Complete rupture of the posterior horn of the medial meniscus. How does damage to the posterior horn of the medial meniscus occur? Stages of conservative treatment

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

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

What is a meniscus

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

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

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

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

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

meniscal injury

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

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

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

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

Symptoms of a meniscus injury

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

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

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

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

Typical symptoms of a medial meniscus tear

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

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

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

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

Read also: Proper rehabilitation for a fracture of the patella

Mechanism of rupture of the posterior horn

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

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

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

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

Conservative treatments

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

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

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

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

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

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

Surgical treatment

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

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 gap is often combined with.

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 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. 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. Developing. 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:

• arthritis of various etiologies;
• gonarthrosis;
• softening of cartilage tissue;

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;
• 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. 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 in a timely manner and.

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.

The structure of the knee joint determines not only the stabilization of the knee or its shock absorption under loads, but also its mobility. Violation of the normal functions of the knee due to mechanical damage or degenerative changes leads to stiffness in the joint and loss of normal amplitude of flexion-extensor movements.

The anatomy of the knee joint distinguishes the following functional elements:

The patella or patella, located in the tendons of the quadriceps femoris, is mobile and serves as an external protection of the joint from lateral displacements of the tibia and femur;

The internal and external lateral ligaments fix the femur and tibia;

The anterior and posterior cruciate ligaments, as well as the lateral ligaments, are intended for fixation;

In addition to the tibia and femur connected to the joint, the fibula is distinguished in the knee, which serves to implement the rotation (turning movements) of the foot;

Meniscus - crescent-shaped cartilage plates designed to cushion and stabilize the joint, the presence of nerve endings allows you to signal the brain about the position of the knee joint. There are external (lateral) and internal (medial) meniscus.

The structure of the meniscus

The menisci are cartilaginous, supplied with blood vessels allowing for nutrition, as well as a network of nerve endings.

In their form, the menisci look like plates, in the form of a crescent, and sometimes a disk, in which the back and anterior horn of the meniscus as well as his body.

Lateral meniscus, also called external (external) is more mobile due to the lack of rigid fixation, this circumstance is the reason that it shifts during mechanical injuries, which prevents injury.

Unlike the lateral medial meniscus has a more rigid fixation by means of attachment to the ligaments, therefore, in case of injuries, it is damaged much more often. In most cases damage to the inner meniscus is combined in nature, that is, it is combined with trauma to other elements of the knee joint, in most cases directly to the lateral and cruciate ligaments associated with injuries posterior horn of the meniscus.

Damage types

The main factor in the operation is the type meniscal injury, since this circumstance affects the possibility or its absence while maintaining a greater meniscus area, in connection with which, there are such damages as:

Detachments from the place of attachment, in which there are detachments in the area of ​​\u200b\u200bthe posterior or anterior horn, as well as the body meniscus;
Front and rear breaks horns and bodies of menisci;
Combination of breaks and breaks;
Rupture of intermeniscal bonds (causes increased mobility and destabilization of the joint);
Chronic injuries and advanced degenerative traumatization of the meniscus(meniscopathy);
cystic formations.

To the most dangerous species meniscal injuries damage can be attributed posterior horn of the meniscus, which has intermeniscal connections, which are also injured not only under the influence of mechanical forces, but also due to degenerative changes, often associated with rupture of the lateral or cruciate ligaments.

Presence in the menisci blood vessels, cause the formation of profuse hematomas of the knee joint, as well as accumulation of fluid, can lead to loss of mobility.

If meniscus injuries are detected and possible complications are prevented, immediate conservative or surgical treatment is required.

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.

A tear in the posterior horn of the medial meniscus is one of the most dangerous knee injuries. Its symptoms include not only pain, but also loss of mobility in the affected area. The meniscus can rupture both slowly due to degenerative processes, and rapidly due to stress. Treatment is determined by the doctor depending on the severity. In many cases, surgery is indispensable.

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Types of breaks

The meniscus is a part of the knee joint that protects the bone tissue from friction and fixes the joint from the inside. The menisci are located between the bone epiphyses of the knee, stabilize its position.

The horns of the meniscus are processes of connective tissue that fix the shape of the knee joint. They do not allow the position of the bones to change relative to each other. Between the horns, the extreme parts of the meniscus, there are denser areas - this is the body of the cartilage.

The medial meniscus is fixed by horns on the bone, it is located on the inside of the lower limb. Lateral is located in the outer part. The lateral meniscus is more responsible for mobility. Therefore, its damage occurs less frequently. But the medial one stabilizes the articular joint and does not always withstand tension.

Meniscus tears are 4 out of 5 cases of all knee injuries. In most cases, they occur due to too strong loads or sudden movements.

Sometimes degenerative processes of the cartilaginous tissue of the joint become a concomitant risk factor. Osteoarthritis of the knee increases the likelihood of traumatic injury. This also includes excess weight, lack of habit of ligaments to loads.

The gap does not always occur instantly due to too much load, bumps and falls. Sometimes it develops over time. Symptoms may or may not be present in this situation. However, if the cartilaginous joint is left untreated, sooner or later its edges will rupture.

Damage to the posterior horn

Types of injuries:

Anterior horn injury

Damage to the anterior horn develops in general according to the same pattern as the posterior horn:

1. The patient often loses the ability to move.
2. The pains are piercing, not allowing to bend and unbend the leg.
3. Muscles weaken, become flabby.

The anterior horn is torn more often than the posterior horn, as it is somewhat less thick. In most cases, damage is of the longitudinal type. In addition, the ruptures are stronger and more often form flaps of cartilage tissue.

signs

The main symptom of a torn meniscus is severe pain in the knee joint. When the posterior horn is torn, the pain is localized mainly in the popliteal region. If you touch the knee with palpable pressure, the pain increases dramatically. It is almost impossible to move because of the pain.

It is easiest to understand that a gap has occurred when trying to move. The most severe pain occurs if the victim tries to straighten the lower limb or carry out other movements with the lower leg.

After injury, symptoms change depending on how much time has passed. The first month and a half pains are quite strong. If the patient has not lost the ability to walk at the same time, the pain will intensify with the slightest exertion. In addition, even ordinary walking will be accompanied by unpleasant sounds, the meniscus will crack.

The knee joint will swell and lose stability. Because of this, doctors may advise not to stand up, even if the injured person is physically capable of it.

If the rupture is not traumatic, but degenerative in nature, the symptoms become chronic. Pain here is less pronounced and manifests itself mainly during tension. Sometimes pain does not develop immediately, and the patient does not visit a doctor for a long time. This can lead to acute traumatic violation of the integrity of the joint.

To diagnose an injury, a doctor may use the following specific symptoms:

• a sharp pain pierces if you press on the front of the knee while straightening the lower leg;
• the injured lower limb can straighten more than usual;
• the skin in the knee and upper leg becomes more sensitive;
• when trying to climb the stairs, the knee joint "jams" and stops working.

Degrees

Classification of the condition of the knee cartilage according to Stoller:

Treatment

If symptoms of the third degree of severity are obvious, you need to provide first aid and call an ambulance. Before the doctors arrive, the victim must not be allowed to move. Ice should be applied to relieve pain and avoid severe swelling.

When the paramedics arrive, they will give you an injection of painkillers. After that, it will be possible, without torturing the victim, to impose a temporary splint.

This is necessary to immobilize the knee joint and prevent damage from worsening. You may need to drain fluid and blood from the joint cavity. The procedure is quite painful, but necessary.

How to treat depends on the strength of the gap and localization. The primary task of the doctor is to choose between conservative therapy and surgical.

Options

If the edges of the cartilage are torn and the flaps are blocking movement, surgery will be required. You can’t do without it either if the position of the bones relative to each other is disturbed, or the meniscus is crushed.

The surgeon can carry out the following actions:

• sew up cartilage flaps;
• remove the entire joint or posterior horn;
• fix parts of the cartilage with fixing parts made of bioinert materials;
• transplant this part of the joint;
• restore the shape and position of the knee joint.

During the operation, an incision is made in the skin. A drainage tube, a light source and an endoscopic lens are inserted through it. These devices help make the operation less traumatic.

Video "Treatment of a torn meniscus"

This video will show you how to treat a knee injury.