Horizontal rupture of the body and posterior horn of the meniscus. Causes and treatment of rupture of the posterior horn of the medial meniscus of the knee joint. Methods for the treatment of meniscus injury

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

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

Rupture of the posterior horn of the medial meniscus

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

Menisci of the knee

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

Anatomical structure of the knee joint

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

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

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

The main reasons for the appearance

Classification of meniscus tears

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

Acute trauma as a cause of rupture

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

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

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

Symptoms of damage

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

Determine the nature of the injury

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

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

   The first sign is acute pain

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

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

   Hemarthrosis

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

Swelling and swelling of the knee

Features of treatment

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

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

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

Conservative treatment

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

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

Reposition

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

Anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs in rheumatology

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

Rehabilitation course

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

Treatment with chondroprotectors

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

ibuprofen photo

Dosage

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

Knee fixation

Surgical treatments

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

Table. Types of operations used in meniscus rupture

Arthroscopy

Total knee arthroplasty

Video - Arthroscopy of the medial meniscus

Rehabilitation

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

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

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

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

Rehabilitation measures after knee surgery

knee recovery

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

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

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

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

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

What is a meniscus

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

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

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

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

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

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

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

Main shock absorber in the knee joint

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

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

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

Thus, the meniscus changes under the influence of:

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

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

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

How to treat a torn meniscus

Orthopedists differentiate damage to the knee meniscus into several types:

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

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

In most cases, diagnose:

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

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

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

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

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

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

Degrees of meniscus injury and surgery

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

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

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

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

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

Conservative treatment of the meniscus in hospital and at home

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

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

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

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

• nimulida,
• voltarena,
• corticosteroids.

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

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

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

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

Treatment of the meniscus with folk remedies

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

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

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

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

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

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

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

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

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

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

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

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

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

Damage symptoms

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

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

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

How to heal damage?

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

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

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

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

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

meniscus tear

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

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

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

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

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

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

Rupture of the posterior horn of the meniscus

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

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

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

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

Rupture symptoms

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

• old;
• chronic;
• spicy.

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

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

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

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

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

How is a meniscus tear treated?

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

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

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

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

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

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

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

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

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

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

Anatomical structure

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

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

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

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

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

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

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

Functional features

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

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

The functional purposes of the menisci are different:

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

Break shapes

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

In modern traumatology, several types of ruptures are distinguished:

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

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

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

It happens:

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

The combined gap is characterized by:

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

Signs of breaks

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

The main symptoms include:

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

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

Causes and mechanisms

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

Gap shapes

Injury occurs due to:

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

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

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

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

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

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

Diagnostics

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

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

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

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

Medical tactics

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

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

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

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

Operation

The method of treatment with the help of surgical intervention solves the main problem - the preservation of the functionality of the knee joint. and its functions and is used when other treatments are excluded.

First of all, the damaged meniscus is examined for stitching, then the specialist makes a choice of one of several forms of surgical treatment:

1. Artromia. A very difficult method. It is used in exceptional cases with extensive damage to the knee joint.
2. Stitching of cartilage. The method is performed using an arthroscope inserted through a mini-hole into the knee in case of a fresh injury. The most favorable outcome is observed when cross-linking in the red zone.
3. Partial meniscectomy is an operation to remove the injured part of the cartilage, restoring its whole part.
4. Transfer. As a result of this operation, someone else's meniscus is inserted into the victim.
5. Arthroscopy. Traumatization with this most common and modern method of treatment is the most minimal. As a result of the arthroscope and saline solution introduced into the two mini-holes in the knee, all the necessary restorative manipulations are carried out.

Rehabilitation

It is difficult to overestimate the importance of the recovery period, compliance with all doctor's prescriptions, its correct implementation, since the return of all functions, painlessness of movements and complete recovery of the joint without chronic consequences directly depend on its effectiveness.

Small loads that strengthen the structure of the knee are given by properly assigned hardware recovery methods - simulators, and physiotherapy and exercise therapy are shown to strengthen internal structures. It is possible to remove edema with lymphatic drainage massage.

Treatment is allowed to be carried out at home, but still a greater effect is observed with inpatient treatment.

Several months of such therapy ends with the return of the victim to his usual life.

Consequences of injury

Ruptures of the internal and external menisci are considered the most complex injuries, after which it is difficult to return the knee to its usual motor functions.

But do not despair - the success of treatment largely depends on the victim himself.

It is very important not to self-medicate, because the result will largely depend on:

• timely diagnosis;
• correctly prescribed therapy;
• rapid localization of injury;
• the duration of the gap;
• successful recovery procedures.

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

Causes of damage

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

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

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

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

Causes of damage

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

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

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

Forms of rupture of the posterior horn of the medial meniscus

Damage to the posterior horn of the medial meniscus can be of the following types:

• Radial or transverse. Often such a tear is partial, but if the cartilage is damaged obliquely, this provokes the mobility of the meniscus body. Once in the interarticular gap, the structure blocks the knee, due to which the victim cannot move.
• A linear or horizontal tear in the posterior horn of the medial meniscus is characterized by flaking of the cartilage, but the body retains its shape and is not deformed. The main sign of such damage is the formation of edema.
• A vertical or longitudinal tear means the destruction of the internal structure of the cartilage in a straight line, while the marginal part of the body remains intact.
• A patchy rupture of the meniscus indicates that the cartilaginous formation is completely destroyed and deformed. The consequence of such damage is the formation of scraps that look like shreds.

Degrees of damage

There are 3 degrees of destruction of the integrity of the cartilage:

• Easy stage. It has no clear symptoms, the pain is often moderate, and the functioning of the knee joint is not impaired. The symptomatic picture is aggravated if the patient increases the load on the leg, and a slight swelling also appears.
• Average. At this stage, the degenerative process becomes more pronounced, the person is worried about acute pain in the knee, and it is impossible to bend and unbend the limb. At first, the block of the joint is incomplete, but after a couple of hours, the mobility of the joint is completely impaired.
• Heavy. Rupture of the posterior horn of the internal meniscus in the severe stage is manifested by an acute unbearable pain symptom that does not go away even after complete immobilization of the limb and taking painkillers. Edema is formed, due to which the knee becomes 2 times larger. The temperature of the damaged area increases, and the skin becomes bluish-brown.

Signs of violation

If the horn of the medial meniscus is damaged, the first sign characterizing the violation will be severe pain in the popliteal part of the joint. But the rupture of the posterior horn of the lateral meniscus is manifested by the localization of the pain syndrome from the outside. On palpation, the signs intensify, the joint becomes immobile, swells and increases in size. To avoid complications, an integrated approach to treatment is needed, otherwise the victim is threatened with complete or partial removal of cartilage.

Diagnostics

In order for the treatment of the gap to be adequate, it is important for the doctor to make an accurate diagnosis and find out the causes of the disorder. It is also important to determine exactly where the violation is localized, because with severe trauma, a rupture of the anterior horn of the medial meniscus can occur. To exclude the destruction of bone tissue, the patient is first sent for an X-ray examination. If the bones are intact, an additional MRI diagnosis is performed. Thanks to him, it will be possible to study the degree of damage to cartilage and other soft tissues, which will help determine the methods of therapy.

What is the treatment?

conservative

If the posterior horn of the medial meniscus is not severely damaged, and the body of the cartilage is only partially destroyed, the doctor prescribes a course of drug therapy, which takes place in several stages:

• Removal of puffiness, inflammation and pain syndrome with the help of NSAIDs, analgesics.
• Restoration of cartilaginous structures with the use of chondroprotectors.
• Normalization of the functioning of the joint with the help of reposition, manual therapy or traction.
• Training of the muscular corset with the help of exercise therapy exercises and therapeutic exercises.
• Activation of blood supply and nutrition of the damaged area with the use of physiotherapy, therapeutic massage, folk remedies.

Damage or rupture of the medial meniscus of the knee usually occurs in athletes and overly active people, this condition requires urgent treatment. In addition to them, people of retirement age are susceptible to this disease, especially those who have arthrosis or arthritis.

What is a meniscus, and where are its horns?

The meniscus is a cartilaginous tissue that consists of fibers and serves as a shock absorber for the knee joint. It looks like two crescents, their ends are called horns.

The small crescent is the outer (lateral) part of the meniscus, and the large crescent is the inner (medial).

Breaks are of different types:

• vertical and horizontal;
• oblique and transverse;
• degenerative;
• ruptures of the posterior and anterior horns of the meniscus.

But most often there is a rupture of the posterior horn of the inner meniscus, since it is less mobile.

What can cause damage to the posterior horn?

This disease always occurs as a result of an injury. The meniscus is not so fragile that it could be damaged by any kind of force. The most common reasons for a break are:

1. Excessive turns of the body, standing on one leg and keeping the foot on the floor.
2. Too vigorous jumping and steeplechase.
3. Very fast walking or, conversely, a long stay in the "squatting" position.
4. An injury received against the background of an already existing degenerative knee joint.
5. Insufficiently good development of joints and ligaments caused by congenital pathology.

In people of retirement and pre-retirement age, a rupture of the posterior horn occurs due to the fact that cartilage tissues are often already destroyed by arthrosis. Therefore, it is much easier to damage it.

How to recognize a gap?

Without a qualified diagnosis, it is impossible to say for sure whether there is damage to the fibrous cartilage tissue. But there are signs that suggest its presence:

1. When injured, a click is clearly heard, pain pierces the knee. Lasts about 5 minutes, then subsides a little. During this period, a person is able to move, overcoming pain. After a significant amount of time, about half a day, pain in the knee again occurs. This time, the sharp pain is accompanied by a burning sensation. Flexion and extension of the knee occurs with increased pain. Rest provides some relief.
2. If, however, there was a rupture of the medial meniscus, then a blockade of the knee joint occurs. Outside of medicine, this is called "jammed." This happens because part of the torn cartilage tissue of the meniscus is fixed by two bones, thereby the movement of the knee becomes limited. But this symptom does not always indicate a meniscus tear. It can also occur due to damage to the ligaments.
3. If in the body of the meniscus, where there are capillaries, then blood accumulates in the knee. They call it hemarthrosis.
4. A few hours after the rupture, swelling of the adjacent tissues occurs.

With the help of hardware research, it is possible to determine whether the gap is chronic or recently acquired. In an acute rupture, the edges are even, there is an accumulation of blood. Chronic rupture has fibrous, uneven edges, edematous tissues. It is not blood that accumulates around it, but synovial fluid.

A degenerative rupture of the posterior horn of the meniscus can be diagnosed by MRI or arthroscopy. Without these methods, this diagnosis is quite difficult to establish, since there are no: acute pain, blockade.

Treatment of rupture of the posterior horn of the medial meniscus of the knee joint

To treat this kind of injury, like any other, it is necessary immediately after the injury.

Important! If left untreated for a long time, the rupture can become chronic.

Treatment not taken in time can lead to destruction of the cartilage of the knee joint, inflammation, changes in its structure and arthrosis. To avoid these troubles, you should immediately visit a doctor as soon as an injury occurs.

A tear in the posterior horn of the knee joint is usually treated without surgery. With the exception of severe trauma that requires prompt assistance. Treatment takes place in several stages:

1. If there is a blockade of the joint, then it must be removed. This is done using manual methods or with hardware traction of the joint.
2. Edema is removed by anti-inflammatory drugs (Diclofenac, Indomethacin).
3. Pain relief with painkillers (Ibuprofen, Paracetamol).
4. After relieving pain and inflammation, it is necessary to start physical therapy, physiotherapy and massage.
5. The longest stage is the restoration of the cartilage that makes up the menisci. For this, preparations containing chondroitin sulfate and hyaluronic acid are prescribed.

It is necessary to take these medicines for a long time, one course can reach up to six months. It is necessary to repeat their intake annually to prevent deterioration of the cartilage.

In some cases, after stretching the joint, plaster is applied. This is done in order to provide the joint with peace and immobility for a certain time. But such a measure is not taken in all cases.

Operative methods of treatment

In the case when the above method of treatment does not have the desired effect on the damaged part, they resort to a surgical method of treatment. If the body of the meniscus itself is damaged, then most often it can be stitched.

There are several types of operations for the treatment of damage to the meniscus horn, but some of them are currently performed extremely rarely, as they are considered ineffective or even harmful. These include, for example, arthrotomy. This is the removal of damaged cartilage tissue, which is carried out with a full opening of the knee.

Surgical methods for the treatment of a torn meniscus of the knee joint are currently aimed at preserving or restoring it. They are of several types:

1. Partial meniscectomy. In this case, the edges of the meniscus are cut off at the site of the lesion, and their remaining part is restored.
2. . The operation, which is performed through three punctures in the knee joint. One of them introduces the tools necessary for manipulation. In the other, saline enters and washes away unnecessary particles of cartilage, accumulated blood, and so on. A camera is inserted into the third puncture, through which the surgeon can see everything that happens inside the knee, and thereby controls the entire process.
3. Transplantation. The donor's meniscus is transplanted to the patient.
4. Endoprosthetics. An artificial organ is implanted into the knee joint.

Regardless of the method of operation, after it, complete rest of the knee joint and protection from the effects of cold are necessary.

Rupture of the posterior horn of the medial meniscus is an injury characteristic of athletes, active people, and the elderly. Such damage also occurs in those who suffer from arthrosis and other pathologies of the joints and ligaments.

Why is it dangerous

The medial meniscus performs important tasks and functions. He performs shock absorber during joint movement c, stabilizes the position of the knee. Damage and rupture of the inner meniscus reduces the area of ​​contact of the knee bones by 60-70% and increases the load on the ligaments by 100-120%.

If there is no external meniscus, then the contact area is reduced by 45-55%, the load is increased by 200%. This affects the ankle and hip joints. The subsequent degradation of cartilage leads to weakening and deformity of the ligaments, changes in the bones. Arthrosis develops, there is a risk of disability.

Symptoms

Damage to the posterior horn of the medial meniscus causes the following symptoms:

• Sharp pain. Acute pain syndrome occurs at the time of trauma and continues for some time. Before the onset of pain, you can hear a click in the knee. The pain gradually fades away, but it is still difficult for a person to walk.
• puffiness. It develops 3-4 hours after the injury.
• Joint block. A clear symptom of a torn posterior horn of the meniscus. It occurs due to the fact that the separated part of the cartilage tissue is clamped by the bones. This leads to a serious, irreversible impairment of the motor function of the limb.
• Accumulation of blood plasma within a joint.

Physicians distinguish between chronic and acute rupture. In the first case, the cartilage is torn, there is an accumulation of intra-articular fluid, edema. In the second - there is severe soreness and stiffness.

Diagnostics

Rupture and damage to the posterior horn of the medial meniscus is detected by a traumatologist. For this purpose, a survey and examination of the patient is carried out. The doctor finds out, after which unpleasant symptoms arose, what kind of complaints are present in a person.

To confirm the diagnosis, the specialist gives a referral to x-ray examination. If the image does not show bone damage, then the patient is recommended to undergo magnetic resonance imaging. This type of diagnosis allows you to identify existing damage to soft tissues, cartilage, to study the degree of damage.

Other diagnostic options:

1. Arthroscopy(visual examination of the articular cavity using an arthroscope inserted through an incision in the tissue)
2. Contrast arthrography(a variant of radiography, in which air, oxygen or a contrast agent is introduced into the joint cavity before the procedure).

Arthroscopy is recognized as the most accurate method of research. Other diagnostic options can give an error in 3% of cases. Based on the data of the anamnesis, the results of the examination, an effective therapeutic therapy is selected.

Treatment

In the treatment of rupture, damage to the posterior horn of the medial meniscus, doctors use conservative and surgical techniques. Conservative treatment is carried out in the case when the damage is not strong, the body of the cartilage is partially preserved. Then the doctor selects a number of medicines. Pharmaceutical preparations are used, which:

• Relieve inflammation, swelling and pain (analgesics)
• Regenerate cartilage (chondroprotectors)

The functioning of the joint is restored with the help of manual therapy, reposition, traction. The muscular corset is trained by performing special therapeutic exercises. Blood circulation and nutrition of the affected area are improved by the use of folk remedies, therapeutic massage, and physiotherapy.

If the damage is extensive and conservative treatment options do not help, then resort to surgical intervention. Doctors with a torn meniscus perform the following types of operations:

• Arthrotomy. The bottom line is to remove the meniscus. It is used for extensive damage to the knee. The procedure is very complicated.
• Transfer. A donor or artificial meniscus is transplanted.
• Stitching of cartilage. Manipulation is done using an arthroscope (miniature video camera), which is inserted through a puncture in the knee. It is carried out with acute injury.
• Arthroscopy. The treatment method is characterized by minimal trauma. The bottom line is that two punctures are made in the knee: an arthroscope is inserted through one, and saline is inserted through the other.
• Partial meniscectomy. The operation consists in removing the damaged layer of cartilage and restoring the rest. Trimming the meniscus is carried out to a flat base.

Prevention

Prevention of damage to the posterior horn of the medial meniscus is as follows.

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The medial (internal) meniscus in the modern medical interpretation is an internal cartilaginous lining that acts as a kind of shock absorber in the joint and stabilizes the designated structure as a whole.

Severity of damage

Damage to the meniscus of the knee joint is a fairly common phenomenon that provokes various degenerative-dystrophic processes of the corresponding structure, which leads to partial destruction, and sometimes complete separation of the body or horns of the cartilaginous component.

The medial meniscus as a whole is injured less frequently than the lateral one, however, almost always the pathology is accompanied by various complications, for example, damage to the ligamentous apparatus, tendons, intraarticular bag.

One of the most common classifications of the degree of rupture of the internal meniscus of the knee joint is the Stoller gradation.

This technique refers to monitoring the state of the cartilage structure by conducting magnetic resonance imaging. The basic principles of classification come from the MRI technique in the form of layer-by-layer scanning in an induction magnetic field.

In general, the degree of damage to the meniscus is classified based on the severity of the severity of the destruction of cartilage tissue by the appearance of the intensity of the change in luminosity during the diagnostic process, which indicates the presence of chronic degenerative or acute pathological processes.

Zero

Zero degree corresponds to the absence of pathological changes during MRI diagnostics (normal). If the diagnostician establishes a zero degree of damage to the meniscus, then this indicates the absence of any pathologies of the aforementioned cartilaginous structure, or they are so insignificant that they are not visualized by modern research methods.

First

In general, 1 degree corresponds to a minor injury. On MRI, the diagnostician sees a small single, strictly localized focus of a signal of increased intensity, which does not reach the surface of the cartilage. In this situation, the injury can be easily cured with standard methods of conservative therapy and proper short-term rehabilitation.

Second

In general, it corresponds to damage to the medial meniscus of moderate severity. As part of the MRI, a linear signal of increased intensity is visualized, which does not reach the surface of the cartilaginous structure.

At the same time, there may be several such foci, in various projections, fragmentary violations of the integrity of the cartilage tissue are visible without degeneration of the general anatomical structure.

In such situations, conservative therapy is initially carried out. If the measures are not effective, the doctor may recommend surgery, as well as long-term rehabilitation until the meniscus is fully restored to working capacity.

Third

Rupture of the medial meniscus of the knee joint grade 3 is the most severe degree of damage. It is associated with a systemic violation of the anatomical structure, in particular, the separation of cartilage tissues. On MRI, it manifests itself as a pronounced systemic appearance of a linear signal of increased intensity, reaching the cartilage tissue.

In this case, the pathology is often accompanied by a displacement of a part of the internal meniscus, as well as a tear of individual cruciate ligaments with the formation of other negative complications.

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Signs of rupture of the posterior horn of the medial meniscus of the knee joint

As modern clinical practice shows, with a rupture of the posterior horn of the internal meniscus of the knee joint, the victim quickly develops acute pain immediately after the injury. In this case, the knee joint significantly increases in size due to volume swelling.

With ruptures of the 3rd degree of severity, a blockade of the knee as a whole can form, respectively, the joint is wedged in one position without the possibility of flexion or extension of the lower limb.

The victim moves with difficulty, often cannot do it on his own. In this case, the leg is initially in a bent position, the pain syndrome manifests itself rather weakly, however, in the case of extension of the limb, the pain intensifies many times, and a characteristic click sound is also heard.

In the absence of the necessary treatment, a few weeks after the injury, seals appear in the structure of the knee joint, which are detected by simple palpation. The above symptoms refer to acute conditions of a traumatic nature.

In chronic injuries of the medial meniscus, the basic symptom is exclusively pain in the joint, often aching.

But it increases with physical exertion on the lower limb. In the case of chronic damage to the internal meniscus, the patient may complain of frequent blockade of the joint and regular swelling of the knee caused by inflammation of the periarticular sac.

Types of ruptures of the posterior horn of the internal meniscus of the knee joint

There are a fairly large number of different types of ruptures of the medial meniscus, while for their specific designation, gradation is used both according to the direct volumetric location of the pathology in the form of a partial tear or complete rupture, and the nature of the problem, which includes longitudinal, radial, horizontal, patchwork and other types destructions.

Horizontal

Under the term horizontal rupture of the posterior horn of the medial meniscus, modern diagnosticians mean a classic violation of the integrity of the above-mentioned internal structure in the central part of the cartilage tissue parallel in relation to the main plane of the corresponding meniscus. Within this problem, the resulting destruction separates the top and bottom of the component.

At the same time, within the framework of communication with the peripheral edges of the planes, synovial fluid can flow into the gap itself and provoke the formation of temporary and permanent cysts.

As modern clinical practice shows, in 9 out of 10 cases, a horizontal rupture of the internal meniscus of the knee joint is combined with the last indicated types of pathologies, and in some situations their removal requires surgical intervention.

Standard protocols for the treatment of a horizontal rupture of the posterior horn of the medial meniscus may include, in addition to possible surgery, also conservative therapy, physiotherapy, massage, and exercise therapy. The last three are recommended as part of the rehabilitation period.

Longitudinal

Under the term longitudinal rupture of the posterior horn of the medial meniscus, modern diagnosticians mean the development of the corresponding pathology not in the central part of the cartilaginous structure, but on its edges.

As practice shows, these types of problems have blurred symptoms, they are diagnosed only with the help of magnetic resonance imaging.

The length of the tear line is usually insignificant and the pathology, in the absence of complications, does not require active surgical intervention. The main focus of treatment is on conservative therapy, including admission:

• non-steroidal anti-inflammatory drugs;
• Glucocorticosteroids;
• Chondroprotectors.

At the same time, minimally invasive methods of intra-articular injection of platelet mass are sometimes used as an addition. The latter is a complex biological preparation from saline and suspensions of donor platelets. Such systems are growth factors and induction of the process of regeneration of connective and cartilaginous tissues.

Linear

Under the term linear rupture of the posterior horn of the medial meniscus, specialized specialists mean the presence of a pathology without a branched structure. Destructive changes are single and easily visualized in the framework of MRI as local focal signals of increased intensity, which do not directly reach the surface of the cartilaginous tissue.

In most cases, such pathologies do not require surgical intervention and implant placement.

Conservative therapy in combination with basic rehabilitation measures in the form of physiotherapy, exercise therapy complexes and massage is quite effective. with parallel reception:

• Chondroprotectors;
• Glucocorticosteroids;
• painkillers;
• Vitamin and mineral complexes;
• Anti-inflammatory drugs in injectable form.

By type of watering can handle

Rupture of the medial meniscus by the type of watering can handle is a rather complex structural pathological modification of the cartilage tissue, which affects the predominant volume of the meniscus. A sufficiently long and wide line of rupture affects the avascular, vascular transition zones of the meniscus.

This, in turn, creates the need for active surgical intervention, since conservative therapy does not give positive prospects in the vast majority of situations.

The complexity of this type of injury is also exacerbated by the impossibility of modern minimally invasive surgical practice using an arthroscope.

In most cases, a classical operation is required with the opening of the joint cavity and, accordingly, surgery for various complications. It should also be taken into account that standard plasty for ruptures of the medial meniscus by the type of a watering can handle is ineffective, therefore, the only way to maintain the operability of the structure as a whole is transplantation of the biomaterial using an artificial prosthesis or a donor structure.

Complex

A complex rupture of the posterior horn of the medial meniscus combines the main features of both horizontal and vertical ruptures, often with separate manifestations of longitudinal and radial destruction. Complex tears most often start from the free cut of the cartilage structure and go all the way to the main body of the component.

Almost always, treatment for a combined rupture of the posterior horn of the medial meniscus requires a rather complex surgical intervention.

At the same time, in the case of a tear line more than 20 mm long with a distance from the capsule of more than 3 mm, the chances of a favorable outcome of surgical intervention are rather low.

In this case, the only method of restoring health is donor meniscus transplantation, the effectiveness of which reaches 50% in the presence of the above adverse factors.

Patchwork

Patchwork rupture of the medial meniscus occurs exclusively on the body's internal cartilaginous structure. The pathology is located between the middle and rear parts of the cartilaginous component, while the size of the gap itself is small.

The torn part of the meniscus often falls into the space between the articular surfaces and creates the prerequisites for a complete blockade of the joint.

With small lesions, conservative therapy is effective, but if the flap is large enough, then surgical intervention is necessary with excision of the torn part.

Another feature of the patchy rupture of the medial meniscus is the great difficulty in its identification. methods of magnetic resonance imaging. In most cases, to confirm the diagnosis, arthroscopy with direct visual examination of the articular cavity and its elements is required.

Degenerative

Degenerative rupture of the medial meniscus of the knee joint is a chronic form of pathology, which is an overgrowth of the connective tissues of the cartilage structure. Similar formations can be diagnosed both on the horns of the meniscus and in its central part.

Degenerative rupture of the posterior horn of the medial disc is a complex and rather complex pathology of a chronic nature, which is expressed in the massive reproduction of the connective tissues of the cartilaginous structure.

The problem itself develops against the background of a number of negative circumstances, for example, the presence of previous cartilage injuries that have not been properly treated, various problems of the musculoskeletal system such as arthritis and arthrosis, and so on.

In the absence of the necessary therapy, the cartilage structures are replaced by seals and unusual connective tissues, provoking not only thickening of the structure of the cartilage component, but also repeated breaks of a non-linear nature, accompanied by the influence of a number of adverse factors.

Conservative therapy in this situation is ineffective, however, at the stage of exacerbation, surgical intervention for degenerative ruptures of the posterior horn of the medial disc is prohibited.

Treatment of a degenerative rupture of the posterior horn of the medial meniscus is carried out according to an individual therapeutic scheme developed by a traumatologist, orthopedist or surgeon. In a number of situations, surgical intervention may be required with resection, plasty, or complete replacement of the meniscus with an implant.

Partial

Most often, with partial ruptures of the posterior horn of the medial meniscus, radial or transverse forms of pathology are formed. The break lines run perpendicular to the main axis of the cartilaginous structure. At the same time, the predominant localization of the rupture creates the prerequisites for the need to visualize the presence of pathology in the coronary projection (MRI).

In the vast majority of cases, partial rupture of the posterior horn of the medial disc can be treated with conservative therapy methods:

• Complex procedures rehabilitation in the form of: physiotherapy exercises, physiotherapy and massage:
• Taking a number of medications, in particular: glucocorticosteroids, chondroprotectors and non-steroidal anti-inflammatory drugs, as well as vitamin-mineral complexes, which accelerates the process of tissue regeneration.

Diagnostic measures

The list of main diagnostic measures includes the following procedures:

• Primary inspection. It includes fixing the subjective complaints of the patient, palpation, history taking, manual express methods for detecting joint stability;
• Radiography. X-rays of the knee are made in two projections. The method allows to reveal gross changes in the structure of the joint and can be used in the context of the initial diagnosis of pathologies of traumatic injuries;
• CT scan. A relatively new visualization method with layer-by-layer scanning of tissues, performed using X-rays on a special modern installation. The result obtained is processed by a computer program and allows you to get a complete picture of the pathological process with a sufficiently high resolution;

• Ultrasound procedure. Basic visualization is formed on the basis of the reflected signals of the sound wave when passing media with different densities. Ultrasound allows you to identify the inflammatory process, as well as the presence of fluid in the joint cavity;
• Magnetic resonance imaging. The "gold standard" for diagnosing an injury to the internal meniscus. It is produced on special equipment by layer-by-layer scanning in a magnetic field with the formation of the effect of nuclear resonance. Specific response perturbations are recorded by a special sensor and, due to digital processing, a high-definition image is built;
• Arthroscopy. A minimally invasive research technique with a direct puncture of the corresponding structure and arthroscope guidance.

Magnetic resonance imaging in pathology

As modern diagnostic practice shows, a normal meniscus on MRI resembles two triangles looking at each other. The most important signs that indicate the presence of pathology are local structural disturbances with an increase in signal intensity and changes in the basic shape of the component.

In this case, the gradation of the severity of the problem is carried out in four degrees. As part of the event, it is possible not only to detect basic pathologies in the form of linear breaks, but also to identify breaks of a complex nature, combining the signs of several subtypes of injuries.

Treatment of the pathological process

The procedure for the treatment of a rupture of the posterior horn of the medial meniscus of the knee joint is a whole range of measures, a horizontal rupture of the internal meniscus

• conservative therapy. As part of standard treatment regimens, non-steroidal anti-inflammatory drugs, glucocorticosteroids, chondroprotectors and vitamin-mineral complexes are prescribed;
• Physiotherapy. Complex measures are applied, including ozocerite applications, electrophoresis, magnetotherapy, balneological procedures, UHF and so on;
• rehabilitation. As part of the rehabilitation period, the main activities are massage and training in the exercise therapy complex;
• Surgery. It is a method of radical treatment of rupture of the internal meniscus of the knee joint. It is prescribed individually if there is expediency and indications, most often with a complete rupture of the internal meniscus. The main methods of execution are classical open invasive surgery and arthroscopy. As part of the surgical intervention, possible procedures include resection of the meniscus, its suturing, plastic surgery, and complete replacement with an implant of an artificial or donor type.

Possible consequences of injury

With mild and moderate injuries of the medial meniscus and the presence of appropriate qualified treatment, the risk of developing various complications is minimal or non-existent. Severe degrees of pathology are often accompanied by secondary negative consequences in the medium term. The most typical consequences of a rupture of the internal meniscus of the knee joint:

• Degenerative-dystrophic meniscus lesions. Formed in the long term against the background of chronic injuries. Often accompanied by a violation of the integrity of nearby structures, in particular tendons and cruciate ligaments;
• Secondary bacterial infections. If the integrity of the joint is violated, the likelihood of secondary infection of the internal cavities and the development of a powerful generalized inflammatory process increases, requiring the use of broad-spectrum antibiotics and other drugs if necessary;
• Problems after surgery. Often, in severe forms of injuries of the internal meniscus, there is a need for surgical intervention. At the same time, short-term and long-term complications in the framework of various post-surgical syndromes are hemarthrosis, deep vein thrombosis, ligament and nerve damage, ischemia of muscle structures, compartment syndromes, disorders of intra-articular structures, regional pain syndromes and symptom complexes of patellar contracture;
• Disability. In the absence of proper qualified treatment with the formation of prerequisites for degenerative-dystrophic processes against the background of a number of complications and negative circumstances, even surgical intervention does not guarantee a complete restoration of the cartilage structure in particular and the joint as a whole, which ultimately becomes one of the factors of permanent disability of the victim.