symptoms, and a competent examination was not carried out, then the injury is taken for a normal sprain or bruise, which is why ineffective treatment is prescribed. It only temporarily relieves the symptoms, without eliminating the disease itself.

signs

As a person gets used to the aching pain in the knee, he may not notice the characteristic symptoms. An old meniscus injury is indicated by:

• frequent pain in the joint, aggravated after long standing and physical exertion;
• relief after rest;
• restriction in movement - there are difficulties when trying to fully bend or straighten the leg;
• from time to time there is a reactive inflammation of the joint, which is accompanied by redness, swelling. Possible synovitis.

If treatment is still not provided, then the articular cartilage is gradually destroyed, which invariably leads to post-traumatic arthrosis. Restoring the joint in such cases is almost impossible. The person loses the ability to walk normally, uses a cane or a wheelchair.

Kinds

Since there are two menisci in the knee joint, there are ruptures of the inner (medial) and outer (lateral) ones. Each has its own symptoms. Chronic damage to the medial meniscus of the knee joint is more often diagnosed. This is due to the fact that he is less mobile and more prone to injury. Tears are possible in different places of the cartilage:

• meniscus body;
• anterior horn;
• back horn.

It is also necessary to establish the cause of the injury. The treatment of pathology will depend on this. There are traumatic ruptures and degenerative ones. The latter develop against the background of existing joint diseases and are caused by a weakening of the cartilage structure. As a rule, they occur in older people against the background of a general weakening of the musculoskeletal system.

Treatment

An old meniscal injury is treated conservatively and surgically. In the first case, a set of traditional measures is assumed to restore the motor functions of the joint and ensure its mobility. That means:

• taking chondroprotectors, anti-inflammatory and pain medications;
• massage and physiotherapy;
• exercise and exercise.

Far from always, these methods are effective, because for a long time the cartilage "gets used" to its condition. It is especially difficult to cure an old rupture of the posterior horn of the medial meniscus in a conservative way. Much depends on the size of the injury and the severity of the injury. You will most likely need to wear a bandage and take the necessary medications regularly. Joint restoration is a long process and can take 1-1.5 years.

Operation

An operation is prescribed if it is impossible to eliminate the damage in a conservative way. Today, surgical intervention in most cases is carried out using arthroscopy, which is characterized by a quick rehabilitation period and a small number of complications. Endoscopic surgery (you can walk and move your knee almost immediately) and open surgeries are also popular. The latter is associated with high trauma and is carried out only in the absence of alternatives.

During a surgical operation, the doctor performs various procedures:

• stitches the torn edges of the meniscus;
• removes parts that cannot be restored;
• removes excess fluid from the joint;
• collects biomaterial for its further study.

If an old meniscus injury is treated surgically, the effect is noticeable immediately after the rehabilitation period. However, the patient is advised to refrain from heavy physical exertion for some time. The recovery period involves taking medication and doing simple exercises.

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Symptoms of a meniscus injury

The menisci of the knee are called cartilaginous formations located in the joint cavity, serving as shock absorbers of movement, stabilizers that protect the articular cartilage. There are two menisci, an inner (medial) and an outer (lateral) meniscus. Damage to the internal meniscus of the knee joint occurs much more often, due to its lesser mobility. Damage to the meniscus manifests itself in the form of limited mobility, pain in the knee, and in chronic cases, it can also be the development of arthrosis of the knee joint.

Sharp cutting pain, swelling of the joint, difficulty in moving the limbs and painful clicks indicate that the meniscus is damaged. These symptoms occur immediately after an injury and may be indicative of other joint damage. More reliable symptoms of meniscus damage appear 2-3 weeks after the injury. With such injuries, the patient feels local pain in the joint space, fluid accumulates in the joint cavity, “blockade” of the knee, weakness of the muscles of the anterior surface of the thigh.

More reliable signs of damage to the meniscus are determined using special tests. There are tests for extension of the joints (Landy, Baikov, Roche, etc.), with a certain extension of the joint, pain symptoms are felt. The technique of rotation tests is based on the manifestation of damage during the scrolling movements of the joints (Bragard, Shteiman). Meniscal injury can also be diagnosed by compression symptoms, mediolateral tests, and MRI.

Damage treatment

A meniscal injury involves different treatments, depending on the severity and type of injury. With the classical type of getting rid of ailments, it is possible to distinguish the main types of exposure used for any damage.

First of all, it is worth relieving pain, therefore, to begin with, the patient is given an anesthetic injection, after which they take a puncture of the joint, remove the accumulated blood and fluid from the joint cavity, and, if necessary, eliminate the blockade of the joints. After these procedures, the joint needs rest, to create which a gibs bandage or a splint is applied. In most cases, 3-4 weeks of immobilization is enough, but in severe cases, the period can be up to 6 weeks. It is recommended to apply local cold, non-steroidal drugs that relieve inflammation. Later, you can add physiotherapy exercises, walking with supports, various types of physiotherapy.

Surgery is recommended in severe cases, such as an old meniscus injury. One of the most popular surgical methods today is arthroscopic surgery. This type of surgery has become popular due to its careful attitude to tissues. The operation is a resection of only the damaged part of the meniscus and polishing of defects.

With such injuries as a meniscus tear, the operation is performed closed. Through two holes, an arthroscope with instruments is inserted into the joint to study the damage, after which a decision is made on partial resection of the meniscus or the possibility of sewing it up. Inpatient treatment lasts about 1-3 days, due to the low trauma of this type of operation. At the recovery stage, limited physical activity is recommended for up to 2-4 weeks. In special cases, walking with supports and wearing a knee brace is recommended. From the very first week, you can already begin rehabilitation physical education.

Rupture of the meniscus of the knee joint

The most common knee injury is a tear in the medial meniscus. Distinguish between traumatic and degenerative ruptures of the menisci. Traumatic injuries occur mainly in athletes, young people aged 20-40 years, if left untreated, they transform into degenerative tears, which are more pronounced in older people.

Based on the localization of the rupture, several main types of meniscal rupture are distinguished: a rupture resembling a watering can handle, transverse rupture, longitudinal rupture, patchwork rupture, horizontal rupture, damage to the anterior or posterior horn of the meniscus, paracapsular injuries.

Consider a tear in the posterior horn of the medial meniscus. This type of tear is the most common, as most longitudinal, vertical, and watering-handle tears begin with a tear in the posterior horn of the meniscus. With long tears, there is a high chance that part of the torn meniscus will interfere with the movement of the joint and cause pain, up to joint blockage. The combined type of meniscus tears occurs, covering several planes, and most often localized in the posterior horn of the meniscus of the knee joint and in the bulk occurs in older people with degenerative changes in the menisci. In case of damage to the posterior horn of the medial meniscus, which does not lead to longitudinal splitting and displacement of the cartilage, the patient constantly feels the threat of blockade of the joint, but it never occurs. Not so often there is a rupture of the anterior horn of the medial meniscus.

Rupture of the posterior horn of the lateral meniscus occurs 6-8 times less often than the medial one, but carries no less negative consequences. Adduction and internal rotation of the lower leg are the main causes of rupture of the lateral meniscus. The main sensitivity in this kind of damage falls on the outer side of the posterior horn of the meniscus. Rupture of the arch of the lateral meniscus with displacement in most cases leads to limitation of movements in the final stage of extension, and sometimes causes blockade of the joint. A rupture of the lateral meniscus is recognized by a characteristic click during rotational movements of the joint inward.

Rupture symptoms

With injuries such as a torn meniscus of the knee joint, the symptoms can be quite different. There is an acute and chronic, inveterate meniscus tear. The main sign of a rupture is the blockade of the joint, in the absence of which it is quite difficult to determine the rupture of the medial or lateral meniscus in the acute period. After some time, in the subacute period, the rupture can be identified by infiltration in the joint space, local pain, as well as with the help of pain tests suitable for any type of damage to the meniscus of the knee joint.

The main symptom of a meniscus rupture is pain when probing the line of the joint space. Special diagnostic tests have been developed, such as the Epley test and the McMurry test. The McMurry test is produced in two types.

In the first variant, the patient is placed on his back, the leg is bent to an angle of about 90 ° in the knee joint and the hip joint. Then, with one hand, they wrap around the knee, and with the other hand, rotational movements of the lower leg are made, first outward and then inward. With clicks or crackles, we can talk about the infringement of the damaged meniscus between the articular surfaces, such a test is considered positive.

The second version of the McMurry test is called flexion. It is produced as follows: with one hand they clasp the knee as in the first test, then the leg at the knee is bent to the maximum level; after which, the lower leg is rotated outward to identify ruptures of the internal meniscus. Under the condition of slow extension of the knee joint up to about 90 ° and rotational movements of the lower leg with a rupture of the meniscus, the patient will experience pain on the surface of the joint from the back of the inner side.

During the Epley test, the patient is placed on the stomach and the leg is bent at the knee, forming an angle of 90 °. With one hand, you need to press on the heel of the patient, and at the same time rotate the foot and lower leg with the other. If pain occurs in the joint space, the test can be considered positive.

Rupture treatment

Meniscus rupture is treated both conservatively and surgically (resection of the meniscus, both complete and partial, and its restoration). With the development of innovative technologies, meniscus transplantation is becoming increasingly popular.

A conservative type of treatment is mainly used to heal small tears in the posterior horn of the meniscus. Such injuries are often accompanied by pain, but they do not lead to infringement of the cartilaginous tissue between the articular surfaces and do not cause clicks and rolling sensations. This type of tear is characteristic of stable joints. The treatment is to get rid of such sports activities, where you can not do without quick jerks from the defender and movements that leave one leg in place, such activities worsen the condition. In the elderly, such treatment leads to a more positive result, since degenerative tears and arthritis are often the cause of their symptoms. A small longitudinal rupture of the medial meniscus (less than 10 mm), a rupture of the lower or upper surface that does not penetrate the entire thickness of the cartilage, transverse ruptures of no more than 3 mm often heal on their own or do not appear at all.

Also, meniscus rupture treatment provides for another way. Sewing from the inside out. For this type of treatment, long needles are used, which are passed perpendicular to the line of damage from the joint cavity to the outside of the strong capsular area. In this case, the seams are superimposed one after the other quite tightly. This is one of the main advantages of the method, although it increases the risk of damage to blood vessels and nerves when the needle is removed from the joint cavity. This method is ideal for treating a torn posterior horn of the meniscus and a torn that runs from the body of the cartilage to the posterior horn. If the anterior horn is torn, it may be difficult to pass the needles.

In cases where damage to the anterior horn of the medial meniscus occurs, it is more correct to use the suturing method from the outside to the inside. This method is safer for nerves and blood vessels; in this case, the needle is passed through the meniscus rupture from the outside of the knee joint and further into the joint cavity.

Seamless fastening of the meniscus inside the joint is gaining more and more popularity with the development of technology. The procedure takes little time and takes place without the participation of such complex devices as an arthroscope, but today it does not give even an 80% chance of healing the meniscus.

The first indications for surgery are effusion and pain, which cannot be eliminated by conservative treatment. Friction during movement or blockade of the joint also serve as indicators for surgery. Resection of the meniscus (meniscectomy) used to be considered a safe intervention. Recent studies have shown that most meniscectomy results in arthritis. This fact influenced the main methods of treatment of injuries such as rupture of the posterior horn of the internal meniscus. Nowadays, partial removal of the meniscus and grinding of deformed parts has become more popular.

Sequelae of a torn meniscus

The success of recovery from injuries such as lateral meniscus injury and medial meniscus injury depends on many factors. For a speedy recovery, factors such as the duration of the gap and its localization are important. The probability of complete recovery is reduced with a weak ligamentous apparatus. If the patient's age is not more than 40 years, then he has a better chance of recovery.

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meniscus injury

The medial meniscus changes shape when moving, because the gait of people is so smooth, plastic. The knee joints have 2 menisci:

The meniscus itself is divided into 3 parts:

• the body of the meniscus itself;
• the posterior horn of the meniscus, that is, its inner part;
• anterior horn of the meniscus.

The inner part differs in that it does not have its own blood supply system, however, because. nutrition should still be, it is carried out due to the constant circulation of the articular synovial fluid.

Such unusual properties lead to the fact that if an injury to the posterior horn of the meniscus occurs, then, unfortunately, it is most often incurable, because the tissues cannot be restored. Moreover, a rupture of the posterior horn of the medial meniscus is difficult to determine. And if such a diagnosis is suspected, urgent research is needed.

Most often, the correct diagnosis can be found using magnetic resonance imaging. But even with the help of developed tests, which are based on the extension of the joints, scrolling movements, as well as the sensation of pain, it is possible to determine the disease. There are a lot of them: Rocher, Landa, Baikov, Shteiman, Bragard.

If the posterior horn of the medial meniscus is damaged, a sharp pain appears, and severe swelling begins in the knee area.

When a horizontal rupture of the posterior horn of the medial meniscus has occurred, it is impossible to go down the stairs due to severe pain. If there is a partial tear of the meniscus, it is almost impossible to move: the torn part dangles freely inside the joint, giving pain at the slightest movement.

If not such painful clicking sounds are felt, then the gaps have occurred, but they are small in size. When the ruptures occupy a large area, the torn part of the meniscus begins to move to the center of the damaged joint, as a result, the movement of the knee is blocked. There is a twisting of the joint. When the posterior horn of the internal meniscus has ruptured, it is practically impossible to bend the knee, and the sore leg will not be able to withstand the load from the body.

Symptoms of a knee meniscus injury

If there is a rupture of the meniscus of the knee joint, then the following symptoms will appear:

• pain, which over time will concentrate in the joint space;
• there is weakness of the muscles in the anterior surface of the thigh;
• accumulation of fluid in the joint cavity begins.

As a rule, a degenerative rupture of the posterior horn of the meniscus in the knee occurs in people of pre-retirement age due to age-related changes in cartilage tissue or in athletes whose load falls mainly on the legs. Even a sudden awkward movement can lead to a break. Very often, ruptures of the degenerative form acquire a protracted chronic character. A symptom of a degenerative tear is the presence of a dull aching pain in the knee area.

Treatment of damage to the medial meniscus

In order for the treatment to be beneficial, it is necessary to correctly determine the severity of the disease and the type of injury.

But first of all, when damage has occurred, it is necessary to relieve pain. In this case, an anesthetic injection and tablets that reduce inflammation help, and cold compresses will help.

You need to be prepared for the fact that doctors will take a puncture of the joint. Then it is necessary to clean the articular cavity from the blood and fluid accumulated there. Sometimes you even have to apply the blockade of the joints.

These procedures for the body are stressful, and after them the joints need rest. In order not to disturb the joints and fix the position, the surgeon applies a plaster or splint. During the rehabilitation period, physiotherapy, fixing the kneecaps will help to recover, it will be necessary to do physiotherapy exercises and walking with various means of support.

Minor damage to the posterior horn of the lateral meniscus or an incomplete tear of the anterior horn can be treated conservatively. That is, you will need anti-inflammatory drugs, as well as painkillers, manual and physiotherapy procedures.

How is damage treated? As a rule, surgery is usually unavoidable. Especially if it is an old medial meniscus of the knee joint. The surgeon is faced with the task of suturing the damaged meniscus, but if the damage is too serious, it will have to be removed. A popular treatment is arthroscopic surgery, thanks to which whole tissues are preserved, only the resection of damaged parts and the correction of defects are performed. As a result, there are very few complications after surgery.

The whole procedure goes like this: an arthroscope with instruments is inserted into the joint through 2 holes in order to first determine the damage, its extent. With ruptures of the posterior horn of the meniscus affecting the body, it happens that the torn fragment is displaced, rotating along its axis. He is immediately returned to his place.

Then make an incomplete biting out of the meniscus. This must be done at the base of the posterior horn, leaving a thin "bridge" to prevent displacement. The next stage is cutting off the torn fragment from the body or the anterior horn. Parts of the meniscus then need to be given the original anatomical shape.

It will be necessary to spend time in the hospital under the supervision of a doctor and undergo rehabilitation recovery.

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As a rule, a meniscus tear haunts football players, dancers and other people whose lives are connected with sports. But you should be prepared for the fact that a disease of this kind can overtake you, so it is important to know the symptoms and methods of treatment.

Rupture of the posterior horn of the medial meniscus is the result of an injury that can be received not only by athletes or overly active individuals, but also by older people who suffer from other diseases along the way, such as arthrosis.

So what is a meniscus tear? To understand this, you need to know, in general, what a meniscus is. This term implies a special fibrous cartilage tissue, which is responsible for cushioning in the joint. In addition to the knee joint, such cartilage is also found in the joints of the human body. However, it is the injury of the posterior horn of the meniscus that is considered the most frequent and dangerous injury, which threatens with complications and serious consequences.

A little about menisci

A healthy knee joint has two cartilage tabs, external and internal, respectively, lateral and medial. Both of these tabs are shaped like a crescent. The lateral meniscus is dense and sufficiently mobile, which ensures its safety, that is, the external meniscus is less likely to be injured. As for the inner meniscus, it is rigid. Thus, damage to the medial meniscus is the most common injury.

The meniscus itself is not simple and consists of three elements - the body, the posterior and anterior horn. Part of this cartilage is penetrated by a capillary mesh, which forms a red zone. This area is the most dense and is located on the edge. In the middle is the thinnest part of the meniscus, the so-called white zone, which is completely devoid of blood vessels. After an injury, it is important to correctly identify exactly which part of the meniscus has been torn. The best restoration is the living zone of the cartilage.

There was a time when specialists believed that as a result of the complete removal of the damaged meniscus, the patient would be spared all the problems associated with the injury. However, today it has been proven that both the external and internal menisci have very important functions for the cartilage of the joint and bones. The meniscus cushions and protects the joint and its complete removal will lead to arthrosis.

To date, experts speak of only one obvious cause of such an injury as a rupture of the posterior horn of the medial meniscus. An acute injury is considered such a cause, since not any aggressive impact on the knee joint can lead to damage to the cartilage responsible for cushioning the joints.

In medicine, there are several factors that predispose to cartilage damage:

vigorous jumping or running on uneven ground;

torsion on one leg, without lifting the limb from the surface;

fairly active walking or long squatting;

trauma received in the presence of degenerative diseases of the joints;

congenital pathology in the form of weakness of the joints and ligaments.

Symptoms

As a rule, damage to the medial meniscus of the knee joint occurs as a result of the unnatural position of the parts of the joint at a certain point when the injury occurs. Or the rupture occurs due to a pinched meniscus between the tibia and femur. The rupture is often accompanied by other knee injuries, so differential diagnosis can be difficult at times.

Doctors advise people who are at risk to be aware of and pay attention to symptoms that indicate a meniscus tear. Signs of injury to the internal meniscus include:

pain that is very sharp at the time of injury and lasts for several minutes. Before the onset of pain, you may hear a clicking sound. After a while, the sharp pain may subside, and you will be able to walk, although it will be difficult to do so, through the pain. The next morning you will feel pain in your knee, as if a nail was stuck there, and when you try to bend or straighten your knee, the pain will intensify. After rest, the pain will gradually subside;

jamming of the knee joint or in other words blockade. This symptom is very characteristic of a rupture of the internal meniscus. Meniscus blockade occurs at the moment when the detached part of the meniscus is sandwiched between the bones, as a result of which the motor function of the joint is impaired. This symptom is also characteristic of damage to the ligaments, so you can find out the true cause of the pain only after diagnosing the knee;

hemarthrosis. This term refers to the presence of blood in the joint. This happens when the gap occurs in the red zone, that is, in the zone penetrated by capillaries;

swelling of the knee joint. As a rule, swelling does not appear immediately after a knee injury.

Nowadays, medicine has learned to distinguish between an acute rupture of the medial meniscus from a chronic one. Perhaps this was due to hardware diagnostics. Arthroscopy examines the condition of cartilage and fluid. A recent rupture of the internal meniscus has smooth edges and accumulation of blood in the joint. While in chronic trauma, the cartilage tissue is multifibered, there is swelling from the accumulation of synovial fluid, and nearby cartilage is often damaged as well.

A rupture of the posterior horn of the medial meniscus must be treated immediately after injury, as over time, unhealed damage will become chronic.

With untimely treatment, meniscopathy is formed, which often, in almost half of the cases, leads to changes in the structure of the joint and, consequently, to degradation of the cartilaginous surface of the bone. This, in turn, will inevitably lead to arthrosis of the knee joint (gonarthrosis).

Conservative treatment

Primary rupture of the posterior horn of the meniscus must be treated therapeutically. Naturally, injuries occur when the patient needs emergency surgery, but in most cases conservative treatment is sufficient. Therapeutic measures for this damage, as a rule, include several very effective steps (of course, if the disease is not running!):

reposition, that is, the reduction of the knee joint during blockade. Manual therapy helps, as well as hardware traction;

elimination of swelling of the joint. For this, specialists prescribe anti-inflammatory drugs to the patient;

rehabilitation activities such as exercise therapy, massage, physiotherapy;

the longest, but at the same time the most important process is the restoration of the menisci. Usually, the patient is prescribed courses of chondroprotectors and hyaluronic acid, which are carried out for 3-6 months annually;

do not forget about painkillers, since damage to the posterior horn of the meniscus is usually accompanied by severe pain. There are many analgesics used for these purposes. Among them, for example, ibuprofen, paracetamol, diclofenac, indomethacin and many other drugs, dosage

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Characteristic signs of a torn internal meniscus

Damage to the medial meniscus most often occurs during physical exercise: running on rough terrain, rotating on one leg, sharp attacks and other situations.

Depending on the clinical manifestations, acute and chronic rupture of the medial meniscus is distinguished. A distinctive feature of the first form is intense pain of a sudden nature, localized along the line of the joint gap, where the damage to the cartilage layer presumably occurred.

Other typical symptoms of a torn medial meniscus of the knee include:

• severe limitation of motor ability (if the torn off area blocks the movement of the joint);
• hemarthrosis (bleeding into the joint cavity);
• edema.

Note: With a bent knee, a person does not always feel intense pain. It appears more often when trying to straighten the leg. This is a hallmark of injury to the interior of the intercartilaginous lining.

Degenerative damage to the medial meniscus of the knee joint is a chronic form of pathology.. Common symptoms in this case are:

• pain sensations of varying intensity that occur both during physical exertion and at rest;
• less often - jamming of the joint;
• damage to adjacent cartilage (femur or tibia);
• swelling of the affected area.

Read also the article "Inflammation of the meniscus of the knee joint" on our portal.

Note: the lack of specificity of clinical manifestations often makes it difficult to independently detect pathology. Therefore, if there are suspicious signs, you should consult a rheumatologist.

Basic therapeutic measures

The choice of methods of therapeutic influence depends on the nature of the injury and its severity. Treatment of damage to the medial meniscus of the knee joint is carried out by two main methods:

• conservative (with the help of medications, physiotherapy, physiotherapy exercises);
• radical, i.e. surgical (complete, partial meniscectomy, reconstructive surgery).

Note: in addition to partial or complete removal of the medial meniscus of the knee joint, surgical treatment involves suturing or transplanting the damaged area. However, these methods of solving the problem are not always effective and appropriate.

Non-surgical treatment of the medial meniscus of the knee

Indications for the use of conservative therapeutic methods are:

• minor rupture of the posterior horn of the medial meniscus;
• radial type of injury;
• lack of infringement of the cartilaginous lining between the surfaces of the joint.

Therapy involves, first of all, a decrease in the intensity of physical activity.

Note: you should not completely exclude movement, if there are no strict contraindications, as blood circulation in the joint will be disturbed. Casting and other incorrect techniques can lead to fusion of the ligaments, limited or complete loss of motor function of the knee.

In the acute phase, rest should be provided to the limbs. Intensive pain syndrome is stopped with the help of anesthetics and anti-inflammatory nonsteroidal drugs that have an analgesic effect (Ibuprofen, Nurofen and others).

A slight longitudinal rupture of the posterior horn of the medial meniscus (up to 1 cm), transverse (up to 0.3 cm), as a rule, grows together independently and practically does not cause concern. Therefore, it is important to limit, but not completely eliminate the motor activity of the lower extremities.

Surgery

Surgical manipulations are carried out by arthroscopic or arthrotomy method. The main task is to partially or completely remove the medial meniscus. The indications for surgery are:

• intense pain;
• significant horizontal rupture of the medial meniscus;
• effusion (fluid buildup in the knee joint);
• clicking when extending the knee;
• blockade of the joint.

When stitching, long surgical needles are used with ligatures fixed on them (absorbable or non-absorbable suture material). Meniscus fixation techniques are used:

• stitching from the inside out;
• seams outside-in;
• inside the joint
• transplantation of the medial meniscus.

Note: Before choosing a specific technique, the physician must consider factors that benefit and harm the patient.

Reconstructive technique

Reconstructive operations have fewer statistics of negative outcomes compared to traditional methods of surgical intervention. They are also performed arthrotomically or arthroscopically. The main task of such manipulations is to eliminate damage to the posterior horn, to ensure the fixation of the medial meniscus on the surface of the articular capsule.

For this purpose, absorbable and non-absorbable surgical devices (arrows, buttons, etc.) are used. Before fixation, pre-treatment of the injured edges is required - excision of the tissue to the capillary network. Then the prepared edges are combined and fixed.

A characteristic feature of the knee joints is their frequent susceptibility to various injuries: damage to the posterior horn of the meniscus, violations of the integrity of the bone, bruises, hematomas and arthrosis.

Anatomical structure

The origin of various injuries in this particular place of the leg is explained by its complex anatomical structure. The structure of the knee joint includes the bone structures of the femur and tibia, as well as the patella, a conglomerate of the muscular and ligamentous apparatus, and two protective cartilages (menisci):

• lateral, in other words, external;
• medial or internal.

These structural elements visually resemble a crescent with the ends slightly forward, in medical terminology called horns. Due to their elongated ends, cartilaginous formations are attached to the tibia with high density.

The meniscus is a cartilaginous body that is found in the interlocking bony structures of the knee. It provides unhindered flexion-extension manipulations of the leg. It is structured from the body, as well as the anterior and posterior horns.

The lateral meniscus is more mobile than the inner meniscus, and therefore it is more often subjected to force loads. It happens that he does not withstand their onslaught and breaks in the region of the horn of the lateral meniscus.

Attached to the inside of the knee is a medial meniscus that connects to the lateral ligament. Its paracapsular part contains many small vessels that supply blood to this area and form a red zone. Here the structure is denser, and closer to the middle of the meniscus, it becomes thinner, since it is devoid of the vascular network and is called the white zone.

After a knee injury, it is important to accurately determine the location of the meniscus rupture - in the white or red zone. Their treatment and recovery are different.

Functional Features

Previously, doctors removed the meniscus through surgery without any problems, considering it justified, without thinking about the consequences. Often, the complete removal of the meniscus led to serious diseases, such as arthrosis.

Subsequently, evidence was presented for the functional importance of leaving the meniscus in place, both for bone, cartilage, articular structures, and for the general mobility of the entire human skeleton.

The functional purposes of the menisci are different:

1. They can be considered as shock absorbers when moving.
2. They produce an even distribution of the load on the joints.
3. Limit the span of the leg at the knee, stabilizing the position of the knee joint.

Break shapes

The characteristic of injury to the meniscus depends entirely on the type of injury, location and shape.

In modern traumatology, several types of ruptures are distinguished:

1. Longitudinal.
2. Degenerative.
3. Oblique.
4. Transverse.
5. Rupture of the anterior horn.
6. Horizontal.
7. Breaks in the posterior horn.

• The longitudinal form of the gap occurs partial or complete. Full is the most dangerous due to the complete jamming of the joint and immobilization of the lower limb.
• An oblique tear occurs at the junction of the posterior horn and the middle of the body part. It is considered "patchwork", may be accompanied by a wandering pain sensation that passes from side to side along the knee area, and is also accompanied by a certain crunch during movement.
• Horizontal rupture of the posterior horn of the medial meniscus is diagnosed by the appearance of soft tissue edema, intense pain in the area of ​​the joint gaps, it occurs inside the meniscus.

The most common and unpleasant knee injury, based on medical statistics, is considered to be a rupture of the posterior horn of the medial meniscus of the knee joint.

It happens:

1. Horizontal or longitudinal, in which the tissue layers are separated from each other with further blocking of the motor ability of the knee. A horizontal rupture of the posterior horn of the internal meniscus appears internally and extends into the capsule.
2. Radial, which manifests itself on oblique transverse tears of the cartilage. The edges of the damaged tissue look like tatters on examination.
3. Combined, including a double lesion of the meniscus - horizontal and radial

The combined gap is characterized by:

• ruptures of cartilaginous formations with tears of the thinnest particles of the meniscus;
• breaks in the back or front of the horn along with its body;
• separation of some particles of the meniscus;
• the occurrence of ruptures in the capsular part.

Signs of breaks

It usually occurs due to an unnatural position of the knee or pinching of the cartilaginous cavity after injury to the knee area.

The main symptoms include:

1. An intense pain syndrome, the strongest peak of which occurs at the very moment of injury and lasts for some time, after which it may fade away - a person will be able to step on his foot with some restrictions. It happens that the pain is ahead of a soft click. After a while, the pain changes into another form - as if a nail was stuck in the knee, it intensifies during the flexion-extension process.
2. Puffiness that appears after a certain time after injury.
3. Blocking of the joint, its jamming. This symptom is considered the main one during the rupture of the medial meniscus, it manifests itself after mechanical clamping of the cartilaginous part by the bones of the knee.
4. Hemarthrosis, manifested in the accumulation of blood inside the joint when the red region of the meniscus is injured.

Modern therapy, in conjunction with hardware diagnostics, has learned to determine what kind of rupture has occurred - acute or chronic. After all, it is impossible to discern the true cause of, for example, a fresh injury, characterized by hemarthrosis and smooth edges of the gap, with human forces. It is strikingly different from a neglected knee injury, where with the help of modern equipment it is possible to distinguish the causes of swelling, which consist in the accumulation of a liquid substance in the joint cavity.

Causes and mechanisms

There are many reasons for the violation of the integrity of the meniscus, and all of them most often occur as a result of non-compliance with safety rules or banal negligence in our daily life.

Injury occurs due to:

• excessive loads - physical or sports;
• twisting of the ankle region during such games, in which the main load goes to the lower limbs;
• excessively active movement;
• prolonged squatting;
• deformations of bone structures that occur with age;
• jumping on one or two limbs;
• unsuccessful rotational movements;
• congenital articular and ligamentous weakness;
• sharp flexion-extensor manipulations of the limb;
• severe bruises;
• falls from a hill.

Injuries in which there is a rupture of the posterior horn of the meniscus have their own symptoms and directly depend on its shape.

If it is acute, in other words, fresh, then the symptoms include:

• sharp pain that does not leave the affected knee even at rest;
• internal hemorrhage;
• joint block;
• smooth fracture structure;
• redness and swelling of the knee.

If we consider a chronic, in other words, an old form, then it can be characterized:

• pain from excessive exertion;
• crackling in the process of motor movements;
• accumulation of fluid in the joint;
• porous structure of the meniscus tissue.

Diagnostics

Acute pain is not to be trifled with, as well as with all the symptoms described above. A visit to the doctor with a rupture of the posterior horn of the medial meniscus or with other types of ruptures of the cartilage tissues of the knee is mandatory. It must be done within a short period of time.

In a medical facility, the victim will be examined and sent to:

1. X-ray, which is used for visible signs of rupture. It is considered not particularly effective and is used to exclude concomitant bone fracture.
2. Ultrasound diagnostics, the effect of which directly depends on the qualifications of the traumatologist.
3. MRI and CT, which is considered the most reliable way to determine the gap.

Based on the results of the above methods of examination, the selection of treatment tactics is performed.

Medical tactics

Treatment of a rupture of the posterior horn of the medial meniscus of the knee joint should be carried out as soon as possible after injury in order to prevent the transition of the acute course of the disease into a chronic one in time. Otherwise, the even edge of the tear will begin to fray, which will lead to violations of the cartilaginous structure, and after that - to the development of arthrosis and a complete loss of motor functions of the knee.

It is possible to treat a primary violation of the integrity of the meniscus, if it is not of a chronic nature, by a conservative method, which includes several stages:

• Reposition. This stage is distinguished by the use of hardware traction or manual therapy to reduce the damaged joint.
• The stage of elimination of edema, during which the victim takes anti-inflammatory drugs.
• The rehabilitation stage, which includes all restorative procedures:
• massage;
• physiotherapy.
• Recovery stage. It lasts up to six months. For complete recovery, the use of chondroprotectors and hyaluronic acid is indicated.

Often, the treatment of the knee joint is accompanied by the imposition of a plaster cast, the need for this is decided by the attending physician, because after all the necessary procedures, it needs long-term immobility, which helps the imposition of plaster.

Operation

The method of treatment with the help of surgical intervention solves the main problem - the preservation of the functionality of the knee joint. and its functions and is used when other treatments are excluded.

First of all, the damaged meniscus is examined for stitching, then the specialist makes a choice of one of several forms of surgical treatment:

1. Artromia. A very difficult method. It is used in exceptional cases with extensive damage to the knee joint.
2. Stitching of cartilage. The method is performed using an arthroscope inserted through a mini-hole into the knee in case of a fresh injury. The most favorable outcome is observed when cross-linking in the red zone.
3. Partial meniscectomy is an operation to remove the injured part of the cartilage, restoring its whole part.
4. Transfer. As a result of this operation, someone else's meniscus is inserted into the victim.
5. Arthroscopy. Traumatization with this most common and modern method of treatment is the most minimal. As a result of the arthroscope and saline solution introduced into the two mini-holes in the knee, all the necessary restorative manipulations are carried out.

Rehabilitation

It is difficult to overestimate the importance of the recovery period, compliance with all doctor's prescriptions, its correct implementation, since the return of all functions, painlessness of movements and complete recovery of the joint without chronic consequences directly depend on its effectiveness.

Small loads that strengthen the structure of the knee are given by properly assigned hardware recovery methods - simulators, and physiotherapy and exercise therapy are shown to strengthen internal structures. It is possible to remove edema with lymphatic drainage massage.

Treatment is allowed to be carried out at home, but still a greater effect is observed with inpatient treatment.

Several months of such therapy ends with the return of the victim to his usual life.

Consequences of injury

Ruptures of the internal and external menisci are considered the most complex injuries, after which it is difficult to return the knee to its usual motor functions.

But do not despair - the success of treatment largely depends on the victim himself.

It is very important not to self-medicate, because the result will largely depend on:

• timely diagnosis;
• correctly prescribed therapy;
• rapid localization of injury;
• the duration of the gap;
• successful restoration procedures.