Degenerative damage to the posterior horn of the internal meniscus. Treatment of the rupture of the posterior horn of the lateral (outer) meniscus. Treatment of a torn posterior meniscus horn

The knee is a complex structure, which includes the patella, femur and tibia, ligaments, menisci, etc.

Menisci are a layer of cartilage that sits between two bones. When moving, the knee constantly withstands heavy loads, so most of the injuries occur on this joint. One of these injuries is the rupture of the posterior horn of the medial meniscus.

Injuries to the knee joint are painful and dangerous in their consequences.

A tearing of the posterior meniscus horn can occur in any active person or athlete, and can lead to serious injury later on.

What is a meniscus

The meniscus is the part of the joint that is a curved strip of fibrous cartilage. They are shaped like a crescent with elongated edges. They are divided into several parts: body, rear and front horns.

There are two menisci in the joint:

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

They are attached by their ends to the tibia.

The medial is located on the inside of the knee and connects to the internal lateral ligament. Along the outer edge, it is connected to the capsule of the knee joint, through which partial blood circulation passes.

Menisci perform important functions:

• amortize the joint during movement;
• stabilize the knee;
• contain receptors that control leg movement.

If this meniscus is removed, the area of ​​contact of the bones in the knee becomes 50-70% less, and the load on the ligaments becomes more than 100% more.

Symptoms

Two periods pass: chronic, acute.

The acute period lasts about a month and is characterized by a number of painful symptoms. With the very injury in the knee area, a person feels severe pain and a sound like a crack. Swelling quickly appears on the knee. Joint hemorrhage is also common.

Joint movement is severely or partially limited.

Typical symptoms of medial meniscus rupture

Such an injury has a number of its characteristic features. In case of damage to the posterior horn of the internal meniscus, intense pain appears on the inside of the knee. On palpation, it increases in the area of ​​attachment of the horn to the knee ligament.

Also, such an injury blocks the movement of the joint.

It is determined when trying to make flexion movements when turning the lower leg outward and extending the leg, the pain becomes stronger and the knee cannot move normally.

In terms of severity, there may be minor, moderate, and severe injuries.

Break types

Full or partial longitudinal rupture of this part is considered very dangerous. It develops from the posterior horn. With a complete rupture, the part that has separated can move between the joints and block further movement.

Also, a gap may be between the beginning of the posterior horn and the middle of the body of the meniscus.

There are often cases when such an injury is of a combined nature and combines different types of injuries. They are developing in several directions at once.

The horizontal rupture of the posterior horn begins from the side of its inner surface and develops towards the capsule. It causes severe swelling in the joint space.

Treatment

Treatment can be carried out both conservatively and operatively.

Conservative therapy is used for mild to moderate injuries.

The operation is performed with severe injuries that block the joint and cause severe pain.

The rupture of the posterior horn of the lateral meniscus or its anterior analogue occurs as a result of trauma. This happens in people in the following risk groups:

• professional athletes (especially football players);
• people leading a very active lifestyle and engaged in various kinds of extreme sports;
• elderly men and women suffering from various types of arthrosis and similar diseases.

What is damage to the anterior or posterior horn of the internal meniscus? To do this, you need to know at least in general terms what the meniscus itself is. In general terms, it is a special, fibrous cartilaginous structure. It is needed to cushion the knee joints. Similar cartilaginous structures are found in other places of the human body - they are equipped with all its parts, which are responsible for flexion and extension of the upper and lower extremities. But damage to the posterior or anterior horn of the lateral meniscus is considered the most dangerous and most frequent injury, which, if not treated promptly, can lead to various complications and make a person disabled.

Brief anatomical description of the meniscus

The knee joint of a healthy body includes the following cartilaginous tabs:

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

Both of these structures resemble a crescent in shape. The density of the first meniscus is higher than that of the posterior cartilaginous structure. Therefore, the lateral part is less prone to injury. The internal (medial) meniscus is rigid and most often trauma occurs when it is damaged.

The very structure of this body consists of several elements:

• cartilaginous body of the meniscus;
• front horn;
• its rear counterpart.

The main part of the cartilaginous tissue is girdled and permeated with a network of capillary vessels, which form the so-called red zone. This entire area has increased density and is located at the edge of the knee joint. In the middle is the thinnest part of the meniscus. There are no vessels in it and it is called the white zone. When initially diagnosing an injury, it is important to determine exactly which area of ​​the meniscus has suffered and underwent a rupture. Previously, it was customary to completely remove the meniscus if damage to the posterior horn of the inner layer was diagnosed, which supposedly helped to rid the patient of complications and problems.

But at the current level of development of medicine, when it is precisely established that the internal and external meniscus perform very important functions for the bones and cartilage tissue of the knee joint, doctors try to treat the injury without resorting to surgical intervention. Since the meniscus acts as a shock absorber and protects the joint, its removal can lead to the development of arthrosis and other complications, the treatment of which will require additional time and money. Damage to the anterior horn of the meniscus is rare, since its structure has an increased density and better resists various loads.

For such injuries, conservative treatment or surgery is usually prescribed if damage to the anterior horn of the lateral meniscus has led to the accumulation of blood in the knee joint.

Causes of rupture of cartilaginous tissue

Damage to the posterior horn of the medial meniscus is most often caused by acute trauma, since when forcefully applied to the knee joint, it does not always lead to rupture of the cartilaginous tissue, which is responsible for the amortization of this area. Doctors identify a number of factors that contribute to cartilage rupture:

• overly active jumping or running on rough terrain;
• twisting a person's body on one leg, when her foot does not come off the surface;
• frequent and prolonged squatting or active walking;
• the development of degeneration of the knee joint in some diseases and trauma to the limb in this condition;
• the presence of congenital pathology, in which there is a weak development of ligaments and joints.

There are varying degrees of damage to the meniscus. Their classification is different in different clinics, but the main thing is that they are all determined by generally accepted criteria, which will be discussed below.

Symptoms of damage to the posterior horn of the internal meniscus

Signs of such an injury to the medial meniscus are as follows:

• there is a sharp, sharp pain when injured. It can be felt within 3-5 minutes. A clicking sound is heard before this. After the pain has disappeared, the person will be able to move around. But this will cause new bouts of pain syndrome. After 10-12 hours, the patient will feel a sharp burning sensation in the knee, as if a sharp object had penetrated there. When bending and extending the knee joint, the pain increases, and after a short rest, it subsides;
• Knee block ("wedging") occurs when the cartilage tissue of the inner meniscus breaks. It can appear at the moment when a torn off piece of the meniscus is clamped between the tibia and femur. This leads to the inability to move. These symptoms also bother a person with damage to the ligaments of the knee joint, therefore, the exact cause of the pain syndrome can only be found out when a diagnosis is made in the clinic;
• when blood penetrates into the joint, traumatic hemarthrosis can occur. This occurs when a meniscus rupture occurs in the red zone, when blood vessels are damaged;
• after a few hours from the moment of injury, swelling of the knee joint may appear.

Read also: Tuberculous arthritis: what it is and how it manifests itself

It is necessary to clearly distinguish between chronic damage to the posterior horn of the medial meniscus of the 2nd degree from acute injury. This is possible today with the use of hardware diagnostics, which allows you to thoroughly examine the condition of the cartilage tissue and fluid in the knee joint. A grade 3 meniscus rupture leads to an accumulation of blood in the inner parts of the knee. At the same time, the edges of the cliff are even, and in a chronic disease the fibers are scattered, there is edema that occurs from damage to the nearby cartilage, and the penetration into this place and the accumulation of synovial fluid there.

Treatment of injury to the posterior horn of the internal meniscus

The rupture of the tissues of the knee joint must be treated immediately after injury, since over time, the disease from the acute stage can turn into a chronic disease. If treatment is not started on time, meniscopathy may develop. This will lead to changes in the structure of the knee joint and degradation of cartilage tissue on the surfaces of the bones. This situation is observed in half of the cases of rupture of the posterior horn of the internal meniscus in patients who, for various reasons, started the disease and later sought medical help.

A tear can be treated with the following methods:

• conservative way;
• surgical intervention.

After an accurate diagnosis has been made, the primary rupture of the meniscus horn is eliminated by doctors using a therapeutic course. In most cases, conservative treatment gives good results, although in about a third of cases of such injuries, surgical intervention is necessary.

Treatment with conservative methods consists of several, rather effective stages (if the injury is not neglected):

• manual therapy and traction with the help of various equipment, which are aimed at reposition, that is, reduction of the knee joint during the development of the blockade;
• the use of anti-inflammatory drugs that doctors prescribe to the patient to eliminate knee swelling;
• a rehabilitation course, in which treatment is carried out using therapeutic, restorative gymnastics, physiotherapy methods and the appointment of massage;
• prescribing a course for the patient, in which treatment is carried out with chondroprotectors and hyaluronic acid. This long-term process can last from 3 to 6 months over several years, but it is important for the restoration of the structure of the menisci;
• since the trauma of the posterior horn of the meniscus is accompanied by a severe pain syndrome, the doctors continue the treatment using pain relievers. For this purpose, analgesics are usually used, for example, Ibuprofen, Paracetamol, Indomethacin, Diclofenac and other drugs. They can be used only as directed by the attending physician in a dosage that is determined by the course of therapy.

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

It is quite possible to cope with this problem. Treatment, if a knee joint meniscus rupture 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 knee meniscus is a crescent-shaped cartilage that sits between the thigh and lower leg in the knee joint. The knee meniscus performs a stabilizing and shock-absorbing function, the horizontal cartilaginous thread softens the friction of surfaces, limiting the mobility of the joint, which prevents injuries.

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

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

Sports doctors say injury and bruising is a common problem among:

• skiers,
• skaters,
• skaters,
• ballet dancers,
• football players.

Diseases of the meniscus and the need for surgery in the future may 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 cartilaginous formation is very elastic, so damage practically does not occur.

Main shock absorber in the knee joint

Sometimes a rupture of the meniscus of the knee joint or its contusion 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 meniscus damage.

A 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 abnormalities 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.

Orthopedic surgeons differentiate damage to the knee meniscus into several types:

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

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

In most cases, they diagnose:

1. injury,
2. pinching,
3. tear,
4. rupture 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, and difficulty in flexing and extending the joint. After a few hours, the symptoms of a rupture in the meniscus area subside, mobility is restored, and the person can forget about the injury.

The consequences of injury, damage to the meniscus of the knee joint, over time make themselves felt, for example, pains return again. 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 injury.

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, pain is greatly increased.

In addition, it is difficult to climb or descend stairs, there is soreness when crossing 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 typical meniscus microtrauma. It can be bruised, pinched, or small tears.

Meniscus damage and surgery

With cartilage injuries, diseases become chronic. No sharp pain is observed, the joint retains its mobility most of the time. Nevertheless, from time to time in the knee area, a person feels unpleasant sensations. This can be: slight tingling, numbness, or clicking. Atrophy of the thigh muscles is recorded.

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

The choice of the 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 time a person stays on an outpatient basis.

To restore joint mobility, mud therapy and restorative remedial gymnastics can be recommended.

Conservative treatment of the meniscus in stationary and at home

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

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

It will take 3-4 procedures to completely straighten the joint. There is another type of meniscus repair - knee traction or apparatus traction. This is a lengthy, inpatient procedure.

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

• nimulida,
• voltaren,
• corticosteroids.

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

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

Typically, restorative drugs need to be taken for about three months daily.

Together 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 restore normal mobility to the joint.

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 fresh burdock leaf compress. The area of ​​the kneecap should be wrapped in 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, you can apply dried leaves by soaking them in a little hot water.

The raw materials must be evenly distributed over the fabric, and then a compress should be applied to the joint. The residence time of the compress on the damaged joint is 8 hours.

A honey compress on the knee helps relieve pain around the kneecap. After a while, the lost joint mobility returns.

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

To speed up the recovery process after damage to the meniscus, you need to make a honey compress 2 times a day. It is necessary to keep the compress for at least two hours.

Treatment of meniscus disease with folk remedies usually lasts several months.

An effective remedy for the meniscus of the knee joint is wormwood tincture. You will need a large spoonful of chopped wormwood, which you need to fill with a glass of boiling water and leave for 1 hour.

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

Knee meniscus treatment without surgery

Injuries and treatment of the medial meniscus of the knee

If we feel pain in the knee, then, as a rule, this means that the meniscus hurts. Since the meniscus is a cartilaginous layer, it is most at risk of rupture or damage. Knee pain can represent several types of meniscus injury and malfunction. During the stretching of the intermeniscus ligaments, chronic injuries, as well as with a ruptured meniscus, different symptoms appear, and the options for dealing with them are also different.

• Damage symptoms
• Meniscus tear
  • Rupture of the posterior horn of the meniscus
  • Rupture of the posterior horn of the lateral (external) meniscus
  • Rupture symptoms
• How is a meniscus tear treated?

Damage symptoms

The meniscus is a cartilaginous formation that is located in the cavity of the knee joint and serves as a shock absorber for movement, as well as a stabilizer that protects the articular cartilage. There are only two menisci in the knee, external (lateral) and internal (medial). Damage to the inner meniscus occurs much more often due to its lower mobility. Damage to the meniscus of the knee joint manifests itself in the form of pain in this area, limitation of mobility, and in old situations, it is possible to develop arthrosis of the knee.

Joint swelling, sharp cutting pain, painful crunching, and difficult limb movement indicate that you have a damaged meniscus. These symptoms appear immediately after injury and may indicate other joint damage. More severe symptoms of injury appear one month after 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, accumulation of fluid in the joint cavity.

The exact signs of damage to the medial meniscus are detected using various examinations. There are special tests for extension of the knee joints (Roche, Baikova, Landa, etc.), when pain symptoms are felt with a certain extension of the knee. Rotational test technology is based on the detection of damage during rolling movements of the knee (Steiman, Bragard). Meniscus damage can also be identified using MRI, mediolateral tests, and compression symptoms.

Injury to the medial meniscus requires a variety of treatments based on the type and severity of the injury. With the traditional method of getting rid of damage, one can distinguish the main types of impact that are used for any injury.

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

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 2 months. In this case, it is necessary to apply topically cold and non-steroidal drugs to relieve inflammation. Over time, you can add different types of physiotherapy, walking with aids, physiotherapy exercises.

Surgery is required in difficult situations, for example, chronic damage to the knee meniscus. One of the most popular surgical procedures today is arthroscopic surgery. This type of surgical intervention has become widespread due to the respect for the tissues. The intervention is only a resection of the damaged area of ​​the meniscus and resurfacing of the defects.

For damage such as a meniscus rupture, the surgery is closed. With the help of two holes in the knee joint, an arthroscope with instruments for determining lesions is inserted, then a decision is made about the possibility of suturing the meniscus or about its partial resection. Inpatient treatment lasts up to about 4 days, due to the low trauma of this type of operation. At the stage of rehabilitation, it is recommended to limit the load on the knee to one month. In special situations, it is recommended to wear a knee pad and walk with aids. After 7 days, you can start remedial gymnastics.

Meniscus tear

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

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

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

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

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

Rupture of the posterior horn of the meniscus

Tears of this type are most common because most of the vertical, longitudinal, and watering-like tears originate from the posterior horn. During a long rupture, there is a good chance that part of the torn meniscus will obstruct knee movement and cause severe pain, up to and including blockage of the knee joint. The combined type of rupture 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 splitting off, a person constantly feels the threat of blockage of the joint, but this does not happen. Rupture of the anterior horn of the knee joint is quite rare.

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

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

Rupture symptoms

Injuries such as a torn meniscus have different symptoms. A meniscus tear can be:

• old;
• chronic;
• spicy.

The main sign of a rupture is a 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 rupture can be determined by local pain, infiltration in the area of ​​the joint fissure, as well as using pain tests that are suitable for any type of injury.

A pronounced symptom of rupture is painful sensations during palpation of the line of the knee joint gap. There are special diagnostic tests such as the McMurry test and the Epley test. The McMurry test is performed in two ways.

In the first case, the patient is placed 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 perform rotational movements of the lower leg, first outward, and then inward. With a crack or clicks, an infringement of the injured meniscus between the surfaces of the joint can be considered, this test is positive.

The other way is called flexion. It is carried out in this way: with one hand, they grab the knee, as in the first version, after that the leg is bent as much as possible at the knee. The lower leg is then rotated outward to detect a rupture. Provided that the knee joint is slowly extended to approximately 90 degrees and rotational movements with the lower leg, then during the meniscus rupture, the patient will feel pain on the joint surface from the inner back side.

During the Epley test, the patient is placed on his stomach and the leg is bent at the knee, creating an angle of 90 degrees. With one hand, you need to press the person on the heel, and with the other, rotate the lower leg and foot. When pain appears 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 cartilaginous tissue between the surfaces of the joint and do not create a rolling and clicking sensation. This type of damage is characteristic of strong joints.

Treatment consists in getting rid of such sports, in which one cannot do without sharp jerks and movements that leave one leg in place, these activities aggravate the condition. In the elderly, this treatment has a better outcome, as arthritis and degenerative tears are often the cause of their symptoms.

A minor 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 damage not more than 2.5 mm usually heals on its own or does not bother in any way.

Also, tear treatment provides another option. Sewing up from the inside out. For this method of treatment, long needles are used, which are wound perpendicular to the rupture line from the joint cavity to the outer part of the strong capsule area. Moreover, the seams are made quite tightly, one by the second. This is the main advantage of this treatment option, although it increases the risk of damage to nerves and blood vessels during the withdrawal of the needle from the joint cavity. This method is great 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 appear in the passage of the needle.

In cases where a rupture of the anterior horn occurs, it is best to use the method of suturing from outside to 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 a 75% chance of success in the healing of the meniscus.

The main indications for surgery are pain and effusion that cannot be treated conservatively. Joint blockage or friction during movement are also indications for surgery. Resection of the meniscus (meniscectomy) was once considered a safe operation. But with the help of recent studies, it turned out that most often meniscectomy leads to the development of arthritis. This fact influenced the main methods of treating a ruptured posterior horn. Today, grinding of damaged parts and partial removal of the meniscus are very popular.

Successful recovery from injuries such as rupture of the medial and lateral meniscus will depend on many factors. For a quick recovery, factors such as the location of the damage and its duration are important. The likelihood of a full-fledged treatment decreases with an insufficiently strong ligamentous apparatus. If the patient's age is no more than 45 years old, then he has a better chance of recovery.

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27
Oct
2014

What is a meniscus?

The meniscus is a cartilage pad that sits between the joints and acts as a shock absorber.

During motor activity, menisci can change their own shape, due to which the gait is smooth and does not pose a danger.

The knee joint contains the outer (lateral) and inner (medial) menisci.

The medial meniscus is less mobile, so it is prone to various injuries, among which tears should be noted.

Each meniscus can be divided into three parts: the anterior horn, the posterior horn, and the body.

The posterior meniscus horn, which is the inner part, is characterized by the absence of a circulatory system. The circulation of synovial fluid is responsible for nutrition.

In this regard, damage to the posterior horn of the medial meniscus is irreversible, because the tissues are not designed for regeneration. Trauma is difficult to diagnose, and therefore magnetic resonance imaging is a mandatory procedure.

Why can meniscus injuries occur?

Meniscus injuries can be caused by a variety of medical conditions and other causes. Knowing all the reasons that increase the risks, you can guarantee the preservation of an ideal state of health.

• Mechanical injuries can be obtained as a result of external mechanical impact. The danger arises from the combined nature of the damage. In most cases, several elements of the knee joint are affected at once. The injury can be global and include damage to the ligaments of the knee joint, rupture of the posterior horn of the medial meniscus, rupture of the lateral meniscus body, fracture of the articular capsule. In this situation, treatment should be started in a timely manner and should be thoughtful, since only in this case it is possible to avoid unwanted complications and restore all functions.
• Genetic causes suggest a predisposition to various joint diseases. Diseases can be hereditary or present as a congenital disorder. In many cases, chronic diseases of the knee joint develop due to the fact that the menisci quickly wear out, lack nutrition, and blood circulation in the knee joint is impaired. Degenerative damage can occur early. Damage to the cartilaginous ligaments and menisci can occur at a young age.
• Joint pathologies caused by postponed or chronic diseases are usually attributed to the biological type of damage. As a result, the risk of injury is increased by exposure to pathogenic microbes. Tears of the horn or the body of the meniscus, abrasion, separation of fragments can be accompanied by inflammatory processes.

It should be noted that the above list only represents the main reasons.

Types of meniscus injuries.

As noted, many people experience combined meniscus injuries that involve tearing or tearing the posterior or anterior horn.

• Tearing off or the appearance in the capsule of the knee joint of a part of the meniscus torn off due to abrasion or damage is one of the most common cases in traumatology. It is customary to refer to these types of damage as the formation of a fragment by tearing off a part of the meniscus.
• Tears are lesions in which a part of the meniscus tears. In most cases, ruptures of the thinnest parts occur, which should take an active part in motor activity. The thinnest and most functional parts are the horns and the edges of the menisci.

Meniscus tear symptoms.

- Traumatic ruptures.

After this injury, a person may feel pain and notice knee swelling.

If you experience pain when descending stairs, you can suspect a rupture of the back of the meniscus.

If the meniscus ruptures, one part may come off, after which it will dangle and interfere with the full functioning of the knee joint. Small tears can cause movement difficulties and painful clicks in the knee joint. A large rupture leads to a blockade of the knee joint, due to the fact that the torn and dangling part of the meniscus moves to the very center and begins to interfere with performing various movements.

Damage to the posterior horn of the medial meniscus in most cases is limited to impaired motor activity of the knee joint and flexion of the knee.

In case of injury, sometimes the painful sensations are especially strong, as a result of which a person cannot step on the foot. In other cases, a rupture can only cause pain when performing certain movements, such as going up or down stairs.

- Sharp break.

In this case, a person may suffer from knee swelling, which develops in a minimal time and is especially pronounced.

- Degenerative ruptures.

Many people after forty years of age suffer from chronic degenerative meniscus tears.

An increase in pain and swelling of the knee is not always possible to detect, since their development occurs gradually.

It is important to note that it is not always possible to find indications of the trauma in the patient's health history. In some cases, a meniscus tear may occur after performing a routine action, such as getting out of a chair. At this time, a blockage of the knee joint may occur. It should be borne in mind that in many cases, chronic ruptures lead only to pain.

With this injury, the meniscus can be damaged, and its adjacent cartilage can cover the tibia or femur.

Signs of chronic meniscus tears are different: pain with a certain movement or a pronounced pain syndrome that does not allow stepping on the foot.

Regardless of the type of injury, you should consult a doctor in a timely manner.

How should a ruptured posterior meniscus horn be treated?

After an accurate diagnosis has been made, it is necessary to start treatment in a hospital setting.

For minor gaps, conservative treatment is necessary. The patient takes anti-inflammatory and analgesic medications, manual therapy and physiotherapy.

Serious damage requires surgery. In this case, the torn meniscus must be sutured. If recovery is not possible, the meniscus should be removed and a menisectomy performed.

Recently, arthroscopy, which is an invasive technique, has become more and more in demand. It is important to note that arthroscopy is a low-traumatic method, characterized by the absence of complications in the postoperative period.

After surgery, the patient should spend some time in the hospital under the supervision of a physician. Rehabilitation treatment must be prescribed without fail, contributing to a full recovery. Rehabilitation includes therapeutic exercises, taking antibiotics and drugs to prevent inflammatory processes.

Features of the surgical intervention.

If necessary, the operation is determined by the possibility of stitching the meniscus. Usually this method is preferred when the "red zone" is damaged.

What types of operations are usually used for trauma to the horn of the medial meniscus?

1. Arthrotomy is a complex operation that involves removing damaged cartilage. They try to refuse this method, but arthrotomy is mandatory if the lesion of the knee joint is extensive.
2. Meniscetomy is an operation that involves the complete removal of cartilage. The technique used to be widespread, but now it is considered harmful, ineffective.
3. Partial meniscectomy is a surgical procedure that removes the damaged part of the cartilage and restores the rest. Surgeons should trim the edge of the cartilage, trying to flatten it.
4. Endoprosthetics and transplantation. Many people have heard of these types of operations. The patient should be transplanted with a donor or artificial meniscus, and the affected meniscus is removed.
5. Arthroscopy is recognized as the most modern type of surgery. This method is characterized by low trauma. The technique involves two small punctures. An arthroscope, which is a video camera, must be inserted through one puncture. Saline enters the joint. Another puncture is needed to perform various manipulations with the joint.
6. Cartilage stitching. This method can be performed using an arthroscope. The operation can be effective only in the thick area, where there is a high chance of cartilage fusion. The operation should be carried out almost immediately after the rupture.

The best method of surgery should be chosen by an experienced surgeon.

The rehabilitation period.

Treatment of the meniscus necessarily involves the restoration of the functions of the knee joint. It is important to remember that rehabilitation should be carried out under the strict supervision of a rehabilitation therapist or orthopedist. The doctor must determine a set of measures aimed at improving the condition of the knee joint. Rehabilitation measures should contribute to a quick recovery. The recovery phase of treatment can be carried out at home, but at the same time it is necessary to visit the clinic. Ideally, rehabilitation should be done in a hospital. It should be noted that the range of measures includes physiotherapy exercises, massage, modern hardware methods. For muscle stimulation and joint development, the load should be different in dosage.

In most cases, it takes several months to fully restore the functions of the knee joint. A habitual lifestyle is allowed to lead one month after surgery. Functions will recover gradually, as intra-articular edema is a serious problem. To eliminate edema, lymphatic drainage massage is required.

An accurate diagnosis and timely treatment can count on a favorable prognosis. A consultation with an experienced physician will ensure that any problems related to the knee joint are eliminated, so that any problems associated with physical activity will be eliminated. Compliance with all the recommendations of an experienced doctor will restore an ideal state of health.

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

During the movement of the meniscus are able to modify their shape, thereby ensuring 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 prone to various kinds of damage up to tearing tissue.

Conditionally meniscus can be divided into three component parts:

— anterior meniscus horn

— posterior meniscus horn

- the body of the meniscus

Posterior meniscus horn 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. Rupture of the posterior meniscus It is 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.

In case of tear meniscus the torn off part of it dangles inside the joint and interferes with movement. Painful clicks are common when tears are small in the joint.

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

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

In case of rupture of the back 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 breaks of a degenerative nature that occur in people after 40 years as a result of age-related changes in cartilage tissue. In such cases, a rupture occurs even with the usual abrupt rise from the chair, such a rupture is very difficult to diagnose.

Very often, ruptures of the degenerative form become protracted and chronic. A symptom of a degenerative rupture is the presence of a dull aching pain in the knee area.

moscow-doctor.rf

A bit of anatomy

This is how the knee joint works.

Each knee joint has two menisci:

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

Each of them is conventionally divided into three parts:

• front horn;
• body;
• rear horn.

Menisci are formed from fibrous cartilage and attach 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 mount makes it more rigid (compared to the outside). Because of this, it is the inner meniscus that is more prone to injury.

The normal meniscus is composed primarily of special collagen fibers. Most of them are located circularly (along), and a smaller part - radially (from edge to center). Such fibers are connected to each other by a small amount of perforating (i.e., random) fibers.

The meniscus consists 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 residues. They are now known to perform a variety of functions:

• contribute to an even distribution of the load on the surface of the joint;
• stabilize the joint;
• absorb shocks when driving;
• 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 dislocation.

Causes and types of ruptures

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

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

Depending on the location of the damage, a meniscus rupture can occur:

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

Depending on the shape, the meniscus rupture can be:

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

After 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 ruptures

At the time of injury, a person feels acute pain in the affected area, the joint swells, and hemarthrosis may develop.

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

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

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

After a meniscus rupture, its detached part moves and impedes movement in the knee joint. With minor injuries, sensations of difficulty in movement and painful clicks may appear, and with large ones, the onset of blockade of the joint is possible, which is caused by the movement of a large moving fragment to the center of the joint (that is, it seems to wedge the joint). Typically, a rupture of the posterior horn leads to limited flexion of the leg at the knee, and damage to the body and anterior horn makes it difficult to extend the limb.

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

Degenerative breaks

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

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

As with traumatic injuries, the severity of pain in degenerative tears can vary. In some cases, because of her, the patient cannot step on the leg, and in others, pain occurs only when a specific movement is made (for example, squats).

Possible complications

Sometimes, in the absence of unbearable pain, a meniscus injury is confused with an ordinary knee injury. The victim may not seek the help of a specialist for a long time, and painful sensations may eventually completely disappear. 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 serious complication - gonarthrosis (deforming arthrosis). This dangerous disease in the future may become an indication for performing knee arthroplasty.

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

• even mild knee pain when climbing stairs;
• the appearance of a crunch or click when bending the leg;
• episodes of knee wedging;
• swelling;
• sensations of interference with movements in the knee joint;
• impossibility of deep squats.

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

First aid

Ice must be applied to the injured knee.

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

1. Immediately give up any stress 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 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 the hospital or trauma center.

Diagnostics

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

• Rotational Steiman tests;
• identification of the extension symptom according to the Roche and Baykov tests;
• mediolateral test to detect a symptom of compression.

The following additional examination methods can be used 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 when a meniscus rupture is suspected to exclude the presence of other injuries (ligament ruptures, fractures, etc.).

Sometimes, diagnostic arthroscopy is done to confirm the diagnosis.

Treatment

The tactics of treating meniscus injuries is determined by the severity of the injury. Small ruptures or degenerative changes can be eliminated by conservative methods, and in case of significant ruptures and blockages of the knee joint, the patient needs 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 injury, cold should be applied to the area of ​​damage. 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 trauma to the meniscus, an operation was performed to remove it completely. Such interventions were considered harmless because the role of these cartilaginous spacers was underestimated. However, after such radical surgeries, 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 carry out 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 the instruments for the operation are introduced through the other.

Arthroscopy is performed in an aqueous environment. Such a surgical technique allows to achieve good therapeutic and cosmetic results and significantly reduces the patient's rehabilitation time after an injury. With the help of an arthroscope, the surgeon can reach the most distant parts of the joint. To eliminate damage to the meniscus, a specialist installs special fasteners (anchors) on it or applies seams. Sometimes, with a significant displacement of the meniscus during the operation, it is partially removed (that is, its detached section is cut off).

If, during arthroscopy, the doctor reveals chondromalacia (cartilage damage), then the patient may be recommended to intra-articular administration of special drugs after surgery. For this, the following 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 patient's age and the presence of degenerative changes in the tissues. A greater likelihood of good results is observed in young patients, and less in patients over 40 years of age or in the presence of severe meniscus damage, horizontal stratification or displacement.

Typically, this surgery takes about 2 hours. Already on the very 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. Its 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 a complete loss of its functionality, the patient may be advised to perform such a surgical operation 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 grafts made from artificial materials.

Rehabilitation

The rehabilitation program after a meniscus injury is drawn up individually for each patient, since its scope 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 remedial gymnastics, 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 meniscus injuries.

Which doctor to contact

If pain, swelling and disturbances in the functioning of the knee joint appear, it is necessary to consult an orthopedic traumatologist. After examining and interviewing the patient, the doctor will conduct a series of diagnostic tests and to confirm the diagnosis of a meniscus rupture, he will prescribe an MRI, X-ray or ultrasound of the knee joint.

Channel One, the program "Living Healthy" with Elena Malysheva, in the section "About Medicine" the specialist talks about injuries of the knee joint meniscus and their treatment (from 32:20 min.):

Traumatologist Y. Glazkov talks about the treatment of knee meniscus injuries:

myfamilydoctor.ru

A little about menisci

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

The meniscus itself is not simple and consists of three elements - this is the body, the posterior and anterior horn. Part of this cartilage is penetrated by a capillary mesh that 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 injury, it is important to correctly determine which part of the meniscus has been torn. The "living" zone of the cartilage is subject to the best restoration.

There was a time when specialists believed that as a result of 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.

Causes

To date, experts talk about only one obvious reason for the occurrence of such an injury as a rupture of the posterior horn of the medial meniscus. This is considered to be an acute injury, since not any aggressive effect on the knee joint can lead to damage to the cartilage, which is responsible for the amortization of the joints.

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

• vigorous jumping or running on uneven ground;
• twisting on one leg without lifting the limb from the surface;
• quite active walking or long squatting;
• trauma caused by degenerative joint diseases;
• congenital pathology in the form of weakness of the joints and ligaments.

Symptoms

Typically, damage to the medial meniscus of the knee occurs as a result of the unnatural position of parts of the joint at a certain point when the injury occurs. Or the rupture is 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 know and pay attention to symptoms that indicate a meniscus rupture. Signs of injury to the internal meniscus include:

• painful sensations that are very sharp at the time of injury and last for several minutes. Before the onset of pain, you may hear a clicking sound. After a while, the sharp pain may subside and you can walk, although it will be difficult to do so through the pain. In the morning, you will feel pain in your knee, as if a nail had been stuck in it, 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 when the internal meniscus is torn. The blockade of the meniscus occurs at the moment when the detached part of the meniscus is squeezed 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 rupture 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 the cartilage and fluid. A recent tear of the inner meniscus has smooth edges and accumulation of blood in the joint. While in chronic injury the cartilaginous tissue is uneven, there is swelling from the accumulation of synovial fluid, and the nearby cartilage is often damaged.

Treatment

A rupture of the posterior horn of the medial meniscus must be treated immediately after injury, as over time, the untreated lesion will develop into a chronic stage.

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 meniscus horn should be treated with therapeutic methods. Naturally, injuries occur when the patient is in need of emergency surgery, but in most cases, conservative treatment is sufficient. Treatment measures for this damage, as a rule, include several very effective stages (of course, if the disease is not started!):

• reduction, that is, reduction of the knee joint during blockade. Manual therapy helps, as well as hardware traction;
• elimination of joint swelling. For this, specialists prescribe anti-inflammatory drugs to the patient;
• rehabilitation activities such as exercise therapy, massage, physiotherapy;
• the most prolonged, 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 pain relievers, 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 only be determined by a doctor.

Sometimes gypsum is used when the meniscus is damaged. Whether or not to apply a cast is up to the doctor. It usually takes several weeks after manual reduction of the joint to be immobilized at a certain angle. For a long time, the desired angle can be maintained only with the help of rigid fixation.

Surgical intervention

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 rupture are useless, surgery is necessary. First of all, the meniscus tear is tested for the possibility of stitching it. As a rule, this method is relevant when the "red zone" is damaged.

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. It is better to avoid this operation, 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;
• Meniscectomy is the complete removal of cartilage. Today it is recognized as harmful and ineffective;
• Partial meniscectomy is an operation in which the damaged part of the cartilage is removed and the rest is restored. Surgeons trim the edge of the cartilage to an even state;
• endoprosthetics and transplantation. Many have heard of this kind of operation and have a rough idea of ​​what it is. A donor meniscus is transplanted to the patient 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, saline gets there. Another puncture is used for various kinds of manipulation of the joint;
• stitching of damaged cartilage. This method is carried out thanks to the above arthroscope. Cartilage restoration surgery will be effective only in the thick "living" zone, where there is a chance for fusion. In addition, the operation is carried out only on the "fresh" gap.

moisustavy.ru

Anatomical features of the knee cartilage

The meniscus is the cartilaginous tissue of the knee that sits between two closing bones and allows one bone to slide over the other, allowing 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 to be outside. Therefore, its damage is much less common than damage to the internal one.

The internal (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 lesions of the medial meniscus are more often referred to traumatology. Damage to the posterior horn of the medial meniscus is accompanied by damage to the ligament connecting the meniscus to the knee joint.

In appearance, it looks like a crescent moon lined with a porous cloth. The body of the cartilaginous pad consists of three parts:

• Front horn;
• Middle part;
• Hind horn.

The cartilage of the knee performs several important functions, without which full movement would be impossible:

1. Cushioning while walking, running, jumping.
2. Stabilization of the knee position 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, make long jumps. Tissue destruction occurs and over time, people over 40 are at risk. Damaged knees at a young age over time begin to take on an old nature of the disease in old age.

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

Break shapes

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

• Longitudinal;
• Degenerative;
• Oblique;
• Transverse;
• Rupture of the posterior horn;
• Horizontal;
• Rupture of the anterior horn.

Rear horn rupture

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 of the posterior horn can be:

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

Symptoms of trauma to the posterior horn of the medial meniscus

Symptoms of the resulting injury depend on what form she wears. If it is an acute form, then the signs of injury are as follows:

1. Sharp pain, even at rest.
2. Hemorrhage inside the tissue.
3. Knee blockage.
4. Arthroscopic tissue has smooth edges.
5. Swelling and redness.

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

• Crackling of the knee joint during movement;
• Accumulation of synovial fluid;
• The tissue is exfoliated during arthroscopy, similar to a porous sponge.

Treatment of damage to the cartilage layer

In order for the acute form not to become chronic, treatment must be started immediately. If treatment is started late, then the tissue begins to acquire significant damage, turning into rags. The destruction of the tissue leads to degeneration of the cartilage, which in turn leads to arthrosis of the knee and its immobility.

Conservative treatment stages

The conservative method is used in the acute non-started stage in the early stages of the course of the disease. Conservative therapy consists of several stages.

• Relief of inflammation, pain and swelling with non-steroidal anti-inflammatory drugs (NSAIDs).
• In cases of "jamming" of the knee joint, reduction 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 (according to the doctor's recommendation).

Surgical treatment steps

The surgical method is used only in the most extreme cases, when, for example, the tissue is damaged so much 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;
• Suturing damaged cartilage (performed with minor damage);
• Arthroscopy - puncture of the knee in two places in order to carry out the following manipulations with the cartilage (for example, stitching or endoprosthetics).

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 during 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 should take care that the cold does not penetrate to the limbs, and the knee does not undergo sudden movements.

Conclusion

Thus, knee injury is a much more common injury than any other injury. In traumatology, meniscus injuries of several types 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, therefore, several types are distinguished: horizontal, transverse, oblique, longitudinal, degenerative. Rupture of the posterior horn of the medial meniscus is much more common than the anterior or middle part. This is due to the fact that the medial meniscus is less mobile than the lateral, therefore, the pressure on it is greater when moving.

Treatment of injured cartilage is carried out both conservatively and surgically. Which method will be chosen is determined by the attending physician on the basis of how strong the damage is, what form (acute or chronic) the injury has, in what condition the cartilage tissue of the knee is, what kind of tear 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 joint tissue and immobility of the knee.

In order to avoid injury to the lower extremities, you should avoid turns, sudden movements, falls, jumping from a height. Exercise is usually contraindicated after meniscus treatment. Dear readers, everyone 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 detected. In the joint cavity, effusion. 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 internal meniscus, in the posterior horn, a pathological MR signal from horizontal damage of grade 3 according to Stoller is determined. The integrity of the cruciform ligaments is preserved. Inhomogeneous signal from the anterior cruciate ligament. The proper patellar ligament was unremarkable. There is a thickening and an increase in the signal from the medial collateral ligament.
The intensity of the signal from the bone marrow is not changed.
Articular hyacinth cartilage of regular thickness, uniform.
The intensity of the signal from the Hoffa print was unremarkable.
Behind the medial silks are 15x13x60 mm. There are no marginal osteophytes. Surrounding soft tissue without visible pathology.

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

Hello.

Based on 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 blockages. The patient either does not fully extend the knee joint (static blockade), or at the moment of walking, turning the lower leg or trunk with a fixed leg, the joint becomes jammed in one position (dynamic blockade).

Dynamic block is usually accompanied by a sharp painful sensation or a painful click. With blockade, part of the torn meniscus falls between the articular surfaces and prevents movement. Accordingly, the cartilaginous covering 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 effusion (synovitis) in the joint, i.e. accumulation of inflammatory fluid. Synovitis can become chronic if left untreated. Such an inflammatory process harms the joint, in addition, 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 flushes the joint, removing effusion, all particles of the damaged cartilaginous cover.

There is one more nuance. If the injury is fresh, wait for the medial collateral ligament to heal before surgery. To do this, for 2-3 weeks, you need to fix the knee with a rigid orthosis or a plaster cast, and then apply surgery. Arthroscopy is performed through 2-3 small punctures along the front surface of the knee, using microinstruments and a miniature camera inserted into the joint. Postoperative recovery is usually quick, especially if supervised by an experienced orthopedic surgeon.