Posterior horn of the medial meniscus. Rupture of the posterior horn of the meniscus Rupture of the posterior meniscus

The knee joint is one of the largest and most complex in the human body. It has many different ligaments, cartilage and few soft tissues that can protect it from injury. The knee joint, like the hip joint, bears the entire load of the human body when walking, running and playing sports.

The structure of the knee with a description

This leads to frequent injuries in the knee joint. Tears of the lateral and cruciate ligaments, fractures of the condyles of the femur and tibia, fracture of the kneecap can occur, and the most common type of injury is a meniscus tear.

What is a meniscus and what is the reason for its increased injury

The menisci of the knee joint are cartilaginous plates that are located between the bones of the knee apparatus and serve as shock absorbers when walking.

The meniscus is a semicircular cartilaginous plate located between the femur and tibia. It consists of a body, posterior and anterior horns. Each meniscus is a semicircle, where the middle is the body of the meniscus, and the edges of the semicircle are the horns. The anterior horn attaches to the intercondylar eminences in the anterior part of the knee joint, and the posterior horn to the posterior ones. There are two types of menisci:

• external, or lateral - located on the outside of the knee joint, more mobile and less prone to injury;
• the inner, or medial, meniscus is less mobile, is located closer to the inner edge and is associated with the internal lateral ligament. The most common type of injury is a torn medial meniscus.

Injury to the meniscus of the knee

Menisci perform the following functions:

1. depreciation and reduction of loads on the surface of the bones of the knee;
2. an increase in the area of ​​​​contact of the surfaces of the bones, which helps to reduce the load on these bones;
3. knee stabilization;
4. proprioceptors - located in the meniscus and give signals to the brain about the position of the lower limb.

The menisci do not have their own blood supply, they are fused with the capsule of the knee joint, so their lateral parts receive blood supply from the capsule, and the internal parts only from the intracapsular fluid. There are three zones of blood supply to the meniscus:

• red zone - located next to the capsule and receiving the best blood supply,
• intermediate zone - located in the middle and its blood supply is insignificant;
• white zone - does not receive blood supply from the capsule.

Depending on the zone in which the damaged area is located, the treatment tactics are chosen. The tears located next to the capsule grow together on their own, due to the abundant blood supply, and the tears in the inner part of the meniscus, where the cartilage tissue is nourished only by the synovial fluid, do not grow together at all.

Incidence of meniscal tears

This injury is in the first place among internal injuries of the knee joint. It is more common in athletes, people involved in heavy physical labor, professional dancers and the like. More than 70% are medial meniscus tears, about 20% are lateral meniscus tears, and approximately 5% are both meniscus tears.

Damaged knee joint

According to the type of damage, there are:

• vertical longitudinal gap - according to the type of "watering can handle";
• oblique, patchwork rupture of the meniscus;
• degenerative rupture - massive reproduction of meniscus tissue;
• radial - transverse rupture;
• horizontal gap;
• damage to the anterior or posterior horns of the meniscus;
• other types of breaks.

Also share isolated damage to the internal or external meniscus or combined damage.

Causes of meniscus tears

The cause of a rupture of the menisci of the knee joint is most often an indirect traumatic effect, which leads to the fact that the lower leg turns sharply inward or outward, which causes rupture of the knee ligaments and menisci. Also, a meniscus rupture is possible with a sharp abduction or adduction of the lower leg, excessive extension at the knee, or direct injury - a sharp blow to the knee.

Meniscus tear clinic

A torn meniscus of the knee has characteristic symptoms. There are acute and chronic periods of the disease.

Acute period - lasts up to 4 - 5 weeks, meniscus rupture is accompanied by a characteristic crack, immediately after injury, acute pain appears, an increase in size, swelling, inability to move, hemorrhage into the joint cavity. Characteristic is the symptom of "floating patella" - from the accumulation of fluid in the cavity of the knee joint.

Meniscus tear - options

These symptoms are common to all injuries of the knee joint, in order to accurately determine the type of injury, an x-ray examination is necessary.

When the acute period passes into the chronic one, characteristic symptoms appear that allow confirming the diagnosis of meniscus rupture.

The symptoms of a torn meniscus are:

• Baikov's symptom is the appearance of pain during palpation in the knee area in front and simultaneous extension of the lower leg.
• Land's symptom - or the “palm” symptom - in a lying patient, the leg is bent at the knee and a palm can be placed under it.
• Turner's symptom - hyper-il hapeesthesia (increased sensitivity of the skin) under the knee and in the upper third of the lower leg.
• Perelman's symptom - the occurrence of pain and instability of the gait when descending the stairs.
• Chaklin's symptom, or "tailor's" symptom - when raising a straight leg, atrophy of the quadriceps femoris muscle and a strong tension of the tailor muscle are visible.
• The symptom of blockade is one of the most important symptoms in the diagnosis of a torn medial meniscus. With a load on the sore leg - climbing stairs, squatting - there is a “jamming” of the knee joint, the patient cannot fully straighten the leg, pain and effusion appear in the knee area.

Symptoms of damage to the medial meniscus:

• the pain is more intense in the inner side of the knee joint;
• when pressing on the place of attachment of the ligament to the meniscus, point pain occurs;
• "blockade" of the knee;
• pain during hyperextension and turning of the lower leg outward;
• pain with excessive bending of the leg.

Symptoms of damage to the lateral meniscus:

• when the knee joint is strained, pain occurs, radiating to the outer section;
• pain during hyperextension and rotation of the lower leg inside;
• weakness of the muscles of the front of the thigh.

Severity of meniscus injury

Knee injury

Depending on the severity, the doctor prescribes treatment. There are the following degrees:

1. A small torn meniscus - accompanied by minor pain and swelling in the knee. Symptoms go away within a few weeks.
2. Rupture of moderate severity - there is acute pain in the knee joint, pronounced swelling appears, movements are limited, but the ability to walk is preserved. With physical exertion, squats, climbing stairs, there is a sharp pain in the knee. These symptoms are present for several weeks, if treatment is not carried out, the disease becomes chronic.
3. Severe rupture - severe pain and swelling of the knee joint, possibly bleeding into its cavity. It is characterized by complete crushing of the meniscus or separation of parts, fragments of the meniscus fall between the articular surfaces, which causes stiffness of movements and the inability to move independently. Symptoms worsen over several days and require surgery.

With frequent microtrauma in the elderly, a chronic or degenerative stage of the disease occurs. Cartilage tissue under the influence of numerous damages loses its properties, undergoing degeneration. With physical exertion or for no apparent reason, knee pain, swelling, gait disturbance, and other symptoms of meniscus damage appear.

Diagnosis of meniscus rupture

The diagnosis is established by the characteristic clinical picture, examination data and laboratory research methods. To make such a diagnosis, an X-ray examination, MRI or arthroscopy of the knee joint is necessary.

X-ray examination of the meniscus

The main symptom of a meniscus tear is pain and swelling of the knee. The severity of this symptom depends on the severity of the injury, its location and the time that has elapsed since the injury. An orthopedic surgeon conducts a detailed examination of the injured joint and performs the necessary diagnostic procedures.

X-ray examination is a fairly simple method of diagnosis. Menisci are not visible on X-ray images, therefore, studies are carried out using contrast agents or more modern research methods are used.

Arthroscopy is the most informative research method. With the help of a special device, you can look inside the damaged knee, accurately determine the location and severity of the rupture, and, if necessary, perform medical procedures.

Medical and surgical treatment

The choice of therapeutic agents depends on the location of the rupture and the severity of the injury. In case of rupture of the meniscus of the knee joint, treatment is carried out conservatively or surgically.

Conservative treatment

1. Providing first aid to the patient:
   • complete rest;
   • applying a cold compress;
   • - anesthesia;
   • puncture - to remove accumulated fluid;
   • plaster cast.
2. Bed rest.
3. Imposition of a plaster splint for up to 3 weeks.
4. Elimination of blockade of the knee joint.
5. Physiotherapy and therapeutic exercises.
6. Taking non-steroidal anti-inflammatory drugs - diclofenac, ibuprofen, meloxicam.
7. Taking chondroprotectors that help restore cartilage tissue, accelerate the regeneration and fusion of cartilage - chondratin sulfate, glucosamine and others.
8. External means - use various ointments and creams for rubbing - Alezan, Ketoral, Voltaren, Dolgit and so on.

With proper treatment, no complications, recovery occurs within 6-8 weeks.

Indications for surgical treatment of meniscus rupture:

1. crushing the cartilaginous tissue of the meniscus;
2. rupture and displacement of the meniscus;
3. the presence of blood in the cavity;
4. detachment of the horns and body of the meniscus;
5. lack of effect from conservative therapy for several weeks.

In these cases, surgical intervention is prescribed, which can be carried out by such methods:

1. Removal of the meniscus or meniscectomy - removal of part of the meniscus or the entire meniscus is indicated with complete decomposition of the cartilage tissue, tearing off a significant part of the meniscus, and complications. Such an operation is considered too traumatic, causes arthritis, maintains inflammation and effusion in the knee joint, and leads to relief from joint pain in only 50-70% of cases.
2. Meniscus repair – The meniscus plays an important role in the biomechanics of the knee joint and surgeons today strive to preserve the meniscus and, if possible, restore it. This operation is usually carried out by young, active people and under certain conditions. It is possible to restore the meniscus in such cases as:
   • longitudinal vertical rupture of the meniscus,
   • peripheral tear,
   • detachment of the meniscus from the capsule,
   • peripheral rupture of the meniscus with its possible displacement to the center,
   • no degenerative changes in cartilage tissue,
   • young age of the patient.

   In this operation, it is necessary to take into account the prescription and localization of the gap. Fresh trauma and localization in the red or intermediate zone, the patient's age up to 40 years increase the chances of a successful operation.

3. Arthroscopic is the most modern and atraumatic method of surgical intervention. With the help of an arthroscope, visualization of the injury site and surgical intervention are performed. The advantages of this method are the minimal disruption of the integrity of the surrounding tissues, as well as the possibility of performing interventions inside the knee. To suture the meniscus from the inside, special needles with non-absorbable suture material are used to connect the gap in the cavity of the knee joint through the cannula of the arthroscope. Seams with this method can be applied tightly, perpendicular to the line of the gap, which makes the seam stronger. This method is suitable for ruptures of the anterior horn or body of the meniscus. In 70-85% of cases, there is a complete fusion of cartilage tissue and restoration of the functions of the knee joint.
4. Fastening the meniscus with special arrow-shaped or dart-shaped retainers. This allows you to fasten the meniscus without additional incisions or the use of special devices, such as an artoscope. Apply absorbable fixatives of the first and second generation. The first generation fixators were made from a material that took longer to dissolve, they had more weight, and in connection with this, complications occurred more often in the form of inflammation, granuloma formation, effusion, damage to the articular cartilage, and the like. Second-generation fixators absorb faster, have a more rounded shape, and the risk of complications is much lower.
5. Transplantation of the meniscus - today, thanks to the development of transplantology, it becomes possible to carry out a complete replacement of the damaged meniscus and restore its functions. Indications for surgery are complete crushing of the meniscus, the impossibility of recovery in other ways, a significant deterioration in the patient's standard of living, and the absence of contraindications.

Contraindications for transplantation:

• degenerative changes;
• knee instability;
• elderly age;
• the presence of somatic diseases.

Rehabilitation

The recovery period after an injury is important. It is necessary to carry out a whole range of rehabilitation measures:

• conducting special training and exercises aimed at developing the knee joint;
• the use of chondroprotectors, non-steroidal anti-inflammatory drugs;
• massage and physiotherapy;
• lack of physical activity for 6-12 months.

The consequences of rupture of the meniscus of the knee joint with proper and timely treatment are practically absent. Pain on exertion, unsteady gait, and the possibility of recurrence of injury may persist.

It is necessary to perform a set of special exercises that the doctor should prescribe, taking into account the location, severity of the injury, the presence or absence of complications, the age of the patient and other related circumstances.

Stages of rehabilitation after a rupture of the meniscus of the knee joint

Rehabilitation after such an injury consists of 5 stages. Once you reach your goals, you can move on to the next stage. The task of any rehabilitation program is to restore the normal functioning of the damaged organ.

• Stage 1 - its duration is 4-8 weeks, during this time it is necessary to expand the range of motion in the damaged joint as much as possible, reduce the swelling of the joint and start walking without crutches.
• Stage 2 - up to 2.5 months. It is necessary to restore the full range of motion in the joint, completely remove swelling, regain control over the knee joint when walking and start training muscles weakened after an injury.
• Stage 3 - to achieve a complete restoration of the range of motion in the knee joint during sports, training and running, to restore muscle strength. At this stage, they begin to actively conduct physical therapy classes and gradually return to the usual rhythm of life.
• Stage 4 - training, its goal is to achieve the opportunity to play sports, run, give a full load on the joint without any pain. Increasing the strength of the muscles of the injured limb.
• Stage 5 - restoration of all lost functions of the knee joint.

After the stages of rehabilitation, it is necessary to reduce the load on the injured joint, try to avoid situations in which there is a risk of injury and take preventive measures. These include exercises to strengthen muscle strength, with the help of special exercises, taking chondroprotectors and drugs that improve peripheral circulation. When playing sports, the use of special knee pads is recommended, which reduce the risk of injury.

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

Anatomical structure

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

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

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

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

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

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

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

Functional Features

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

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

The functional purposes of the menisci are different:

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

Break shapes

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

In modern traumatology, several types of ruptures are distinguished:

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

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

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

It happens:

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

The combined gap is characterized by:

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

Signs of breaks

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

The main symptoms include:

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

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

Causes and mechanisms

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

Injury occurs due to:

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

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

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

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

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

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

Diagnostics

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

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

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

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

Medical tactics

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

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

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

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

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.

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.

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.

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

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.

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Anatomy

The menisci of the knee joint are crescent-shaped cartilage formations that increase the congruence of the articular surfaces, act as shock absorbers in the joint, participate in the nutrition of the hyaline cartilage, and also stabilize the knee joint. When moving in the knee joint, the menisci move in different directions, slide along the tibial plateau, their shape and tension may change. There are two menisci of the knee joint:
- medial meniscus
- outer (lateral) meniscus

The menisci are made up of fibrous cartilage. As a rule, the menisci are crescent-shaped, although there are variants of disc-shaped menisci (more often external). On a transverse section, the shape of the meniscus is close to a triangle, the base facing the joint capsule.

Allocate meniscus body, anterior and posterior horn of the meniscus. The medial meniscus forms a larger semicircle than the lateral one. Its narrow anterior horn inserts on the medial part of the intercondylar eminence, anterior to the ACL (anterior cruciate ligament), while its wide posterior horn inserts on the lateral part of the intercondylar eminence, anterior to the PCL (posterior cruciate ligament) and posterior to the insertion of the lateral meniscus. The medial meniscus is firmly fixed to the joint capsule throughout and therefore less mobile, which leads to a greater frequency of its damage. The lateral meniscus is wider than the medial one and has an almost annular shape. Also, the lateral meniscus is more mobile, which reduces the frequency of its rupture.

It is carried out from the arteries of the joint capsule. According to the degree of blood supply 3 zones. The most well-perfused area of ​​the meniscus is located closer to the joint capsule (red zone). The inner parts of the menisci do not have their own blood supply (white zone), the nutrition of this part is carried out due to the circulation of the intraarticular fluid. Therefore, meniscal injuries near the joint capsule (paracapsular tears) are more likely to heal, and tears on the inside of the meniscus tend not to heal. These features largely determine the tactics of treating meniscus damage, and the possibility of performing a meniscus suture.

According to the localization of damage, there are several types of meniscal injury: damage to the body of the meniscus (rupture like a "watering can handle", longitudinal tear, transverse tear, horizontal tear, patchwork tear, etc.), damage to the anterior or posterior horn of the meniscus, paracapsular damage.

There are both isolated damage to the internal or external meniscus, and their combined damage. Sometimes a meniscal injury is part of a more complex injury to the structures of the knee joint.

Symptoms

Meniscus injury are among the most common pathologies of the knee joint.

The typical mechanism of meniscus injury is injury caused by rotation of a bent or half-bent leg at the time of its functional load, with a fixed foot (playing football, hockey, other game sports, collisions, falling while skiing).

Less often, meniscal tears occur when squatting, jumping, uncoordinated movement. Against the background of degenerative changes, an injury that leads to damage to the meniscus may be minor.

In the clinical picture of meniscus injury, it is customary to distinguish between acute and chronic periods. Acute period occurs immediately after the initial injury. The patient develops strong pain in the knee joint, limitation of movement due to pain, sometimes the lower leg is fixed in the flexion position ( blockade of the joint). In an acute case, a meniscus tear is often accompanied by bleeding into the cavity of the knee joint ( hemarthrosis). There is swelling of the joint area.

Often, meniscus damage in recent cases is not diagnosed, often a bruised joint or sprain is diagnosed. As a result of conservative treatment, primarily due to the fixation of the leg and the creation of rest, the condition gradually improves. However, with serious damage to the meniscus, the problem remains.

After some time, when the load is resumed, or with a repeated minor injury, and often with an awkward movement, pain again occurs, joint function is impaired, synovial fluid in the joint accumulates again ( post-traumatic synovitis), or blockades of the joint are repeated. This is the so-called chronic period diseases. In this case, one can say about stale or chronic damage to the meniscus.

Typical symptoms: The patient complains of pain in the projection of the meniscus during movement, and usually can clearly show the pain point. Limitation of range of motion (impossibility of full extension of the leg, or full squat). violation of movements in the knee joint. A symptom of joint blockade, when the torn part of the meniscus moves in the joint cavity and is periodically infringed between the articular surfaces of the femur and tibia. In some cases, the patient himself knows how to eliminate the resulting block of the joint or resorts to the help of outsiders. After the blockade of the joint is eliminated, movements in it again become possible in full. Periodically, reactive inflammation of the inner lining of the joint occurs, synovial fluid accumulates in the joint - post-traumatic synovitis. Gradually, weakening and impaired coordination of muscles develops - muscle hypotrophy, impaired gait.

An additional danger of chronic meniscus damage is the gradual damage to the articular cartilage, and the development of post-traumatic arthrosis.

Diagnosis of meniscal injury includes taking an anamnesis, a clinical examination by a specialist, and instrumental research methods. To exclude damage to bone structures and clarify the relationship between the components of the joint, as a rule, an x-ray examination is performed (damage to the menisci is not visible on the pictures, since the menisci are transparent to x-rays). To visualize menisci and other intra-articular structures, the most informative non-invasive method at present is magnetic resonance imaging (MRI), computed tomography (CT), ultrasound diagnostics (ultrasound) is also used.

1 intact menisci.
2 Damage to the posterior horn of the meniscus.

Traumatic injuries of the menisci are often combined with damage to other structures of the knee joint: cruciate ligaments, lateral ligaments, cartilage, knee joint capsule.

The most accurate and complete diagnosis is carried out during the initial stage of arthroscopic surgery, during examination and revision of all parts of the joint.

Treatment of meniscal injuries

Conservative treatment: First aid is usually anesthesia, puncture of the joint, removal of blood accumulated in the joint, if necessary, the blockade of the joint is eliminated. To create rest, a plaster splint bandage or splint is applied. The term of immobilization is 3-4 weeks (sometimes up to 6 weeks). A protective regimen is prescribed, local cold, observation in dynamics, non-steroidal anti-inflammatory drugs. After some time, physiotherapy exercises, walking with a cane or crutches, physiotherapy are added. With a favorable course, restoration of function and return to sports loads is achieved in 6-8 weeks.

If it is not possible to eliminate the blockade of the joint, or after conservative treatment, the blockade of the joint occurs again, the patient is constantly worried about pain in the joint, difficulty walking - surgical treatment is indicated.

To date, the most effective treatment is arthroscopic surgery.

The operation is closed. Through 2 punctures (0.5 cm each), an arthroscope and the necessary instruments are inserted into the joint cavity. An examination of all parts of the joint is carried out, the nature and degree of damage to the meniscus is specified. Depending on the nature and location of the damage, the issue of the need to remove the damaged part of the meniscus, or the possibility of a meniscus suture, is decided.

A bit of history: In 1962, Professor Watanabe M. described the technique and performed the first endoscopic operation - a partial resection of the meniscus. In 1971 O'Connor R.L. gets acquainted with the new technique of meniscus resection and begins to apply it in his clinic. In 1975 O'Connor R.L. published the first results of arthroscopic operations, and describes the technique of endoscopic resection of a damaged meniscus fragment with subsequent alignment of the remaining part. The first works on performing an arthroscopic meniscus suture with a description of the technique and instruments were published by Wirth C.R., 1981; Stone R.G., Miller G., 1982. These works marked a new stage in meniscus surgery, since previously these operations were performed only in an open way. In modern times, most operations for meniscal injury are performed arthroscopically.

The arthroscopic technique of the operation allows the most careful treatment of the tissues of the joint. As a rule, only the damaged part of the meniscus is removed, and the edges of the defect are aligned. The greater part of the intact meniscus can be preserved, the less likely the progression of post-traumatic changes in the joint. Complete removal of the meniscus leads to the development of severe arthrosis.
With a fresh injury, and the localization of damage is closer to the paracapsular zone, an operation can be performed - an arthroscopic meniscus suture.

The decision on the tactics of the treatment is made by the operating surgeon during the operation, based on the study of the damaged meniscus and technical capabilities.

Due to the low invasiveness of the operation, the inpatient stage of treatment usually takes 1-3 days. In the postoperative period, physical activity is limited to 2-4 weeks. In some cases, walking on crutches and wearing a knee brace is recommended. Rehabilitation treatment can begin from the first week. Full recovery and return to sports activities usually occur within 4-6 weeks.

With timely diagnosis and a skilled operation, the treatment gives excellent functional results and allows you to fully restore physical activity.

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Development mechanism

The knee has a complex structure. The joint includes the surfaces of the condyles of the femur, the cavity of the lower leg, and the patella. For better stabilization, cushioning and load reduction, paired cartilaginous formations are localized in the joint space, which are called medial (internal) and lateral (external) menisci. They have the shape of a crescent, the narrowed edges of which are directed forward and backward - the anterior and posterior horns.

The outer meniscus is a more mobile formation, therefore, with excessive mechanical action, it shifts slightly, which prevents its traumatic damage. The medial meniscus is fixed by ligaments more rigidly; when exposed to mechanical force, it does not move, as a result of which damage occurs more often in various departments, in particular in the region of the posterior horn.

The reasons

Damage to the posterior horn of the medial meniscus is a polyetiological pathological condition that develops under the influence of various factors:

• The impact of kinetic force in the knee area in the form of a blow or fall on it.
• Excessive bending of the knee, leading to tension in the ligaments that fix the menisci.
• Rotation (rotation) of the femur with a fixed lower leg.
• Frequent and long walking.
• Congenital changes that cause a decrease in the strength of the knee ligaments, as well as its cartilage.
• Degenerative-dystrophic processes in the cartilaginous structures of the knee, leading to their thinning and damage. This cause is most common in the elderly.

Finding out the reasons allows the doctor not only to choose the optimal treatment, but also to give recommendations regarding the prevention of re-development.

Kinds

Violation of the structure and shape of the medial meniscus in the region of the posterior horn is classified according to several criteria. Depending on the severity of the injury, there are:

Depending on the main causative factor that led to the development of the pathological condition of the cartilaginous structures of the knee, traumatic and pathological degenerative damage to the posterior horn of the medial meniscus is distinguished.

According to the criterion of prescription of an injury or a pathological violation of the integrity of this cartilaginous structure, fresh and chronic damage to the posterior horn of the medial meniscus is distinguished. Combined damage to the body and the posterior horn of the medial meniscus is also highlighted separately.

Manifestations

Clinical signs of damage to the posterior horn of the medial meniscus are relatively characteristic and include:

• Pain that is localized on the inner surface of the knee joint. The severity of pain depends on the cause of the violation of the integrity of this structure. They are more intense with traumatic injury and increase dramatically while walking or going down stairs.
• Violation of the condition and functions of the knee, accompanied by a limitation of the fullness of range of motion (active and passive movements). With a complete detachment of the posterior horn of the medial meniscus, a complete block in the knee may occur against the background of sharp pain.
• Signs of the development of inflammation, including hyperemia (redness) of the skin of the knee area, swelling of the soft tissues, as well as a local increase in temperature, which is felt after touching the knee.

With the development of a degenerative process, the gradual destruction of cartilage structures is accompanied by the appearance of characteristic clicks and a crunch in the knee during movements.

Clinical manifestations are the basis for the doctor to prescribe an objective additional diagnosis. It includes research, primarily aimed at visualizing the internal structures of the joint:

Arthroscopy also allows for therapeutic manipulations under visual control after additional introduction of special microinstrumentation into the joint cavity.

Damage to the posterior horn of the medial meniscus - treatment

After an objective diagnosis with the determination of localization, the severity of the violation of the integrity of the cartilaginous structures of the joint, the doctor prescribes a comprehensive treatment. It includes several areas of activities, which include conservative therapy, surgical intervention, as well as subsequent rehabilitation. Mostly all events complement each other and are assigned sequentially.

Treatment without surgery

If partial damage to the posterior horn of the medial meniscus was diagnosed (grade 1 or 2), then conservative treatment is possible. It includes the use of drugs of various pharmacological groups (non-steroidal anti-inflammatory drugs, vitamin preparations, chondroprotectors), the performance of physiotherapeutic procedures (electrophoresis, mud baths, ozocerite). During therapeutic measures, functional rest for the knee joint is necessarily ensured.

The main goal of the operation is to restore the anatomical integrity of the medial meniscus, which allows to ensure the normal functional state of the knee joint in the future.

Surgical intervention can be performed with open access or with the help of arthroscopy. Modern arthroscopic intervention is considered the method of choice, since it is less traumatic and can significantly reduce the duration of the postoperative rehabilitation period.

Rehabilitation

Regardless of the type of treatment performed, rehabilitation measures are necessarily prescribed, which include the performance of special gymnastic exercises with a gradual increase in the load on the joint.

Timely diagnosis, treatment and rehabilitation of violations of the integrity of the medial meniscus of the knee allows you to achieve a favorable prognosis for the restoration of the functional state of the knee joint.

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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 lining 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.

meniscus tears

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.

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.

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?

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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 severe. 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.

All manipulations with the meniscus, including removal, are carried out with thin instruments inserted through the incision. This provides not only less "bloody" operation, but in principle makes it possible. The region of the posterior horn is difficult to reach, and only in this way can it be influenced.

Conservative therapy and rehabilitation after surgery may include:

The menisci of the knee joint are cartilaginous plates that are located between the bones of the knee apparatus and serve as shock absorbers when walking.

The meniscus is a semicircular cartilaginous plate located between the femur and tibia. It consists of a body, posterior and anterior horns. Each meniscus is a semicircle, where the middle is the body of the meniscus, and the edges of the semicircle are the horns. The anterior horn attaches to the intercondylar eminences in the anterior part of the knee joint, and the posterior horn to the posterior ones. There are two types of menisci:

• external, or lateral - located on the outside of the knee joint, more mobile and less prone to injury;
• the inner, or medial, meniscus is less mobile, is located closer to the inner edge and is associated with the internal lateral ligament. The most common type of injury is a torn medial meniscus.

Injury to the meniscus of the knee

Menisci perform the following functions:

1. depreciation and reduction of loads on the surface of the bones of the knee;
2. an increase in the area of ​​​​contact of the surfaces of the bones, which helps to reduce the load on these bones;
3. knee stabilization;
4. proprioceptors - located in the meniscus and give signals to the brain about the position of the lower limb.

The menisci do not have their own blood supply, they are fused with the capsule of the knee joint, so their lateral parts receive blood supply from the capsule, and the internal parts only from the intracapsular fluid. There are three zones of blood supply to the meniscus:

• red zone - located next to the capsule and receiving the best blood supply,
• intermediate zone - located in the middle and its blood supply is insignificant;
• white zone - does not receive blood supply from the capsule.

Depending on the zone in which the damaged area is located, the treatment tactics are chosen. The tears located next to the capsule grow together on their own, due to the abundant blood supply, and the tears in the inner part of the meniscus, where the cartilage tissue is nourished only by the synovial fluid, do not grow together at all.

Athletes and people leading an active lifestyle face this problem. The meniscus of the knee joint is a shock absorber made up of cartilage.

As it moves, it shrinks. There are two layers of cartilage in the knee - outer (lateral) and inner (medial).

If damage occurs to the second, splicing is more difficult. Without diagnostics, it is difficult to distinguish a tear from a bruise.

Injuries can be traumatic (with sudden movement) and degenerative (due to age). The detached part of the cartilage tissue interferes with walking, causing pain.

Causes of a torn meniscus

• Meniscus injuries are typical for active people aged 10-45 years.
• Degenerative changes- common in people over 40 years of age.

Traumatic ruptures are the result of combined injuries. Outward rotation of the lower leg leads to damage to the medial layer, and internal rotation affects the outer one.

Rarely, direct injury occurs - a meniscus bruise, for example, when hitting the edge of a step during a fall.

Side impacts to the knee (knee joint) cause the pad to shift and compress, which is common in football players. Landing on the heels with rotation of the lower leg is a typical example of injury. However, injuries in people under 30 are observed only with extremely serious falls and bumps.

Asymptomatic lesions are often found on MRI in middle-aged or elderly patients. A tear in the meniscus leads to arthrosis, but also due to degenerative changes, a spontaneous weakening of the structure of the cartilage pads occurs.

Degeneration in middle and old age is a sign of the early stages of osteoarthritis. Arthrosis, gout, overweight, ligament weakness, muscle atrophy, and standing work increase the risk of disease.

Degenerative lesions become part of the aging process as collagen fibers break down, reducing structural support. By the way, due to aging, not only the risk of the disease increases, but also complications after a knee joint injury.

Internal drying of cartilage begins closer to 30 years and progresses with age. The fibrocartilaginous structure becomes less elastic and supple,

This is what a meniscus crack looks like

therefore, a breakdown can occur with minimal unusual load. For example, when a person squats down.

A meniscus tear can take on a variety of geometric patterns and any

location. Injuries exclusively to the anterior horns are isolated and exceptional cases. Usually, the posterior horns of the meniscus of the knee joint are affected, and then the deformities spread to the body and anterior zones.

If the meniscus fracture runs horizontally, simultaneously affecting the upper and lower segments, this does not lead to blockage of the joint.

Radial or vertical lesions tend to dislodge the meniscus, and moving fragments can cause joint pinching and pain.

The plate can break away from the attachment area, become excessively mobile when the ligaments are damaged.

The structure and anatomical features of the location of the menisci cause a high incidence of pathologies in different age categories. Athletes who are prone to ruptures, injuries and cysts are at risk.

Possible causes of cartilage lining ruptures:

• improper formation or sprain of ligaments;
• flat feet;
• improperly formed knee joint;
• the presence of gout, syphilis, tuberculosis, rheumatism and other diseases that can affect the joints;
• excess weight.

The most common causes of a meniscus tear are:

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

After the age of 50, a meniscus tear can be triggered by degenerative changes in the composition of the bones.

• traumatic injuries;
• degenerative damage.

Injuries due to indirect or combined injuries are experienced by young people.

meniscus tear

• forced extensor movements;
• increased load on the knee;
• prolonged static position of the joint;
• unnatural movements in the form of torsion, walking on toes, goose step;
• ligament weakness;
• direct injury due to a fall, blow to the knee.

In this case, damage to the medial meniscus occurs during extensor actions, and rupture of the external meniscus occurs during rotation of the lower leg inward.

For older patients, chronic and degenerative ruptures of the medial meniscus are characteristic.

Among the traumatic pathologies of the articular apparatus, knee injuries occupy a special place in terms of frequency, complexity and significance of the consequences, due to its complex structure and a smaller amount of soft tissues that protect the bone part of the joint from damage.

The most common diagnosis is a rupture of the meniscus of the knee joint.

The injury is widespread among athletes, occurs with uncontrolled loads on the legs, comorbidities, and in aged patients with developed arthrosis.

Anatomy and functions of the meniscus

The meniscus is a small cartilage that looks like a crescent, with a fibrous structure, located in the space between the articular surfaces of the femur and tibia.

Of the functions, the most important is the cushioning of movements, the meniscus also reduces joint friction and ensures full contact of the joint surfaces.

There are two menisci in the knee joint:

• external, also called lateral;
• internal, also called medial.

The lateral meniscus, which is more mobile and dense in structure, is injured to a lesser extent, the medial is attached by a ligament to the bone and joint capsule, and is more susceptible to damage.

The anatomy of the meniscus includes a body that passes into two horns. The edge, or red area, is the most dense part of the organ, with a dense network of blood vessels, and recovers faster after damage than the central white area - a thin part devoid of capillaries.

Classification and causes of meniscal injuries

Depending on the severity of the injury and the point of application of its impact, damage can be as follows:

• Rupture of the posterior horn of the medial meniscus, can be internal, transverse or longitudinal, patchwork, fragmented. The anterior horn is affected less frequently. According to the degree of complexity, the gap can be complete and partial.
• A tear at the point of attachment to the joint, in the area of ​​the body in the pericapsular region, and a horizontal tear of the posterior horn. It is considered the most serious injury to the meniscus cartilage, which requires the intervention of surgeons to avoid pinching the meniscus, blocking the joint and destroying adjacent cartilage.
• Pinching of the meniscus - this happens in almost 40% of cases of rupture or tearing of cartilage, when part of the meniscus blocks the joint in movements.
• Associated injuries.
• Chronic cartilage degeneration, permanent trauma and degeneration into a cyst.
• Pathological mobility due to injury of the meniscus ligaments or degenerative processes of its tissue structures.

A torn meniscus is most often caused by acute trauma. At risk are athletes and people with high physical activity. The age of occurrence is from 18 to 40 years. In childhood, trauma is rare, due to the peculiarities of the anatomy of the body.

Provoking factors:

1. Spinning on one leg, not looking up from the surface.
2. Intense running, jumping on an unsuitable surface.
3. Long squatting position, intensive walking in single file.
4. Congenital or acquired weakness of the articular apparatus of the knee.
5. Cartilage degeneration, when even a small injury can cause a rupture.

Types of therapy for meniscus injury

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

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

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

If the diagnosis of a torn meniscus of the knee joint is confirmed, treatment without surgery includes the following areas:

1. conservative therapy.
2. Treatment with folk methods.

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

The severity of a meniscus tear

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

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

Symptoms and signs

With such a pathology as a traumatic rupture of the meniscus of the knee joint, the symptoms are expressed:

1. Severe pain that occurs immediately after injury. Damage is accompanied by a specific click. Over time, the sharp pain subsides and manifests itself in moments of stress on the joint. It is difficult for the patient to make flexion movements.
2. Movement problems. Walking with damage to the external meniscus of the knee joint is given through pain. With a rupture of the internal meniscus, it is problematic to climb the stairs, such a symptom is still often found with direct direct injuries of the meniscus.
3. Joint blockade. Such signs of damage occur when a piece of cartilage drastically changes its location and prevents the normal movement of the joint.
4. Puffiness. This symptom appears a couple of days after injury and is associated with the accumulation of intra-articular fluid.
5. Hemarthrosis. Intra-articular accumulation of blood is a sign of a rupture of the red zone of the meniscus, which has its own blood supply.

Symptoms of damage of a degenerative nature are associated with the specifics

• pains of varying intensity; (one cannot speak of pain as one single symptom; rather, the symptom itself in the form of pain can be different, depending on the nature of it).
• inflammatory process (this symptom is accompanied by swelling);
• violation of motor abilities;
• accumulation of intra-articular fluid;
• degenerative structural changes.

With an old rupture of the meniscus of the knee joint, the process has a chronic form, which is accompanied by mild pain.

Pain makes itself felt with certain movements with unpredictable exacerbations. What is especially dangerous is the rupture of the meniscus of the knee joint, with it complete blockades can appear.

Symptoms of a torn meniscus

• knee flexion is painfully limited when the posterior horn is affected;
• extension of the knee is painful with lesions of the body and anterior horn.

Pain is localized inside the joint, a feature on the inside;

Noticeable soreness with strong flexion;

- weaken the muscles of the anterior surface of the thigh;

Shootings during muscle tension;

Pain in the tibial ligament when bending the knee and turning the lower leg outward;

Joint blockade;

Accumulation of joint fluid.

Pain in the peroneal lateral ligament radiating to the outer part of the knee;

Muscular weakness of the front of the thigh.

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

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

Acute injury to the meniscus is manifested by:

1. Sharp and severe pain.
2. Edema.
3. Impaired joint mobility.

The meniscus of the knee joint is a cartilaginous formation that has a crescent shape. The main task of the meniscus is to perform a shock-absorbing function and stabilize the knee joint.

The meniscus also takes part in the nutrition of hyaline cartilage. During movements in the knee joint, sliding movements of the menisci occur along the surface of the tibia, while their shape may change slightly.

There are two menisci in the knee joint:

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

The knee joint is one of the largest in the human body. It has a rather complex structure and includes many cartilages and ligaments.

Along with this, there is little soft tissue in this part of the body that could protect it from damage.

That is why injuries of the knee joint are diagnosed quite often, and one of the most common injuries is a meniscus tear.

The structure of the meniscus

The meniscus is a cartilaginous formation shaped like a crescent. It is located between the lower leg and thigh and is a kind of gasket between the articular ends of the bones.

The meniscus performs a number of functions, the main of which is the cushioning of movement and protection of the articular cartilage. In addition, it performs a stabilizing function, which is aimed at increasing the mutual correspondence of all articular surfaces in contact with each other.

Also, the meniscus helps to significantly reduce friction in the joints.

There are two menisci in the knee joint:

1. outer;
2. interior.

The outer meniscus is more mobile, and therefore damaged much less frequently than the inner one.

The blood supply to the meniscus also has certain features. The fact is that in newborns, blood vessels permeate their entire tissue, but already at nine months, the vessels completely disappear from the inside.

As we age, the blood supply to the meniscus deteriorates. From this point of view, two zones are distinguished - white and red.

Damage classification

There are such types of damage to the meniscus of the knee joint:

• Separation from the place of attachment. This can occur in the region of the body of the meniscus in the paracapsular zone or in the region of the anterior and posterior horns.
• Rupture of the body of the meniscus. This can occur in the transchondral region, as well as in the region of the posterior and anterior horns.
• All sorts of combinations of such damage.
• Excessive movement of the menisci. This may be a degeneration of the meniscus or a rupture of its ligaments.
• Chronic degeneration or traumatization of the meniscus, cystic degeneration.

Meniscus tears can also have several varieties:

• longitudinal;
• transverse;
• patchwork;
• fragmented.

According to the degree of complexity, there are complete and incomplete breaks.

Diagnosis of meniscus rupture

The diagnosis is established by the characteristic clinical picture, examination data and laboratory research methods. To make such a diagnosis, an X-ray examination, MRI or arthroscopy of the knee joint is necessary.

X-ray examination of the meniscus

The main symptom of a meniscus tear is pain and swelling of the knee. The severity of this symptom depends on the severity of the injury, its location and the time that has elapsed since the injury. An orthopedic surgeon conducts a detailed examination of the injured joint and performs the necessary diagnostic procedures.

X-ray examination is a fairly simple method of diagnosis. Menisci are not visible on X-ray images, therefore, studies are carried out using contrast agents or more modern research methods are used.

Arthroscopy is the most informative research method. With the help of a special device, you can look inside the damaged knee, accurately determine the location and severity of the rupture, and, if necessary, perform medical procedures.

During the initial examination, the surgeon or traumatologist perform provocative tests to identify the characteristic signs of a meniscus tear:

• The McMurray test shows an increase in pain when the doctor presses on the inside of the joint space of the half-flexed knee and simultaneously unbends and turns the leg outward, holding on to the foot.
• The Apley test is performed lying on the stomach: the doctor presses on the foot of the leg bent at the knee and performs a turn. With external rotation, an injury of the lateral cartilage is diagnosed, with internal rotation - the medial one.
• Baikov's test - with pressure on the joint space and extension of the knee, pain increases.

Detected knee pain when descending stairs indicates Perelman's symptom and the need to diagnose problems.

Diagnosis of the disease can be carried out using the following studies:

1. Magnetic resonance imaging;
2. CT scan;
3. radiography;
4. Diagnostic arthroscopy.

The diagnosis of meniscus injury is most often established on the basis of patient complaints and an objective examination of the damaged area. To specify the diagnosis, the severity and nature of the damage are prescribed instrumental studies.

It is considered inappropriate to prescribe a simple radiography of the knee joint, since the meniscus is not visible on a conventional x-ray. X-ray images with contrasting of the knee joint can help to make a more accurate diagnosis, however, this method has lost its relevance compared to more modern diagnostic methods.

The main methods by which meniscal injuries can be detected are:

Ultrasound procedure

The principle of operation of ultrasound is based on the fact that different tissues of the body transmit and reflect ultrasonic waves in different ways. The sensor of the ultrasound machine receives the reflected signals, which then undergo special processing and are displayed on the screen of the machine.

Advantages of the ultrasonic research method:

• harmlessness;
• efficiency;
• low cost;
• ease of reading the results;
• high sensitivity and specificity;
• non-invasiveness (the integrity of tissues is not violated).

No special preparation is required for an ultrasound of the knee joint. The only requirement is that intra-articular injections should not be performed a few days before the study.

For better visualization of the menisci, the examination is carried out with the patient reclining with legs bent at the knee joints.

Pathological processes in the meniscus, which are detected by ultrasound:

• ruptures of the posterior and anterior horns of the menisci;
• excessive mobility;
• the appearance of meniscus cysts (pathological cavity with contents);
• chronic injury and degeneration of the menisci;
• detachment of the meniscus from the place of its attachment in the region of the posterior and anterior horns and the body of the meniscus in the paracapsular zone (the area around the joint capsule).

Also, ultrasound of the knee joint can find not only pathological processes, but also some signs that indirectly confirm the diagnosis of meniscus rupture.

Symptoms that indicate damage to the meniscus on ultrasound of the knee joint:

• violation of the meniscus contour line;
• the presence of hypoechoic areas and bands (areas with low acoustic density, which look darker on ultrasound compared to surrounding tissues);
• the presence of effusion in the joint cavity;
• signs of edema;
• displacement of the lateral ligaments.

CT scan

Computed tomography is a valuable method in the study of injuries of the knee joint, but it is the lesions of the meniscus, ligaments and soft tissues that are not very high on CT.

These tissues are better seen on MRI, so it is more appropriate to prescribe magnetic resonance imaging of the knee joint in case of damage to the menisci.

Magnetic resonance imaging

MRI is a highly informative method for diagnosing meniscal injuries. The method is based on the phenomenon of nuclear magnetic resonance. This method makes it possible to measure the electromagnetic response of nuclei to their excitation by a certain combination of electromagnetic waves in a constant magnetic field of high intensity. The accuracy of this method in diagnosing meniscal injuries is up to 90 - 95%. The study usually does not require special training. Immediately before the MRI, the subject must remove all metal objects (glasses, jewelry, etc.).

). During the examination, the patient should lie flat and not move. If the patient suffers from nervousness, claustrophobia, then he will first be given

sedative drug Classification of the degree of meniscus change visualized on MRI (according to Stoller):

1. normal meniscus (no change);
2. the appearance in the thickness of the meniscus of a focal signal of increased intensity, which does not reach the surface of the meniscus;
3. the appearance in the thickness of the meniscus of a casting signal of increased intensity, which does not reach the surface of the meniscus;
4. the appearance of a signal of increased intensity, which reaches the surface of the meniscus.

Only changes of the third degree are considered a true meniscus tear. The third degree of changes can also be conditionally divided into degrees 3-a and 3-b.

Grade 3-a is characterized by the fact that the rupture extends only to one edge of the articular surface of the meniscus, and degree 3-b is characterized by the spread of the rupture to both edges of the meniscus.

You can also diagnose a meniscus injury by looking at the shape of the meniscus. In normal photographs, in the vertical plane, the meniscus has a shape that resembles a butterfly. A change in the shape of the meniscus can be a sign of damage to it.

A third cruciate ligament symptom can also be a sign of a meniscal injury. The appearance of this symptom is explained by the fact that, as a result of the displacement, the meniscus is in the intercondylar fossa of the femur and is practically adjacent to the posterior cruciate ligament.

Choice of treatment method

The choice of therapeutic agents depends on the location of the rupture and the severity of the injury. In case of rupture of the meniscus of the knee joint, treatment is carried out conservatively or surgically.

Conservative treatment

1. Providing first aid to the patient:
   • complete rest;
   • applying a cold compress;
   • - anesthesia;
   • puncture - to remove accumulated fluid;
   • plaster cast.
2. Bed rest.
3. Imposition of a plaster splint for up to 3 weeks.
4. Elimination of blockade of the knee joint.
5. Physiotherapy and therapeutic exercises.
6. Taking non-steroidal anti-inflammatory drugs - diclofenac, ibuprofen, meloxicam.
7. Taking chondroprotectors that help restore cartilage tissue, accelerate the regeneration and fusion of cartilage - chondratin sulfate, glucosamine and others.
8. External means - use various ointments and creams for rubbing - Alezan, Ketoral, Voltaren, Dolgit and so on.

With proper treatment, no complications, recovery occurs within 6-8 weeks. Indications for surgical treatment of meniscus rupture:

1. rupture and displacement of the meniscus;
2. the presence of blood in the cavity;
3. detachment of the horns and body of the meniscus;
4. lack of effect from conservative therapy for several weeks.

In these cases, surgical intervention is prescribed, which can be carried out by such methods:

To answer the question: "how to treat inflammation and damage?". The surgeon makes a thorough diagnosis. With minor tears, a splint is applied for three weeks, the patient undergoes a course of anti-inflammatory therapy and support for the joint with chondroprotectors.

Sometimes a puncture is required to remove the accumulated fluid. Complete recovery of the joint occurs in 6-8 weeks, subject to well-chosen exercise therapy exercises, undergoing courses of physiotherapy procedures.

• cartilage crushing;
• displaced rupture;
• detachment of the body or horn;
• accumulation of blood in the joint cavity;
• failure of conservative treatment.

Repeated blockades of the knee are an indication for surgical intervention.

The degree of damage determines the choice of the method of surgical intervention:

After the diagnosis and confirmation of the diagnosis, the specialist prescribes complex therapeutic methods, including a set of such measures:

• puncture from the knee joint;
• appointment of physiotherapy: phonophoresis, UHF, iontophoresis, ozocerite;
• the appointment of analgesics, drugs containing narcotic substances (Promedol), NSAIDs, chondroprotectors (provide the body with substances that help restore the damaged area of ​​the meniscus).

For 2 weeks, a splint is applied to the straightened leg, which ensures the fixation of the joint in the desired position. With ruptures, chronic dystrophy, joint dysplasia, surgery is performed.

In the presence of gout or rheumatism, the treatment of the underlying disease that provoked the process of degenerative changes is also carried out.

The main method of treatment of pathologies of the knee cartilage is surgical intervention. Arthroscopy is performed, the operation is carried out through two incisions one centimeter long.

The torn part of the meniscus is removed, and its inner edge is aligned. After such an operation, the recovery period depends on the condition of the patient, but on average it ranges from 2 days to several weeks.

The choice of treatment depends on the degree of damage to the meniscus, which was established during the diagnostic examination of the knee joint using ultrasound or MRI. The traumatologist chooses a more rational type of treatment in each individual case.

The following methods are used to treat meniscal injury:

• conservative treatment;
• surgery.

Conservative treatment

Conservative treatment is to eliminate the blockade of the knee joint. To do this, you need to punctuate (

make a puncture

) knee joint, evacuate the contents of the joint (

effusion or blood

) and inject 10 ml of 1% procaine solution or 20-30 ml of 1% novocaine solution. Next, the patient is seated on a high chair so that the angle between the thigh and lower leg is 90º. 15-20 minutes after the administration of procaine or novocaine, a procedure is performed to eliminate the blockade of the knee joint.

Manipulation to eliminate the blockade of the joint is performed in 4 stages:

• First stage. The doctor performs traction (traction) of the foot down. Traction of the foot can be carried out by hand or with the help of an impromptu device. To do this, a loop of bandage or dense fabric is put on the foot, covering the lower leg from behind and crossing on the back of the foot. The doctor performs traction by inserting the leg into the loop and pressing down.
• The second stage consists in the deviation of the lower leg in the direction opposite to the strangulated meniscus. In this case, the joint space expands, and the meniscus can return to its original position.
• Third stage. At the third stage, depending on the damage to the internal or external meniscus, rotational movements of the lower leg inward or outward are performed.
• The fourth stage consists in free extension of the knee joint in full. Extension movements should be effortless.

In most cases, if this manipulation was carried out correctly at all stages, then the blockade of the knee joint is eliminated. Sometimes, after the first attempt, the blockade of the joint persists, and then you can re-perform this procedure, but no more than 3 times.

In case of successful removal of the blockade, it is necessary to apply a posterior plaster splint, starting from the toes and ending with the upper third of the thigh. This immobilization is carried out for a period of 5 to 6 weeks.

Conservative treatment is performed according to the following scheme:

• UHF therapy. UHF or ultra-high frequency therapy is a physiotherapeutic method of exposing the body to an electric field of ultra-high or ultra-high frequency. UHF therapy increases the barrier ability of cells, improves regeneration and blood supply to meniscus tissues, and also has a moderate analgesic, anti-inflammatory and anti-edematous effect.
• Physiotherapy. Therapeutic exercise is a complex of special exercises without the use or with the use of certain equipment or projectiles. During the period of immobilization, it is necessary to perform general developmental exercises that cover all muscle groups. To do this, they perform active movements with a healthy lower limb, as well as special exercises - tension of the femoral muscles of the injured leg. Also, to improve blood supply in the injured knee joint, it is necessary to lower the limb for a short time, and then raise it to give it an elevated position on a special support (this procedure avoids venous stasis in the lower limb). In the period of post-immobilization, in addition to general strengthening exercises, active rotational movements of the foot, in large joints, as well as alternate tension of all muscles of the injured lower limb (muscles of the thigh and lower leg) should be performed. It should be noted that in the first few days after the removal of the splint, active movements should be carried out in a sparing mode.
• Massotherapy. Therapeutic massage is one of the components of complex treatment for injuries and ruptures of the meniscus. Therapeutic massage helps improve tissue blood supply, reduces pain sensitivity of the damaged area, reduces tissue swelling, and restores muscle mass, muscle tone and elasticity. Massage must be prescribed in the post-immobilization period. This procedure should start from the anterior femoral surface. At the very beginning, a preparatory massage is performed (2-3 minutes), which consists of stroking, kneading and squeezing. Then they move on to more intensive stroking of the injured knee joint, after placing a small pillow under it. After that, rectilinear and circular rubbing of the knee is carried out for 4-5 minutes. In the future, the intensity of the massage should be increased. When performing a massage on the back of the knee joint, the patient should lie on his stomach and bend the leg at the knee joint (at an angle of 40 - 60º). Massage must be completed by alternating active, passive movements with movements with resistance.
• Reception of chondroprotectors. Chondroprotectors are medications that restore the structure of cartilage tissue. Chondroprotectors are prescribed if the doctor has established not only damage to the meniscus, but also damage to the cartilage tissue of the knee joint. It should be noted that the use of chondroprotectors has an effect on both traumatic and degenerative meniscus rupture.

Chondroprotectors used to restore cartilage tissue

With correct and complex conservative treatment, as well as in the absence of complications (

re-blockade of the knee joint

) the recovery period, as a rule, lasts from one and a half to two months.

Surgery

Surgical treatment is indicated in cases where it is not possible to eliminate the blockade of the knee joint or with repeated blockades. Also, surgical treatment is resorted to in the chronic period.

Indications for surgical treatment of meniscus rupture:

• crushing the cartilaginous tissue of the meniscus;
• hemarthrosis;
• rupture of the anterior or posterior horn of the meniscus;
• rupture of the body of the meniscus;
• rupture of the meniscus with its displacement;
• repeated blockade of the knee joint for several weeks or days.

Depending on the nature and type of damage, the presence of complications, the age of the patient, surgical treatment can be carried out in various ways.

Surgical treatment can be carried out by the following methods:

This type of therapy includes the following:

1. First aid, which is as follows:

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

2. Compliance with bed rest.

3. A plaster splint is applied for a period of at least 2-3 weeks.

4. Remove the blockade of the knee joint.

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

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

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

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

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

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

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

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

First aid for suspected meniscus injury

The first thing to do if a meniscal injury is suspected is to ensure immobilization (

immobilization

) knee joint. As a rule, the immobilization of the joint is carried out in the position in which the joint was blocked. To do this, you must use a splint bandage or a removable splint (

special type of fastener

). It is strictly forbidden to try to eliminate the blockade of the knee joint on your own. This procedure can only be performed by a doctor who has the necessary qualifications.

A cold compress should be applied to the injured knee joint in the most painful place. This procedure will help narrow the superficial and deep vessels and prevent fluid from accumulating in the joint cavity (.

decrease in effusion

). Also, cold helps to reduce the sensitivity of pain receptors and, as a result, will reduce pain. The duration of the use of a cold compress should be at least 10-15 minutes, but not more than 30 minutes.

In the event that a combined injury occurs and the victim complains of severe unbearable pain, it is necessary to use

painkillers

Pain medications used to relieve pain

If you suspect a meniscus injury, you should consult a traumatologist to clarify the exact diagnosis. Also, only a doctor can prescribe treatment (

Damage to the posterior horn of the 2nd degree according to Stoller is a frightening and incomprehensible formulation of the diagnosis, which hides a common type of knee injury. There is one encouraging truth in such a diagnosis: joints are treatable at any time and at any age.

Where is the meniscus and its posterior horn located?

The knee joint is the largest and most complex of all joints. Menisci, they are also interarticular cartilages, are located inside the articular capsule and connect the femur and tibia to each other. When walking or moving in any other way, the interarticular cartilages act as a shock absorber and soften shock loads that pass to the body and, in particular, to the spine.

There are only two types of menisci in the knee joints: internal (scientifically medial) and external (lateral). The interarticular cartilage is divided into the body, and into the horn: anterior and posterior.

Important! Performing a shock-absorbing role, the menisci are not fixed and are displaced during flexion and extension of the joint in the required direction. Only the inner meniscus has an infringement in mobility, and therefore, it is most often damaged.

The results (posterior horn of the medial meniscus) are irreversible in terms of regeneration, since these tissues do not have their own circulatory system, and therefore do not have such an ability.

How is the meniscus damaged?

Interarticular cartilage injury can be obtained in a variety of ways. Conventionally, damage is divided into two types.

Attention! Signs of knee damage can be similar in various diseases or injuries. For a more accurate diagnosis, you should consult a doctor, do not self-medicate.

Degenerative damage to the inner meniscus

The meniscus is damaged as a result of the following factors:

1. Chronic microtraumas are mainly inherent in athletes and people with physically hard work.
2. Age-related wear of cartilage plates.
3. Getting injured two or more times.
4. Chronic diseases.

Diseases leading to degenerative damage to the internal meniscus:

• rheumatism;
• arthritis;
• chronic intoxication of the body.

A distinctive signal of this type of injury is the age of patients older than 40 years, excluding athletes.

Symptoms

The clinical picture of damage to the posterior horn of the meniscus has the following features:

1. The occurrence of injury can occur spontaneously, from any sudden movement.
2. Persistent continuous aching pain, aggravated by movement of the joint.
3. Slow build-up of swelling above the kneecap.
4. Possible blockage of the knee joint, resulting from a sharp movement, that is, flexion - extension.

The symptoms are expressed rather weakly, and it is possible to establish the degree of degenerative changes in the MRMM according to Stoller only after an x-ray or an MRI.

Traumatic damage to the SRMM

Based on the name, it is not difficult to understand that the cornerstone is a knee injury. This variant of injuries is characteristic of a younger age category of people, that is, under 40 years old. occur in the following cases:

• when jumping from above;
• with a sharp landing on your knees;
• torsion on one leg leads to a break;
• running on uneven surfaces;
• subluxation of the knee joint.

You can independently determine the injury of the SRMM, regardless of the level of the pain symptom, using the following methods in combination:

1. Bazhov's reception. During extension of the joint and when pressed on the back of the patella, the pain intensifies.
2. Land sign. In the supine position, under the injured knee of the victim, the palm should pass with gaps - freely.
3. Turner's sign. The sensitivity of the skin around the knee increases.

Pain sensations come in three degrees of severity, with accompanying symptoms.

1. Easy 1 degree. There is no pronounced pain, no restriction in movement is felt, only with certain loads, a slight increase in pain is felt, for example, when squatting. There is slight swelling above the kneecap.
2. Medium 2 severity. Accompanied by severe pain. The patient walks with a limp, with periodic blockage (blockade) of the knee joint. The position of the leg is only in a bent state, it is impossible to straighten the leg even with help. Puffiness intensifies, the skin acquires a blue tint.
3. 3 severity. The pain is unbearable and sharp. The leg is half-bent and motionless, there is a strong purple-violet edema.

Even with a detailed description of complaints and symptoms, the patient is sent for an x-ray. It is possible to assign a Stoller grade to a meniscal injury only with the help of an MRI machine. This is due to the inability to view directly.

Degrees of damage ZRMM and Stoller classification

A tomographic examination on an MRI device according to Stoller does not require special preparation. Despite the rather high cost, the method is informative, and this irreplaceable study cannot be neglected.

Important! MRI cannot be performed in the presence of a pacemaker, a metal artificial implant. All metal objects (piercings, rings) must be removed before examination. Otherwise, the magnetic field will force them out of the body.

Damage is classified into 3 degrees of Stoller changes.

1. Degree one. It is characterized by the appearance of a point signal in the interarticular cartilaginous plate. A slight violation in the structure of the meniscus.
2. The second degree includes a linear formation that has not yet reached the edge of the meniscus. Crack ZRMM.
3. Third degree. Stage 3 is characterized by a tearing signal reaching the very edge of the meniscus, in other words, it.

The accuracy of MRI data in diagnosing a rupture of the RMM is 90-95%.

Treatment of damaged SRMM

Basically, for the period of treatment, there is a temporary loss of ability to work. The sick leave period can last from a few weeks to four months.
Basically, with a rupture of the RMM, it will not do without surgical intervention, treatment is carried out by whole or broken off part of it. This operation is called a meniscectomy. Only a few small incisions are made on the knee, open manipulations are carried out in extremely rare cases.

With a slight damage to the SRMM, the treatment cycle will look approximately as follows:

1. Long rest using elastic bandages and various compresses.
2. Surgery that corrects the functions of tissues and organs.
3. Physiotherapy.

The rehabilitation period is reduced to the relief of a pain symptom with an emphasis on reducing swelling and normalizing the motor activity of the injured organ. For a full recovery, you need to be patient, since the rehabilitation period can last quite a long time.