Damage to the medial meniscus of the knee joint: symptoms, treatment. How to treat a rupture of the posterior horn of the medial meniscus. Damage to the posterior horn of the medial meniscus. Grade 3.

The structure of the knee joint determines not only the stabilization of the knee or its amortization under stress, but also its mobility. Dysfunction of the knee due to mechanical damage or degenerative changes leads to stiffness in the joint and loss of normal amplitude of flexion-extension movements.

The anatomy of the knee joint distinguishes between the following functional elements:

The patella or patella, located in the tendons of the quadriceps femoris muscle, is flexible and serves as an external joint protection against lateral displacement of the tibia and femur;
Internal and external lateral ligaments provide fixation of the femur and tibia;
The anterior and posterior cruciate ligaments, as well as the lateral ligaments, are designed for fixation;
In addition to the tibia and femur connected to the joint, the fibula is distinguished in the knee, which serves to carry out rotation (pivotal movements) of the foot;
The meniscus are crescent-shaped cartilage plates designed to cushion and stabilize the joint; the presence of nerve endings allows the brain to signal the position of the knee joint. Distinguish between external (lateral) and internal (medial) meniscus.

Meniscus structure

Menisci have a cartilaginous structure, equipped with blood vessels allowing for nutrition, as well as a network of nerve endings.

In their shape, menisci look like plates, in the shape of a crescent, and sometimes a disc, in which the posterior and anterior meniscus horn as well as his body.

Lateral meniscus, also called external (external), is more mobile due to the lack of rigid fixation, this circumstance is the reason that with mechanical injuries it displaces, which prevents injury.

Unlike lateral, medial meniscus has a more rigid fixation by means of attachment to the ligaments, therefore, with injuries, it is damaged much more often. In most cases damage to the inner meniscus is of a combined nature, that is, it is combined with trauma to other elements of the knee joint, in most cases directly to the lateral and cruciate ligaments associated with injuries posterior meniscus horn.

Damage types

The main factor in the operation is the type damage to menisci, since this circumstance affects the possibility or its absence while maintaining a greater meniscus area, in this connection, such damages are distinguished as:

Detachments from the attachment point, at which detachments are distinguished in the region of the posterior or anterior horn, as well as the same body meniscus;
Anterior and posterior tears horns and bodies of menisci;
Combination of rips and breaks;
Breaks of intermenis relations (causes increased mobility and destabilization of the joint);
Old trauma and advanced degenerative traumatization of menisci(meniscopathy);
Cystic formations.

To the most dangerous species meniscus injuries include damage posterior meniscus horn, which has intermeniscal connections, which are also injured not only under the influence of mechanical forces, but also due to degenerative changes, often associated with rupture of the lateral or cruciate ligaments.

Presence in menisci blood vessels, cause the formation of profuse hematomas of the knee joint, as well as the accumulation of fluid, can lead to loss of mobility.

If meniscus injuries are detected and possible complications are prevented, immediate conservative or surgical treatment is required.

Menisci in the human body can be found not only in the knees. They are also a cartilage pad in the clavicle and jaw joints. But it is the knee joint that constantly experiences increased stress. So over time, degenerative changes in the posterior horn of the medial meniscus develop. Also, not only internal, but also external (lateral) cartilage can suffer.

Degenerative-dystrophic changes in the structure of the knee joints

Degenerative changes in the posterior horn of the medial meniscus

Normally, the joints of the knees of the left and right legs are protected from stress by the menisci. Two cartilages anchor and cushion the bones of the lower extremities, preventing most damage during normal walking. The meniscus ligaments attach the protective layer to the anterior and posterior projections (horns).

Over time, due to dystrophic phenomena and injuries, the menisci are damaged. Most often, the medial suffers, since it is thinner. Over time, the picture of the disease gradually worsens until the pathology begins to seriously affect the patient's health and ability to move. There are 5 types of degeneration processes:

Meniscopathy. This is a dystrophic phenomenon that is most often the result of another problem, such as arthritis, gout, or osteoporosis. At the same time, the cartilage gradually becomes thinner and ceases to fulfill its functions.
Cystosis. Small tumors form in the cartilage cavity, which interfere with the normal movement of the joint and deform the surrounding tissue.
Degenerative rupture of the posterior horn of the medial meniscus. Likewise, the anterior or body of the cartilage can rupture.
Rupture of the meniscus ligaments. At the same time, the cartilage retains its integrity, but becomes too mobile, which can lead to subsequent injuries and dislocations.
Detachment of the meniscus. In this case, the cartilaginous lining is simply displaced from its intended place, which has an extremely negative effect on the ability to walk.

Also, doctors distinguish several degrees of development of the disease, depending on which the doctor will prescribe one or a completely different treatment.

The reasons for the development of pathology

Knee contusion as a result of degenerative changes in the cartilage

Degenerative changes in the structure of cartilage tissue occur not only due to bruises and fractures, when damaged bones begin to wear out the cartilage. Much more often, the cause of such pathological phenomena is a person's lifestyle or natural processes associated with the peculiarities of the structure of the body:

Hyperload. The main stratum of the population suffering from degenerative changes in the meniscus are athletes and dancers. Also at risk are people engaged in hard physical labor. We should also mention the problem of excess weight. Every day, extra pounds put additional stress on the knees, gradually damaging the menisci.
Improper formation of the musculoskeletal system. Degeneration is a side effect of dysplasia, flat feet and disorders in the development of the ligamentous apparatus. The body tries to compensate for all these problems by additional load on the knees, which leads not only to meniscus dystrophy, but also to other chronic pathologies.
Diseases. Syphilis, tuberculosis, rheumatism and a number of other pathologies of a different nature affect the health of the knees. In addition, treatment for these conditions can also aggravate the condition of the joint. So glucocorticoids worsen the condition of the meniscus ligaments.

Damage to the articular cartilage manifests itself sharply only with severe injuries. Otherwise, it is a lengthy process that can be reversed if timely treatment is taken.

Signs of degeneration

The first symptoms of initial meniscus lesions are unlikely to force a person to seek medical attention. Usually, signs of degenerative changes in the posterior horn of the medial meniscus appear when walking and running. It is enough to give a serious load to the joint to feel pain. At the same time, a person can still play sports and do morning exercises without much discomfort in injured knees. This is how the first stage of the disease begins.

But there are other symptoms, according to the gradation suggested by American sports physician Steven Stoller:

Zero degree. Completely healthy meniscus.
First degree. All injuries remain inside the joint capsule. Outwardly, only slight swelling can be seen from the outer front of the knee. Pain occurs only with severe exertion.
Second degree. Degenerative changes in the medial meniscus 2 tbsp. according to Stoller differ little from the first stage. The cartilage is about to rupture, but all the damage is still inside the joints. The swelling gets worse, as does the pain. When moving, characteristic clicks appear. Joints begin to swell with prolonged immobility.
Third degree. The stretching of the cartilage reaches its maximum possible value and tears the meniscus. The person feels severe pain and easily notices the swelling above the knee. If there is a complete rupture of the tissues, then the loose areas can move and block the joint.

Degenerative lesions of the posterior horn of the internal meniscus of 2 and even 3 degrees can still be treated with conservative methods, if everything is done correctly. And the first guarantee of healing is timely diagnosis.

Knee examination

The doctor can determine degenerative damage to the posterior horn and the body of the medial meniscus simply by the characteristic tumor, joint blockade and clicks. But for a more accurate diagnosis and identification of the degree of joint damage, an additional examination will be required, which is carried out using hardware and laboratory methods:

Ultrasound. Ultrasound helps to detect the cavities of the joint capsule filled with blood and exudate. Thanks to this data, the doctor can prescribe further puncture.
MRI. The most accurate method that demonstrates a complete picture of the disease.
Puncture. With a pronounced tumor, the doctor may take a fluid intake to make sure that there is no infection of the knee joints.

An additional examination with an arthroscope may also be done. A camera will be inserted through a small puncture in the tissues inside the joint, which will allow you to see what the damaged area looks like from the inside.

Healing procedures

In all situations, except for the complete separation of the meniscus, the doctor will insist on a conservative method of treatment. Surgery is best reserved as a last resort. First of all, it is necessary to reduce the mobility of the joint. Depending on the degree of degenerative changes, orthoses or bandages that fix the knee or completely immobilize it can be prescribed. In addition, complex therapy will be prescribed:

Medical treatment. Medicines are used primarily as adjuvants. These are pain relievers and anti-inflammatory pills and ointments. Also, the doctor will prescribe a course of chondroprotectors. These substances will help to restore and strengthen the meniscus using the natural regenerative abilities. With a bacterial infection, a course of antibiotics will also be required.
Hardware treatment. UHF, electrophoresis, shock wave therapy, acupuncture, iontophoresis, magnetic therapy and eosokerite improve knee health. The specific list of procedures will depend on the individual history and the capabilities of the hospital.
Puncture. The procedure is prescribed for severe swelling that provokes pain and reduces joint mobility. Excess fluid is pumped out through the puncture. A drain can be installed if necessary.

If conservative methods of treatment do not help, then it is necessary to wait for remission and go to surgery. The use of an arthroscope is usually sufficient. The only difference from the diagnostic procedure is that microinstruments will be inserted through 2 punctures and an incision. With their help, the doctor will suture the damaged tissue. Then the sutures are applied to the soft tissues, and after a week you can already walk, though only with a cane.

For more extensive injuries, arthroplasty may be required. In this case, instead of the decayed cartilage, artificial substitutes will be installed. They are durable and usually do not require replacement for a couple of decades. Thus, it is possible to correct not only degenerative changes in the meniscus, but also a number of other concomitant chronic pathologies of the knee joint.

The knee joint is one of the largest and most complex joints in the human body. It has many different ligaments, cartilage and little soft tissue that can protect it from injury. The knee joint, like the hip joint, bears the entire load of the human body when walking, running and playing sports.

Content:

Knee structure with description

This leads to frequent injuries to the knee joint. Tears of the lateral and cruciate ligaments, fractures of the condyles of the femur and tibia, fracture of the kneecap can occur, and the most common type of injury is meniscus rupture.

What is a meniscus and what is the reason for its increased injury

The menisci of the knee joint are cartilaginous plates that are located between the bones of the knee apparatus and serve as shock absorbers when walking.

The meniscus is a semicircular cartilaginous plate located between the femur and tibia. It consists of a body, hind and anterior horns. Each meniscus is a semicircle, where the middle is the body of the meniscus, and the edges of the semicircle are the horns. The anterior horn attaches to the intercondylar eminences in the front of the knee joint, and the posterior horn to the posterior ones. There are two types of menisci:

external, or lateral - located on the outside of the knee joint, more mobile and less prone to injury;
internal, or medial meniscus - less mobile, located closer to the inner edge and associated with the internal lateral ligament. The most common type of injury is a ruptured medial meniscus.

Knee meniscus injury

Menisci perform the following functions:

shock absorption and reduction of loads on the surface of the knee bones;
an increase in the area of contact between the surfaces of the bones, which helps to reduce the load on these bones;
knee stabilization;
proprioceptors - are located in the meniscus and send signals to the brain about the position of the lower limb.

Menisci do not have their own blood supply, they are spliced with the capsule of the knee joint, so their lateral parts receive blood supply from the capsule, and the internal ones - only due to the intracapsular fluid. There are three zones of blood supply to the meniscus:

red zone - located next to the capsule and receiving the best blood supply,
intermediate zone - located in the middle and its blood supply is insignificant;
white area - does not receive blood supply from the capsule.

Depending on the zone in which the damaged area is located, the tactics of treatment are chosen. The breaks located next to the capsule grow together independently, due to the abundant blood supply, and the breaks in the inner part of the meniscus, where the cartilage tissue is nourished only by the synovial fluid, do not grow together at all.

Frequency of occurrence of meniscus tears

This injury ranks first among the internal injuries of the knee joint. It is more common in athletes, people engaged in hard physical labor, professional dancers, and the like. More than 70% is due to the rupture of the medial meniscus, about 20% - to the lateral meniscus and about 5% - to the rupture of both menisci.

Damaged knee joint

By the type of damage, they are distinguished:

vertical longitudinal gap - like a "watering can handle";
oblique, patchwork meniscus rupture;
degenerative rupture - massive proliferation of meniscus tissue;
radial - transverse rupture;
horizontal break;
damage to the anterior or posterior horns of the meniscus;
other types of breaks.

Also, isolated damage to the internal or external meniscus or associated damage is shared.

Causes of meniscus tears

The cause of a ruptured knee meniscus is most often an indirect traumatic effect, which leads to the fact that the lower leg sharply turns inward or outward, which causes rupture of the knee ligaments and menisci. Also, rupture of the menisci is possible with a sharp abduction or adduction of the lower leg, excessive extension in the knee or direct injury - a sharp blow to the knee.

Clinic of meniscus tears

Ruptured meniscus of the knee has characteristic symptoms. There are acute and chronic periods of the disease.

The acute period lasts up to 4 - 5 weeks, the meniscus rupture is accompanied by a characteristic crackle, immediately after the injury, acute pain appears, an increase in size, swelling, inability to move, hemorrhage into the joint cavity. A characteristic symptom is "floating patella" - from the accumulation of fluid in the cavity of the knee joint.

Meniscus tear - options

These symptoms are common to all knee injuries, and an x-ray is necessary to determine the exact type of injury.

With the transition from an acute period to a chronic one, characteristic symptoms appear that make it possible to confirm the diagnosis of meniscus rupture.

The symptoms of a meniscus rupture are as follows:

Baikov's symptom is the appearance of pain on palpation in the front of the knee and simultaneous extension of the lower leg.
Land's symptom - or the symptom of the "palm" - in a lying patient, the leg is bent at the knee, and a palm can be placed under it.
Turner's symptom is hyper-il hapeesthesia (increased skin sensitivity) under the knee and in the upper third of the lower leg.
Perelman's symptom is the occurrence of pain and unsteadiness of gait when going downstairs.
Chaklin's symptom, or "tailor's" symptom - when raising a straight leg, atrophy of the quadriceps femoris muscle and strong tension of the tailor muscle are visible.
The blockage symptom is one of the most important symptoms in diagnosing a medial meniscus rupture. With a load on the sore leg - climbing stairs, squatting - there is a "jamming" of the knee joint, the patient cannot fully straighten the leg, pain and effusion appear in the knee area.

Symptoms of damage to the medial meniscus:

pain is more intense on the inside of the knee joint;
when pressing on the place of attachment of the ligament to the meniscus, pinpoint pain occurs;
"Blockage" of the knee;
pain during hyperextension and turning the lower leg outward;
pain with excessive bending of the leg.

Symptoms of damage to the lateral meniscus:

with tension of the knee joint, pain occurs, radiating to the outer section;
pain when overextension and turning the lower leg inside;
muscle weakness in the front of the thigh.

The severity of the meniscus injury

Knee injury

Depending on the severity, the doctor prescribes treatment. The following degrees are distinguished:

Small meniscus tear - accompanied by minor pain and swelling in the knee. Symptoms resolve within a few weeks.
A rupture of moderate severity - there is acute pain in the knee joint, pronounced edema appears, movements are limited, but the ability to walk is preserved. With physical exertion, squatting, climbing stairs, there is a sharp pain in the knee. These symptoms are present for several weeks, if no treatment was carried out, the disease becomes chronic.
A rupture of a severe degree - severe pain and swelling of the knee joint, possibly hemorrhage into its cavity. It is characterized by a complete crush of the meniscus or separation of parts, fragments of the meniscus fall between the articular surfaces, which causes stiffness of movements and the inability to move independently. Symptoms increase over several days and surgery is required.

With frequent microtraumas in elderly people, a chronic or degenerative stage of the disease occurs. Cartilage tissue under the influence of numerous damage loses its properties, undergoing degeneration. With physical exertion or for no apparent reason, knee pain, swelling, gait disturbance and other symptoms of meniscus damage appear.

Diagnostics of the meniscus rupture

The diagnosis is established by the characteristic clinical picture, examination data and laboratory research methods. Such a diagnosis requires X-ray, MRI, or knee arthroscopy.

X-ray examination of the meniscus

The main sign of a torn meniscus is pain and swelling in the knee. The severity of this symptom depends on the severity of the injury, its location and the time elapsed since the moment of injury. The orthopedic surgeon conducts a detailed examination of the injured joint and carries out the necessary diagnostic procedures.

X-ray examination is a fairly simple diagnostic method. Menisci are not visible on X-ray images, therefore, studies are carried out using contrast agents or more modern research methods are used.

Arthroscopy is the most informative research method. With the help of a special device, you can look inside the injured knee, accurately determine the place and severity of the rupture and, if necessary, perform medical procedures.

Medical and surgical treatment

The choice of remedies depends on the location of the rupture and the severity of the injury. In case of a ruptured knee meniscus, treatment is carried out conservatively or surgically.

Conservative treatment

First aid to the patient:
- complete rest;
- applying a cold compress;
- - pain relief;
- puncture - to remove accumulated fluid;
- the imposition of a plaster cast.
Bed rest.
Plaster splints for up to 3 weeks.
Elimination of the blockage of the knee joint.
Physiotherapy and remedial gymnastics.
Taking non-steroidal anti-inflammatory drugs - diclofenac, ibuprofen, meloxicam.
Reception of chondroprotectors that help restore cartilage tissue, accelerate the regeneration and fusion of cartilage - chondratin sulfate, glucosamine and others.
External remedies - various ointments and creams are used for grinding - Alezan, Ketoral, Voltaren, Dolgit and so on.

With proper treatment, no complications, recovery occurs within 6-8 weeks.

Indications for surgical treatment of meniscus rupture:

crushing of the cartilaginous tissue of the meniscus;
rupture and displacement of the meniscus;
the presence of blood in the cavity;
detachment of the horns and the body of the meniscus;
lack of effect from conservative therapy for several weeks.

In these cases, a surgical intervention is prescribed, which can be carried out by the following methods:

Removal of the meniscus or meniscectomy - removal of a part of the meniscus or the entire meniscus is indicated when the cartilage tissue is completely decomposed, a significant part of the meniscus is torn off, and complications appear. Such an operation is considered too traumatic, causes arthritis, persists inflammation and effusion in the knee joint and leads to getting rid of joint pain in only 50-70% of cases.
Meniscus repair - The meniscus plays an important role in the biomechanics of the knee joint and today surgeons strive to preserve the meniscus and, if possible, restore it. This operation is usually performed on young, active people and under certain conditions. It is possible to restore the meniscus in such cases as:
- longitudinal vertical tear of the meniscus,
- peripheral rupture
- separation of the meniscus from the capsule,
- peripheral meniscus rupture with possible displacement to the center,
- absence of degenerative changes in cartilage tissue,
- young age of the patient.
With this operation, it is necessary to take into account the prescription and localization of the rupture. Fresh trauma and localization in the red or intermediate zone, the patient's age up to 40 years, increase the chances of a successful operation.
Arthroscopic is the most modern and atraumatic method of surgical intervention. With the help of an arthroscope, the site of injury is visualized and surgery is performed. The advantages of this method are in the minimum violation of the integrity of the surrounding tissues, as well as in the possibility of performing interventions inside the knee. To suture the meniscus from the inside, special needles with non-absorbable suture material are used, which connect the gap in the knee joint cavity through the arthroscope cannulas. The sutures with this method can be applied tightly, perpendicular to the tear line, which makes the suture stronger. This method is suitable for tears in the anterior horn or the body of the meniscus. In 70-85% of cases, there is a complete fusion of the cartilaginous tissue and restoration of the functions of the knee joint.
Fastening the meniscus with special arrow-shaped or dart-shaped clamps. This allows the meniscus to be fastened without additional incisions or the use of special devices, such as an artoscope. First and second generation absorbable retainers are used. The first generation fixators were made from a material that absorbed longer, they had a greater weight and, therefore, more often complications occurred in the form of inflammation, granuloma formation, effusion, damage to the articular cartilage, and the like. Second-generation fixators dissolve faster, have a more rounded shape and the risk of complications is much lower.
Meniscus transplantation - today, thanks to the development of transplantation, it becomes possible to carry out a complete replacement of the damaged meniscus and restore its functions. Indications for surgery are complete crushing of the meniscus, the impossibility of recovery by other means, a significant deterioration in the patient's standard of living, and the absence of contraindications.

Contraindications for transplantation:

degenerative changes;
knee instability;
elderly age;
the presence of general diseases.

Rehabilitation

The recovery period after injury is important. It is necessary to carry out a whole range of rehabilitation measures:

conducting special trainings and exercises aimed at developing the knee joint;
the use of chondroprotectors, non-steroidal anti-inflammatory drugs;
massage and physiotherapy;
lack of physical activity for 6-12 months.

There are practically no consequences of a ruptured knee meniscus with proper and timely treatment. Pain during exertion, unsteadiness of gait, and the possibility of recurrent injury may persist.

It is necessary to perform a set of special exercises, which should be prescribed by the doctor, taking into account the localization, the severity of the injury, the presence or absence of complications, the patient's age and other accompanying circumstances.

Stages of rehabilitation after a ruptured knee meniscus

Rehabilitation after such an injury consists of 5 stages. Only after achieving the set goals, you can move on to the next stage. The goal of any rehabilitation program is to restore the normal functioning of the damaged organ.

Stage 1 - its duration is 4-8 weeks, during this time it is necessary to expand the range of motion in the damaged joint as much as possible, reduce the swelling of the joint and start walking without crutches.
Stage 2 - up to 2.5 months. It is necessary to restore the full range of motion in the joint, completely relieve swelling, restore control over the knee joint when walking and engage in training of muscles weakened after injury.
Stage 3 - to achieve full restoration of the range of motion in the knee joint during sports, training and running, to restore muscle strength. At this stage, they begin to actively carry out physiotherapy exercises and gradually return to their usual rhythm of life.
Stage 4 - training, its goal is to achieve the ability to play sports, run, give full load to the joint without any pain. Strengthening the muscle strength of the injured limb.
Stage 5 - restoration of all the lost functions of the knee joint.

After the stages of rehabilitation, it is necessary to reduce the load on the injured joint, try to avoid situations in which there is a risk of injury and take preventive measures. These include exercises to strengthen muscle strength, using special exercises, taking chondroprotectors and drugs that improve peripheral circulation. When playing sports, the use of special knee pads is recommended, which reduce the risk of injury.

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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 intensifies 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 blockade or wedging knee joint.

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

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.

Treatment of a torn posterior meniscus horn

After establishing an accurate diagnosis by testing and conducting magnetic resonance imaging, the attending physician prescribes appropriate treatment, which is carried out in a hospital.

If the gaps are minor, conservative treatment is prescribed. The patient is prescribed medication with anti-inflammatory and analgesic drugs, as well as manual and physiotherapy sessions.

In cases of serious injury, the doctor prescribes surgical treatment, the essence of which is that during having a torn meniscus undergoing surgery sutured, or in some cases, when recovery is impossible, meniscus removed, a meniscectomy is performed.

In modern clinics, such an operation is performed by the invasive method of arthroscopy, an operation that has a low-traumatic effect and has no complications in the postoperative period.

After the operation, the patient spends some time in the hospital under the supervision of the attending physician. He is prescribed rehabilitation rehabilitation treatment, including therapeutic exercises, a course of antibiotics and other medications for the prevention of inflammatory processes.

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

Trauma classification

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

1 degree of trauma to the posterior horn of the meniscus. Focal damage to the surface of the cartilage is characteristic. The holistic structure does not undergo changes.
2nd degree. The changes become much more pronounced. There is a partial violation of the structure of the cartilage.
3 degree. The painful condition worsens. Pathology affects the posterior horn of the medial meniscus. Painful changes in the anatomical structure occur.

Considering the main causative factor that led to the development of the pathological state of the cartilage of the knee joint, the body of the lateral meniscus distinguishes between traumatic and pathological damage to the posterior horn of the medial meniscus. According to the criterion of the prescription of the trauma or pathological violation of the integrity of this cartilaginous structure, a fresh and old damage to the posterior horn of the medial meniscus stands out. Also, the combined damage to the body and the posterior horn of the medial meniscus is highlighted.

Break types

In medicine, there are several types of meniscus ruptures:

Longitudinal vertical.
Patchwork oblique.
Horizontal break.
Radial-transverse.
Degenerative rupture with tissue crush.
Oblique horizontal.

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

Causes of damage

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

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

Contribute to injury:

Alcoholic intoxication.
Fights.
Haste.
Failure to comply with safety precautions.

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

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

Symptoms

Typical signs of a ruptured posterior horn are:

Sharp pain.
Swelling.
Joint block.
Hemarthrosis.

Painful sensations

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

Puffiness

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

Joint block

Joint wedging is considered the main symptom of rupture of the posterior horn of the medial meniscus. Blockade of the joint occurs after the clamping of the separated part of the cartilage with bones, while the motor function of the limb is impaired. This symptom can also be observed when the ligaments are stretched, which complicates the diagnosis of pathology.

Hemarthrosis (accumulation of blood inside a joint)

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

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

Diagnostics

If there is no blockage, it is very difficult to diagnose a meniscus rupture in the acute period. In the subacute period, a diagnosis of a meniscus rupture can be established based on the manifestation of local pain syndrome, compression symptoms, and extension symptoms. If a meniscus rupture was not diagnosed, during treatment, edema, pain, effusion in the joint will pass, but with the slightest injury, careless movement, the symptoms will manifest themselves again, which will mean the transition of pathology to a chronic form.

Often, patients are diagnosed with a bruised knee joint, a parameniscus cyst, or a sprain.

X-ray

X-rays are given to exclude bone damage from fractures and fissures. X-rays fail to diagnose soft tissue damage. To do this, you must use magnetic resonance imaging.

MRI

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

Ultrasound

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

Treatment of injuries of the posterior horn of the meniscus

After injury, it is necessary to immediately immobilize the limb. It is dangerous to treat a blockage victim on your own. 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 physiotherapy procedures. Of the physiotherapeutic procedures, the following are successfully used:

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

Important! During the 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

Surgical intervention is an effective method of treating pathology. During surgical therapy, doctors focus on the preservation of the organ and its functions. When the back horn of the meniscus ruptures, the following types of operations are used:

Cartilage stitching. The operation is performed using an arthroscope - a miniature video camera. It is inserted at the site of the knee puncture. The operation is performed with fresh meniscus tears.
Partial meniscectomy. During the operation, the damaged area of the cartilaginous layer is removed, the rest is restored. The meniscus is circumcised 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 which saline is supplied. The second hole makes it possible to perform the necessary manipulations with the knee joint.
Arthrotomy. Complicated meniscus removal procedure. The operation is performed if the patient has extensive damage to the knee joint.

A modern method of therapy with a low trauma rate

Rehabilitation

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

Late rehabilitation pursues 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

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