Rupture of the posterior horn of the meniscus. Posterior horn of the meniscus How to treat a torn posterior horn of the meniscus

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 internal (medial) and external (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 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, a transverse rupture, a longitudinal rupture, a patchwork rupture, a horizontal rupture, damage to the anterior or posterior horn of the meniscus, and 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 using 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 rupture 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. Blockade of the meniscus 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.

The whole truth about: the posterior horn of the meniscus of the knee joint and other interesting information about the treatment.

Rupture of the posterior horn of the medial meniscus is a consequence of an injury that occurs both in athletes or those who lead an active lifestyle, and in people in advanced years suffering from other concomitant diseases (for example, arthrosis).

Rupture of the posterior horn of the medial meniscus

To find out what the features of such damage are, you need to figure out what the meniscus is in general. This concept means a specific cartilaginous layer in the knee joint, which performs shock-absorbing functions. It includes the posterior horn, anterior, body, it is not only medial (internal), but also lateral (external). Here are just an injury to the medial meniscus (more specifically, its posterior horn) is the most dangerous, since it is fraught with serious complications and serious consequences.

Menisci of the knee

Both cartilage layers - external and internal - are C-shaped and differ significantly from each other. So, the lateral meniscus has an increased density, it is quite mobile, due to which it is not injured so often. As for the inner tab, it is rigid, therefore, rupture (or other injuries) of the medial meniscus is much more common.

Anatomical structure of the knee joint

Part of the meniscus includes a capillary network that forms the "red zone". This part, located on the edge, is highly dense. In the center is the thinnest area (“white zone”), in which there are no vessels at all. When a person injures a meniscus, the first thing to do is determine which element was torn. By the way, the "living" area of ​​the meniscus recovers better.

The menisci of the knee joint are cartilaginous formations, lunate in shape.

Note! Once upon a time, doctors believed that removing a torn meniscus could save a person from all troubles. But now it has been proven that both menisci play a very important role in the joint - they protect it, absorb shocks, and the complete removal of one of them leads to early arthrosis.

The main reasons for the appearance

Classification of meniscus tears

Now experts point to only one reason for the appearance of a gap - an acute injury. This is explained by the fact that no other impact on the joint can cause damage to the cartilage responsible for cushioning.

Acute trauma as a cause of rupture

It is also worth noting that there are the following risk factors that predispose to rupture:

• congenital weakness of the joints;
• regular jumping, running on uneven surfaces;
• injuries resulting from degenerative diseases;
• rotational movements performed on one leg without taking it off the ground;
• long-term squatting;
• strenuous walking.

The posterior horn of the medial meniscus may be damaged for reasons other than acute trauma.

Symptoms of damage

In more detail, the signs of a meniscus tear have already been considered in one of the previous articles, so we will focus only on the main points. Usually, an injury occurs when the parts of the joint are in an unnatural position at a particular moment (namely, at the moment of rupture). Less commonly, this happens as a result of cartilage pinching.

Determine the nature of the injury

Note! As a rule, a rupture is accompanied by other joint injuries, which means that in some cases it is a rupture that is not so easy to identify in differential diagnosis.

1. Sharp pain. It is especially acute at the moment of injury and lasts for several minutes. Sometimes, before the onset of pain, you can hear a characteristic click in the knee. After a while, the pain syndrome fades away, a person can walk again, but this is not easy for him.

   The first sign is acute pain

   The next morning, another pain is felt - as if a nail was stuck in the knee - which only intensifies with flexion / extension.

2. Puffiness. Usually it does not appear immediately, but several hours after the injury.
3. "Jamming" of the joint (blockade). This is the main sign of a rupture of the medial meniscus, which occurs after the separated part of the cartilage is clamped by the bones, and the motor functions of the limb are impaired. It is worth knowing that this symptom is also observed with sprains, so the true cause of the pain can only be found out after diagnosis.
4. Intra-articular accumulation of blood (hemarthrosis). This happens if the "red zone" of the depreciation cartilage layer is damaged.

   Hemarthrosis

Today, medicine differentiates between acute rupture and chronic (launched), which is possible due to the use of hardware diagnostics. So, the "fresh" gap has smooth edges, it is accompanied by hemarthrosis. In the case of a chronic injury, the cartilage is multifibered, swelling caused by the accumulation of fluids is observed.

Swelling and swelling of the knee

Features of treatment

If the posterior horn is damaged, then treatment must be started immediately, otherwise it will all develop into a chronic stage. We also note that in the absence of timely treatment, meniscopathy occurs, causing irreversible changes in the articular structure in almost 50% of cases. And this, therefore, can cause gonarthrosis.

Rupture of the posterior horn of the medial meniscus requires immediate treatment

Treatment of the described injury can be conservative and surgical. Consider the features of each of them.

Conservative treatment

Primary damage to the meniscus is treated with therapeutic methods. Of course, in some cases, after an injury, patients require emergency surgery, but often conservative therapy is quite enough. The treatment procedure itself in this case consists of several stages (we repeat - if the gap is not chronic).

Stage 1. Reposition. When blocking the joint, it must be set. Manual therapy or, alternatively, hardware traction is especially effective here.

Reposition

Stage 2. Elimination of edema. To do this, doctors prescribe a course of anti-inflammatory medications.

Anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs in rheumatology

Stage 3. Rehabilitation. The rehabilitation course includes massages, physiotherapy exercises and physiotherapy.

Rehabilitation course

Stage 4. Recovery. The most important, but at the same time the longest stage of treatment. Often, in order to restore the meniscus, chondroprotectors and hyaluronic acid are prescribed. A long course can be from three to six months, it is held once a year.

Treatment with chondroprotectors

Note! The rupture of the posterior horn is accompanied by acute pain, so the patient is also prescribed painkillers. There are quite a lot of them - ibuprofen, paracetamol and others. As for the dosage, it should be prescribed exclusively by the attending physician!

ibuprofen photo

Dosage

In some cases, a cast is applied to the injured knee. The need for gypsum is determined by the doctor in each case. After repositioning the knee joint, immobilization is carried out for a long time at the required angle, and rigid fixation in this case helps to maintain the correct position.

Knee fixation

Surgical treatments

During surgical treatment, specialists are guided by one principle - we are talking about the safety of the organ and its functionality. Surgery is performed only when other methods of treatment are ineffective. First, the organ is tested, it is checked whether it can be sutured (this is often relevant in cases of trauma to the “red zone”).

Table. Types of operations used in meniscus rupture

Arthroscopy

Total knee arthroplasty

Video - Arthroscopy of the medial meniscus

Rehabilitation

One of the most important stages of treatment is the restoration of the functionality of the joint. You need to know that rehabilitation should take place exclusively under medical supervision. A doctor - an orthopedist or a rehabilitation specialist - individually prescribes a set of measures that contribute to a faster recovery of damaged tissues.

During the rehabilitation period, it is good to do a knee massage.

Note! The rehabilitation course can take place at home, it is advisable to do this in a hospital where there is equipment for physiotherapy exercises.

In addition to exercises, during the rehabilitation period, massages and hardware recovery methods are prescribed, associated with dosed loads on the joint. This contributes to the stimulation of muscle tissue and the development of the limb. As a rule, functionality is restored within a few months after the operation, and you can return to your previous life earlier (even a month later).

Rehabilitation measures after knee surgery

knee recovery

The main difficulty of the rehabilitation period is considered to be intra-articular swelling, which makes it impossible to quickly restore functions. Puffiness is eliminated with the help of lymphatic drainage massage.

Note! As a result, we note that with proper and - more importantly - timely treatment, the prognosis of rupture of the posterior horn is very favorable. And this is not surprising, because in modern orthopedics there are many effective methods.

Rupture of the horn of the medial meniscus of the knee joint: treatment and symptoms

Very often, athletes and people who are constantly engaged in physical labor complain of disorders in the functioning of the joints. The most common cause of pain and discomfort is a tear in the meniscus of the knee.

It is quite possible to deal with this problem. Treatment, if a rupture of the meniscus of the knee joint is diagnosed, is expressed in a wide range of actions: from surgical interventions to alternative methods of treatment at home.

What is a meniscus

The meniscus of the knee joint is a cartilaginous formation that has the shape of a crescent and is located between the thigh and lower leg in the knee joint. The knee meniscus performs a stabilizing and shock-absorbing function, the horizontal cartilage gap softens the friction of the surfaces, limiting joint mobility, which prevents injuries.

In the process of movement, the meniscus contracts and stretches, changing its shape, as can be seen in the photo. There are two menisci in the joint:

1. lateral meniscus (external),
2. medial meniscus (internal).

Sports doctors say that injuries and bruising are a common problem among:

• skiers,
• skaters,
• figure skaters,
• ballet dancers,
• footballers.

Meniscus disease and the need for surgery in the future may also appear in those who are engaged in strenuous physical labor. The risk group includes men aged 17 to 45 years.

Among children, rupture of the posterior horn of the internal meniscus or displacement is extremely rare. Until the age of 14, this cartilage formation is very elastic, so damage almost never occurs.

Main shock absorber in the knee joint

Sometimes a rupture of the meniscus of the knee joint or its bruising is observed at an older age. So, at the age of 50-60, degenerative changes in the joints affect the condition.

The rupture of the posterior horn of the medial meniscus occurs under the influence of trauma. This is especially true for the elderly and athletes. Osteoarthritis is also a common cause of meniscal injury.

Rupture of the posterior horn of the medial meniscus is always accompanied by damage to the ligament that connects the meniscus to the knee joint.

Thus, the meniscus changes under the influence of:

1. loads,
2. injuries,
3. degenerative age-related changes,
4. congenital pathologies that gradually damage tissues.

In addition, some diseases that damage statics also make their own negative adjustments.

Flat feet can be cited as an example of the consequences of violations.

How to treat a torn meniscus

Orthopedists differentiate damage to the knee meniscus into several types:

• pinching,
• rupture of the posterior horn of the medial meniscus and a rupture of the posterior horn of the internal meniscus,
• separation.

In the latter case, the treatment of the meniscus is the most difficult process. Education is required to be completely separated from the attachment area. This type of injury requires a surgical operation, it is quite rare.

In most cases, diagnose:

1. injury,
2. pinching,
3. tear,
4. tear of the medial meniscus
5. rupture of the posterior horn of the meniscus.

These injuries are characterized by sharp pain in the knee area, inability to perform movements, numbness, difficulty in flexion and extension of the joint. After a few hours, the symptoms of a torn meniscus subside, mobility is restored, and the person can forget about the injury.

The consequences of an injury, damage to the meniscus of the knee joint, eventually make themselves felt, for example, the pain returns again. A rupture of the medial meniscus is a complex injury that requires intervention. The intensity of the pain syndrome depends on the strength and nature of the damage.

Baikov's symptom is known: when the joint is bent to an angle of 90 degrees, and a finger is pressed on this area of ​​the joint space, producing a slow extension of the lower leg, the pain increases very much.

In addition, it is difficult to go up or down the stairs, there is pain when crossing the limbs and situational numbness. In some severe cases, the consequences become extremely dangerous, we are talking about atrophy of the muscles of the lower leg and thigh.

Professional athletes often suffer from characteristic microtraumas of the meniscus. It can be a bruise, infringement or small tears.

Degrees of meniscus injury and surgery

With cartilage injuries, the diseases become chronic. Sharp pain is not observed, the joint retains its mobility most of the time. However, from time to time, a person feels discomfort in the knee area. These may be: slight tingling, numbness, or clicking. Atrophy of the thigh muscles is recorded.

A rupture in the area of ​​the meniscus of the knee joint in severe cases involves the separation of its capsule, and the need for surgery appears. The detached part of the meniscus can be removed partially or completely. If there is a tear or tear, then the patient may be offered a form of surgery such as suturing.

The choice of type of operation depends on the age of the patient, his condition and the nature of the injury. The younger the person, the faster the consequences pass, and the recovery process accelerates.

As a rule, the recovery period takes about 4-6 weeks, during which the person stays on an outpatient basis.

To restore joint mobility, mud therapy and restorative therapeutic exercises can be recommended.

Conservative treatment of the meniscus in hospital and at home

For micro-ruptures, chronic injuries and infringements of the meniscus of the knee joint, a more moderate conservative treatment is recommended.

If the meniscus is pinched, then it is necessary to reposition, that is, reduce the joint. The procedure is performed by a traumatologist, chiropractor or orthopedist in a medical facility.

It will take 3-4 procedures to fully reset the joint. There is another type of meniscus repair - traction of the knee joint or hardware traction. This is a long procedure carried out in stationary conditions.

To restore cartilage tissue, intra-articular injections of preparations that contain hyaluronic acid are necessary. If there is swelling and the patient suffers from pain, intra-articular injections are necessary:

• nimulida,
• voltarena,
• corticosteroids.

After these measures, long-term drug therapy is indicated to restore the required amount of joint fluid.

The most commonly prescribed are chondroitin sulfate and glucosamine. It is not recommended to self-medicate, the exact dosage of the drug is prescribed only by a doctor.

As a rule, restorative drugs need to be taken for about three months daily.

Along with the use of drugs, it is necessary to turn to massage and therapeutic exercises so that there is no need for an operation.

Treatment of the meniscus with folk remedies

Various rubbing and compresses are considered especially effective. They reduce pain and return the joint to normal mobility.

Before treating meniscus disease at home, you should consult your doctor. It is necessary to take into account the nature of the meniscus injury and individual characteristics. For example, a honey compress may be contraindicated if a person is allergic to bee products.

Treatment can be done with a compress of fresh burdock leaves. The patella area should be wrapped with a sheet and a restraining bandage applied. The compress should be kept on the body for about 4 hours.

The procedure should be carried out every day, while the meniscus hurts. If fresh burdock is not available, dried leaves can be used after soaking them in a small amount of hot water.

Raw materials must be evenly distributed over the tissue, and then apply a compress to the joint. The compress stays on the damaged joint for 8 hours.

A honey compress on the knee helps relieve pain in the patella area. After some time, the lost mobility of the joint returns.

It is necessary to take in equal proportions natural bee honey and purified alcohol, mix and slightly warm. Apply a warm mixture to the knee area, wrap it well with a woolen cloth and secure with a bandage.

To speed up the recovery process after a meniscus injury, you need to make a honey compress 2 times a day. Keep the compress for at least two hours.

Treatment of meniscus disease with folk remedies lasts, as a rule, several months.

An effective remedy for the meniscus of the knee joint is a tincture of wormwood. You will need a large spoonful of chopped wormwood, which must be poured with a glass of boiling water and insisted for 1 hour.

After that, the liquid is filtered and used for compresses. A cloth soaked in liquid should be applied for half an hour to the damaged joint. A traumatologist will tell you in detail about problems with the meniscus in the video in this article.

If we feel pain in the knee, then, as a rule, this means that the meniscus hurts. Since the meniscus is a layer of cartilage, it is most at risk of rupture or damage. Knee pain can indicate several types of damage and meniscal dysfunction. During sprains of the intermeniscal ligaments, chronic injuries, as well as when the meniscus is torn, different symptoms appear, and the options for dealing with them also differ.

• Damage symptoms
  • How to heal damage?
• meniscus tear
  • Rupture of the posterior horn of the meniscus
  • Rupture symptoms
• How is a meniscus tear treated?

Damage symptoms

The meniscus is a cartilage formation that is located in the cavity of the knee joint and serves as a shock absorber of movement, as well as a stabilizer that protects the articular cartilage. There are two menisci in the knee, the outer (lateral) and the inner (medial). Damage to the inner meniscus happens much more often due to its less mobility. Damage to the meniscus of the knee joint manifests itself in the form of pain in this area, limited mobility, and in chronic situations, the development of knee arthrosis is also possible.

Swelling of the joint, sharp cutting pain, painful crunching and difficulty in moving the limbs indicate that you have a damaged meniscus. These symptoms appear immediately after the injury and may indicate other joint damage. More pronounced symptoms of damage appear one month after the injury. With these injuries, a person begins to feel local pain in the gap of the knee joint, weakness of the muscles of the outer surface of the thigh, “blockade” of the knee, and accumulation of fluid in the joint cavity are manifested.

The exact signs of damage to the medial meniscus are identified through various examinations. There are special tests for extension of the knee joints (Rocher, Baikov, Landa, etc.), when pain symptoms are felt with a certain extension of the knee. The technology of rotational tests is based on the detection of damage during rolling movements of the knee (Shteiman, Bragard). Meniscal injury can also be identified by MRI, mediolateral tests, and compression symptoms.

How to heal damage?

Injury to the medial meniscus involves a variety of treatments that take into account the type and severity of the injury. With the traditional method of getting rid of damage, it is possible to distinguish the main types of exposure that are used for any injuries.

To begin with, it is necessary to relieve pain, therefore, first of all, the patient is given an anesthetic injection, then they take a puncture of the joint, remove the accumulated fluid and blood from the cavity, and, if necessary, remove the blockade of the joints.

After these procedures, the knee needs rest, for which a splint or plaster cast is applied. As a rule, one month of immobilization is enough, but in difficult situations, the period sometimes reaches up to 2 months. In this case, it is necessary to apply local cold and non-steroidal agents to relieve inflammation. Over time, you can add different types of physiotherapy, walking with support, physiotherapy exercises.

Surgery is required in severe situations, for example, chronic damage to the meniscus of the knee joint. One of the most popular types of surgery today is arthroscopic surgery. This type of surgical intervention has become common due to the careful attitude to tissues. The intervention is only a resection of the damaged area of ​​the meniscus and polishing of defects.

With such damage as a torn meniscus, the surgical operation is performed closed. With the help of two holes, an arthroscope is inserted into the knee joint with instruments to determine the damage, then a decision is made on the possibility of sewing up the meniscus or its partial resection. Inpatient treatment lasts up to approximately 4 days, due to the low invasiveness of this type of operation. At the rehabilitation stage, it is recommended to limit the load on the knee to one month. In special situations, wearing a knee brace and walking with support is recommended. After 7 days, you can start therapeutic exercises.

meniscus tear

The most common injury to the knee joint is a tear in the medial medial meniscus. There are degenerative and traumatic meniscal tears. The latter appear, as a rule, in people aged 18-45 years and athletes, with untimely treatment, they turn into degenerative tears, which most often appear in elderly people.

Taking into account the localization of damage, there are several main types of ruptures:

• transverse;
• in the form of a watering can;
• patchwork;
• paracapsular;
• longitudinal;
• damage to the posterior or anterior horn;
• horizontal.

At the same time, meniscus tears are also divided by shape:

• oblique;
• longitudinal;
• transverse;
• degenerative;
• combined.

Traumatic ruptures appear, as a rule, at a young age and they occur vertically in a longitudinal or oblique direction. Combined and degenerative usually occur in the elderly. Watering can-shaped or vertical longitudinal tears can be incomplete or complete and usually begin with damage to the posterior horn.

Rupture of the posterior horn of the meniscus

This type of tear is the most common, as most of the vertical, longitudinal, and watering hole tears occur in the posterior horn. During a long tear, there is a good chance that part of the torn meniscus will interfere with the movement of the knee and cause severe pain, up to blockage of the knee joint. The combined type of tears passes, capturing several planes, and usually forms in the posterior horn of the meniscus and for the most part appears in elderly people who have degenerative changes in them.

During damage to the posterior horn, which does not lead to displacement of the cartilage and longitudinal cleavage, the person always feels the threat of blockade of the joint, but this never happens. Quite rarely, a rupture of the anterior horn of the knee joint occurs.

Rupture of the posterior horn of the lateral (outer) meniscus

This gap happens 8-10 times less often than the medial one, but it has no less negative consequences. The internal rotation of the tibia and its movement are the main causes that cause a rupture of the external lateral meniscus. The main sensitivity in these lesions falls on the outer side of the posterior horn. Rupture of the arch of the external meniscus with displacement, as a rule, creates a restriction of movements at the final stage of extension, and sometimes can cause blockade of the joint. The rupture of the external meniscus is determined by the characteristic clicking during rotational movements inside the knee joint.

Rupture symptoms

With injuries such as a torn meniscus, symptoms vary. A meniscus tear can be:

• old;
• chronic;
• spicy.

The main sign of a rupture is blockage of the knee joint, in its absence it is very difficult to determine a rupture of the lateral or medial meniscus in the acute period. After a certain time, in the early period, the gap can be determined by local pain, infiltration in the area of ​​​​the joint gap, as well as using pain tests that are suitable for any type of damage.

A pronounced symptom of a rupture is pain during probing the line of the gap of the knee joint. There are special tests for diagnosis, such as the McMurry test and the Epley test. The McMurry test is performed in two ways.

In the first case, the patient is laid on his back, the leg is bent at the hip and knee joint to a right angle. Then they grab the knee with one hand, and with the other hand they perform rotational movements of the lower leg, first outward, and then inward. When cracking or clicking, it is possible to consider the infringement of the injured meniscus between the surfaces of the joint, this test is positive.

The other way is called bending. It is carried out in this way: with one hand they grab the knee, as in the first version, after the leg is bent as much as possible at the knee. The lower leg is then rotated outward to determine the tear. Under the condition of slow extension of the knee joint to approximately 90 degrees and rotational movements of the lower leg, then during the rupture of the meniscus, the patient will feel pain on the surface of the joint from the inside back side.

During the Epley test, the patient is placed on the stomach and the leg is bent at the knee, creating an angle of 90 degrees. With one hand, it is necessary to press the person on the heel, and with the second, rotate the lower leg and foot. When pain occurs in the joint space, the test is positive.

How is a meniscus tear treated?

The rupture can be treated either surgically (resection of the meniscus, both partial and its restoration, and complete), or conservatively. With the advent of new technologies, meniscus transplantation has become increasingly popular.

Conservative treatment is usually used to treat minor lesions of the posterior horn. Very often, these injuries are accompanied by severe pain, but do not lead to pinching of the cartilage tissue between the surfaces of the joint and do not create a sensation of rolling and clicking. This type of damage is characteristic of strong joints.

The treatment consists in liberation from such sports, in which sharp jerks and movements that leave one leg in place are indispensable, these activities aggravate the condition. In the elderly, this treatment leads to a better outcome, since arthritis and degenerative tears are often the cause of their symptoms.

A slight longitudinal tear (less than 1 cm), a tear of the upper or lower surface that does not penetrate the entire thickness of the cartilage, transverse injuries of no more than 2.5 mm usually heal on their own or do not bother.

Also, the treatment of the gap provides another option. Sewing from the inside out. For this method of treatment, long needles are used, which are inserted perpendicular to the rupture line from the joint cavity to the outer part of the strong capsular area. And the seams are made quite tightly, one by one. This is the main advantage of this treatment option, although it increases the risk of nerve and vascular damage during the withdrawal of the needle from the joint cavity. This method is excellent for treating damage to the posterior horn and a tear that runs from the cartilage itself to the posterior horn. During damage to the anterior horn, difficulties may arise in the passage of the needle.

In cases where a rupture of the anterior horn occurs, it is best to use the suturing method from the outside to the inside. This option is safer for blood vessels and nerves, in this case the needle is passed through the gap on the outside of the knee joint and then into its cavity.

With the development of technology, seamless fastening inside the joint is gradually gaining popularity. The process itself takes a little time and takes place without the participation of such complex devices as an arthroscope, but now it still does not have even a 75% chance of successful healing of the meniscus.

The main indications for surgery are pain and effusion, which cannot be eliminated using conservative methods. Blockade of the joint or friction during movement are also indications for surgical intervention. Resection of the meniscus (meniscectomy) was once considered a safe operation. But with the help of recent research, it turned out that meniscectomy most often leads to the development of arthritis. This fact influenced the main methods of treatment of posterior horn rupture. Today, grinding of damaged parts and partial removal of the meniscus is very popular.

The success of recovery after injuries such as a torn medial and lateral meniscus will depend on many factors. For a quick recovery, factors such as the location of the damage and its age are important. The probability of a full-fledged treatment is reduced if the ligamentous apparatus is not strong enough. If the patient's age is not more than 45 years, then he has a better chance of recovery.

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

Usually, a rupture of the meniscus of the knee joint occurs due to an unnatural position of the knee or pinching of the cartilage cavity after injury to the knee area.

The main symptoms include:

1. 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.

Gap shapes

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 institution, 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 recovery procedures.

Often, after injury to the structures located in the knee joint, a rupture of the posterior horn of the medial meniscus is diagnosed. To avoid negative consequences and complications after an injury, it is important to start treating the injury. If the damage is partial, it will be possible to correct the situation with the help of conservative therapy. When a complete rupture and destruction of cartilage is diagnosed, surgical intervention is indispensable.

Causes of damage

If damage to the posterior horns of the meniscus is diagnosed, most likely, a complex fracture of the limb occurred with damage to the integrity of the ligamentous apparatus, bone, and soft tissues.

The medial meniscus is an inactive, cartilaginous formation located on the inside of the knee joint. Much less often, a rupture of the outer cartilage is diagnosed, which is located on the outside of the knee, it is called lateral. However, in addition to injuries, a rupture of the internal meniscus is provoked by:

• A degenerative disease of the musculoskeletal system, due to which the bone structures become fragile and prone to fractures.
• Unsuccessful landing on feet when jumping from a great height.
• Chronic, untreated damage to the internal meniscus of the knee joint.
• Congenital diseases that negatively affect the condition of the articular joints.

Knee pain is a common reason for seeking medical attention. They can occur due to various pathologies, including damage to the menisci - special cartilage plates located between the articular surfaces. Their main task is to cushion and stabilize the joint. And in conditions of significant loads that the knee has to experience, this is extremely important.

Pathology of the meniscus is often traumatic in nature, manifesting itself either as an isolated injury or in combination with ruptures of the ligamentous apparatus. This is more typical for young people who are actively involved in sports. After 40 years, cases of degenerative changes predominate, which lead to a rupture of the menisci. It is possible to eliminate such problems of the knee joint after finding out their origin, clinical manifestations and severity.

The reasons

Degenerative-dystrophic processes do not develop in a healthy organism. This must be preceded by violations at various levels: local and general. They have a clear relationship, which distinguishes the development of pathology from traumatic injuries, when only a mechanical effect on the knee joint is sufficient. Undoubtedly, injuries and prolonged excessive stress on the joints are the key points in the formation of degenerative changes, but there are other conditions that contribute to such processes:

• Dysplasia of the knee.
• Obesity.
• Gout.
• Rheumatoid arthritis.
• Rheumatism.
• Osteoarthritis.
• Infectious diseases (tuberculosis, brucellosis, yersiniosis).
• Connective tissue diseases (lupus erythematosus, scleroderma).
• Endocrine pathology (hypothyroidism).
• Systemic vasculitis.

Dystrophic processes in the knee joint are largely due to metabolic, immune, endocrine and vascular disorders, which can occur in conjunction with age-related changes that inevitably appear after 50 years.

Degenerative changes in the menisci develop due to many reasons. In most cases, there is a combined effect of adverse factors.

Symptoms

Damage of a degenerative-dystrophic nature - meniscopathy - does not occur suddenly. It takes time for the initiation and progression of pathological processes in the knee joint. The following symptoms may appear first:

• Feeling of fatigue in the joint.
• Crunching, rubbing and clicking in the knee.
• Periodic pain after intense exercise.

Over time, pathological changes appear not only in the menisci, but also in the adjacent articular surfaces, ligaments. Tissues become less durable, which contributes to their damage. As a result, ruptures of cartilage shock-absorbing pads can occur even without previous trauma - just an awkward movement, squatting or simply bending the leg is enough. In this case, the symptoms worsen, the following signs become characteristic:

• Swelling and redness in the joint space.
• Restriction of movements.
• Knee instability.
• Blocking (jamming) of the joint.

But most often, chronic damage, which is dystrophic in nature, occurs with the only symptom - pain, only occasionally manifesting itself as blocking the joint. The severity of symptoms varies from minimal to very strong, when it is impossible to even stand on one leg or make any movements. Unpleasant sensations can disturb only when going down the stairs or during squats. It depends on the degree of damage and what structures are involved. The concomitant pathology of the knee joint also plays a role: fractures of the condyles, torn ligaments, osteoarthritis.

According to their localization, the breaks can be located in the following zones:

• The body of the meniscus: internal (medial) or external (lateral).
• Anterior horn of the lateral meniscus.
• Posterior horn of the inner meniscus.
• Combined damage.

More often you can meet ruptures of the outer meniscus, because it has more mobility than the inner one. The latter is more often torn when combined with damage to the anterior cruciate ligament. Degenerative changes in the posterior horn of the medial meniscus are accompanied by less intense symptoms, signs of wedging are often absent. The anterior horn comes off much less frequently.

If the lesion affects the vascular zone, then the development of hemarthrosis (accumulation of blood) is likely. The joint swells significantly, which can be seen from the change in the shape of the patella zone. Palpation is characterized by pain in the joint space, which occurs during tests with passive flexion and extension of the knee.

A lesion of the internal or external meniscus can be suspected clinically, but additional methods help confirm the diagnosis.

Diagnostics

To make a final conclusion about meniscopathy, it is necessary to conduct an imaging examination. This includes x-rays or magnetic resonance imaging. The latter method has significant advantages, since it allows you to accurately assess the state of intra- and periarticular soft tissues, and does not have radiation exposure. According to the results of tomography, the degree of damage to the meniscus is determined (according to Stoller):

• 1 - focal changes that do not reach the surface layer.
• 2 - linear changes that do not reach the surface layer.
• 3 - changes reach the surface of the meniscus.

One can speak of a true break only in the latter case. In addition, the picture clearly shows the dislocation of cartilaginous structures, a change in shape, and the detachment of one of the horns.

Treatment

It is necessary to treat meniscopathy of the knee joint in a complex manner. Apply conservative and operative methods. Depending on the severity of the disease, the effect of the drugs used may be different. To achieve maximum results, you should follow all the recommendations of the doctor. And first of all, it is necessary to reduce the load on the sore leg. You can wear an elastic bandage or a knee brace, but completely immobilizing the joint with a cast is fundamentally wrong - this will not improve its function, but will lead to contractures.

Degenerative-dystrophic changes in the menisci require persistent and intensive therapy, which can take quite a long time.

Medical therapy

The pathology of the knee joint, including meniscal damage, requires the use of medications. Drugs are especially needed for acute ruptures, but chronic processes cannot be effectively corrected without drugs. With dystrophic changes, it is important to normalize the biochemical processes in the body. To improve the condition of the meniscus and reduce symptoms, use the following medicines:

• Non-steroidal anti-inflammatory.
• Chondroprotectors.
• metabolic.
• Vascular.
• Vitamins.

All drugs should be taken according to the recommendations of a specialist. Self-medication is not allowed.

They also use the possibilities of physiotherapy to restore the integrity of the meniscus. For this purpose, some procedures are used: electro- and phonophoresis, laser and wave treatment, magnetic, paraffin and balneotherapy. Which of them are indicated in each case, the doctor will determine. But a pronounced effect from the isolated use of physiotherapy should not be expected - it is used only in combination with other methods.

Physiotherapy

Even with meniscus ruptures, exercise therapy is indicated. It should include exercises aimed at strengthening the thigh muscles - the anterior and posterior groups. This allows you to stabilize the knee and eliminate its instability. But still, you should be careful during classes, exclude sudden movements, especially rotational ones.

Conservative measures are good for small tears, as well as for the elderly, who often have signs of osteoarthritis.

Operation

If the lesion of the internal or external meniscus reaches Stoller grade 3, is of considerable size and is accompanied by severe symptoms, as well as with the ineffectiveness of previous therapy, that is, all indications for surgical intervention. Only a doctor can determine when the operation should begin, but you should not hesitate with this.

The most common surgical treatment is arthroscopic surgery. This is a minimally invasive technology that can be used to perform a meniscectomy (partial removal), suture, transplant or meniscus arthroplasty.

Pain in the knee may appear due to the development of degenerative processes and rupture of the meniscus. It is important to carry out treatment in a timely manner in order to restore damaged tissues. What is better to use - conservative therapy or surgery - is determined by the clinical situation.

The pathology of the musculoskeletal system includes a rupture of the posterior horn of the medial meniscus. This injury is the result of an indirect injury to the lower extremity. The human knee joint is very complex. Each of them has 2 menisci. They are made up of cartilage. They consist of a body, back and front horns. Menisci are essential for cushioning, limiting range of motion, and matching bone surfaces.

Types of breaks

A rupture of the posterior horn of the medial meniscus is a type of closed joint injury. This pathology is most often found in adults. In children, this injury is rare. Women suffer from this disease 2 times more often than men. The rupture is often combined with damage to the cruciate ligament of the knee.

This is the most common joint injury. Complex rupture is diagnosed mainly in people from 18 to 40 years old. This is due to an active lifestyle. Sometimes there is a combined damage to both menisci.

The relevance of this problem is due to the fact that such an injury often requires surgical intervention and a long recovery period.

After surgical treatment, patients move on crutches. Distinguish between complete and incomplete tissue rupture. The following options for rupture of the medial meniscus are known:

• longitudinal;
• vertical;
• patchwork oblique;
• radial transverse;
• horizontal;
• degenerative with crushing of tissues;
• isolated;
• combined.

An isolated rupture of the posterior kind is diagnosed in 30% of all cases of this injury.

Causes of damage

The development of this pathology is based on a strong extension of the lower leg or its sharp turn outward. The longitudinal gap is due to several reasons. The main etiological factors are:

• falling on a hard surface;
• bruises;
• traffic accidents;
• blows;
• degenerative processes against the background of gout and rheumatism;
• stretching;
• microtrauma.

Rupture of the posterior horn of the meniscus is most often caused by indirect and combined trauma. This usually happens in winter in ice. Failure to take precautions, haste, drunkenness and fighting all contribute to injury. Often, rupture occurs with fixed extension of the joint. Athletes face the same problem. The risk group includes football players, figure skaters, gymnasts and hockey players.

Permanent damage causes meniscopathy. Subsequently, with sharp turns, a gap occurs. Separately, degenerative damage is highlighted. It occurs mainly in elderly people with repeated microtraumas. The reason may be intense exercise during training or careless work. Degenerative horizontal rupture of the posterior horn of the medial meniscus often occurs against the background of rheumatism.

It is facilitated by previously transferred angina and scarlet fever. At the heart of damage to the menisci on the background of rheumatism is a violation of the blood supply to tissues with edema and other pathological changes. The fibers become less elastic and strong. They are not able to withstand a large load.

Less commonly, the cause of the rupture is gout. Traumatization of tissues by uric acid crystals occurs. Collagen fibers become thinner and less durable.

How does the gap manifest?

If there is damage to the posterior horn of the medial meniscus, then the following symptoms are possible:

• pain in the knee area;
• restriction of movements;
• crackling while walking.

In the acute period, reactive inflammation develops. The intensity of the pain syndrome is determined by the degree of rupture. If it is incomplete, then the symptoms are mild. Clinical signs persist for 2-4 weeks. Flap rupture of moderate severity is characterized by acute pain and limited extension of the limb in the knee.

The sick person can walk. If proper treatment is not carried out, then this pathology becomes chronic. Severe pain in combination with tissue edema is characteristic of a severe rupture. In such people, small blood vessels in the knee area can be damaged. Hemarthrosis develops. Blood accumulates in the cavity of the knee joint.

Supporting the leg is difficult. In severe cases, the local temperature rises. The skin takes on a bluish tint. The knee joint becomes spherical. After 2-3 weeks from the moment of injury, a subacute period develops. It is characterized by localized pain, effusion, and blockages. Specific symptoms of Roche, Baykov and Steiman-Bragard are typical. With the degenerative form of this pathology of the meniscus, complaints can appear only during work.

Patient examination plan

It is necessary to treat a linear rupture after clarifying the diagnosis. The following research will be required:

• general clinical tests;
• CT or MRI;
• radiography;
• arthroscopy.

Differential diagnosis is carried out in the following cases:

• Koenig's disease;
• arthritis of various etiologies;
• gonarthrosis;
• Hoff's disease;
• softening of cartilage tissue;
• osteoporosis.

If the posterior horn of the meniscus is damaged, treatment begins after assessing the condition of the joint tissues. Magnetic resonance imaging is very informative. Its advantage is the absence of radiation exposure. According to the indications, arthroscopy is performed. This is an endoscopic method of research. Examination of the knee can be carried out for both therapeutic and diagnostic purposes. Arthroscopy can be used to visually assess the condition of the knee joint. Before the procedure it is necessary to pass a number of tests. The study can be carried out on an outpatient basis.

Medical tactics

Partial damage to the meniscus requires conservative therapy. The main aspects of treatment are:

• plaster overlay;
• the use of painkillers;
• puncture of the knee joint;
• keeping calm;
• setting cold compresses;
• physiotherapy;
• massage;
• physiotherapy.

If the cause was degenerative-dystrophic processes, then chondroprotectors are prescribed. These are drugs that strengthen the cartilage of the joints. They contain chondroitin sulfate and glucosamine. Chondroprotectors include Artra, Teraflex, Dona and Chondrogard. To eliminate the pain syndrome, NSAIDs are prescribed (Ibuprofen, Movalis, Diclofenac Retard). These medicines are taken orally and applied to the skin around the joint.

External means are used after removal of the plaster. Patients need to observe motor rest. To accelerate the healing of the medial meniscus, physiotherapy is performed (electrophoresis, UHF therapy, exposure to magnetic fields). Often a puncture is required. A needle is inserted into the joint. With a small amount of blood, the puncture is not performed.

During the procedure, analgesics and anti-inflammatory drugs may be administered. In severe cases, radical treatment is required. The indications for the operation are:

• detachment of the horns and body of the medial meniscus;
• lack of effect from conservative therapy;
• displaced rupture;
• crushing of tissues.

The most common are reconstructive surgeries. Complete meniscectomy is less common. This is due to the fact that the removal of the medial meniscus in the future can lead to the development of deforming gonarthrosis. Special structures are used to restore tissues. In the case of peripheral and vertical tears, the meniscus can be sutured.

Such an intervention is justified only if there are no degenerative changes in the cartilage tissue. A complete meniscectomy can be performed only with a large detachment and severe damage to the meniscus. Arthroscopic surgery is now widely used. Their advantage is less trauma. After the operation, painkillers, physiotherapy and gymnastics are prescribed. Up to a year, patients need to remain calm.

Forecast and preventive measures

The prognosis for a rupture of the posterior horn of the internal meniscus of the knee is most often favorable. It worsens with severe hemarthrosis, concomitant lesions and untimely treatment. After therapy, the pain syndrome disappears and the range of motion is restored. In some cases, gait instability and discomfort during walking are observed.

The accumulation of a large amount of blood in the knee joint, in the absence of proper assistance, can cause arthrosis.

In the elderly, treatment is difficult due to the impossibility of the operation. Rupture of the horns of the medial meniscus can be prevented. To do this, you must adhere to the following recommendations:

• avoid sudden foot movements;
• observe safety precautions while working at work and at home;
• stop drinking alcohol;
• do not get into fights;
• wear knee pads when playing sports;
• to refuse traumatic activities;
• be careful during ice;
• in winter weather, wear shoes with thread;
• refuse to engage in extreme sports;
• timely treat arthritis and arthrosis;
• diversify the diet;
• move more;
• take vitamin and mineral supplements;
• treat rheumatism and gout in a timely manner.

A torn meniscus is a very common pathology in adults and adolescents. In case of a fall or bruise and pain syndrome, you need to contact the emergency room.

Rupture of the posterior horn of the medial meniscus of the knee joint - treatment, symptoms, complete analysis of the injury

One of the most complex structures of the human body parts are joints, both large and small. The structural features of the knee joint allow us to consider it the most susceptible to various injuries, such as fractures, bruises, hematomas, arthrosis, rupture of the posterior horn of the medial meniscus.

This is justified by the fact that the bones of the joint (femoral, tibial), ligaments, menisci and patella, working together, provide normal flexion when walking, sitting and running. However, heavy loads on the knee, placed on it during various manipulations, can lead to a rupture of the posterior horn of the meniscus.

Rupture of the posterior horn of the internal meniscus is an injury to the knee joint caused by damage to the cartilage layer located between the femur and tibia.

Anatomical features of the cartilage tissue of the knee

The meniscus is a cartilaginous tissue of the knee that is located between two adjacent bones and ensures that one bone slides over the other, ensuring unimpeded flexion/extension of the knee.

The structure of the knee joint includes two types of menisci:

1. External (lateral).
2. Internal (medial).

The most mobile is considered external. Therefore, its damage is much less common than damage to the internal.

The inner (medial) meniscus is a cartilaginous pad connected to the bones of the knee joint by a ligament located on the side of the inner side, it is less mobile, therefore, people with a lesion of the medial meniscus more often turn to traumatology. Damage to the posterior horn of the medial meniscus is accompanied by damage to the ligament that connects the meniscus to the knee joint.

In appearance, it looks like a crescent moon lined with a porous fabric. The body of the cartilage pad consists of three parts:

• Anterior horn;
• middle part;
• Back horn.

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

1. Cushioning while walking, running, jumping.
2. Stabilization of the knee at rest.
3. Permeated with nerve endings that send signals to the brain about the movement of the knee joint.

Knee injury is not uncommon. At the same time, not only people who lead an active lifestyle can get injured, but also those who, for example, sit on squats for a long time, try to rotate on one leg, and make long jumps. Tissue destruction occurs and over time, people over 40 are at risk. Injured knees at a young age eventually become chronic diseases in old age.

The nature of its damage can be different depending on exactly where the rupture occurred and what shape it has.

Break shapes

Cartilage ruptures can be different in nature and form of the lesion. Modern traumatology distinguishes the following groups of ruptures of the internal meniscus:

• Longitudinal;
• degenerative;
• oblique;
• transverse;
• Rupture of the posterior horn;
• horizontal;
• Rupture of the anterior horn.

Rupture of the posterior horn

Rupture of the posterior horn of the medial meniscus is one of the most common groups of knee injuries. This is the most dangerous damage.

Tears in the posterior horn can be:

1. Horizontal, that is, a longitudinal gap, in which the separation of tissue layers from one another occurs, followed by blocking the mobility of the knee joint.
2. Radial, that is, such damage to the knee joint, in which oblique transverse tears of the cartilage tissue appear. The edges of the lesion look like rags, which, falling between the bones of the joint, create a crack of the knee joint.
3. Combined, that is, bearing damage to the (medial) internal meniscus of two types - horizontal and radial.

More

Symptoms of an injury to the posterior horn of the medial meniscus

The symptoms of the resulting injury depend on what form it wears. If this is an acute form, then the signs of injury are as follows:

1. Sharp pain even at rest.
2. Hemorrhage within the tissue.
3. Blockage of the knee.
4. Arthroscopy tissue has smooth edges.
5. Swelling and redness.

The chronic form (an old rupture) is characterized by the following symptoms:

• Cracking of the knee joint during movement;
• Accumulation of synovial fluid;
• The tissue during arthroscopy is stratified, similar to a porous sponge.

Treatment of cartilage damage

In order for the acute form not to become chronic, it is necessary to immediately begin treatment. If treatment is started late, then the tissue begins to acquire significant destruction, turning into tatters. Destruction of the tissue leads to degeneration of the cartilage, which in turn leads to knee arthrosis and its immobility.

Stages of conservative treatment

The conservative method is used in the acute non-started stage in the early stages of the course of the disease. Therapy by conservative methods consists of several stages.

• Relieve inflammation, pain and swelling with non-steroidal anti-inflammatory drugs (NSAIDs).
• In cases of “jamming” of the knee joint, reposition is used, that is, reduction with the help of manual therapy or traction.
• Physiotherapy.
• Massotherapy.
• Physiotherapy.

• Treatment with chondroprotectors.
• Joint treatment with hyaluronic acid.
• Treatment with folk remedies.
• Pain relief with analgesics.
• Plaster cast (on doctor's recommendation).

Stages of surgical treatment

The surgical method is used only in the most extreme cases, when, for example, the tissue is so damaged that it cannot be restored, or if conservative methods have not helped.

Surgical methods for repairing torn cartilage consist of the following manipulations:

• Arthrotomy - partial removal of damaged cartilage with extensive tissue damage;
• Meniscotomy - complete removal of cartilage tissue; Transplantation - moving the donor meniscus to the patient;
• Endoprosthetics - the introduction of artificial cartilage into the knee;
• Stitching of damaged cartilage (performed with minor damage);
• Arthroscopy - knee puncture in two places in order to carry out the following cartilage manipulations (for example, stitching or arthroplasty).

After the treatment is carried out, regardless of what methods it was carried out (conservative or surgical), the patient will have a long course of rehabilitation. The patient is obliged to provide himself with complete rest throughout the entire time while the treatment is being carried out and after it. Any physical activity after the end of therapy is contraindicated. The patient must take care that the cold does not penetrate to the limbs, and the knee is not subjected to sudden movements.

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Conclusion

Thus, knee injury is an injury that occurs much more often than any other injury. In traumatology, several types of meniscal injuries are known: ruptures of the anterior horn, ruptures of the posterior horn, and ruptures of the middle part. Such injuries can be different in size and shape, so there are several types: horizontal, transverse, oblique, longitudinal, degenerative. Rupture of the posterior horn of the medial meniscus is much more common than that of the anterior or medial meniscus. This is due to the fact that the medial meniscus is less mobile than the lateral one, therefore, the pressure on it when moving is greater.

Treatment of injured cartilage is carried out both conservatively and surgically. Which method will be chosen is determined by the attending physician based on how severe the damage is, what form (acute or chronic) the damage has, what condition the cartilage tissue of the knee is in, what kind of rupture is present (horizontal, radial or combined).

Almost always, the attending physician tries to resort to the conservative method, and only then, if he turned out to be powerless, to the surgical one.

Treatment of cartilage injuries should be started immediately, otherwise the chronic form of the injury can lead to complete destruction of the articular tissue and immobility of the knee.

In order to avoid injury to the lower extremities, turns, sudden movements, falls, jumps from a height should be avoided. After treatment of the meniscus, physical activity is usually contraindicated. Dear readers, that’s all for today, share in the comments about your experience in treating meniscus injuries, in what ways did you solve your problems?

Although the bones of the knee joints are the largest in the human skeleton, the majority of injuries occur in the knee. Injury occurs due to high loads on this part of the limb. Let's talk about such an injury as damage to the posterior horn of the medial meniscus and methods to eliminate its consequences.

Appointment of the meniscus

The limb joint refers to a complex structure, where each element solves a specific problem. Each knee is equipped with menisci that bisect the articular cavity, and perform the following tasks:

• stabilizing. During any physical activity, the articular surfaces are displaced in the right direction;
• act as shock absorbers, softening shocks and shocks while running, jumping, walking.

Injury to shock-absorbing elements occurs with various articular injuries, precisely because of the load that these articular parts take on. Each knee has two menisci, which are made up of cartilage:

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

Each type of shock-absorbing plate is formed by a body and horns (rear with front). Shock-absorbing elements move freely during physical activity.

The main damage occurs to the posterior horn of the internal meniscus.

Why injury happens

A common injury to the cartilage plate is a tear, complete or incomplete. Professional athletes and dancers are often injured, and whose specialty is associated with high loads. Injuries occur in the elderly, and as a result of accidental, unforeseen stress on the knee area.

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

• increased, sports loads (jogging over rough terrain, jumping);
• active walking, prolonged squatting position;
• chronic, articular pathologies in which inflammation of the knee region develops;
• congenital articular pathology.

These causes lead to injuries of the meniscus of varying severity.

Classification

Symptoms of trauma to the cartilage elements depend on the severity of the damage to the cartilage tissue. There are the following stages of internal meniscal damage:

• Stage 1 (mild). Movement of the injured limb is normal. Pain is weak, and becomes more intense during squats or jumps. There may be slight swelling above the kneecap;
• 2 degree injury is accompanied by severe pain. It is difficult to straighten the limb even with outside help. You can move with a limp, but at any moment the joint can become blocked. Puffiness gradually becomes more and more, and the skin changes shade;
• damage to the posterior horn of the medial meniscus 3 degrees accompanied by pain syndromes of such intensity that it is impossible to endure. It hurts the most at the location of the kneecap. Any physical activity is impossible. The knee becomes larger in size, and the skin changes its healthy color to purple or cyanotic.

If the medial meniscus is damaged, the following symptoms exist:

1. pain intensifies if you press on the patella from the inside and at the same time straighten the limb (Bazhov's technique);
2. the skin of the knee area becomes too sensitive (Turner's symptom);
3. when the patient lies down, the palm passes under the injured knee without problems (Land's symptom).

After the diagnosis is made, the doctor decides which treatment method to apply.

Horizontal gap

Depending on the location of the injured area and the general characteristics of the damage, there are types of injury to the medial meniscus:

• walking along;
• oblique;
• passing across;
• horizontal;
• chronic form of pathology.

Features of horizontal damage to the posterior horn of the medial meniscus are as follows:

• with this type of tearing of the internal shock-absorbing plate, injury occurs, directed to the joint capsule;
• there is swelling in the area of ​​the joint gap. This development of the pathology has common signs with damage to the anterior meniscus horn of the external cartilage, therefore, special attention is needed when diagnosing.

With horizontal, partial damage, the cavity begins to accumulate excess synovial fluid. Pathology can be diagnosed by ultrasound.

Treatment of a horizontal rupture of the posterior horn of the medial meniscus, during timely seeking medical help, is prescribed as a complex, traditional therapy, because this type of injury does not block the joint. First, non-steroidal medications are prescribed to eliminate pain and swelling. Then the injured knee is fixed with a plaster cast. The traditional method of treatment can last from six months to 12 months. During the first 3 months, the joint is immobilized with a plaster splint.

After the removal of the first symptoms, a set of special gymnastic exercises is developed for each patient. Physiotherapy and massage sessions are prescribed.

If traditional methods of treatment do not give a positive result, then surgical intervention is indicated.

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Synovitis due to trauma to the medial meniscus

Against the background of damage to the posterior horn of the medial meniscus, synovitis may begin. This pathology develops due to structural cartilage changes that occur in the tissues during injury. When ruptured, synovial fluid begins to be produced in large volume, and fills the joint cavity.

As synovitis (fluid buildup) develops, it becomes increasingly difficult to move. If there is a transition to the degenerative course of the pathology, then the knee is constantly in a bent position. As a result, muscle spasm develops.

Advanced forms of synovitis lead to the development of arthritis. Therefore, at the time of diagnosis, the symptoms of a torn meniscus are similar to chronic arthritis.

If synovitis is not treated in time, the cartilaginous surface will completely collapse. The joint will no longer receive nutrition, which will lead to further disability.

Therapeutic techniques

With any articular injury, treatment should be started in a timely manner, without delay. If you postpone the appeal to the clinic, then the trauma passes to a chronic course. The chronic course of the pathology leads to changes in the tissue structure of the joints, and further deformation of the damaged limb.

Treatment for damage to the posterior horn of the medial meniscus can be conservative or surgical. In the treatment of such injuries, traditional methods are often used.

Complex, traditional therapy for injuries of the internal meniscus includes the following activities:

1. an articular blockade is performed using special medications, after which the motor ability of the joint is partially restored;
2. anti-inflammatory drugs are prescribed to remove puffiness;
3. recovery period, including a set of special gymnastic exercises, physiotherapy and massage sessions;
4. then comes the reception of chondoprotectors (drugs that help restore the structure of the cartilage). Hyaluronic acid is present among the active components of chondoprotectors. The course of admission can last up to six months.

During the entire course of treatment, painkillers are present, because damage to the ligaments is accompanied by constant pain. To eliminate pain, drugs such as Ibuprofen, Diclofenac, Paracetamol are prescribed.

Surgical intervention

When the meniscus is injured, the following points serve as indications for surgical manipulations:

• severe injuries;
• when cartilage is crushed and tissues cannot be restored;
• severe injuries of the meniscus horns;
• tear of the posterior horn;
• articular cyst.

The following types of surgical procedures are performed in case of damage to the posterior horn of the shock-absorbing cartilage plate:

1. resection broken elements, or meniscus. This kind of manipulation is performed with incomplete or complete anguish;
2. recovery destroyed tissues;
3. replacement destroyed tissue by implants;
4. stitching menisci. Such surgical intervention is carried out in case of fresh damage, and immediate medical attention is sought.

Let us consider in more detail the types of surgical treatment of knee injuries.

Arthrotomy

The essence of arthrotomy is reduced to the complete resection of the damaged meniscus. Such an operation is performed in rare cases when the articular tissues, including blood vessels, are completely affected and cannot be restored.

Modern surgeons and orthopedists have recognized this technique as ineffective, and is practically not used anywhere.

Partial meniscectomy

During the surgical intervention, the torn, dangling parts of the damaged meniscus are resected, and the surviving elements are restored.

When repairing the meniscus, the damaged edges are trimmed so that there is a flat surface.

Endoprosthetics

A donor organ is transplanted to replace the damaged meniscus. This type of surgical intervention is not often performed, because the rejection of donor material is possible.

Stitching of damaged tissues

Surgical treatment of this type aims to restore the destroyed cartilage tissue. Surgical intervention of this type gives positive results if the injury has affected the thickest part of the meniscus, and there is a possibility of fusion of the damaged surface.

Stitching is performed only with fresh damage.

Arthroscopy

Surgery using arthroscopic techniques is considered the most modern and effective method of treatment. With all the advantages during the operation, trauma is practically excluded.

To perform the operation, several small incisions are made in the joint cavity, through which the instrumentation is inserted along with the camera. Through the incisions, during the intervention, a saline solution is supplied.

The technique of arthroscopy is remarkable not only for its low traumatism during the procedure, but also for the fact that you can simultaneously see the true state of the damaged limb. Arthroscopy is also used as one of the diagnostic methods in making a diagnosis after damage to the meniscus of the knee joint.

How to forget about joint pain forever?

Have you ever experienced unbearable joint pain or constant back pain? Judging by the fact that you are reading this article, you already know them personally. And, of course, you know firsthand what it is:

• constant aching and sharp pains;
• inability to move comfortably and easily;
• constant tension of the back muscles;
• unpleasant crunching and clicking in the joints;
• sharp shooting in the spine or causeless pain in the joints;
• inability to sit in one position for a long time.

Now answer the question: does it suit you? Can such pain be endured? And how much money have you already spent on ineffective treatment? That's right - it's time to end this! Do you agree? That is why we decided to publish, which reveals the secrets of getting rid of pain in the joints and back.

How dangerous is the rupture of the posterior horn of the medial meniscus of the knee joint, the treatment of damage to the horns of the meniscus - these issues are of interest to patients. Movement is one of the most beautiful gifts that human nature has endowed. Walking, running - all types of movement in space are carried out thanks to a complex system, and largely depend on such a small cartilage pad, which is otherwise called the meniscus. It is located between the knee joints and serves to be a kind of shock absorber when any movement of a person occurs.

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 rupture 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.