What is a tear in the posterior horn of the medial meniscus? Damage to the posterior horn of the medial meniscus How to treat a torn posterior horn of the meniscus

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, there is no restriction in movement, 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.

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

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

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

Anatomical features of the cartilage tissue of the knee

- cartilaginous tissue of the knee, located between two interlocking bones and ensuring the sliding of one bone 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

The illustration shows a rupture of the anterior horn of the external meniscus of the knee joint.

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

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

Break shapes

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

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

Rupture of the posterior horn

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

Tears in the posterior horn can be:

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

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. Swelling and redness.

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

• Cracking of the knee joint during movement;
• 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.

• Removal of inflammation, pain and swelling with the help of.
• In cases of “jamming” of the knee joint, reposition is used, that is, reduction with the help of manual therapy or traction.
• Massotherapy.
• Physiotherapy.

• 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;
• – implantation of artificial cartilage into the knee;
• Stitching of damaged cartilage (performed with minor damage);
• – 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 one. 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?

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

signs

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

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

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

Kinds

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

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

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

Treatment

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

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

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

Operation

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

During a surgical operation, the doctor performs various procedures:

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

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

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Symptoms of a meniscus injury

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

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

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

Damage treatment

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

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

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

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

Rupture of the meniscus of the knee joint

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

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

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

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

Rupture symptoms

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

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

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

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

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

Rupture treatment

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

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

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

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

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

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

Sequelae of a torn meniscus

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

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meniscus injury

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

The meniscus itself is divided into 3 parts:

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

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

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

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

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

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

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

Symptoms of a knee meniscus injury

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

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

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

Treatment of damage to the medial meniscus

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

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

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

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

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

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

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

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

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

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

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

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

A little about menisci

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

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

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

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

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

vigorous jumping or running on uneven ground;

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

fairly active walking or long squatting;

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

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

Symptoms

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

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

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

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

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

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

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

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

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

Conservative treatment

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

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

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

rehabilitation activities such as exercise therapy, massage, physiotherapy;

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

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

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Characteristic signs of a torn internal meniscus

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

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

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

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

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

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

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

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

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

Basic therapeutic measures

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

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

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

Non-surgical treatment of the medial meniscus of the knee

Indications for the use of conservative therapeutic methods are:

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

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

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

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

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

Surgery

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

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

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

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

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

Reconstructive technique

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

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

Meniscus is a dense cartilaginous tissue that looks like a disk and connects the two articular bones of the knee. The meniscus plays a role damper while driving. During movement, the synovial fluid lubricates the cartilage, thereby protecting them from shocks and impacts, protecting them from possible injuries. menisci guarantee the functionality and stability of the knee joint. The functions of the menisci also consist in protecting the bones of the joints from premature wear, meniscus reduce stress on the joints. Main meniscus functions are:

- lubrication and nutrition of the hyaline cartilage of the tibia;

Function of the shock-absorber (mitigation of blows and concussions);

- formation of the integrity of the structure of the knee joint;

Joint stability function.

Rupture of the posterior horn of the meniscus

The knee has two menisci, outdoor and indoor. The meniscus is horizontal, consists of a front and back part, called a horn, as well as a body. Rupture of the posterior horn inner meniscus represents meniscus tear in the back of it. In this case, an operation is prescribed only if the functional state of the joint leaves much to be desired. The doctor must determine how much the injured person interferes with movement. meniscus inside the joint. In some cases, a conservative form of treatment of injuries, namely treatment with physiotherapy and anti-inflammatory drugs, is sufficient. When damaged posterior horn of the meniscus the patient usually complains about the instability of the joint, anticipating its subsequent blocking. Usually the feeling of insecurity in the patient appears when going down the stairs. In any case, it is difficult to correctly diagnose this disease on your own; it is necessary to consult a doctor immediately after the injury.

Rupture treatment

Treatment of torn posterior meniscus It is carried out by a conservative method with the help of physiotherapy and medicines, as well as by a surgical method of resection and restoration of the meniscus. Recently, an innovative method in surgery is considered to be gaining popularity. meniscus transplant method. A conservative treatment technique is used mainly in the treatment of small ruptures of the posterior meniscus horns. Very often, this kind of damage is accompanied by characteristic pain, but other symptoms, such as clicking and rolling of the joint, are not observed.

Small longitudinal tears no larger than 10 mm sometimes do not require treatment, often healing on their own. In some cases, physiotherapy is prescribed, as well as treatment with medications. In some cases torn meniscus treated by suturing the gap from the inside out. In this case, a long needle is used, which is passed perpendicular to the site of damage from the joint cavity on the outside of the joint capsule. The sutures must be applied tightly, thereby guaranteeing the stability of the sutured fragments, but this increases the risk of damage to the nerves and blood vessels when the needle is removed from the joint cavity. This method effectively treats rupture of the posterior horn of the meniscus and a tear extending from the cartilage body to the posterior horn.

Postoperative treatment

After the operation, the operated joint is fixed with bandages and a pad of several layers of cotton wool. The patient must spend several days in the hospital, but full recovery sometimes occurs only after a month. The patient must perform a set of exercises that the attending physician will prescribe to maintain the tone of the thigh muscles. Additionally, anti-inflammatory and analgesic drugs are prescribed to prevent postoperative complications.

The meniscus is the lining of cartilage in the knee joint. It acts as a shock absorber, located between the femur and tibia of the knee, which bears the greatest load in the musculoskeletal system. The rupture of the posterior horn of the medial meniscus is irreversible, since it does not have its own blood supply system, it receives nutrition through the circulation of the synovial fluid.

Injury classification

Damage to the structure of the posterior horn of the medial meniscus is differentiated according to various parameters. According to the severity of the violation, there are:

• 1st degree injury to the posterior horn of the meniscus. Characterized by focal damage to the surface of the cartilage. The overall structure does not change.
• 2 degree. The changes are becoming more pronounced. There is a partial violation of the structure of the cartilage.
• 3 degree. The disease state worsens. Pathology affects the posterior horn of the medial meniscus. There are painful changes in the anatomical structure.

Given the main causative factor that led to the development of the pathological condition of the cartilage of the knee joint, the bodies of the lateral meniscus distinguish between traumatic and pathological damage to the posterior horn of the medial meniscus. 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.

Types of breaks

In medicine, there are several types of meniscus ruptures:

• Longitudinal vertical.
• Patchwork braid.
• Horizontal break.
• Radially transverse.
• Degenerative rupture with tissue crush.
• Oblique-horizontal.

Breaks can be complete and incomplete, isolated or combined. The most common ruptures of both menisci, isolated injuries of the posterior horn are diagnosed less frequently. The part of the inner meniscus that has come off may remain in place or move.

Causes of damage

A sharp movement of the lower leg, a strong outward rotation are the main causes of damage to the posterior horn of the medial meniscus. Pathology is provoked by the following factors: microtraumas, falls, stretch marks, traffic accidents, bruises, blows. Gout and rheumatism can provoke the disease. In most cases, the posterior horn of the meniscus suffers due to indirect and combined trauma.

Especially many injured seek help in winter, during ice.

Injuries contribute to:

• Alcohol intoxication.
• Fights.
• Haste.
• Failure to take precautions.

In most cases, the tear occurs during fixed extension of the joint. Hockey players, football players, gymnasts, and figure skaters are at particular risk. Frequent ruptures often lead to meniscopathy - a pathology in which the integrity of the internal meniscus of the knee joint is violated. Subsequently, with each sharp turn, the gap is repeated.

Degenerative damage is observed in elderly patients with the repetition of microtraumas caused by strong physical exertion during labor activity or irregular training. Rheumatism can also provoke a rupture of the posterior horn of the medial meniscus, since the disease disrupts the blood circulation of tissues during edema. Fibers, losing strength, cannot withstand the load. Rupture of the posterior horn of the medial meniscus can provoke tonsillitis, scarlet fever.

Symptoms

The characteristic signs of a torn posterior horn are:

• Sharp pain.
• Puffiness.
• Joint block.
• Hemarthrosis.

Pain

The pain is acutely manifested in the first moments of injury, lasts for several minutes. Often, the appearance of pain is preceded by a characteristic click in the knee joint. Gradually, the pain subsides, a person can step on a limb, although he does this with difficulty. When lying down, during a night's sleep, the pain intensifies imperceptibly. But by morning, the knee hurts so much, as if a nail had been stuck into it. Flexion and extension of the limb increases pain.

puffiness

The manifestation of puffiness is not observed immediately, it can be seen a few hours after the rupture.

Joint block

Jamming of the joint is considered the main sign of rupture of the posterior horn of the medial meniscus. There comes a blockade of the joint after clamping the separated part of the cartilage by the bones, while there is a violation of the motor function of the limb. This symptom can also be observed with sprains, which makes it difficult to diagnose the pathology.

Hemarthrosis (accumulation of blood inside a joint)

Intra-articular accumulation of blood is detected when the "red zone" of the cartilage layer, which performs a shock-absorbing function, is damaged. According to the time of development of pathology, there are:

• Acute break. Hardware diagnostics shows sharp edges, the presence of hemarthrosis.
• Chronic rupture. It is characterized by swelling caused by the accumulation of fluids.

Diagnostics

If there is no blockage, diagnosing a meniscal tear in the acute period is very difficult. In the subacute period, a meniscus tear can be diagnosed based on the manifestation of local pain, compression symptoms, and extension symptoms. If a meniscus rupture has not been diagnosed, the swelling, pain, and effusion in the joint will disappear during treatment, but with the slightest injury, careless movement, the symptoms will manifest themselves again, which will mean the transition of the pathology to a chronic form.

It is not uncommon for patients to be diagnosed with a knee bruise, parameniscal cyst, or sprain.

x-ray

Radiography is prescribed to rule out damage to the bones of fractures and cracks. X-rays are not able to diagnose soft tissue damage. To do this, you need to use magnetic resonance imaging.

MRI

The research method does not harm the body, like radiography. MRI makes it possible to consider layered images of the internal structure of the knee. This allows not only to see the gap, but also to obtain information about the extent of its damage.

ultrasound

Allows visualization of knee tissue. With the help of ultrasound, the presence of a degenerative process, an increased volume of intracavitary fluid is determined.

Treatment of damage to the posterior horn of the meniscus

After injury, it is necessary to immediately immobilize the limb. It is dangerous to treat a victim of a blockage on your own. The complex treatment prescribed by the doctor includes conservative therapy, surgery, and rehabilitation.

Therapy without surgery

With partial damage to the posterior horn of the medial meniscus of 1-2 degrees, conservative therapy is carried out, including drug treatment and physiotherapy. Of the physiotherapy procedures successfully applied:

• Ozokerite.
• Electrophoresis.
• Mud cure.
• Magnetotherapy.
• Electrophoresis.
• Hirudotherapy.
• Electromyostimulation.
• Aerotherapy.
• UHF therapy.
• Massotherapy.

Important! During the treatment of rupture of the posterior horn of the medial meniscus, it is necessary to ensure the rest of the knee joint.

Surgical methods

An effective method of treating pathology is surgical intervention. During surgical therapy, doctors are aimed at the preservation of the organ and its functions. When the posterior horn of the meniscus is torn, the following types of operations are used:

• Cartilage stitching. The operation is performed using an arthroscope - a miniature video camera. It is injected at the site of the knee puncture. The operation is performed with fresh ruptures of the meniscus.
• Partial meniscectomy. During the operation, the area of ​​damage to the cartilage layer is removed, and the rest is restored. The meniscus is cut to a smooth state.
• Transfer. A donor or artificial meniscus is transplanted.
• Arthroscopy. 2 small punctures are made in the knee. An arthroscope is inserted through the puncture, along with which saline enters. The second hole makes it possible to perform the necessary manipulations with the knee joint.
• Arthrotomy. Complicated meniscus removal procedure. The operation is performed if the patient has an extensive lesion of the knee joint.

A modern method of therapy, characterized by a low rate of trauma

Rehabilitation

If the operations were carried out with a small amount of interventions, a short period of time will be required for rehabilitation. Early rehabilitation in the postoperative period includes elimination of the inflammatory process in the joint, normalization of blood circulation, strengthening of the thigh muscles, limiting the range of motion. Therapeutic exercises are allowed to be performed only with the permission of the doctor in different positions of the body: sitting, lying, standing on a healthy leg.

Late rehabilitation aims to:

• Elimination of contracture.
• Correction of gait
• Functional restoration of the joint
• Strengthening the muscle tissue that stabilizes the knee joint.

The most important

Rupture of the posterior horn of the medial meniscus is a dangerous pathology. To reduce the risk of injury, precautions should be taken seriously: do not rush when moving up the stairs, exercise muscles with physical activity, regularly take prophylactic chondroprotectors, vitamin complexes, and use knee pads during training. You need to constantly monitor your weight. In case of injury, a doctor should be called immediately.