Horizontal rupture of the posterior horn. How to treat a tear of the posterior horn of the medial meniscus. Brief anatomical description of the meniscus

Good afternoon

I am 42 years old. I live in Kurgan. Pain in the left knee joint periodically occurred for approximately 2 years. IN Lately pain with sudden movements became daily. Seek advice from medical Center Ilizarov. They did an MRI. Diagnosis: Rupture of the posterior horn of the medial meniscus. Synovitis. DOA 1st degree, Chondromalacia patella 2nd degree. Increased fluid in the joint cavity. The medial meniscus has a heterogeneous structure, with the presence of a linear horizontal section of hyperintense signal at the level of the posterior horn with transition to the lower articular surface. Lateral meniscus of heterogeneous structure. The doctor immediately said that only surgery was recommended for me, there were no other options. I would like to know your opinion. Thank you.

Answer to the question:

Hello! Meniscal injuries knee joint lead to pain, disturbances in walking, and instability of body position. Further destruction of these cartilaginous formations contributes to the progression of arthrosis of the knee joint and leads to long-term disability or even disability.

If part of the meniscus is torn, conservative treatment is possible, but it usually only helps in initial stage diseases. If the disease lasts for a long time, surgery is indicated. A torn meniscus will not “heal” on its own, and the disease will only progress over time.

At the Russian Research Center "WTO" named after. acad. The Ilizarov Department, where arthroscopic treatment of knee meniscal injuries is carried out, has existed for many years. This is a federal-level institution, it is well equipped, and doctors have great experience in carrying out such procedures. Therefore, you should not refuse the operation due to possible doubts about the professionalism of the center’s staff.

If the horn of the meniscus is damaged during arthroscopy, it can either be “sutured” to the intact part or removed. This depends on the severity of the damage. In any case, this is a low-traumatic intervention. Removing a small portion of the meniscus results in only minimal reduction of the contact surface of the knee joint, and therefore the recovery time after such surgery is short.

The operation is indicated for pain in the knee, repeated blockades (“jamming”) of the joint, limited mobility in it, ineffectiveness of drug treatment and exercise therapy. It is also prescribed for a tear longer than 1.5 cm.

After the operation, a bandage is applied and the knee can be bent immediately. In the first 2–3 days, it is recommended to use a cane or crutch; by the 10th day, full load on the joint is allowed. The duration of hospital stay is 3–4 days, the ability to work is restored in about a month.

In patients young doctors often choose the most gentle methods, that is, they do not remove the torn part of the meniscus, but sew it on. Therefore, in the future, the function of the joint is completely restored.

Another important argument in favor of surgery in your case is economic efficiency. In the future, long courses of chondroprotectors and other expensive drugs will not be needed. You will not have to go on sick leave if pain in the joint worsens, and in the future you will not need endoprosthetics.

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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, on which the most huge pressure in the musculoskeletal system. A 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 circulation 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 causal factor that led to the development pathological condition cartilage of the knee joint, the body of the lateral meniscus, traumatic and pathological damage to the posterior horn of the medial meniscus is distinguished. 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. Part internal meniscus that has come off may remain in place or move.

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 microtraumas caused by strong physical stress during work or abnormal 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 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 the motor function of the limb is impaired. 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, it is very difficult to diagnose a meniscus tear in the acute period. 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 internal structure 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. Prescribed by a doctor complex treatment includes conservative therapy, surgical intervention, 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 meniscal 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 that differs low rate traumatic

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 elimination inflammatory process in the joint, normalization of blood circulation, strengthening of 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.

Pathology of the musculoskeletal system includes a rupture of the posterior horn of the medial meniscus. This injury is the result of indirect trauma lower limb. The human knee joint is very complex. Each of them contains 2 menisci. They are formed by cartilage tissue. They consist of a body, posterior and anterior horns. Menisci are essential for shock absorption, limiting range of motion, and matching bone surfaces.

Types of breaks

A type of tear of the posterior horn of the medial meniscus is called closed injury joint This pathology is most often found in adults. This type of injury is rare in children. Women suffer from this disease 2 times more often than men. The gap is often combined with.

This is the most common joint injury. Complex rupture is diagnosed mainly in people from 18 to 40 years old. This is due to an active lifestyle. Sometimes combined damage to both menisci is observed.

The relevance of this problem is due to the fact that such an injury often requires surgical intervention and a long recovery period.

After surgical treatment patients move on crutches. A distinction is made between complete and incomplete tissue rupture. The following options are known:

longitudinal;
vertical;
patchwork bias;
radial-transverse;
horizontal;
degenerative with tissue crushing;
isolated;
combined.

Isolated Gap posterior diagnosed in 30% of all cases of this injury.

Causes of damage

The development of this pathology is based on strong extension of the lower leg or its sharp outward rotation. The longitudinal gap is due to several reasons. Main etiological factors are:

falling onto a hard surface;
bruises;
traffic accidents;
blows;
degenerative processes against the background of gout and rheumatism;
sprains;
microtraumas.

A rupture of the posterior horn of the meniscus is most often caused by indirect and combined trauma. This usually happens in winter when there is ice. Lack of precautions, haste, condition alcohol intoxication and fighting all contribute to injury. Often, rupture occurs when the joint is in fixed extension. Athletes face a similar problem. The risk group includes football players, figure skaters, gymnasts and hockey players.

Permanent damage causes meniscopathy. Subsequently, when making sharp turns, a rupture occurs. Stands out separately degenerative damage. It occurs mainly in elderly people with repeated microtraumas. The cause may be intense loads during training or careless work activities. Degenerative horizontal rupture of the posterior horn of the medial meniscus often occurs against the background of rheumatism.

It is facilitated by previously suffered tonsillitis and scarlet fever. Damage to the meniscus due to rheumatism is caused by impaired blood supply to tissues due to edema and other pathological changes. The fibers become less elastic and durable. They are not able to withstand heavy loads.

Less commonly, the cause of rupture is gout. Tissue traumatization occurs due to crystals uric acid. Collagen fibers become thinner and less durable.

How does a gap manifest itself?

If there is damage to the posterior horn of the medial meniscus, the following symptoms are possible:

pain in the knee area;
restriction of movements;
cracking sound when walking.

In the acute period, reactive inflammation develops. The intensity of the pain syndrome is determined. If it is incomplete, then the symptoms are mild. Clinical signs lasts 2–4 weeks. Patchwork gap medium degree severity is characterized by acute pain and limited extension of the limb at the knee.

The sick person can walk. If proper treatment is not carried out, this pathology becomes chronic. Strong pain in combination with tissue swelling is characteristic of a severe rupture. In such people, small blood vessels in the knee area may become damaged. Developing. Blood accumulates in the cavity of the knee joint.

It is difficult to support your leg. IN severe cases local temperature rises. The skin takes on a bluish tint. The knee joint becomes spherical. After 2–3 weeks from the moment of injury, a subacute period develops. It is characterized by localized pain, effusion and blockages. Typical specific symptoms Roche, Baykova and Shteiman-Bragarda. In the degenerative form of this meniscus pathology, complaints may appear only during work.

Patient examination plan

Treat line break necessary after clarification of the diagnosis. The following studies will be needed:

general clinical tests;
CT or MRI;
radiography;
arthroscopy.

Differential diagnosis is carried out in the following cases:

arthritis of various etiologies;
gonarthrosis;
softening cartilage tissue;

If the posterior horn of the meniscus is damaged, treatment begins after assessing the condition of the joint tissues. Magnetic resonance imaging is very informative. Its advantage is the absence radiation exposure. Arthroscopy is performed according to indications. This endoscopic method research. Examination of the knee can be carried out with both therapeutic and diagnostic purpose. Arthroscopy can be used to visually assess the condition of the knee joint. Before the procedure, you must undergo a series of tests. The study can be carried out on an outpatient basis.

Treatment tactics

Partial damage to the meniscus requires conservative therapy. The main aspects of treatment are:

plaster application;
use of painkillers;
puncture of the knee joint;
maintaining peace;
applying cold compresses;
massage;
physiotherapy.

If the cause is degenerative-dystrophic processes, then chondroprotectors are prescribed. These are medications that strengthen the cartilage tissue of the joints. They contain chondroitin sulfate and glucosamine. Chondroprotectors include Arthra, Teraflex, Dona and. To eliminate pain, NSAIDs are prescribed (Ibuprofen, Movalis, Diclofenac Retard). These medications are taken orally and applied to the skin in the joint area.

External agents are used after the plaster is removed. Patients must maintain motor rest. To accelerate the healing of the medial meniscus, physiotherapy (electrophoresis, UHF therapy, exposure to magnetic fields). A puncture is often required. A needle is inserted into the joint. If there is a small amount of blood, the puncture is not performed.

Analgesics and anti-inflammatory drugs may be administered during the procedure. medications. In severe cases, radical treatment is required. Indications for the operation are:

separation of the horns and body of the medial meniscus;
lack of effect from conservative therapy;
displacement rupture;
tissue crushing.

Reconstructive surgical interventions are most often performed. A complete meniscectomy is performed less frequently. This is due to the fact that removal of the medial meniscus in the future can lead to the development of deforming gonarthrosis. Special designs are used for tissue restoration. In the case of peripheral and vertical tears, the meniscus may be sutured.

Such an intervention is justified only if there are no degenerative changes in cartilage tissue. A complete meniscectomy can only be performed if there is a large tear and severe damage to the meniscus. Currently, arthroscopic operations are widely used. Their advantage is less trauma. After the operation, painkillers, physiotherapy and exercises are prescribed. Patients need to rest for up to a year.

Forecast and preventive measures

The prognosis for a rupture of the posterior horn of the internal meniscus of the knee is most often favorable. It worsens with severe hemarthrosis, combined lesions and Not timely treatment. After therapy, pain disappears and range of motion is restored. In some cases, gait instability and discomfort while walking are observed.

Cluster large quantity If left untreated, blood in the knee joint can cause arthrosis.

In old age, treatment can be difficult due to the impossibility of surgery. Rupture of the horns of the medial meniscus can be prevented. To do this, you need to adhere to the following recommendations:

avoid sudden movements of the legs;
observe safety precautions while working at work and at home;
stop drinking alcohol;
do not get into fights;
wear knee pads when playing sports;
give up traumatic activities;
be careful during icy conditions;
in winter weather, wear shoes with threads;
give up extreme sports;
promptly treat arthritis and arthrosis;
diversify your diet;
move more;
take vitamins and mineral supplements;
treat rheumatism in a timely manner and.

A meniscus tear is a very common pathology in adults and adolescents. In case of a fall or injury and pain, you should go to the emergency room.

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

Anatomical structure

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

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

Data structural elements visually resemble a crescent with the ends pushed slightly forward, in medical terminology called horns. Thanks to their elongated ends, the cartilaginous formations are attached to the tibia with great density.

The meniscus is a cartilaginous body that is located in the closure bone structures ah knees. It ensures unhindered flexion-extension manipulations of the leg. It is structured by a body and an anterior and posterior horn.

The lateral meniscus is more mobile than the internal meniscus, and therefore it is more often subjected to force loads. It happens that it cannot withstand their pressure and tears in the area of the horn of the lateral meniscus.

The medial meniscus is attached to the inside of the knee and connects to the collateral ligament. Its paracapsular part contains a lot small vessels, supplying blood to this area and forming the red zone. Here the structure is denser, and closer to the middle of the meniscus it becomes thinner, since it is deprived vascular network and is called the white zone.

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

Functional Features

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

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

The functional purposes of the menisci are different:

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

Forms of discontinuities

The characteristics of meniscal injuries depend entirely on the type of injury, location and shape.

In modern traumatology, there are several types of ruptures:

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

The longitudinal form of the rupture occurs partial or complete. Complete is the most dangerous due to complete jamming of the joint and immobilization of the lower limb.
An oblique tear occurs at the junction of the posterior horn and the middle of the body. It is considered “patchwork” and may be accompanied by a wandering pain sensation moving along the knee area from side to side, and is also accompanied by a certain crunching sound during movement.
A horizontal rupture of the posterior horn of the medial meniscus is diagnosed by the appearance of soft tissue swelling, intense pain in the area of the joint cracks, and it occurs inside the meniscus.

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

It happens:

Horizontal or longitudinal, in which the tissue layers are separated from each other, further blocking the motor ability of the knee. A horizontal tear of the posterior horn of the internal meniscus manifests itself in inside and extends to the capsule.
Radial, which appears on oblique transverse tears of the cartilage. The edges of the damaged tissue look like rags upon examination.
Combined, including double damage to the meniscus - horizontal and radial

A combined rupture is characterized by:

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

Signs of ruptures

Usually occurs due to an unnatural position of the knee or pinching of the cartilage cavity after injury to the knee area.

The main symptoms include:

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

Modern therapy, combined with hardware diagnostics, has learned to determine whether the gap has occurred - acute or chronic. After all, it is impossible to see with human power the real reason, for example, a fresh injury characterized by hemarthrosis and smooth edges of the rupture. It is strikingly different from an advanced knee injury, where with the help of modern equipment it is possible to distinguish the causes of swelling, which consist in the accumulation of a liquid substance in the joint cavity.

Causes and mechanisms

There are many reasons for which a violation of the integrity of the meniscus occurs, and all of them most often occur as a result of non-compliance with safety rules or simple carelessness in our Everyday life.

Forms of rupture

Injury occurs due to:

excessive stress - physical or sports;
twisting of the ankle area during games in which the main load is on the lower limbs;
excessively active movement;
prolonged squatting;
deformations of bone structures that occur with age;
jumping on one or two limbs;
unsuccessful rotational movements;
congenital articular and ligamentous weakness;
sharp flexion-extension manipulations of the limb;
severe bruises;
falls from heights.

Injuries in which the posterior horn of the meniscus ruptures have their own symptoms and directly depend on its shape.

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

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

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

pain from excessive exertion;
crackling noise during motor movements;
accumulation of fluid in the joint;
porous structure of meniscal tissue.

Diagnostics

Acute pain is not something to joke about, just like all the symptoms described above. Seeing a doctor with a rupture of the posterior horn of the medial meniscus or other types of ruptures of the cartilage tissue of the knee is mandatory. It must be carried out in a short period of time.

At the medical institution, the victim will be examined and referred to:

Radiography, which is used for visible signs rupture. It is considered not particularly effective and is used to exclude concomitant bone fractures.
Ultrasound diagnostics, the effect of which directly depends on the qualifications of the traumatologist.
MRI and CT, considered the most reliable way to determine a rupture.

Based on the results of the above examination methods, treatment tactics are selected.

Treatment tactics

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

Primary damage to the integrity of the meniscus, if it is not chronic, can be treated conservative method, which includes several stages:

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

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

Operation

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

First of all, the damaged meniscus is examined for stitchability, then the specialist chooses one of several forms of surgical treatment:

Arthromia. A very complex method. It is used in exceptional cases with extensive damage to the knee joint.
Stitching of cartilage tissue. The method is carried out using an arthroscope inserted through a mini-hole into the knee in case of a fresh injury. The most favorable outcome is observed when stitching in the red zone.
Partial meniscectomy is an operation to remove the injured part of the cartilage and restore its entire part.
Transfer. As a result of this operation, someone else's meniscus is inserted into the victim.
Arthroscopy. Trauma with this most common and modern method of treatment is minimal. As a result of the arthroscope and saline solution being inserted into two mini-holes in the knee, all necessary restorative manipulations are carried out.

Rehabilitation

The importance of the recovery period, compliance with all doctor’s instructions, its correct implementation is difficult to overestimate, since the return of all functions, painlessness of movements and full recovery joint without chronic consequences.

Small loads that strengthen the structure of the knee are provided by properly prescribed hardware methods of recovery - exercise machines, and to strengthen the internal structures, physiotherapeutic procedures and exercise therapy are indicated. It is possible to remove swelling with lymphatic drainage massage.

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

Several months of such therapy ends with the victim returning to normal life.

Consequences of injury

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

But there is no need to despair - the success of treatment largely depends on the victim himself.

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

timely diagnosis;
correctly prescribed therapy;
rapid localization of injury;
how long ago the breakup was;
with the success of the restoration procedures.

The knee joint is one of the largest and most complex in the human body. It contains 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:

The structure of the knee with a description

It leads to frequent injuries in the area of the knee joint. Tears of the lateral and cruciate ligaments, fractures of the femoral and femoral condyles may occur. tibia, a fracture of the kneecap, and the most common type of injury is a meniscus tear.

What is the meniscus and what is the reason for its increased incidence of injuries?

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 cartilage plate located between the femur and tibia. It consists of a body, posterior 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 is attached to the intercondylar eminences in the anterior part of the knee joint, and the posterior horn is attached to the posterior ones. There are two types of menisci:

external, or lateral – located with outside knee joint, more mobile and less susceptible to injury;
the internal, or medial meniscus is less mobile, located closer to the inner edge and is connected to the internal collateral ligament. The most common type of injury is a medial meniscus tear.

Knee meniscus injury

Menisci perform the following functions:

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

The menisci do not have their own blood supply; they are fused with the capsule of the knee joint, so their lateral parts receive blood supply from the capsule, and the internal parts only from 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 zone – does not receive blood supply from the capsule.

Depending on the zone in which the damaged area is located, treatment tactics are chosen. Tears located next to the capsule heal on their own due to the abundant blood supply, while tears in the inner part of the meniscus, where the cartilage tissue is nourished only by synovial fluid, do not heal at all.

Incidence of meniscal tears

This injury ranks first among internal injuries of the knee joint. It is more common among athletes, people involved in heavy physical labor, professional dancers, and the like. More than 70% are tears of the medial meniscus, about 20% are tears of the lateral meniscus, and about 5% are tears of both menisci.

Damaged knee joint

Depending on the type of damage, they are distinguished:

vertical longitudinal tear - like a “watering can handle”;
oblique, patchwork tear of the meniscus;
degenerative rupture - massive proliferation of meniscus tissue;
radial – transverse gap;
horizontal break;
damage to the front or posterior horns meniscus;
other types of ruptures.

Also distinguished are isolated injuries of the internal or external menisci or combined damage.

Causes of meniscal tears

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

Meniscus tear clinic

A torn meniscus of the knee has characteristic symptoms. There are acute and chronic period diseases.

Acute period - lasts up to 4 - 5 weeks, a meniscus tear is accompanied by a characteristic cracking sound, immediately after the injury appears sharp pain, increase in size, swelling, inability to move, hemorrhage into the joint cavity. A characteristic symptom is the “floating patella” - from the accumulation of fluid in the cavity of the knee joint.

Meniscus tear - options

These symptoms are common to all injuries of the knee joint; in order to accurately determine the type of injury, it is necessary to carry out X-ray examination.

During the transition acute period In chronic cases, characteristic symptoms appear that confirm the diagnosis of meniscal rupture.

Symptoms of a torn meniscus are:

Baikov's symptom is the appearance of pain upon palpation in the front of the knee and simultaneous extension of the lower leg.
Landa's sign - or the "palm" symptom - in a lying patient, the leg is bent at the knee and you can place your palm under it.
Turner's symptom – hyper-il gapesthesia ( increased sensitivity skin) under the knee and in the upper third of the leg.
Perelman's symptom is the occurrence of pain and instability of gait when going down the stairs.
Chaklin's symptom, or “sartorius” symptom - when raising the straight leg, atrophy of the quadriceps femoris muscle and severe tension of the sartorius muscle are visible.
The blockade symptom is one of the most important symptoms in the diagnosis of medial meniscal tears. When putting stress on the sore leg - climbing stairs, squatting - the knee joint becomes “jammed”, the patient cannot fully straighten the leg, pain and effusion appear in the knee area.

Symptoms of medial meniscus damage:

the pain is more intense on the inside of the knee joint;
when pressing on the place of attachment of the ligament to the meniscus, point pain occurs;
"block" of the knee;
pain when hyperextending and turning the leg outward;
pain when bending the leg too much.

Symptoms of lateral meniscus damage:

when the knee joint is strained, pain occurs, radiating to the outer part;
pain when hyperextending and internally rotating the lower leg;
weakness of the muscles of the front of the thigh.

Severity of meniscus injury

Damage to the knee joint

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

A small tear of the meniscus is accompanied by minor pain and swelling in the knee. Symptoms subside within a few weeks.
Moderate rupture - acute pain occurs in the knee joint, severe swelling appears, movements are limited, but the ability to walk is preserved. During physical activity, squats, climbing stairs, acute pain appears in the knee. These symptoms are present for several weeks; if treatment is not carried out, the disease becomes chronic.
Severe rupture – severe pain and swelling of the knee joint, possible hemorrhage into its cavity. It is characterized by complete crushing of the meniscus or separation of parts; fragments of the meniscus fall between the articular surfaces, which causes stiffness of movement and the inability to move independently. Symptoms worsen over several days and surgery is required.

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

Diagnosis of meniscal tears

The diagnosis is established by the characteristic clinical picture, examination data and laboratory methods research. To make such a diagnosis, an X-ray examination, MRI or arthroscopy of the knee joint is necessary.

X-ray examination of the meniscus

The main symptom of a meniscus tear is pain and swelling in the knee. The severity of this symptom depends on the severity of the injury, its location and the time that has passed since the injury. An orthopedic surgeon conducts a detailed examination of the injured joint and performs the necessary diagnostic procedures.

X-ray examination is a fairly simple diagnostic method. The menisci are not visible on X-ray photographs, so studies are carried out using contrast agents or use more modern research methods.

Arthroscopy is the most informative method research. Using a special device, you can look inside the damaged knee, accurately determine the location and severity of the tear, and, if necessary, carry out treatment procedures.

Medical and surgical treatment

The choice of treatment depends on the location of the rupture and the severity of the injury. If the meniscus of the knee joint is torn, treatment is carried out conservatively or surgically.

Conservative treatment

Providing first aid to a patient:
- complete peace;
- applying a cold compress;
- - pain relief;
- puncture – to remove accumulated fluid;
- applying a plaster cast.
Bed rest.
Applying a plaster splint for up to 3 weeks.
Elimination of blockade of the knee joint.
Physiotherapy and therapeutic exercises.
Taking non-steroidal anti-inflammatory drugs - diclofenac, ibuprofen, meloxicam.
Taking chondroprotectors that help restore cartilage tissue, accelerate the regeneration and fusion of cartilage - chondratin sulfate, glucosamine and others.
External means - used various ointments and rubbing creams - Alezan, Ketoral, Voltaren, Dolgit and so on.

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

Indications for surgical treatment Meniscus tear:

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

In these cases, surgical intervention is prescribed, which can be performed using the following methods:

Removal of the meniscus or meniscectomy - removal of 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, or complications arise. Such an operation is considered too traumatic, causes arthritis, persists inflammation and effusion in the knee joint and leads to relief from joint pain in only 50-70% of cases.
Meniscus repair – The meniscus plays an important role in the biomechanics of the knee joint and surgeons today strive to preserve the meniscus and, if possible, repair it. This operation is usually performed by young people, active people and if available 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 tear with possible displacement to the center,
- absence degenerative changes in cartilage tissue,
- young age of the patient.
During this operation, it is necessary to take into account the duration and location of the rupture. A fresh injury and localization in the red or intermediate zone, the patient’s age under 40 years increase the chances of a successful operation.
Arthroscopic is the most modern and atraumatic method of surgical intervention. An arthroscope is used to visualize the injury site and perform surgical intervention. The advantages of this method are minimal disruption of the integrity of surrounding tissues, as well as the possibility of performing interventions inside the knee. To suture the meniscus from the inside, special needles with non-absorbable suture material, which connect the gap in the cavity of the knee joint through arthroscope cannulas. With this method, the seams can be placed tightly, perpendicular to the tear line, which makes the seam stronger. This method is suitable for tears of the anterior horn or meniscal body. In 70-85% of cases, complete fusion of cartilage tissue and restoration of the functions of the knee joint occurs.
Fastening the meniscus using special arrow-shaped or dart-shaped clamps. This allows the meniscus to be fixed without additional incisions or application. special devices, like an artoscope. Absorbable fixatives of the first and second generation are used. The first generation of fixators were made of a material that took longer to dissolve, they weighed more, and therefore more often complications occurred in the form of inflammation, granuloma formation, effusion, damage to 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 transplantology, it becomes possible to carry out a complete replacement damaged meniscus and restore its functions. Indications for surgery are complete crushing of the meniscus, the impossibility of restoration 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 somatic diseases.

Rehabilitation

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

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

With proper and timely treatment, the consequences of a rupture of the meniscus of the knee joint are practically absent. Pain may persist physical activity, gait instability, the possibility of recurrence of injury.

It is necessary to complete the complex special exercises, which should be prescribed by the doctor, taking into account the location, severity of the injury, the presence or absence of complications, the age of the patient and other related circumstances.

Stages of rehabilitation after a knee meniscus tear

Rehabilitation after such an injury consists of 5 stages. Only after achieving your goals can you move on to the next stage. Any task rehabilitation program- restore normal functioning damaged organ.

Stage 1 – its duration is 4-8 weeks, during which time you need to expand the range of motion in the damaged joint as much as possible, reduce swelling of the joint and start walking without crutches.
Stage 2 – up to 2.5 months. It is necessary to restore full range of motion in the joint, completely remove swelling, restore control over the knee joint when walking and begin training muscles weakened after injury.
Stage 3 – achieve complete restoration of the range of motion in the knee joint during sports, training and running, and restore muscle strength. At this stage, they begin to actively conduct classes physical therapy and gradually return to the normal rhythm of life.
Stage 4 is training, its goal is to achieve the ability to play sports, run, put a full load on the joint without any pain. Increasing muscle strength in the injured limb.
Stage 5 – restoration of all lost functions of the knee joint.

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

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