Treatment of rupture of the posterior horn of the lateral (outer) meniscus. Meniscus tear How to treat a torn posterior horn of the medial meniscus

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 (femur, tibia), 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?

Menisci are cartilaginous layers inside the knee joint, which mainly perform shock-absorbing and stabilizing functions. There are two menisci of the knee joint: internal (medial) and external (lateral)

Meniscal tears are the most common knee problem. Basically, meniscal tears are traumatic, which often occur as a result of trauma in young people, and degenerative, which are more common in older people and can occur without injury against the background of degenerative changes in the meniscus, which are a variant of the course of arthrosis of the knee joint. If left untreated, a traumatic tear will eventually become degenerative.

A doctor can diagnose a meniscus tear. Magnetic resonance imaging (MRI) may be needed to confirm the diagnosis of a meniscus tear. Less commonly, an ultrasound examination (ultrasound) may be used to confirm the diagnosis.

Meniscus tears occur in the posterior horn, in the body and in the anterior horn of the meniscus.

A rupture of the meniscus can lead to the fact that its torn and dangling part will serve as a mechanical obstacle to movement, cause pain and, possibly, block the joint, restrict movement. Moreover, the dangling part of the meniscus destroys the adjacent cartilage that covers the femur and tibia.

The main method of treatment of ruptures of the meniscus of the knee joint is surgical. But this does not mean that you always need to do an operation if a meniscus tear is detected on an MRI. Operate only those tears that are the cause of pain and mechanical obstruction of movement in the knee joint.

Currently, the "gold standard" for the treatment of ruptures of the meniscus of the knee joint is arthroscopy - a low-traumatic operation that is performed through two incisions one centimeter long. There are other techniques (meniscus suture, meniscus transplantation), but they give less reliable results.

During arthroscopy, the dangling and torn part of the meniscus is removed and the inner edge of the meniscus is aligned with special surgical instruments. Note that only part of the meniscus is removed, not the entire meniscus. The torn off part of the meniscus no longer fulfills its function, so it makes little sense to save it.

After arthroscopic surgery, you can walk on the same day, but full recovery may take from several days to several weeks.

Anatomy

In the knee joint, between the femur and tibia, there are menisci - crescent-shaped cartilage layers that increase the stability of the joint by increasing the area of ​​​​contact of the bones.

Both the outer (lateral) and inner (medial) meniscus are conditionally divided into three parts: the posterior (posterior horn), middle (body), and anterior (anterior horn).

The shape of the inner (medial) meniscus of the knee joint usually resembles the letter "C", and the outer (lateral) - the correct semicircle. Both menisci are formed by fibrous cartilage and are attached anteriorly and posteriorly to the tibia. The medial meniscus is also attached along the outer edge to the capsule of the knee joint by the so-called coronary ligament. The thickening of the capsule in the region of the middle part of the body of the meniscus is formed by the tibial collateral ligament. The attachment of the medial meniscus to both the capsule and the tibia makes it less mobile than the lateral meniscus. This lesser mobility of the inner meniscus causes its tears to occur more frequently than those of the outer meniscus. The lateral meniscus covers most of the upper lateral articular surface of the tibia and, unlike the medial meniscus, has the shape of an almost regular semicircle. Due to the more rounded shape of the lateral meniscus, the anterior and posterior points of its attachment to the tibia lie closer to each other. Slightly medially from the anterior horn of the lateral meniscus is the site of attachment of the anterior cruciate ligament. The anterior and posterior meniscofemoral ligaments, which attach the posterior horn of the lateral meniscus to the medial femoral condyle, run anterior and posterior to the posterior cruciate ligament and are also called Humphrey's ligament and Wriesberg's ligament, respectively. Lateral menisci, extending to the articular surface more than normal, are called discoid; they occur, according to reports, in 3.5-5% of people. In simple terms, a discoid lateral meniscus means that it is wider than the normal lateral meniscus of the knee joint. Among the discoid menisci, one can distinguish the so-called continuous discoid (entirely covering the external condyle of the tibia), semi-disc and Wrisberg variants. In the latter, the posterior horn is fixed to the bone only by the Wrisberg ligament.

On the posterior surface of the joint, through the gap between the capsule and the lateral meniscus, the tendon of the popliteal muscle penetrates into the joint cavity. It is attached to the meniscus by thin bundles that apparently perform a stabilizing function. To the joint capsule, the lateral meniscus is fixed much weaker than the medial one and therefore is more easily displaced. The microstructure of the meniscus is normally represented by fibers of a special protein - collagen. These fibers are predominantly oriented circularly, i.e. along the meniscus. A smaller part of the collagen fibers of the meniscus is oriented radially, i.e. from edge to center. There is another option for fibers - perforating. They are the least, they go "randomly", connecting the circular and radial fibers.

a - radial fibers, b - circular fibers (there are most of them), c - perforating, or "random" fibers Radially, the fibers are oriented mainly at the surface of the meniscus; crossing, they form a network, which is believed to provide the resistance of the meniscus surface to the shear force. Circular fibers make up the bulk of the core of the menisci; this arrangement of fibers ensures the distribution of the longitudinal load on the knee joint. On a dry matter basis, the meniscus is approximately 60-70% collagen, 8-13% extracellular matrix proteins, and 0.6% elastin. Collagen is mainly represented by type I and in a small amount by types II, III, V and VI. In newborns, the entire tissue of the menisci is permeated with blood vessels, but by the age of 9 months, the vessels completely disappear from the inner third of the menisci. In adults, the vascular network is present only in the outermost part of the meniscus (10-30% of the outer edge), and with age, the blood supply to the meniscus only worsens. It is worth noting that with age, the blood supply to the meniscus deteriorates. From the point of view of blood supply, the meniscus is divided into two zones: red and white.

Cross section of the meniscus of the knee joint (in the section it has a triangular shape). Blood vessels enter the thickness of the meniscus from the outside. In children, they penetrate the entire meniscus, but with age, the blood vessels become smaller and in adults there are blood vessels only in 10-30% of the outer part of the meniscus adjacent to the joint capsule. The first zone is the border between the joint capsule and the meniscus (red-red zone, or R-R). The second zone is the border between the red and white zones of the meniscus (red-white zone or R-W zone). The third zone is white-white (W-W), i.e. where there are no blood vessels. Relatively poor in blood vessels is that part of the lateral meniscus, near which the tendon of the popliteal muscle penetrates into the knee joint. The cells of the inner two-thirds of the meniscus receive nutrients through diffusion and active transport from the synovial fluid.

Photograph of the blood vessels of the lateral meniscus (a contrast agent was injected into the bloodstream). Note the lack of vessels at the site where the hamstring tendon passes (red arrow). The anterior and posterior horns of the meniscus, as well as its peripheral part, contain nerve fibers and receptors that are presumably involved in proprioceptive afferentation during movements in the knee joint, i.e. signal to our brain about the position of the knee joint.

Why are menisci needed?

At the end of the 19th century, the menisci were considered the "non-functioning remnants" of muscles. However, as soon as the importance of the function performed by the menisci was discovered, they began to be actively studied. The menisci perform different functions: they distribute the load, absorb shocks, reduce contact stress, act as stabilizers, limit the range of motion, participate in proprioceptive afferentation during movements in the knee joint, i.e. signal to our brain about the position of the knee joint. Among these functions, the first four are considered to be the main ones - load distribution, shock absorption, contact stress distribution and stabilization. When the leg is flexed and extended at the knee by 90 degrees, the menisci account for approximately 85% and 50-70% of the load, respectively. After removal of the entire medial meniscus, the area of ​​contact of the articular surfaces decreases by 50-70%, and the tension at their junction increases by 100%. Complete removal of the lateral meniscus reduces the contact area of ​​the articular surfaces by 40–50% and increases the contact stress by 200–300%. These changes, caused by a meniscectomy (i.e., an operation in which the meniscus is completely removed), often lead to narrowing of the joint space, the formation of osteophytes (bone spikes, growths) and the transformation of the condyles of the femur from rounded to angular, which is clearly visible on radiographs. Meniscectomy also affects the function of articular cartilage. Menisci are 50% more elastic than cartilage and therefore play the role of reliable shock absorbers during shocks. In the absence of a meniscus, the entire load during impacts without shock absorption falls on the cartilage. Finally, the medial meniscus prevents the tibia from moving forward relative to the femur when the anterior cruciate ligament is injured. With a preserved anterior cruciate ligament, the loss of the medial meniscus has little effect on the anteroposterior displacement of the tibia during flexion and extension of the leg at the knee. But with damage to the anterior cruciate ligament, the loss of the medial meniscus by more than 50% increases the displacement of the tibia forward when the leg is flexed at the knee by 90°. In general, the inner two-thirds of the menisci are important for increasing the contact area of ​​the articular surfaces and shock absorption, while the outer third is important for distributing the load and stabilizing the joint. How common is a meniscus tear in the knee?

How common is a meniscus tear in the knee?

Meniscus tears occur at a frequency of 60-70 cases per 100,000 population per year. In men, meniscus tears occur 2.5-4 times more often, with traumatic tears predominating at the age of 20 to 30 years, and tears due to chronic degenerative changes in the meniscus at the age of 40 years. It happens that a meniscus rupture occurs at the age of 80-90. In general, the inner (medial) meniscus of the knee joint is most often damaged.

Photos taken during arthroscopy of the knee joint: a video camera (arthroscope) was introduced into the joint cavity through a 1 cm incision, which allows you to examine the joint from the inside and see all the damage. On the left - a normal meniscus (no fibrillation, elastic, smooth edge, white), in the center - a traumatic meniscus rupture (the edges of the meniscus are even, the meniscus is not torn). Right - degenerative rupture of the meniscus (the edges of the meniscus are torn)

At a young age, acute, traumatic ruptures of the meniscus occur more often. An isolated rupture of the meniscus may occur, however, combined injuries of intra-articular structures are also possible, when, for example, a ligament and a meniscus are damaged at the same time. One of these combined injuries is the rupture of the anterior cruciate ligament, which is accompanied by a rupture of the meniscus in about every third case. At the same time, the lateral meniscus is torn approximately four times more often, more mobile, like the entire outer half of the knee joint. The medial meniscus, which becomes the limiter of the anterior displacement of the tibia when the anterior cruciate ligament is damaged, is more often torn when the anterior cruciate ligament has already been damaged earlier. Meniscus ruptures accompany up to 47% of tibial condylar fractures and are often observed in fractures of the femoral shaft with concomitant effusion into the joint cavity.

Symptoms

Traumatic breaks. At a young age, meniscal tears occur more often as a result of injury. As a rule, the break occurs when twisting on one leg, i.e. with axial load in combination with rotation of the lower leg. For example, such an injury can occur when running, when one foot suddenly stands up on an uneven surface, when landing on one foot with a torsion of the body, but a meniscus tear can also occur with a different mechanism of injury.

Usually, immediately after the rupture, pain in the joint appears, the knee swells. If the meniscus tear affects the red zone, i.e. the place where there are blood vessels in the meniscus, then there will be hemarthrosis- accumulation of blood in the joint. It is manifested by bulging, swelling above the patella (patella).

When the meniscus is torn, the detached and dangling part of the meniscus begins to interfere with movements in the knee joint. Small tears can cause painful clicking or a feeling of difficulty moving. With large tears, blockade of the joint is possible due to the fact that the relatively large size of the torn and dangling fragment of the meniscus moves to the center of the joint and makes some movements impossible, i.e. the joint is "jammed". With ruptures of the posterior horn of the meniscus, flexion is often limited, with ruptures of the body of the meniscus and its anterior horn, extension in the knee joint suffers.

The pain of a torn meniscus can be so severe that it is impossible to step on the foot, and sometimes a torn meniscus manifests itself only as pain with certain movements, such as going down stairs. At the same time, climbing stairs can be completely painless.

It should be noted that the blockade of the knee joint can be caused not only by a meniscus rupture, but also by other causes, for example, rupture of the anterior cruciate ligament, a free intraarticular body, including a detached cartilage fragment in Koenig's disease, knee joint "prick" syndrome, osteochondral fractures , fractures of the condyles of the tibia and many other reasons.

With an acute rupture in combination with damage to the anterior cruciate ligament, swelling may develop faster and be more pronounced. Injuries to the anterior cruciate ligament are often accompanied by rupture of the lateral meniscus. This is due to the fact that when the ligament is torn, the outer part of the tibia dislocates forward and the lateral meniscus is pinched between the femur and tibia.

Chronic or degenerative tears more common in people over 40 years of age; pain and swelling at the same time develop gradually, and it is not always possible to detect their sharp increase. Often there is no history of injury, or only a very minor impact, such as bending the leg, squatting, or even a tear can occur simply when getting up from a chair. In this case, blockade of the joint may also occur, however, degenerative ruptures often give only pain. It is worth noting that with a degenerative meniscus tear, the adjacent cartilage covering the femur or, more often, the tibia is often damaged.

Like acute meniscal tears, degenerative tears can give a variety of symptoms: sometimes it is completely impossible to step on the foot or even move it a little because of the pain, and sometimes the pain appears only when descending stairs, squatting.

Diagnosis

The main symptom of a meniscus tear is pain in the knee joint that occurs or worsens with a certain movement. The severity of pain depends on the place where the meniscus ruptured (body, posterior horn, anterior horn of the meniscus), the size of the rupture, and the time elapsed since the injury.

Once again, we note that a meniscus rupture can occur suddenly, without any injury. For example, a degenerative tear can occur at night while the person is sleeping and present with pain in the morning when getting out of bed. Often degenerative tears occur when getting up from a low chair.

The intensity of pain is affected by both individual sensitivity and the presence of concomitant diseases and injuries of the knee joint (arthritis of the knee joint, ruptures of the anterior cruciate ligament, ruptures of the lateral ligaments of the knee joint, fractures of the condyles and other conditions that themselves can cause pain in the knee joint) .

So, pain during a meniscus tear can be different: from weak, appearing only occasionally, to strong, making movements in the knee joint impossible. Sometimes it is even impossible to step on the foot because of the pain.

If the pain appears when descending the stairs, then most likely there is a rupture of the posterior horn of the meniscus. If there is a rupture of the body of the meniscus, then the pain increases with extension in the knee joint.

If the knee joint is “jammed”, i.e. the so-called blockade of the joint has arisen, then most likely there is a rupture of the meniscus, and the blockade is due to the fact that the torn part of the meniscus just blocked the movement in the joint. However, the blockade happens not only when the meniscus is torn. For example, the joint can also “jam” in case of ruptures of the anterior cruciate ligament, infringement of the synovial folds (“plik” syndrome), exacerbation of arthrosis of the knee joint.

It is impossible to diagnose a meniscus rupture on your own - you need to contact an orthopedic traumatologist. It is advisable that you contact a specialist who is directly involved in the treatment of patients with injuries and diseases of the knee joint.

First, the doctor will ask you about how the pain appeared, about the possible causes of its occurrence. Then he starts the inspection. The doctor carefully examines not only the knee joint, but the entire leg. First, the amplitude and pain of movements in the hip and knee joints are assessed, since part of the pain in the hip joint radiates to the knee joint. The doctor then examines the thigh for muscle atrophy. Then the knee joint itself is examined: first of all, it is assessed whether there is an effusion in the knee joint, which may be synovitis or hemarthrosis.

As a rule, effusion, i.e. accumulation of fluid in the knee joint, manifested by visible swelling above the kneecap (patella). The fluid in the knee joint may be blood, in which case they speak of hemarthrosis of the knee joint, which in literal translation from Latin means "blood in the joint." Hemarthrosis occurs with fresh meniscus ruptures.

If the rupture occurred a long time ago, then effusion is also possible in the joint, but this is no longer hemarthrosis, but synovitis, those. excess accumulation of synovial fluid, which lubricates the joint and nourishes the cartilage.

Swelling of the right knee joint. Please note that the swelling is located above the patella (kneecap), i.e. fluid accumulates in the suprapatellar bag (upper torsion of the knee joint). The left, normal knee is shown for comparison.

A meniscus tear often manifests itself as an inability to fully extend or bend the leg at the knee joint.

As we have already noted, the main symptom of a meniscus tear is pain in the knee joint that occurs or increases with a certain movement. If the doctor suspects a meniscus tear, then he tries to just provoke this pain in a certain position and with a certain movement. As a rule, the doctor presses with his finger in the projection of the joint space of the knee joint, i.e. slightly below and to the side (outside and inside) of the patella and flexes and unbends the leg at the knee. If this causes pain, then most likely there is a torn meniscus. There are other special tests that can diagnose a meniscus tear.

The main tests that a doctor performs to diagnose a torn meniscus of the knee.

The doctor must perform not only these tests, but also others that allow you to suspect and diagnose problems with the cruciate ligaments, the patella, and a number of other situations.

In general, if the doctor evaluates the knee joint by a combination of tests, and not by any one of the signs, then a rupture of the internal meniscus can be diagnosed in 95% of cases, and external - in 88% of cases. These figures are very high, and in fact, often a competent traumatologist can accurately diagnose a meniscus rupture without any additional examination methods (radiography, magnetic resonance imaging, ultrasound). However, it will be very unpleasant if the patient gets into those 5-12% of cases when a meniscus rupture is not diagnosed despite the fact that it exists, or is diagnosed erroneously, therefore in our practice we quite often try to resort to additional research methods that confirm or refute doctor's guess.

Radiography. An X-ray of the knee joint can be considered mandatory for any pain in the knee joint. Sometimes there is a desire to immediately perform magnetic resonance imaging (MRI), which "shows more than x-rays." But this is wrong: in some cases, X-rays make it easier, faster and cheaper to establish the correct diagnosis. Therefore, you should not assign yourself research, which can be a waste of time and money.

Radiography is performed in the following projections: 1) in a direct projection in a standing position, including when the legs are bent at the knees by 45 ° (according to Rosenberg), 2) in a lateral projection and 3) in an axial projection. The posterior surfaces of the condyles of the femur in arthrosis of the knee joint usually wear out earlier, and when the legs are flexed 45 ° in the standing position, a corresponding narrowing of the joint space can be seen. In any other position, these changes will most likely not be noticeable, so other x-ray positions are not relevant for examining knee pain. If a patient with complaints of pain in the knee joint radiographically revealed a significant narrowing of the joint space, extensive damage to the meniscus and cartilage is very likely, in which arthroscopic resection of the meniscus (incomplete or partial meniscectomy), which we will discuss below, is useless. To exclude such a cause of pain as chondromalacia of the patella, an x-ray is needed in a special axial projection (for the patella). Plain radiography, which in no way facilitates the diagnosis of meniscus rupture, nevertheless makes it possible to exclude such concomitant disorders as osteochondritis dissecans (Koenig's disease), fracture, tilt or subluxation of the patella, and articular mice (free intraarticular bodies).

MRI (Magnetic resonance imaging) significantly improved the accuracy of diagnosing meniscus ruptures. Its advantages are the ability to image the meniscus in several planes and the absence of ionizing radiation. In addition, MRI allows you to assess the condition of other articular and periarticular formations, which is especially important when the doctor has serious doubts about the diagnosis, as well as if there are concomitant injuries that make it difficult to perform diagnostic tests. The disadvantages of MRI include high cost and the possibility of incorrect interpretation of changes with the ensuing additional studies. A normal meniscus for all pulse sequences gives a weak homogeneous signal. In children, the signal may be enhanced due to a more abundant blood supply to the meniscus. Increased signal in older people may be a sign of degeneration.

According to MRI, there are four degrees of meniscus changes (classification according to Stoller). Degree 0 is a normal meniscus. Grade I is the appearance in the thickness of the meniscus of a focal signal of increased intensity (not reaching the surface of the meniscus). Grade II - the appearance in the thickness of the meniscus of a linear signal of increased intensity (not reaching the surface of the meniscus). Grade III - signal of increased intensity, reaching the surface of the meniscus. Only grade III changes are considered a true meniscus tear.

0 degree (normal), meniscus unchanged.

I degree - a spherical increase in signal intensity, not associated with the surface of the meniscus.

II degree - a linear increase in signal intensity, not associated with the surface of the meniscus.

III degree (rupture) - an increase in signal intensity in contact with the surface of the meniscus.

Magnetic resonance imaging. On the left, a normal, intact meniscus (blue arrow). Right - rupture of the posterior horn of the meniscus (two blue arrows)

The accuracy of MRI in diagnosing a meniscal tear is approximately 90-95%, especially if twice in a row (i.e., on two adjacent slices) a high-intensity signal is recorded that captures the surface of the meniscus. To diagnose a rupture, you can also focus on the shape of the meniscus. Usually in the pictures in the sagittal plane, the meniscus has the shape of a butterfly. Any other shape could be a sign of a break. A sign of rupture is also the symptom "double posterior cruciate ligament" (or "third cruciate ligament"), when, as a result of displacement, the meniscus is in the intercondylar fossa of the femur and is adjacent to the posterior cruciate ligament.

A torn meniscus can be detected on MRI even in the absence of complaints in the patient, and the frequency of such cases increases with age. This indicates how important it is to take into account all clinical and radiological data during the examination. In a recent study, meniscal tears with no complaints or physical signs (i.e., positive test results when examined by a physician) were found on MRI in 5.6% of patients aged 18 to 39 years. According to another study, 13% of patients younger than 45 years and 36% of patients older than 45 years had signs of meniscal tears on MRI in the absence of complaints and physical signs.

What are knee meniscal tears?

Meniscus tears can be classified according to the cause and the nature of the changes found during the examination (MRI) or during surgery (knee arthroscopy).

As we have already noted, ruptures can be traumatic (excessive load on the unchanged meniscus) and degenerative (normal load on the meniscus changed by degenerative processes).

In the place where the rupture occurred, ruptures of the posterior horn, body and anterior horn of the meniscus are isolated.

Since the blood supply to the meniscus is uneven, three zones are distinguished in it: peripheral (red) - in the area of ​​\u200b\u200bthe junction of the meniscus with the capsule, intermediate (red-white) and central - white, or avascular, zone. The closer to the inner edge of the meniscus the rupture is located, the fewer vessels pass near it and the lower the likelihood of its healing.

The shape of the gaps are divided into longitudinal, horizontal, oblique and radial (transverse). There may be breaks combined in form. In addition, there is also a special variant of the meniscus rupture form: “watering can handle” (“basket handle”).

Classification of meniscal tears according to H. Shahriaree: I - longitudinal tear, II - horizontal tear, III - oblique tear, IV - radial tear

A special variant of the meniscus tear shape: "watering can handle" ("basket handle")

Acute traumatic ruptures that occur at a young age run vertically in a longitudinal or oblique direction; combined and degenerative tears are more common in the elderly. Vertical longitudinal tears, or tears in the form of a watering can handle, are complete and incomplete and usually begin with the posterior horn of the meniscus. With long ruptures, significant mobility of the torn part is possible, allowing it to move into the intercondylar fossa of the femur and block the knee joint. This is especially true for tears of the medial meniscus, possibly due to its lesser mobility, which increases the shear force acting on the meniscus. Oblique tears usually occur at the border between the middle and posterior thirds of the meniscus. More often these are small tears, but their free edge can fall between the articular surfaces and cause a sensation of rolling or clicking. Combined tears run in several planes at once, are often localized in the posterior horn or near it, and usually occur in older people with degenerative changes in the menisci. Horizontal longitudinal tears are often associated with cystic degeneration of the menisci. These tears usually begin at the inner edge of the meniscus and travel to the junction of the meniscus with the capsule. They are thought to be caused by shear forces and, when associated with cystic degeneration of the meniscus, form in the medial medial meniscus and cause localized swelling (bulging) along the joint line.

How to treat a torn meniscus in the knee?

Treatment of meniscal tears is conservative (i.e. non-surgical) and surgical (meniscectomy, i.e. removal of the meniscus, which may be complete or incomplete (partial)).

Meniscus suture and transplantation are special surgical options for meniscal tears, but these techniques are not always possible and sometimes do not give very reliable results.

Conservative (non-surgical) treatment of ruptures of the meniscus of the knee joint. Conservative treatment is usually indicated for small tears in the posterior horn of the meniscus or for small radial tears. These ruptures may be painful, but do not compress the meniscus between the articular surfaces and do not cause any clicking or rolling sensation. Such tears usually occur in stable joints.

Treatment consists of temporarily reducing stress. Unfortunately, one can often come across a situation when in our country a plaster cast is applied for a meniscus rupture, which completely excludes movement in the knee joint. If there are no other injuries in the knee joint (fractures, torn ligaments), but only a meniscus tear, then such treatment is fundamentally wrong and can even be called crippling. The fact is that large meniscal tears still will not grow together, despite the plaster and complete immobilization of the knee joint. And small meniscus tears can be treated in more gentle ways. Complete immobilization of the knee joint with a heavy plaster cast is not only painful for a person (after all, it is impossible to wash normally, bedsores can occur under the plaster), but it has a detrimental effect on the knee joint itself. The fact is that complete immobilization can lead to contracture of the joint, i.e. persistent limitation of the range of motion due to the fact that non-moving cartilaginous surfaces stick together, and, unfortunately, movements in the knee after such treatment are not always possible to restore. It is doubly sad when the treatment with a plaster cast is used in cases where the gap is large enough, and after several weeks of torment in the cast, an operation still has to be performed. Therefore, it is so important to immediately contact a specialist who is familiar with the treatment of torn menisci and ligaments of the knee joint in case of a knee joint injury.

If the patient is involved in sports, then with conservative treatment it is necessary to exclude situations that can further injure the joint. For example, temporarily stopping sports that require quick jerks, especially turns and movements in which one leg remains in place, can worsen the condition.

In addition, exercises that strengthen the quadriceps femoris and the posterior thigh muscles are needed. The fact is that strong muscles additionally stabilize the knee joint, which reduces the likelihood of such shifts of the femur and tibia relative to each other, which injure the meniscus.

Often, conservative treatment is more effective in the elderly, since in them the cause of the described symptoms is often arthrosis, rather than a meniscal tear. Small (less than 10 mm) stable longitudinal tears, tears of the upper or lower surface that do not penetrate the entire thickness of the meniscus, and small (less than 3 mm) transverse tears may heal on their own or do not appear at all.

In cases where a meniscus tear is combined with an anterior cruciate ligament tear, conservative treatment is usually first resorted to.

Surgical treatment of ruptures of the meniscus of the knee joint. The indications for arthroscopic surgery are a significant size of the gap, causing mechanical symptoms (pain, clicking, blockade, restriction of movement), persistent effusion in the joint, as well as cases of unsuccessful conservative treatment. Once again, we note that the very fact of the existence of the possibility of conservative treatment does not mean that all meniscus ruptures should first be treated conservatively, but then, if it fails, then resort to "operation as a last resort." The fact is that quite often meniscal tears are of such a nature that it is more reliable and more efficient to operate immediately, and sequential treatment (“first conservative, and then, if it doesn’t help, then surgery”) can significantly complicate recovery and worsen the results. Therefore, we emphasize once again that with a meniscus rupture, and indeed with any injury to the knee joint, it is important to consult a specialist.

In meniscal tears, friction and blockage, called mechanical or motor symptoms (because they occur with movement and disappear or are greatly relieved by rest), can be a hindrance both in daily life and in sports. If the symptoms occur in everyday life, then the doctor can easily detect signs of a gap on examination. As a rule, an effusion is found in the joint cavity (synovitis) and pain in the projection of the joint space. There may also be limited movement in the joint and pain during provocative tests. Finally, other causes of knee pain should be ruled out based on the history, physical examination, and x-ray. If these symptoms are present, then this means that a meniscus tear is significant and surgery should be considered.

It is important to know that with meniscus ruptures, you do not need to delay the operation for a long time and endure pain. As we have already noted, a dangling meniscus flap destroys the adjacent cartilage covering the femur and tibia. The cartilage from smooth and elastic becomes softened, loose, and in advanced cases, a dangling flap of a torn meniscus erases the cartilage completely to the bone. Such cartilage damage is called chondromalacia, which has four degrees: in the first degree, the cartilage is softened, in the second, the cartilage begins to loosen, in the third, there is a “dent” in the cartilage, and in the fourth degree, the cartilage is completely absent.

Photograph taken during knee arthroscopy. This patient endured pain for almost a year, after which he finally turned to traumatologists for help. During this time, the dangling flap of the torn meniscus completely obliterated the cartilage down to the bone (grade 4 chondromalacia)

removal of the meniscus or meniscectomy (arthrotomy through a large incision 5-7 centimeters long), was initially considered a harmless intervention and complete removal of the meniscus was performed very often. However, long-term results were disappointing. Recovery or marked improvement was noted in 75% of men and less than 50% of women. Complaints disappeared in less than 50% of men and less than 10% of women. The results of the operation were worse in young people than in older people. In addition, 75% of the operated patients developed arthritis (against 6% in the control group of the same age). Arthrosis often appeared 15 years or more after surgery. Degenerative changes developed faster after lateral meniscectomy. When the role of the menisci finally became clear, the surgical technique changed and new tools were created to restore the integrity of the menisci or remove only part of them. Since the late 1980s, arthrotomic total meniscus removal has been recognized as an ineffective and harmful operation, which has been replaced by the possibility of arthroscopic surgery, which allows preserving the intact part of the meniscus. Unfortunately, in our country, due to organizational reasons, arthroscopy is far from being available everywhere, so there are still surgeons who offer their patients to completely remove a torn meniscus.

Nowadays, the meniscus is not completely removed, since its important role in the knee joint has become clear, but a partial (partial) meniscectomy is performed. This means that not the entire meniscus is removed, but only the detached part, which has already ceased to fulfill its function. What is the principle of partial meniscectomy, i.e. partial removal of the meniscus? The video and illustration below will help you understand the answer to this question.

The principle of partial meniscectomy (i.e., incomplete removal of the meniscus) is not only to remove the torn and dangling part of the meniscus, but also to make the inner edge of the meniscus smooth again.

The principle of partial removal of the meniscus. Different variants of meniscus ruptures are shown. A part of the meniscus is removed from its inner side in such a way as not only to remove the dangling flap of the torn meniscus, but also to restore the smooth inner edge of the meniscus.

In the modern world, the operation of partial removal of a torn meniscus is performed arthroscopically, i.e. through two small holes. An arthroscope is inserted into one of the punctures, which transmits the image to the video camera. Essentially, an arthroscope is an optical system. A saline solution (water) is injected through the arthroscope into the joint, which inflates the joint and allows it to be examined from the inside. Through the second puncture, various special instruments are introduced into the cavity of the knee joint, with which the damaged parts of the menisci are removed, the cartilage is "restored" and other manipulations are performed.

Arthroscopy of the knee. BUT- The patient lies on the operating table, the leg is in a special holder. Behind - the arthroscopic stand itself, which consists of a xenon light source (a xenon light guide illuminates the joint), a video processor (to which a video camera is attached), a pump (injects water into the joint), a monitor, a wiper (a device for ablation of cartilage, the synovial membrane of the joint), shaver (a device that "shaves"). B- an arthroscope (on the left) and a working instrument (nippers, on the right) were inserted into the knee joint through two punctures one centimeter each. AT- Appearance of arthroscopic nippers, clamps.

If cartilage damage (chondromalacia) is detected during arthroscopy, the doctor may recommend that you inject special preparations into the knee joint after the operation (ostenil, fermatron, duralan, etc.). You can find out more about which drugs can be injected into the knee joint and which cannot be found on our website in a separate article.

In addition to meniscectomy, there are methods for repairing the meniscus. These include meniscus suture and meniscus transplantation.It is difficult to decide when it is better to remove part of the meniscus and when it is better to restore the meniscus. It is necessary to take into account many factors that affect the outcome of the operation. In general, it is considered that if the meniscus is damaged so extensively that during arthroscopic surgery it is necessary to remove almost the entire meniscus, then it is necessary to decide whether it is possible to restore the meniscus.

A meniscus suture can be performed in cases where a little time has passed since the rupture. A necessary condition for the successful fusion of the meniscus after its stitching is a sufficient blood supply to the meniscus, i.e. The rupture must be located in the red zone, or at least on the border of the red and white zones. Otherwise, if you perform stitching of a meniscus that has developed in the white zone, the suture will sooner or later become insolvent again, a “re-rupture” will occur and an operation will be required again. A meniscus suture can be performed arthroscopically.

The principle of arthroscopic suture of the meniscus is "from inside to outside". There are also outside-in methods and meniscus stapling

Photo taken during arthroscopy. Meniscus suture stage

Meniscus transplant. Now there is the possibility of transplantation (transplantation) of the meniscus. Meniscus transplantation is possible and may be appropriate when the meniscus of the knee joint is significantly damaged and completely ceases to function. Contraindications include severe degenerative changes in the articular cartilage, instability of the knee joint and curvature of the leg.

For transplantation, both frozen (donor or cadaveric) and irradiated menisci are used. Reportedly, the best results are to be expected with donor (fresh frozen) menisci. There are also artificial meniscal endoprostheses.

However, operations for transplantation and meniscus arthroplasty are associated with a number of organizational, ethical, practical and scientific difficulties, and this method does not have a convincing evidence base. Moreover, among scientists and surgeons there is still no consensus on the expediency of transplantation and meniscus arthroplasty.

In general, it should be noted that transplantation and meniscal arthroplasty are performed extremely rarely.

Questions to discuss with your doctor

1. Do I have a torn meniscus?

2. What is my meniscus tear? Degenerative or traumatic?

3. What is the size of a meniscus tear and where is the tear located?

4. Are there any other injuries besides a meniscus tear (is the anterior cruciate ligament intact, lateral ligaments, are there any fractures, etc.)?

5. Is there any damage to the cartilage covering the femur and tibia?

6. Do I have a significant meniscus tear? Is an MRI required?

7. Can my torn meniscus be treated without surgery or should I have arthroscopy?

8. What are the chances of cartilage damage and arthrosis if I delay the operation?

9. What are the chances of cartilage damage and arthrosis if I go for arthroscopic surgery?

10. If arthroscopy has a better chance of success than non-surgical method, and I agree to the operation, how long will the recovery take?

An intact knee joint has 2 cartilaginous inlays: lateral and medial. These tabs look like a crescent. The outer meniscus has a fairly dense base, it is more mobile, so it is much less likely to be injured. The medial meniscus is not flexible enough, so damage to the medial meniscus occurs most frequently.

Rupture of the posterior horn of the medial meniscus.

At the present time, qualified specialists name one main reason for the origin of the rupture of the posterior horn of the medial meniscus. This cause is an acute injury. There are also a couple of additional factors that contribute to the occurrence of the above injury.
- A strong jump, which is done on a very flat surface.
- Rotation on one leg, without taking off the foot.
- Too active walking or prolonged sitting on squats.
- Injury, which is obtained as a result of a disease of the joints.
- Pathology in the form of weak joints or ligaments.
When the posterior horn of the medial meniscus is torn, the patient immediately feels severe pain, which lasts for a long time. Before feeling pain, the person hears a clicking sound. The patient may experience a blockade of the internal meniscus, this symptomatology occurs as a result of clamping between the bones of a torn meniscus particle. The patient develops hemarthrosis. After a short amount of time, the patient develops swelling of this joint.

Damage to the posterior horn of the medial meniscus.

Damage to the posterior horn of the medial meniscus occurs due to the incorrect position of the parts of the joints during the formation of damage. Qualified specialists strongly recommend that you know the first symptoms of damage to the above part of the knee, especially for people who are at risk. There are two types of damage to the above part.
- Traumatic tear occurs as a result, if the joint is slightly bent, a rotating movement occurs in this joint.
- Degenerative rupture typically occurs in the 45 to 50 age group. Often damage to this form occurs due to repeated microtrauma.

Posterior horn of the medial meniscus, methods of treatment.

If the rupture of the above type of meniscus is mild or moderately severe, then the treatment is prescribed in a conservative way. The patient is strongly advised not to do strong physical exertion on the affected knee. To do this, the patient is assigned crutches, it is necessary to minimize long walks in the fresh air. Compliance with bed rest is not necessary, a person can quite easily do all the housework. In order to relieve pain and swelling, the patient is advised to apply ice packs to the injured area for 15-20 minutes at least 3 times a day. It is forbidden to keep ice for a long time, due to the fact that damage to the skin can occur.
A person with this injury must wear an elastic bandage. The bandage will not only help the swelling go down faster, but also significantly limit the mobility of the knee. Specialists should show the patient how to adjust the bandage. While watching TV or reading, the leg should be slightly higher than the heart. If you are worried about severe pain, it is allowed to use paracetamol or non-steroidal medicines.
If conservative treatment does not show the desired result, the patient is prescribed surgery. There are several types of surgical intervention.
1. Restoration of the meniscus. This type of intervention is quite gentle and is performed on patients under the age of forty, due to the fact that their cartilage tissue is healthy.
2. Removal of the meniscus, is prescribed if there is severe damage to the cartilage tissue. This operation is prescribed extremely rarely, since the complete removal of the meniscus can provoke complications.
3. Meniscus transplantation, is prescribed if it is not possible to restore a damaged meniscus. The transplant is made of artificial material or there is a donor.
A couple of days before the operation, the medical staff conducts a conversation with the patient, telling in detail about the course of the operation. A few weeks before the scheduled date of surgery, the patient is strongly advised to completely eliminate the use of tobacco and alcohol, as this will significantly reduce the risk of blood clots. The success rate increases if the operation is performed within 2 months of the injury.
After the operation, the patient is prescribed a course of physiotherapy. The time it takes a person to return to normal life is directly related to how well the operation went and how long the postoperative period lasts.

Changes in the meniscus are anatomical lesions that are formed as a result of trauma, a previous illness, or an unnatural structure of the joints. As a rule, 11 arise as a result of severe injuries, which cause injury to the cartilaginous discs and, accordingly, pain begins. These changes in the internal menisci are more often diagnosed in males.
In the process of movement, the meniscus change significantly in shape. Any meniscus, according to the anatomical structure, is divided into several parts: anterior horn, posterior horn, body. The medial meniscus on the outer surface is quite firmly connected to the joint capsule. If we compare the medial and lateral meniscus, then the first is not so mobile.

Damage to the lateral and medial meniscus have many similarities. It should be noted that damage to the medial meniscus is much more common than the medial one. Also, do not exclude the fact that damage to two meniscus may occur at once. Most of the damage occurs on the posterior horn of the meniscus. With longitudinal injuries of the posterior kind of the medial meniscus, an external examination will not help to determine the changes that have occurred, for this it is necessary to use only medical equipment.
To determine the extent of damage, doctors resort to using an artiscopic hook. If there is a gap, then the tip of the probe will fully enter into it. Due to a flap rupture, the flap may slightly bend into the posteromedial section or into the medial flag, respectively, in this case, the meniscus looks thickened or compacted.

Damage to the posterior horn of the medial meniscus

The posterior horn of the meniscus is the inner part, and has the distinguishing feature that there is no blood circulation in it. The meniscus is nourished by the circulation of synovial fluid. That is why 11.1 is inevitable, since tissues do not count on regeneration. In order to confirm or refute the above damage, first of all, a clinical examination of the patient takes place, then an x-ray is prescribed for him. It should be noted that the menisci themselves are transparent and will not be visible on the x-ray, but the x-ray will exclude damage to the bone, which has similar symptoms. To accurately determine the intra-articular structure, the patient is assigned to undergo magnetic resonance imaging, as well as computed tomography. If necessary, a person needs to undergo an ultrasound examination.
When the above damage occurs, the patient develops certain symptoms.
- As soon as the injury is received, the person feels sharp pain sensations for the first 5 minutes. Before an injury, a person may hear a definite click.

After the pain has passed, a person can move around, but this will provoke the occurrence of new pains. After 10 to 12 hours, the patient will begin to feel sudden burning sensations in the knee. During the period of flexion and extension of the knee, the pain only intensifies.
- If you press your finger on the joint space while the leg is bent at 90° of the lower leg of the knee joint, the patient experiences severe pain. If you continue to press and unbend the lower leg, then the pain sensations intensify as a result of the fact that during the period of extension the meniscus simply rests against the tissue, which is motionless due to the finger.
- Unbearable pain begins to disturb when walking up the stairs.
Also, the patient is offered to undergo a certain test. The patient, while standing, should slightly bend the legs at the knee joints. Next, the person is asked to gently turn the torso first to the right side, then to the left side. If pain occurs in the knee joint during an inward turn (in relation to the injured leg), this indicates that there is damage to the posterior horn of the medial meniscus; if pain occurs when turning outward, then the lateral meniscus is damaged.

Treatment of the posterior horn of the medial meniscus begins with specialists confirming the diagnosis. If the damage is minor, then the treatment will be carried out in a conservative way. The patient is prescribed special medications that eliminate pain, inflammation. It is also necessary to complete a full course of manual therapy and physiotherapy. If damage to the damage to the posterior horn of the medial meniscus is serious enough, then surgery is indispensable. Any specialist in any case tries to save the meniscus, regardless of the fact that the posterior horn is damaged. The main goal is to preserve the capacity of the organ as much as possible. If the patient is undergoing arthroscopy. Then the period of healing of peripheral calving of the meniscus is significantly reduced.

Treatment of damage to the posterior horn of the meniscus is based on the restoration of the functions of the knee joint. It should be noted that any rehabilitation period should be under the supervision of medical personnel. Doctors prescribe a certain set of measures, taking into account all the individual characteristics of the patient. The recovery period can be carried out at home, but it is necessary to visit the clinic several times a week. It is necessary to focus on the fact that the rehabilitation period after injury is based on the passage of a course of massage, physiotherapy exercises. In order to stimulate the muscles and to develop the joints, the load must have different dosages.
As soon as the patient has the first prerequisites that there is damage to the medial meniscus, you should not waste time while being at home with the thought that everything will pass, it is urgently necessary to go for a consultation with specialists. In most cases, the patient needs from 4 to 7 months for the final recovery of the damaged posterior horn of the medial meniscus. Normal life is allowed to lead after 1 month after the operation. Timely seeking help, a confirmed diagnosis, as well as a fully completed course of treatment and rehabilitation increase the chances of a full recovery.

The meniscus is a cartilaginous lining located between the joints and acting as a shock absorber.

During the movement of the meniscus are able to modify their shape, which ensures the smoothness of a person's gait.

There are two menisci in the knee joint., one of which is external or lateral, the other meniscus internal or medial.

medial meniscus in its structure, it has less mobility, and therefore it is most often subject to various kinds of damage up to tissue tear.

Conditionally meniscus can be divided into three parts:

— anterior horn of the meniscus

— posterior horn of the meniscus

- meniscus body

Posterior horn of the meniscus or its inner part does not have a blood supply system, nutrition occurs due to the circulation of the articular synovial fluid.

Exactly because of this reason damage to the posterior horn of the meniscus irreversible, tissues do not have the ability to regenerate. torn posterior meniscus very difficult to diagnose, which is why the doctor usually prescribes magnetic resonance imaging to establish an accurate diagnosis.

Rupture symptoms

Immediately after the injury, the victim feels a sharp pain, the knee begins to swell. In cases rupture of the posterior horn of the meniscus the pain increases sharply when the victim goes down the stairs.

When tearing meniscus the torn off part of it dangles inside the joint and interferes with movement. When the gaps are small in size, painful clicks are usually observed in the joint.

If the gap is large in area, there is a blockade or wedging knee joint.

This is because the torn part meniscus moves to the center of the damaged joint and blocks the movement of the knee.

In case of rupture of the posterior horn meniscus knee flexion is usually limited. When the meniscus is torn, the pain is quite strong.

The victim cannot step on the injured leg at all. Sometimes the pain gets worse when the knee is bent.

It is often possible to observe degenerative tears that occur in people after 40 years of age as a result of age-related changes in cartilage tissue. In such cases, the gap occurs even with the usual abrupt getting up from the chair, such a gap is very difficult to diagnose.

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.

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A bit of anatomy

There are two menisci in each knee joint:

• lateral (or external) - its shape resembles the letter C;
• medial (or internal) - has the shape of a regular semicircle.

Each of them is conditionally divided into three parts:

• anterior horn;
• body;
• back horn.

Menisci are formed from fibrous cartilage and are attached to the tibia (front and back). In addition, the inner meniscus along the outer edge is attached by the coronary ligament to the joint capsule. This triple fastening makes it more immovable (compared to the outer one). Because of this, it is the inner meniscus that is more prone to injury.

A normal meniscus consists mainly of collagen fibers. Most of them are located circularly (along), and the smaller part is radially (from the edge to the center). Between themselves, such fibers are connected by a small amount of perforating (i.e., disordered) fibers.

The meniscus is made up of:

• collagen - 60-70%;
• extracellular matrix proteins - 8-13%;
• elastin - 0.6%.

In the meniscus, a red zone is distinguished - an area with blood vessels.

Meniscus functions

Previously, scientists believed that menisci were non-functional muscle remnants. They are now known to perform a range of functions:

• contribute to a uniform distribution of the load on the surface of the joint;
• stabilize the joint
• absorb shocks during movement;
• reduce contact voltage;
• send signals to the brain about the position of the joint;
• limit the range of motion of the cartilage and reduce the likelihood of dislocations.

Causes and types of gaps

Depending on the causes of damage to the menisci, there are:

• traumatic ruptures - appear as a result of traumatic impact (awkward turn or jump, deep squat, squatting, rotational-flexion or rotational movements during sports, etc.);
• degenerative tears - appear due to chronic diseases of the joint, which lead to degenerative changes in its structures.

Depending on the location of the injury, a meniscus tear can occur:

• in the anterior horn;
• body;
• back horn.

Depending on the shape, a meniscus tear can be:

• horizontal - occurs due to cystic degeneration;
• oblique, radial, longitudinal - occurs at the border of the middle and posterior third of the meniscus;
• combined - occurs in the posterior horn.

After an MRI, specialists can judge the degree of damage to the meniscus:

• 0 - meniscus unchanged;
• I - a focal signal is recorded in the thickness of the meniscus;
• II - a linear signal is recorded in the thickness of the meniscus;
• III - an intense signal reaches the surface of the meniscus.

Symptoms

Traumatic tears

At the moment of injury (when jumping, deep squatting, etc.), the patient develops a sharp pain in the knee joint and the soft tissues of the knee swell. If the damage occurred in the red zone of the meniscus, then the blood flows into the joint cavity and leads to the development of hemarthrosis, which is manifested by the appearance of swelling and swelling above the patella.

The intensity of pain in case of damage to the meniscus can be different. Sometimes, due to its sharpness, the victim cannot even step on his foot. And in other cases, it is felt only when performing certain movements (for example, it is felt when going down the stairs, but not when going up).

After an injury to the internal meniscus, when trying to strain the leg, the victim feels a sharp shooting pain, and flexion of the limb leads to pain along the tibial ligament. After an injury, the patella cannot be moved, and muscle weakness is determined in the area of ​​​​the anterior surface of the thigh.

If the external meniscus is damaged, the pain intensifies when trying to turn the lower leg inward. It is felt when the peroneal collateral ligament is tense and shoots along it and into the outer part of the joint. In the area of ​​the anterior part of the thigh, the patient has muscle weakness.

After a rupture of the meniscus, its detached part moves and makes it difficult to move in the knee joint. With minor injuries, sensations of difficulty in movement and painful clicks may appear, and with large injuries, blockade of the joint may occur, which is caused by the movement of a large moving fragment to the center of the joint (i.e., it seems to jam the joint). As a rule, a rupture of the posterior horn leads to limited knee flexion, and damage to the body and anterior horn makes it difficult to extend the limb.

Sometimes a meniscus tear (usually external) can be combined with damage to the anterior cruciate ligament. In such cases, swelling of the knee occurs faster and it is more significant than with an uncombined injury.

Degenerative tears

Usually such damage occurs in people over 40 years of age. Their appearance is not always associated with a traumatic factor, and a gap can occur after performing habitual actions (for example, after getting up from a chair, bed, armchair) or with minor physical impact (for example, regular squatting).

The patient develops swelling and pain in the knee area, which does not occur acutely. Usually, the manifestations of a degenerative meniscus end there, but in some cases they may be accompanied by blockade of the joint. Often, with such damage to the meniscus, there is a violation of the integrity of the adjacent cartilage that covers the tibia or femur.

As with traumatic injuries, the severity of pain in degenerative tears can be variable. In some cases, because of it, the patient cannot step on the foot, and in others, pain occurs only when performing a specific movement (for example, squats).

Possible Complications

Sometimes, in the absence of unbearable pain, a meniscus injury is confused with a common knee injury. The victim may not seek help from a specialist for a long time, and pain may eventually disappear completely. Despite this relief, the meniscus remains damaged and ceases to function.

Subsequently, the destruction of the articular surfaces occurs, leading to the development of a severe complication - gonarthrosis (deforming arthrosis). This dangerous disease in the future may become an indication for knee arthroplasty.

In case of a knee injury, the following symptoms are the reason for a mandatory visit to the doctor:

• even mild pain in the knee when moving up the stairs;
• the appearance of a crunch or click when bending the leg;
• episodes of knee jamming;
• swelling;
• sensation of interference with movements in the knee joint;
• the impossibility of deep squatting.

If at least one of the above signs appears, you should contact an orthopedist or traumatologist.

First aid

For any knee injury, the victim should be given first aid:

1. Immediately abandon any load on the knee joint and subsequently use crutches for movement.


2. To reduce pain, swelling and stop bleeding, apply a cold compress to the area of ​​injury or wrap the leg with a cotton cloth and apply ice to it (be sure to remove it every 15-20 minutes for 2 minutes to prevent frostbite).
3. Give the victim to take an anesthetic drug in the form of tablets (Analgin, Ketanol, Nimesulide, Ibuprofen, etc.) or perform an intramuscular injection.
4. Give the leg an elevated position.
5. Do not postpone the visit to the doctor and help the victim get to a medical institution or trauma center.

Diagnostics

After questioning and examining the patient, the doctor conducts a series of tests that allow, with an accuracy of 95%, to establish the presence of meniscus damage:

• rotational Steiman tests;
• detection of a symptom of extension according to the tests of Roche and Baikov;
• mediolateral test to identify the symptom of compression.

The following additional examination methods allow to accurately establish the presence of a meniscus rupture:

• MRI of the knee joint (accuracy up to 95%);
• Ultrasound (sometimes used);
• radiography (less informative).

The informational value of radiography in the study of cartilage tissue is small, but it is always prescribed for suspected meniscus rupture to exclude the presence of other injuries (ligament tears, fractures, etc.).

Sometimes diagnostic arthroscopy is performed to confirm the diagnosis.

Treatment

The treatment of meniscal injuries is determined by the severity of the injury. Small tears or degenerative changes can be repaired conservatively, while significant tears and blockades of the knee joint require surgery.

Conservative therapy

The patient is advised to provide the injured limb with maximum rest. To ensure the immobility of the joint, an elastic bandage is applied to the area of ​​injury, and when in bed, an elevated position of the leg is recommended. In the first days after the injury, cold should be applied to the area of ​​injury. When moving, the patient must use crutches.

To eliminate pain and inflammation, antibacterial and non-steroidal anti-inflammatory drugs are prescribed. After stopping the acute period, the patient is recommended a rehabilitation program that provides the most complete restoration of the functions of the knee joint.

Surgery

Previously, with a severe injury to the meniscus, an operation was performed to completely remove it. Such interventions were considered harmless, since the role of these cartilage pads was underestimated. However, after such radical surgery, 75% of patients developed arthritis, and 15 years later, arthrosis. Since 1980, such interventions have been found to be completely ineffective. By the same time, it became technically possible to perform such a minimally invasive and effective operation as arthroscopy.

Such a surgical intervention is performed through two small punctures (up to 0.7 cm) using an arthroscope, which consists of an optical device connected to a video camera that displays an image on a monitor. The device itself is inserted into one of the punctures, and instruments for the operation are inserted through the other.

Arthroscopy is performed in an aquatic environment. This surgical technique allows achieving good therapeutic and cosmetic results and significantly reduces the time of rehabilitation of the patient after the injury. With the help of an arthroscope, the surgeon can reach the most distant parts of the joint. To eliminate damage to the meniscus, the specialist installs special fasteners (anchors) on it or sutures it. Sometimes, with a significant displacement of the meniscus during the operation, its partial removal is performed (i.e., its detached section is cut off).

If during arthroscopy the doctor detects chondromalacia (cartilage damage), then the patient may be recommended intra-articular administration of special drugs after surgery. For this can be used: Dyuralan, Ostenil, Fermaton, etc.

The success of arthroscopic interventions for meniscus ruptures largely depends on the severity of the injury, the location of the injury, the age of the patient, and the presence of degenerative changes in the tissues. A high probability of good results is observed in young patients, and a smaller one in patients older than 40 years or in the presence of severe meniscal damage, its horizontal dissection or displacement.

As a rule, such a surgical intervention lasts about 2 hours. Already on the first day after arthroscopy, the patient can walk on crutches, stepping on the operated leg, and after 2-3 days he walks with a cane. Full recovery takes about 2 weeks. Professional athletes can return to training and their usual loads after 3 weeks.

In some cases, with significant damage to the meniscus and the complete loss of its functionality, the patient may be recommended a surgical operation such as meniscus transplantation. Frozen (donor and cadaveric) or irradiated menisci are used as a transplant. According to statistics, better results from such interventions are observed when using frozen donor menisci. There are also transplants made of artificial materials.

Rehabilitation

The rehabilitation program after a meniscus injury is compiled individually for each patient, since its volume depends on the complexity and type of injury. The start date is also set by the doctor for each patient. To restore the lost functions of the knee joint, such a program includes therapeutic exercises, massage and physiotherapy.

Damage to the meniscus of the knee joint is accompanied by a violation of the integrity of these cartilaginous "shock absorbers". Such injuries can vary in severity, and the tactics of their treatment depend on the type and complexity of the injury. Both conservative and surgical techniques can be used to treat meniscal injuries.

Which doctor to contact

If you experience pain, swelling and dysfunction of the knee joint, you should contact an orthopedic traumatologist. After examining and questioning the patient, the doctor will conduct a series of diagnostic tests and, to confirm the diagnosis of meniscus tear, will prescribe an MRI, X-ray or ultrasound of the knee joint.

The first channel, the program “Live healthy” with Elena Malysheva, in the “About medicine” section, the specialist talks about damage to the meniscus of the knee joint and their treatment (from 32:20 min.):

Traumatologist Yu. Glazkov talks about the treatment of injuries to the meniscus of the knee joint:

myfamilydoctor.ru

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 quite 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 - this is 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 “living” zone of cartilage is subject to the best restoration.

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.

The reasons

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 the 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.

Treatment

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, the dosage of which should be determined only by a doctor.

Sometimes, when the meniscus is damaged, gypsum is used. Apply plaster or not, the doctor decides. Usually, after manual reduction of the joint, it takes several weeks to immobilize at a certain angle. For a long time, the desired angle can be maintained only with the help of rigid fixation.

Surgery

The main principle that doctors are guided by when performing an operation after damage to the posterior horn of the meniscus is the maximum safety of the organ and its functionality. If other methods of treating a meniscus tear are useless, surgery is necessary. First of all, a meniscus tear is tested to see if it can be repaired. As a rule, this method is relevant in case of damage to the "red zone".

Also, if the horn of the medial meniscus is damaged, the following types of operations are used:

• Arthrotomy is a complex operation to remove damaged cartilage. This operation is best avoided, moreover, most of the leading modern specialists today have completely abandoned arthrotomy. The operation is really indicated if an extensive lesion of the knee joint is diagnosed;
• A meniscectomy is the complete removal of cartilage. Today it is recognized as harmful and ineffective;
• A partial meniscectomy is an operation in which the damaged part of the cartilage is removed and the remaining part is restored. Surgeons cut the edge of the cartilage to a flat state;
• endoprosthetics and transplantation. Many have heard of such operations and have a rough idea of ​​what it is. The patient is transplanted with a donor meniscus or an artificial one is placed;
• The most modern type of surgical treatment of joints is arthroscopy, which is characterized by low trauma. The principle of the operation is that the surgeon makes two small punctures in the knee and inserts an arthroscope (video camera) through one of them. At the same time, physiological saline enters there. Another puncture serves for various kinds of manipulations with the joint;
• stitching of damaged cartilage. This method is carried out thanks to the above arthroscope. Cartilage repair surgery will only be effective in the thick "living" zone, where there is a chance for fusion. In addition, the operation is carried out only on a "fresh" gap.

moisustavy.ru

Anatomical features of the cartilage tissue of the knee

The meniscus is the cartilaginous tissue of the knee, located between two adjacent 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

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?

sustavlive.ru

Hello!
Please tell me if surgery is required? MRI of the knee joint showed: on a series of MRI tomograms weighted by T1 and T2 in three projections with fat suppression, images of the left knee joint were obtained.

Bone traumatic changes are not determined. Effusion in the joint cavity. The structure of the bone tissue is not changed. The joint space is not narrowed, the congruence of the articular surfaces is preserved. In the inner meniscus, in the posterior horn, an abnormal MR signal from a horizontal Stoller grade 3 injury is determined. The integrity of the cross-shaped ligaments is preserved. Inhomogeneous signal from the anterior cruciate ligament. Own ligament of the patella without features. There is thickening and increased signal from the medial collateral ligament.
The intensity of the signal from the bone marrow is not changed.
Articular hyacinth cartilage of normal thickness, uniform.
The intensity of the signal from Goff's cell without any features.
Behind the medial we are silks 15x13x60 mm. There are no marginal osteophytes. Surrounding soft tissues without visible pathology.

Conclusion: MR picture of rupture of the internal meniscus, synovitis, Baker's cyst, partial damage to the collateral ligament.

Hello.

Judging by the presented interpretation of magnetic resonance imaging, there is a complete rupture of the internal meniscus. Usually this condition requires surgical intervention - arthroscopy, especially if it leads to blockades. The patient either does not fully extend the knee joint (static block), or at the moment of walking, turning the lower leg or torso with a fixed leg, the joint jams in one position (dynamic block).

Dynamic blockade is usually accompanied by a sharp pain sensation or a painful click. With blockade, part of the torn meniscus falls between the articular surfaces and does not allow movements to be carried out. Accordingly, the cartilage coating suffers, over time, deforming arthrosis of the knee joint develops, its stiffness.

During arthroscopic debridement, part of the meniscus (in this case, its posterior horn) is excised. The remaining tissue continues to perform its cushioning function in the joint. Also, according to MRI, there is an effusion (synovitis) in the joint, i.e. accumulation of inflammatory fluid. Synovitis in the absence of adequate treatment can become chronic. Such an inflammatory process harms the joint, in addition, the Baker's cyst in the popliteal fossa can increase. It is an accumulation of fluid in the back of the joint. When performing arthroscopic intervention, the surgeon washes the joint, removing the effusion, all particles of the damaged cartilage.

There is one more nuance. If the injury is fresh, then before the operation, you should wait for the fusion of the medial collateral ligament. To do this, you need to fix the knee with a rigid orthosis or a plaster splint for 2-3 weeks, and then apply surgery. Arthroscopy is performed through 2-3 small punctures along the anterior surface of the knee, using micro-instruments and a miniature camera inserted into the joint. Postoperative recovery is usually quick, especially if it is under the supervision of an experienced orthopedist.