Horizontal tear of the posterior horn of the medial meniscus. Treatment of a rupture of the posterior horn of the medial (internal) meniscus. Brief anatomical description of the meniscus

The menisci of the knee joint are the cartilage discs located between the tibia and femur. They are crescent-shaped “spacers” and provide stability to the joint, play the role of a shock absorber and increase the contact area of ​​the articular surfaces. When talking about meniscal damage, experts usually mean its rupture. In this article we will introduce you to the main causes, symptoms, types, methods of diagnosing and treating injuries to the meniscus of the knee joint.

Despite the large margin of strength of the menisci, such injuries are one of the most common problems of the knee joint and are usually observed in physically active people (youth, athletes, physical workers).

According to statistics, 60-70 people out of 100 thousand encounter such injuries every year, and 3-4 times more often such injuries occur in men. People under 30 years of age usually experience traumatic ruptures of the menisci, and after 40, a violation of their integrity due to the appearance of chronic degenerative changes in them.

A little anatomy

There are two menisci in each knee joint:

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

Each of them is divided into three parts:

• anterior horn;
• body;
• posterior horn.

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

A normal meniscus consists primarily of special collagen fibers. Most of them are located circularly (alongwise), and the smaller part is located radially (from the edge to the 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 there is a red zone - an area with blood vessels.

Functions of the menisci

Previously, scientists believed that menisci were nonfunctional muscle remnants. It is now known that they perform a number of functions:

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

Causes and types of ruptures

Depending on the causes of meniscus damage, there are:

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

Depending on the location of the damage, meniscal rupture can occur:

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

Depending on the shape, a meniscus tear can be:

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

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

• 0 – meniscus without changes;
• 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 – intense signal reaches the surface of the meniscus.

Symptoms

Traumatic ruptures

At the time of injury (during a jump, deep squat, etc.), the patient experiences sharp pain in the knee joint and the soft tissues of the knee swell. If damage occurs in the red zone of the meniscus, then blood flows into the joint cavity and leads to development, manifested by the appearance of bulging and swelling above the kneecap.

The intensity of pain when a meniscus is damaged can vary. 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 the 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 flexing the limb leads to pain along the tibial ligament. After an injury, the kneecap cannot be moved, and muscle weakness is detected in the area of ​​the front surface of the thigh.

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

After a meniscus rupture, the torn 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, a blockade of the joint may occur, which is caused by the movement of a large moving fragment to the center of the joint (i.e., it seems to jam the joint). As a rule, a rupture of the posterior horn leads to limited 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 tear (usually the external one) can be combined with. In such cases, swelling of the knee occurs faster and is more significant than with an unrelated injury.

Degenerative tears

Typically, such injuries occur 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 rising from a chair, bed, armchair) or with minor physical impact (for example, a normal squat).

The patient experiences 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 may be accompanied by a blockade of the joint. Often, with such injuries to the meniscus, there is a violation of the integrity of the adjacent cartilage that covers the tibia or femur.

As with traumatic injuries, the severity of pain during degenerative ruptures may vary. In some cases, because of it, the patient cannot step on his leg, and in others, pain occurs only when performing a specific movement (for example, squatting).

Possible complications

Sometimes, in the absence of unbearable pain, meniscus damage is confused with ordinary damage. The victim may not seek help from a specialist for a long time, and the painful sensations may disappear completely over time. Despite this relief, the meniscus remains damaged and ceases to perform its functions.

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

If a knee injury is the reason for compulsory treatment See your doctor for the following symptoms:

• even mild pain in the knee when walking up stairs;
• the appearance of a crunching or clicking sound when bending the leg;
• episodes of knee locking;
• swelling;
• sensations of interference when moving in the knee joint;
• inability to squat deeply.

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

First aid

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

1. Immediately avoid any stress on the knee joint and subsequently use crutches to move around.
2. To reduce pain, swelling and stop bleeding, apply a cold compress to the area of ​​injury or wrap your leg in cotton cloth and apply ice to it (be sure to remove it every 15-20 minutes for 2 minutes to prevent frostbite).
3. Allow the victim to take a painkiller in the form of tablets (Analgin, Ketanol, Nimesulide, Ibuprofen, etc.) or perform an intramuscular injection.
4. Give your leg an elevated position.
5. Do not delay visiting a doctor and help the victim get to medical institution or trauma center.

Diagnostics

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

• Steinman rotation tests;
• identification of the extension symptom using the Roche and Baikov tests;
• mediolateral test to identify the symptom of compression.

The following can accurately determine the presence of a meniscus tear: additional methods examinations:

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

The information value of radiography in the study of cartilage tissue is small, but it is always prescribed if a meniscus tear is suspected to exclude the presence of other injuries (ligament ruptures, fractures, etc.).

Sometimes diagnostic arthroscopy is performed to confirm the diagnosis.

Treatment

Treatment tactics for meniscus injuries are determined by the severity of the injury. Small ruptures or degenerative changes can be eliminated using conservative methods, but for significant ruptures and blockages of the knee joint, the patient must undergo surgical intervention.

Conservative therapy

The patient is advised to provide maximum rest to the injured limb. To ensure 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 injured area. When moving, the patient must use crutches.

To eliminate pain and inflammation, antibacterial and. After the acute period has stopped, the patient is recommended a rehabilitation program that ensures the most complete restoration of the functions of the knee joint.

Surgery

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

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

Arthroscopy is performed in an aquatic environment. This surgical technique allows one to achieve good therapeutic and cosmetic results and significantly reduces the patient’s rehabilitation time after an injury. Using an arthroscope, the surgeon can reach the most distant areas of the joint. To eliminate damage to the meniscus, a specialist installs special fasteners (anchors) on it or applies sutures. Sometimes, if the meniscus is significantly displaced during surgery, it is partially removed (that is, its torn section is cut off).

If during arthroscopy the doctor detects chondromalacia (cartilage damage), then the patient may be recommended to administer special drugs intra-articularly after surgery. For this, the following can be used: Duralan, Ostenil, Fermaton, etc.

The success of arthroscopic interventions for meniscal tears largely depends on the severity of the injury, the location of the injury, the age of the patient and the presence of degenerative changes in the tissues. A greater likelihood of good results is observed in young patients, and a lower likelihood in patients over 40 years of age or in the presence of severe meniscal damage, horizontal dissection or displacement.

Typically, such surgery lasts about 2 hours. Already on the first day after arthroscopy, the patient can walk on crutches, stepping on the operated leg, and after 2-3 days he walks with a cane. Its full recovery lasts 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 complete loss of its functionality, the patient may be recommended a surgical operation such as meniscus transplantation. Frozen (donor and cadaveric) or irradiated menisci are used as a graft. According to statistics, better results from such interventions are observed when using frozen donor menisci. There are also grafts made from artificial materials.

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

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

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

Anatomical features of the cartilage tissue of the knee

– cartilaginous tissue of the knee, located between two intersecting bones and allowing one bone to slide over the other, allowing unhindered flexion/extension of the knee.

The structure of the knee joint includes two types of menisci:

1. External (lateral).
2. Internal (medial).

The outer one is considered the most mobile. Therefore, damage to it is much less common than damage to the internal one.

The internal (medial) meniscus is a cartilage pad 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 more often turn 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 porous fabric. The body of the cartilage pad consists of three parts:

• Anterior horn;
• Middle part;
• Posterior 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. They are riddled with nerve endings that send signals to the brain about the movement of the knee joint.

Meniscus tears

The illustration shows a tear in the anterior horn of the lateral meniscus of the knee joint.

Knee injuries are not that uncommon. In this case, injuries can occur not only to people who lead an active lifestyle, but also to those who, for example, sit on squats for a long time, try to rotate on one leg, or perform long jumps. Tissue destruction occurs over time; people over 40 years of age are at risk. Damaged knees at a young age eventually begin to have an inveterate nature of the disease in old age.

The nature of its damage may vary depending on where exactly the rupture occurred and what shape it has.

Forms of discontinuities

Cartilage ruptures can vary in nature and shape of the lesion. Modern traumatology distinguishes the following groups of internal meniscal tears:

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

Dorsal horn rupture

A tear of the posterior horn of the medial meniscus is one of the most common types of knee injuries. This is the most dangerous damage.

Lacerations of the posterior horn can be:

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

Symptoms of injury to the posterior horn of the medial meniscus

The symptoms of the resulting injury depend on what form it takes. If this is an acute form, then the signs of injury are as follows:

1. Acute pain that occurs even at rest.
2. Hemorrhage within the tissue.
3. Knee joint lock.
4. Swelling and redness.

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

• Cracking of the knee joint during movement;
• During arthroscopy, the tissue is stratified, similar to a porous sponge.

Treatment of cartilage damage

To prevent the acute form from becoming chronic, it is necessary to begin treatment immediately. If treatment is started late, the tissue begins to suffer significant damage, turning into rags. Tissue destruction leads to cartilage degeneration, which in turn leads to knee arthrosis and immobility.

Stages of conservative treatment

The conservative method is used in the acute, unadvanced stage in the early stages of the disease. Therapy using conservative methods consists of several stages.

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

• Pain relief with analgesics.
• Applying plaster (as recommended by a doctor).

Stages of surgical treatment

The surgical method is used only in the most extreme cases, when, for example, the tissue is so damaged that it cannot be restored or if conservative methods have not helped.

Surgical methods for repairing torn cartilage consist of the following procedures:

• Arthrotomy – partial removal of damaged cartilage with extensive tissue damage;
• Meniscotomy – complete removal of cartilage tissue; Transplantation – moving the donor meniscus to the patient;
• – introduction of artificial cartilage into the knee;
• Stitching of damaged cartilage (carried out for minor damage);
• – puncturing the knee in two places in order to carry out further manipulations with the cartilage (for example, suturing or endoprosthetics).

After treatment has been completed, regardless of how it was carried out (conservative or surgical), the patient will have a long life. The patient must provide himself with complete rest throughout the entire period of treatment and after it. Any physical activity after completion of therapy is contraindicated. The patient should take care that the cold does not penetrate to the extremities and that the knee is not subjected to sudden movements.

Conclusion

Thus, knee injury is an injury that occurs much more often than any other injury. In traumatology, several types of meniscus injuries are known: ruptures of the anterior horn, ruptures of the posterior horn and ruptures of the middle part. Such injuries can be different in size and shape, so there are several types: horizontal, transverse, oblique, longitudinal, degenerative. Rupture of the posterior horn of the medial meniscus is much more common than the anterior or middle part. This is due to the fact that the medial meniscus is less mobile than the lateral one, therefore, the pressure on it during movement is greater.

Treatment of injured cartilages is carried out both conservatively and surgically. Which method will be chosen is determined by the attending physician based on how severe the damage is, what form (acute or old) the damage is, what condition the cartilage tissue of the knee is in, what specific gap is present (horizontal, radial or combined).

Almost always, the attending physician tries to resort to conservative method, and only then, if he turned out to be powerless, to surgery.

Treatment of cartilage tissue injuries must be started immediately, otherwise the chronic form of the injury can lead to complete destruction of the articular tissue and immobility of the knee.

In order to avoid injury to the lower extremities, you should avoid turning, sudden movements, falls, and jumping from heights. After meniscus treatment, physical activity is usually contraindicated. Dear readers, that’s all for today, share in the comments about your experience in treating meniscus injuries, in what ways did you solve your problems?

The meniscus is an important structural element of the knee joint. In appearance, it resembles a crescent with slightly forward-leaning edges.

The meniscus is divided into several parts:

• body,
• end zones,
• posterior and anterior horn.

The knee joint has a complex structure; it contains two menisci – the lateral (outer) and the medial. They are attached to the tibia using their elongated ends. The outer meniscus is considered more mobile than the medial one and is located in the outer part of the knee. The first rupture occurs quite rarely.

The medial meniscus is located in the inner region of the knee and connects to the medial collateral ligament. The paracapsular part of the meniscus (or red zone) contains many small capillaries through which it is supplied with blood. The intermediate part of the cartilage has fewer capillaries, and therefore is not as strongly supplied with blood. The inner part of the cartilage (meniscus) does not receive blood at all, since it does not have blood vessels.

Menisci perform many different functions: serve as shock absorbers during movement, reduce and evenly distribute the load on the joints, participate in stabilizing the position of the knee joint, thereby limiting the range of movements, which protects a person from injury.

Common meniscus injuries

Most patients present to the hospital with a combined meniscus tear, which includes a tear or tear of the posterior, anterior horn, or body of the meniscus.

• cartilage rupture is an injury that is characterized by a tear in its thinner parts, or as a result of severe trauma, a rupture of the anterior or posterior horn occurs, either alone or in combination with the body;
• separation of part of the meniscus or its appearance in the capsule of the knee joint occurs as a result of damage or abrasion. This case occurs frequently in traumatology.

Signs of rupture of the posterior and anterior horn of the meniscus

There are a number of signs by which you can determine a meniscal horn tear:

• traumatic rupture. This type of injury is characterized by a sharp onset of pain in the knee joint after the injury, as well as swelling. The result of a meniscus injury can be a tear of one of its parts, which will cause severe discomfort person while walking. With simple tears of the medial meniscus, there are clicks in the knee during movement, the patient loses the ability to walk fully, and daily activity is limited.

Large tears cause jamming of the knee joint (blockage), since the torn part of the cartilage prevents the knee from bending and straightening. With such injuries, the pain can be unbearable, in special cases the patient is unable to even step on his foot. Sometimes severe pain can only occur as a result of performing certain activities, for example, going up or down stairs.

• degenerative gap.

Degenerative tear of the posterior horn of the meniscus

This type of meniscus injury often occurs in patients over 40 years of age. It is not characterized by acute pain and swelling, since both of these symptoms develop gradually. The damage has progressed to the chronic stage; in order to detect it, it is necessary to undergo diagnostics. A rupture of the posterior horn of the medial meniscus is an insidious ailment that often occurs after getting up from a sofa or chair, or deep squatting, as everyone is accustomed to.

Often, with chronic ruptures, the joint is blocked, but this type of injury is mainly characterized by pain and sometimes swelling. When the posterior horn of the meniscus ruptures, the cartilage of the articular surfaces located nearby is often damaged. By analogy with acute ruptures, degenerative ones also manifest themselves in different ways. In one case, pain appears when performing certain actions, in the other - constant pain that prevents you from stepping on your foot.

Causes and mechanisms of ruptures

Medicine knows a number of reasons that lead to meniscus injury:

• strong physical exertion, twisting of the shin (especially while playing tennis or football);
• active walking or running on uneven terrain;
• sitting for a long time in a “half squat”;
• age-related tissue changes;
• jumping on one leg or spinning;
• congenital weakness of ligaments and joints;
• bending or straightening the leg too sharply;
• direct knee injury (severe bruise or fall).

What happens to a damaged meniscus?

A longitudinal tear of the meniscus can be partial or complete. The latter form is considered more dangerous because the separated part of the posterior horn or body of the meniscus enters the area between the articular surfaces, which leads to blocking the movement of the entire joint. A longitudinal rupture is fraught with complete immobilization of the joint.

Oblique tears occur between the posterior horn of the meniscus and the middle of the cartilage body. Such an injury is considered a partial rupture (flap), but the edge of the cartilage can get between the joints, which will lead to “wandering pain” from one part of the knee to another, and a cracking sound is heard when the knee moves. Horizontal gap occurs in the inner part of the joint (meniscus). This type of injury is characterized by swelling in the joint space and acute pain.

Often this type of injury combines several types of damage at the same time (combined rupture).

Diagnosis of meniscus damage

Acute pain syndrome and other symptoms described above clearly indicate that it is necessary to as soon as possible seek help from a traumatologist. To make an accurate diagnosis, a doctor must conduct a number of studies, including:

• X-ray diagnostics. Can be used when obvious signs meniscus tear. The method is considered ineffective, therefore it is used to determine the presence or absence of fractures;
• Ultrasound diagnostics. It is considered ineffective because the correctness and accuracy of the diagnostic results obtained largely depends on the experience and qualifications of the doctor;

• MRI is a more reliable method for detecting cartilage damage. An MRI shows the condition of the meniscus and the complexity of the injury (tear or complete rupture).

The reliability of the data obtained is important for further choice of treatment method (surgery, medication).

Consequences of injury

A tear of the medial and lateral meniscus is a complex injury, after which it is difficult to restore the motor functions of the knee joint. However, the success of this event depends on several factors, including the location of the rupture and the duration of the injury. The likelihood of a speedy recovery decreases in a certain group of patients, which includes people over 50 years of age.

From year to year ligamentous apparatus becomes weaker, which affects the duration of the recovery period after illness. Another important point– speed of seeking help from a traumatologist. The longer the patient delays the meeting with the doctor, the longer the period of treatment and rehabilitation will last.

What to do if the meniscus is damaged?

Emergency care for injuries of the internal or external meniscus consists of limiting walking and load on the leg, and in some cases, immobilizing the injured leg. The knee must be fixed with an orthosis, elastic bandage, apply cold, walk with crutches if necessary.

To relieve the victim of unbearable pain, you need to give him an anesthetic in the form of a tablet or injection. It is necessary to seek help from a traumatologist as soon as possible in order to reduce the patient’s suffering.

Treatment methods for meniscus damage

There are two ways to restore the functions of the external and medial meniscus - operative and conservative. The choice of one treatment method or another depends on the complexity of the injury and the accuracy of the diagnosis.

Drug treatment

A conservative way of treating injuries to the posterior horn of the lateral and internal meniscus is used in cases where there is no avulsion or large tear that has mild degree gravity. To avoid complications, the traumatologist resorts to the following measures:

• upon the patient’s arrival at the hospital immediately after the injury, the doctor applies a cold compress to the injured area, injects an anesthetic intramuscularly and fixes the joint with an elastic bandage or orthosis if necessary;
• joint puncture and fluid evacuation are performed (if required);
• if there is a joint block, the doctor removes the block;
• instrumental diagnostic methods are used to clarify the diagnosis;
• the patient takes special medications that accelerate the healing and restoration of the meniscus;
• Physiotherapy and therapeutic exercises are prescribed.

The recovery period can last up to 8-12 weeks, but the speed of healing directly depends on the age of the victim, the nature of the damage and the correctness of the prescribed treatment.

Surgical method of treatment

Surgical intervention is indicated in cases where the cartilage tissue is completely destroyed, with severe tears or tears of part of the meniscus.

Kinds surgical treatment:

• removal of the meniscus if it is not possible to restore it (can be complete or partial);
• suturing the injury site (arthroscopy, meniscal suture);
• removal of the damaged portion of the meniscus and reconstruction of the remaining part (partial meniscectomy + suture);
• meniscus transplant (an implant or donor cartilage is implanted into the patient);

The period of complete recovery and restoration of the meniscus depends on the nature of the damage and the type of surgical intervention. After surgical treatment, the patient undergoes a rehabilitation course, which includes physiotherapy, massage, physical therapy, taking chondroprotectors. For 3 months, the patient should avoid heavy physical exertion on the knee joint. To avoid damage to the meniscus, attention must be paid to sports training, avoid falls, impacts, and also treat joint diseases in a timely manner.

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

Classification of injury

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

• 1st degree injury to the posterior horn of the meniscus. Characteristic is focal disruption of the cartilage surface. The entire structure does not undergo changes.
• 2nd degree. The changes become significantly pronounced. There is a partial disruption of the structure of the cartilage.
• 3rd degree. The painful condition worsens. The pathology affects the posterior horn of the medial meniscus. Painful changes in the anatomical structure occur.

Considering the main causative factor, which led to the development of a pathological condition of the cartilage of the knee joint, the body of the lateral meniscus, a distinction is made between traumatic and pathological damage to the posterior horn of the medial meniscus. According to the criterion of the duration of the injury or pathological violation of the integrity of this cartilaginous structure, fresh and old damage to the posterior horn of the medial meniscus is distinguished. Combined damage to the body and posterior horn of the medial meniscus was also identified separately.

Types of breaks

In medicine, there are several types of meniscal tears:

• Longitudinal vertical.
• Patchwork bias.
• Horizontal gap.
• Radial-transverse.
• Degenerative rupture with tissue crushing.
• Oblique-horizontal.

Tears can be complete or incomplete, isolated or combined. The most common are ruptures of both menisci; isolated injuries to the posterior horn are diagnosed less frequently. The portion of the inner meniscus that has become torn may remain in place or become displaced.

Causes of damage

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

Especially many injured people seek help in winter, during icy conditions.

Injuries are caused by:

• Alcohol intoxication.
• Fights.
• Haste.
• Failure to comply with precautions.

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

Degenerative damage is observed in elderly patients with repeated microtrauma caused by strong physical activity during labor activity or irregular training. Rheumatism can also provoke a rupture of the posterior horn of the medial meniscus, since the disease interferes with the blood circulation of the tissues due to swelling. Fibers, losing strength, cannot withstand the load. A rupture of the posterior horn of the medial meniscus can be caused by tonsillitis and scarlet fever.

Symptoms

Characteristic signs of a rupture of the posterior horn are:

• Sharp pain.
• Swelling.
• Joint block.
• Hemarthrosis.

Painful sensations

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

Swelling

The manifestation of swelling is not observed immediately; it can be seen several hours after the rupture.

Joint block

Joint wedging is considered the main sign of a tear in the posterior horn of the medial meniscus. A blockade of the joint occurs after the separated part of the cartilage is clamped by the bones, and a violation occurs. motor function limbs. This symptom can also be observed with sprained ligaments, which makes it difficult to diagnose the pathology.

Hemarthrosis (accumulation of blood inside a joint)

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

• Acute rupture. Hardware diagnostics show sharp edges and the presence of hemarthrosis.
• Chronic rupture. Characterized by swelling caused by the accumulation of fluids.

Diagnostics

If there is no blockage, diagnose a meniscus tear in acute period very hard. In the subacute period, a diagnosis of meniscus tear can be made based on the manifestation of local pain syndrome, compression symptoms, and extension symptoms. If a meniscus tear has not been diagnosed, with treatment the swelling, pain, and effusion in the joint will go away, but with the slightest injury or careless movement, the symptoms will manifest themselves again, which will mean that the pathology has become chronic.

Patients are often diagnosed with a knee joint bruise, a parameniscal cyst, or a sprain.

X-ray

X-rays are prescribed to rule out bone damage from fractures and cracks. X-rays cannot diagnose soft tissue damage. To do this, you need to use magnetic resonance imaging.

MRI

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

Ultrasound

Makes it possible to visualize the tissues of the knee. Using ultrasound, the presence of a degenerative process and an increased volume of intracavitary fluid are determined.

Treatment of injuries to the posterior horn of the meniscus

After receiving an injury, it is necessary to immobilize the limb immediately. Treating a blockage victim yourself is dangerous. The complex treatment prescribed by the doctor includes conservative therapy, surgery, and rehabilitation.

Therapy without surgery

In case of partial damage to the posterior horn of the medial meniscus of 1-2 degrees, conservative therapy is carried out, including drug treatment and physiotherapeutic procedures. The following physiotherapeutic procedures are successfully used:

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

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

Surgical methods

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

• Cartilage suturing. The operation is performed using an arthroscope - a miniature video camera. It is injected at the puncture site of the knee. The operation is performed for fresh meniscus tears.
• Partial meniscectomy. During the operation, the damaged area of ​​the cartilage layer is removed and the remaining part is restored. The meniscus is trimmed to an even state.
• Transfer. A donor or artificial meniscus is transplanted.
• Arthroscopy. 2 small punctures are made in the knee. An arthroscope is inserted through the puncture, along with a saline solution. The second hole makes it possible to perform necessary manipulations with the knee joint.
• Arthrotomy. Complex meniscus removal procedure. The operation is performed if the patient has extensive damage to the knee joint.

A modern method of therapy with a low morbidity rate

Rehabilitation

If the operations were performed with a small volume of interventions, rehabilitation will require a short period of time. Early rehabilitation in postoperative period includes eliminating the inflammatory process in the joint, normalizing blood circulation, strengthening the thigh muscles, limiting the range of motion. Therapeutic exercises It is allowed to perform only with the permission of a doctor in different body positions: sitting, lying, standing on a healthy leg.

Late rehabilitation has the following goals:

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

The most important

A rupture of the posterior horn of the medial meniscus is a dangerous pathology. To reduce the risk of injury, you should take precautions seriously: take your time when moving up the steps, train your muscles with physical activity, regularly take preventive medications with chondroprotectors, vitamin complexes, use knee pads during training. It is necessary to constantly monitor your weight. In case of injury, call a doctor immediately.