A characteristic feature of the rupture of the posterior horn of the medial meniscus. Rupture of the medial meniscus of the knee: symptoms and treatment of the injury Damaged meniscus horn

What is the danger of rupture of the posterior horn of the medial meniscus of the knee joint, treatment of damage to the horns of the menisci - these questions are of interest to patients. Movement is one of the finest gifts that human nature has endowed. Walking, running - all types of movement in space are performed thanks to a complex system, and largely depend on such a small cartilaginous pad, which is otherwise called the meniscus. It is located between the knee joints and serves to be a kind of shock absorber when any movement of a person occurs.

Damage to the meniscus

The medial meniscus changes shape when moving, because the gait of people is so smooth, plastic. The knee joints have 2 menisci:

The meniscus itself is divided by doctors into 3 parts:

the body of the meniscus itself;
the posterior horn of the meniscus, that is, its inner part;
the front horn of the meniscus.

The inner part differs in that it does not have its own blood supply system; nutrition should still be, then it is carried out due to the constant circulation of the articular synovial fluid.

Such unusual properties lead to the fact that if an injury occurs to the posterior horn of the meniscus, then, unfortunately, it is most often incurable, because the tissues cannot be restored. Moreover, the rupture of the posterior horn of the medial meniscus is difficult to determine. And if there is a suspicion of just such a diagnosis, urgent research is needed.

Most often, the correct diagnosis can be found with the help of magnetic resonance imaging. But even with the help of the developed tests, which are based on the extension of the joints, rolling movements, as well as the sensation of pain, it is possible to determine the disease. There are a lot of them: Roche, Landa, Baykov, Steiman, Bragard.

If the posterior horn of the medial meniscus is damaged, a sharp pain appears, and severe swelling begins in the knee area.

When there is a horizontal rupture of the posterior horn of the medial meniscus, it is impossible to descend the stairs due to severe pain. If there is a partial tear of the meniscus, it is almost impossible to move: the torn off part freely dangles inside the joint, giving off pain with the slightest movement.

If not such painful clicking sounds are felt, it means that the breaks have occurred, but they are small in size. When the tears occupy a large area, then the torn off part of the meniscus begins to move to the center of the damaged joint, as a result, the knee movement is blocked. The joint shrinks. When the posterior horn of the inner meniscus has ruptured, it is almost impossible to bend the knee, and the sore leg will not be able to withstand the load from the body.

Symptoms of a knee meniscus injury

If there is a rupture of the meniscus of the knee joint, then the following symptoms will appear:

pain that will eventually concentrate in the joint space;
there is muscle weakness in the front of the thigh;
the accumulation of fluid in the articular cavity begins.

As a rule, there is a degenerative rupture of the posterior horn of the meniscus in the knee in people of pre-retirement age due to age-related changes in cartilage tissue or in athletes whose load is mainly on the legs. Even a sudden, awkward movement can cause rupture. 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 damage to the medial meniscus

For treatment to be beneficial, it is necessary to correctly determine the severity of the disease and the type of injury.

But above all, when the injury has occurred, the pain must be relieved. In this case, an anesthetic injection and pills that reduce inflammation help, and cold compresses will also help.

You need to be prepared for the doctors to take a joint puncture. Then it is necessary to clear the articular cavity of the accumulated blood and fluid there. Sometimes you even have to use joint blockade.

These procedures are stressful for the body, and after them the joints need rest. In order not to disturb the joints and fix the position, the surgeon applies a plaster cast or splint. During the rehabilitation period, physiotherapy, fixing the knee pads, will help to recover, you will need to do physiotherapy exercises and walking with various means of support.

Minor damage to the posterior horn of the lateral meniscus or incomplete rupture of the anterior horn can be treated conservatively. That is, you will need anti-inflammatory drugs, as well as pain relievers, manual and physiotherapy procedures.

How is the injury treated? As a rule, surgery cannot usually be avoided. Especially if it is an old medial meniscus of the knee joint. The surgeon's task is to suture the damaged meniscus, but if the damage is too serious, it will have to be removed. The popular treatment is arthroscopic surgery, thanks to which whole tissues are preserved, only the damaged parts are resected and the defects are corrected. As a result, complications rarely occur after surgery.

The whole procedure goes like this: an arthroscope with instruments is inserted into the joint through 2 holes in order to first determine the damage, its extent. When the posterior horn of the meniscus ruptures with touching the body, it happens that the torn off fragment is displaced, rotating along its axis. It is immediately returned to its place.

Then, an incomplete biting of the meniscus is performed. This should be done at the base of the posterior horn, leaving a thin “bridge” to prevent displacement. The next stage is cutting off the torn off fragment from the body or the anterior horn. The parts of the meniscus then need to be restored to their original anatomical shape.

It will be necessary to spend time in the hospital under the supervision of a doctor and undergo rehabilitation recovery.

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

This is due to the fact that the bones of the joint (femur, tibial), ligaments, menisci and patella, working together, provide normal flexion when walking, sitting and running. However, heavy loads on the knee placed on it during various manipulations can lead to rupture of the posterior meniscus horn.

Rupture of the posterior horn of the internal meniscus is an injury to the knee joint caused by damage to the cartilaginous layer between the femur and tibia.

Anatomical features of the knee cartilage

- the cartilaginous tissue of the knee, located between two closing bones and allowing one bone to slide over the other, providing unimpeded flexion / extension of the knee.

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

External (lateral).
Internal (medial).

The most mobile is considered to be outside. Therefore, its damage is much less common than damage to the internal one.

The internal (medial) meniscus is a cartilaginous lining connected to the bones of the knee joint by a ligament located on the side of the inner side, it is less mobile, therefore, people with damage to the medial meniscus are more likely to go to traumatology. Damage to the posterior horn of the medial meniscus is accompanied by damage to the ligament connecting the meniscus to the knee joint.

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

Front horn;
Middle part;
Rear horns.

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

Cushioning while walking, running, jumping.
Stabilization of the knee position at rest.
Permeated with nerve endings that send signals to the brain about the movement of the knee joint.

Meniscus tears

The illustration shows a rupture of the anterior horn of the external meniscus of the knee joint

Knee injury is not uncommon. At the same time, not only people who lead an active lifestyle can get injured, but also those who, for example, sit on squats for a long time, try to rotate on one leg, make long jumps. Tissue destruction occurs and over time, people over 40 are at risk. Damaged knees at a young age over time begin to take on an old nature of the disease in old age.

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

Break shapes

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

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

Rear horn rupture

Rupture of the posterior horn of the medial meniscus is one of the most common groups of knee injuries. This is the most dangerous damage.

Tears of the posterior horn can be:

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

Symptoms of trauma to the posterior horn of the medial meniscus

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

Sharp pain, even at rest.
Hemorrhage inside the tissue.
Knee blockage.
Swelling and redness.

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

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

Treatment of damage to the cartilage layer

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

Conservative treatment stages

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

Removal of inflammation, pain and swelling with help.
In cases of "jamming" of the knee joint, reduction is used, that is, reduction with the help of manual therapy or traction.
Massotherapy.
Physiotherapy.

Pain relief with analgesics.
Plaster cast (according to the doctor's recommendation).

Surgical treatment steps

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

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

Arthrotomy - partial removal of damaged cartilage with extensive tissue damage;
Meniscotomy - complete removal of cartilage tissue; Transplantation - moving the donor meniscus to the patient;
- the introduction of artificial cartilage in the knee;
Suturing damaged cartilage (performed with minor damage);
- puncture of the knee in two places in order to carry out the following manipulations with the cartilage (for example, stitching or endoprosthetics).

After the treatment is carried out, regardless of what methods it was carried out (conservative or surgical), the patient will have a long one. The patient is obliged to provide himself with complete rest during the entire time, while the treatment is being carried out and after it. Any physical activity after the end of therapy is contraindicated. The patient should take care that the cold does not penetrate to the limbs, and the knee does not undergo sudden movements.

Conclusion

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

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

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

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

In order to avoid injury to the lower extremities, you should avoid turns, sudden movements, falls, jumping from a height. Exercise is usually contraindicated after meniscus treatment. Dear readers, everyone for today, share in the comments about your experience in treating meniscus injuries, in what ways did you solve your problems?

Meniscus is a dense, disc-like cartilaginous tissue that connects the two articular bones of the knee. Meniscus fulfills the role shock absorber when driving. During movement, the synovial fluid lubricates the cartilage, thereby protecting them from bumps and impacts, protecting them from possible injury. Menisci guarantee the functionality and stability of the knee joint. The function of the menisci is also to protect the bones of the joints from premature wear, meniscus reduce stress on joints. The main meniscus functions are:

- lubrication and nutrition of the hyaline cartilage of the tibia;
Shock absorber function (cushioning shock and shock);

- the formation of the integrity of the structure of the knee joint;
The function of maintaining the stability of the joint.

Rupture of the posterior horn of the meniscus

In the knee there are two menisci, outdoor and indoor. The meniscus is horizontal, consists of the front and back, called the horn, as well as the body. Rear horn rupture internal meniscus represents meniscus tear in the back of it. In this case, an operation is prescribed only if the functional state of the joint leaves much to be desired. The doctor must determine how much the injured person interferes with movement. meniscus inside the joint... In some cases, a conservative form of treatment for injuries is sufficient, namely, treatment with physiotherapy and anti-inflammatory drugs. If damaged posterior meniscus horn the patient usually complains of joint instability, anticipates its subsequent blockage. Usually, the patient begins to feel insecure when going downstairs. In any case, it is difficult to correctly diagnose this disease on your own, it is necessary to immediately consult a doctor after an injury.

Treatment of tears

Treatment of posterior meniscus tears it is carried out conservatively with the help of physiotherapy and medications, as well as a surgical method of resection and restoration of the meniscus. Recently, an innovative method in surgery is considered to be gaining popularity meniscus transplant method... The conservative method of treatment is used mainly in the treatment of small tears of the posterior horn meniscus... Very often, this kind of damage is accompanied by characteristic pain, but other symptoms, such as clicks and rolling of the joint, are not observed.

Small longitudinal tears no more than 10 mm in size sometimes do not require treatment, often healing on their own. In some cases, physiotherapy is prescribed, as well as treatment with medications. In some cases meniscus tear is treated by the method of sewing the gap from the inside out. In this case, a long needle is used, which is passed perpendicular to the site of injury from the joint cavity on the outside of the joint capsule. The sutures must be applied tightly, thereby guaranteeing the stability of the stitched fragments, but this increases the risk of damage to the nerves and blood vessels when the needle is removed from the joint cavity. This method effectively treats rupture of the posterior horn of the meniscus and a tear extending from the body of cartilage to the posterior horn.

Postoperative treatment

After the operation, the operated joint is fixed with bandages and a pad of several layers of cotton wool. The patient must spend several days in the hospital, but sometimes complete recovery occurs only after a month. The patient should perform a set of exercises, which will be prescribed by the attending physician to maintain the tone of the thigh muscles. Additionally, anti-inflammatory and analgesic drugs are prescribed to prevent postoperative complications.

The pathology of the musculoskeletal system includes a rupture of the posterior horn of the medial meniscus. This injury is the result of an indirect injury to the lower limb. The human knee joint is very complex. Each of them has 2 menisci. They are formed by cartilage tissue. They consist of a body, hind and anterior horns. Menisci are needed for cushioning, limiting range of motion, and matching bone surfaces.

Break types

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

This is the most common joint injury. A complex gap is diagnosed mainly in people from 18 to 40 years old. This is due to an active lifestyle. Sometimes there is a combined damage to both menisci.

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

After surgical treatment, patients move on crutches. Distinguish between complete and incomplete tissue rupture. The following options are known:

longitudinal;
vertical;
patchwork oblique;
radial-transverse;
horizontal;
degenerative with crushing of tissues;
isolated;
combined.

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

Causes of damage

The development of this pathology is based on a strong extension of the lower leg or its sharp turn outward. The longitudinal rupture is due to several reasons. The main etiological factors are:

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

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

Permanent damage causes meniscopathy. Subsequently, with sharp turns, a rupture occurs. Degenerative damage is distinguished separately. It occurs mainly in elderly people with repeated microtrauma. The reason may be intense stress during training or careless work activity. Degenerative horizontal rupture of the posterior horn of the medial meniscus often occurs against the background of rheumatism.

Previously transferred tonsillitis and scarlet fever contribute to it. Damage to the menisci against the background of rheumatism is based on a violation of the blood supply to tissues with edema and other pathological changes. The fibers become less elastic and less durable. They are not able to withstand heavy loads.

Less commonly, gout is the cause of rupture. Tissue trauma occurs with uric acid crystals. Collagen fibers become thinner and weaker.

How does the gap manifest

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

knee pain;
restriction of movement;
crackling sound while 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 persist for 2–4 weeks. A moderately sever flap rupture is characterized by acute pain and limited extension of the limb at the knee.

A sick person can walk. If proper treatment is not carried out, then this pathology becomes chronic. Severe pain combined with tissue edema is characteristic of severe rupture. In such people, the small blood vessels in the knee area can be damaged. Develops. Blood accumulates in the knee joint cavity.

Lean support becomes difficult. In severe cases, the 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. Specific symptoms of Roche, Baykov and Steiman-Bragard are typical. With the degenerative form of this pathology of the meniscus, complaints may appear only during work.

Patient examination plan

It is necessary to treat a linear rupture after the diagnosis has been clarified. The following research will be required:

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

Differential diagnosis is carried out in the following cases:

arthritis of various etiologies;
gonarthrosis;
softening of cartilage tissue;

In case of damage to the posterior horn of the meniscus, treatment begins after assessing the condition of the joint tissues. Magnetic resonance imaging is very informative. Its advantage is the absence of radiation exposure. Arthroscopy is performed according to indications. This is an endoscopic research method. Examination of the knee can be carried out for both therapeutic and diagnostic purposes. With the help of arthroscopy, you can visually assess the condition of the knee joint. Before the procedure, it is necessary to pass a number of tests. The study can be carried out on an outpatient basis.

Therapeutic tactics

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

the imposition of plaster;
the use of painkillers;
puncture of the knee joint;
keeping calm;
setting of cold compresses;
massage;
physiotherapy.

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

External remedies are used after removing the plaster. Patients need to observe motor rest. To accelerate the healing of the medial meniscus, physiotherapy is performed (electrophoresis, UHF therapy, exposure to magnetic fields). Puncture is often required. A needle is inserted into the joint. With an insignificant amount of blood, the puncture is not performed.

During the procedure, analgesics and anti-inflammatory drugs may be administered. In severe cases, radical treatment is required. The indications for the operation are:

detachment of the horns and the body of the medial meniscus;
lack of effect from conservative therapy;
rupture with displacement;
crushing of tissues.

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

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

Forecast and preventive measures

The prognosis for rupture of the posterior horn of the internal meniscus of the knee is most often favorable. It worsens with severe hemarthrosis, combined lesion and delayed treatment. After therapy, the pain syndrome disappears and the range of motion is restored. In some cases, gait instability and discomfort while walking are observed.

The accumulation of large amounts of blood in the knee joint, if not properly treated, can cause arthrosis.

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

exclude sudden movements of the legs;
observe safety precautions while working at work and at home;
refuse to drink alcohol;
do not get into fights;
put on patella when playing sports;
give up traumatic activities;
be careful during icy conditions;
in winter weather, wear threaded shoes;
refuse to engage in extreme sports;
timely treat arthritis and arthrosis;
diversify the diet;
move more;
take vitamins and mineral supplements;
timely treat rheumatism and.

Meniscus rupture is a very common condition in adults and adolescents. In case of a fall or injury and pain syndrome, you need to contact the emergency room.

Knee pain is a common reason for seeking medical attention. They can occur due to various pathologies, including damage to the meniscus - special cartilaginous plates located between the articular surfaces. Their main task is to cushion and stabilize the joint. And in conditions of significant stress that the knee has to experience, this is extremely important.

Meniscus pathology is more often traumatic in nature, manifesting itself either as an isolated injury, or in combination with ruptures of the ligamentous apparatus. This is more typical for young people who are actively involved in sports. After 40 years, cases of degenerative changes predominate, which lead to rupture of the menisci. It is possible to eliminate such problems of the knee joint after clarifying their origin, clinical manifestations and severity.

Causes

Degenerative-dystrophic processes do not develop in a healthy body. This must be preceded by violations at various levels: local and general. They have a clear relationship, which distinguishes the development of pathology from traumatic injuries, when only a mechanical effect on the knee joint is sufficient. Undoubtedly, injuries and prolonged excessive stress on the joints are key points in the formation of degenerative changes, but there are other conditions that contribute to such processes:

Knee dysplasia.
Obesity.
Gout.
Rheumatoid arthritis.
Rheumatism.
Osteoarthritis.
Infectious diseases (tuberculosis, brucellosis, yersiniosis).
Connective tissue diseases (lupus erythematosus, scleroderma).
Endocrine pathology (hypothyroidism).
Systemic vasculitis.

Dystrophic processes in the knee joint are largely due to metabolic, immune, endocrine and vascular disorders, which can occur together with age-related changes that inevitably appear after 50 years.

Degenerative changes in the menisci develop for many reasons. In most cases, there is a combined effect of adverse factors.

Symptoms

Damage of a degenerative-dystrophic nature - meniscopathy - does not occur suddenly. It takes time for the initiation and progression of pathological processes in the knee joint. The following symptoms may appear at first:

A feeling of fatigue in the joint.
Crunching, rubbing and clicking at the knee.
Recurrent pain after intense exertion.

Over time, pathological changes appear not only in the menisci, but also in the adjacent articular surfaces, ligaments. Fabrics become weaker, which can damage them. As a result, ruptures of the cartilaginous shock-absorbing pads can appear even without previous injury - just an awkward movement, squatting or simple bending of the leg is enough. In this case, the symptoms are aggravated, the following signs become characteristic:

Swelling and redness in the joint space.
Restriction of movement.
Knee instability.
Blockage (jamming) of the joint.

But most often, chronic damage, which has a dystrophic nature, proceeds with the only symptom - pain, only occasionally manifesting itself by blocking the joint. The severity of symptoms varies from minimal to very severe, when it is impossible even to stand on one leg or make any movements. Unpleasant sensations can only bother you when going down stairs or while squatting. It depends on the degree of damage and which structures are involved. The concomitant pathology of the knee joint also plays a role: fractures of the condyles, ligament ruptures, osteoarthritis.

By their localization, the breaks can be located in the following zones:

Meniscus body: internal (medial) or external (lateral).
Anterior horn of the lateral meniscus.
The posterior horn of the inner meniscus.
Concomitant damage.

More often you can find ruptures of the outer meniscus, since it has greater mobility than the inner one. The latter is often torn when combined with a lesion of the anterior cruciate ligament. Degenerative changes in the posterior horn of the medial meniscus are accompanied by less intense symptoms, signs of wedging are often absent. The anterior horn comes off much less frequently.

If the lesion affects the vascular zone, then the development of hemarthrosis (accumulation of blood) is likely. The joint swells significantly, which is evident from the change in the shape of the patellar zone. On palpation, pain in the joint space is characteristic, which occurs during tests with passive flexion and extension of the knee.

The defeat of the internal or external meniscus can be suspected clinically, however, additional methods help to confirm the diagnosis.

Diagnostics

To make a final conclusion about meniscopathy, it is necessary to conduct an imaging examination. It includes radiography or magnetic resonance imaging. The latter method has significant advantages, since it allows you to accurately assess the state of intra- and periarticular soft tissues, does not have radiation exposure. According to the results of tomography, the degree of damage to the meniscus is determined (according to Stoller):

1 - focal changes that do not reach the surface layer.
2 - linear changes that do not reach the surface layer.
3 - changes reach the surface of the meniscus.

One can speak of a true break only in the latter case. In addition, the picture clearly shows the dislocation of cartilaginous structures, a change in shape, a detachment of one of the horns.

Treatment

It is necessary to comprehensively treat knee meniscopathy. Conservative and operative methods are used. Depending on the severity of the disease, the effect of the agents used may be different. To achieve maximum results, you should follow all the doctor's recommendations. And first of all, it is necessary to reduce the load on the sore leg. You can wear an elastic bandage or a knee orthosis, but completely immobilizing the joint with a plaster cast is fundamentally wrong - this will not improve its function, but will lead to contractures.

Degenerative-dystrophic changes in the menisci require persistent and intensive therapy, which can take quite a long time.

Drug therapy

The pathology of the knee joint, including the defeat of the menisci, requires the use of medication. Drugs are especially needed for acute ruptures, but chronic processes cannot be effectively corrected without drugs. With dystrophic changes, it is important to normalize the biochemical processes in the body. To improve the condition of the meniscus and reduce symptoms, the following medications are used:

Non-steroidal anti-inflammatory.
Chondroprotectors.
Metabolic.
Vascular.
Vitamins.

All medications should be taken as recommended by a specialist. Self-medication is not allowed.

They also use the possibilities of physiotherapy to restore the integrity of the meniscus. For this purpose, some procedures are used: electro- and phonophoresis, laser and wave treatment, magneto-, paraffin- and balneotherapy. Which of them are shown in each case, the doctor will determine. But one should not expect a pronounced effect from the isolated use of physiotherapy - it is used only in combination with other methods.

Physiotherapy

Even with meniscus ruptures, exercise therapy is indicated. It should include exercises aimed at strengthening the muscles of the thighs - the front and back groups. This stabilizes the knee and prevents instability. But still, you should be careful during classes, to exclude sudden movements, especially rotational ones.

Conservative measures are good for small breaks, as well as for the elderly, who often have signs of osteoarthritis.

Operation

If the lesion of the internal or external meniscus reaches 3 degrees according to Stoller, they are of significant size and are accompanied by severe symptoms, as well as with the ineffectiveness of previous therapy, that is, all indications for surgery. Only a doctor can determine when to start the operation, but you should not hesitate with this.

The most common surgical method is arthroscopic surgery. This is a minimally invasive technology that can be used to perform a meniscectomy (partial removal), suture, transplant or endoprosthetics of the meniscus.

Knee pain can appear due to the development of degenerative processes and rupture of the meniscus. It is important to carry out treatment in a timely manner in order to repair the damaged tissue. What is better to use - conservative therapy or surgery - is determined by the clinical situation.

Break types

This is the most common joint injury. A complex gap is diagnosed mainly in people from 18 to 40 years old. This is due to an active lifestyle. Sometimes there is a combined damage to both menisci.

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

After surgical treatment, patients move on crutches. Distinguish between complete and incomplete tissue rupture. The following variants of rupture of the medial meniscus are known:

longitudinal;
vertical;
patchwork oblique;
radial-transverse;
horizontal;
degenerative with crushing of tissues;
isolated;
combined.

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

Causes of damage

The development of this pathology is based on a strong extension of the lower leg or its sharp turn outward. The longitudinal rupture is due to several reasons. The main etiological factors are:

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

Less commonly, gout is the cause of rupture. Tissue trauma occurs with uric acid crystals. Collagen fibers become thinner and weaker.

How does the gap manifest

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

knee pain;
restriction of movement;
crackling sound while walking.

In the acute period, reactive inflammation develops. The intensity of the pain syndrome is determined by the degree of rupture. If it is incomplete, then the symptoms are mild. Clinical signs persist for 2–4 weeks. A moderately sever flap rupture is characterized by acute pain and limited extension of the limb at the knee.

A sick person can walk. If proper treatment is not carried out, then this pathology becomes chronic. Severe pain combined with tissue edema is characteristic of severe rupture. In such people, the small blood vessels in the knee area can be damaged. Hemarthrosis develops. Blood accumulates in the knee joint cavity.

Patient examination plan

It is necessary to treat a linear rupture after the diagnosis has been clarified. The following research will be required:

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

Differential diagnosis is carried out in the following cases:

Koenig's disease;
arthritis of various etiologies;
gonarthrosis;
Goff's disease;
softening of cartilage tissue;
osteoporosis.

Therapeutic tactics

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

the imposition of plaster;
the use of painkillers;
puncture of the knee joint;
keeping calm;
setting of cold compresses;
physiotherapy;
massage;
physiotherapy.

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

During the procedure, analgesics and anti-inflammatory drugs may be administered. In severe cases, radical treatment is required. The indications for the operation are:

detachment of the horns and the body of the medial meniscus;
lack of effect from conservative therapy;
rupture with displacement;
crushing of tissues.

Forecast and preventive measures

The accumulation of large amounts of blood in the knee joint, if not properly treated, can cause arthrosis.

exclude sudden movements of the legs;
observe safety precautions while working at work and at home;
refuse to drink alcohol;
do not get into fights;
put on patella when playing sports;
give up traumatic activities;
be careful during icy conditions;
in winter weather, wear threaded shoes;
refuse to engage in extreme sports;
timely treat arthritis and arthrosis;
diversify the diet;
move more;
take vitamins and mineral supplements;
promptly treat rheumatism and gout.

Meniscus rupture is a very common condition in adults and adolescents. In case of a fall or injury and pain syndrome, you need to contact the emergency room.

Rupture of the posterior horn of the medial meniscus of the knee joint - treatment, symptoms, complete analysis of the injury

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

Rupture of the posterior horn of the internal meniscus is an injury to the knee joint caused by damage to the cartilaginous layer between the femur and tibia.

Anatomical features of the knee cartilage

The meniscus is the cartilaginous tissue of the knee that sits between two adjoining bones and allows one bone to slide over the other, allowing unimpeded flexion / extension of the knee.

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

External (lateral).
Internal (medial).

The most mobile is considered to be outside. Therefore, its damage is much less common than damage to the internal one.

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

Front horn;
Middle part;
Rear horns.

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

Cushioning while walking, running, jumping.
Stabilization of the knee position at rest.
Permeated with nerve endings that send signals to the brain about the movement of the knee joint.

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

Break shapes

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

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

Rear horn rupture

Rupture of the posterior horn of the medial meniscus is one of the most common groups of knee injuries. This is the most dangerous damage.

Tears of the posterior horn can be:

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

More details

Symptoms of trauma to the posterior horn of the medial meniscus

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

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

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

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

Treatment of damage to the cartilage layer

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

Conservative treatment stages

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

Relief of inflammation, pain and swelling with non-steroidal anti-inflammatory drugs (NSAIDs).
In cases of "jamming" of the knee joint, reduction is used, that is, reduction with the help of manual therapy or traction.
Physiotherapy.
Massotherapy.
Physiotherapy.

Treatment with chondroprotectors.
Joint treatment with hyaluronic acid.
Treatment with folk remedies.
Pain relief with analgesics.
Plaster cast (according to the doctor's recommendation).

Surgical treatment steps

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

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

Arthrotomy - partial removal of damaged cartilage with extensive tissue damage;
Meniscotomy - complete removal of cartilage tissue; Transplantation - moving the donor meniscus to the patient;
Endoprosthetics - the introduction of artificial cartilage into the knee;
Suturing damaged cartilage (performed with minor damage);
Arthroscopy - puncture of the knee in two places in order to carry out the following manipulations with the cartilage (for example, stitching or endoprosthetics).

After the treatment is carried out, regardless of what methods it was carried out (conservative or surgical), the patient will have a long course of rehabilitation. The patient is obliged to provide himself with complete rest during the entire time, while the treatment is being carried out and after it. Any physical activity after the end of therapy is contraindicated. The patient should take care that the cold does not penetrate to the limbs, and the knee does not undergo sudden movements.

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Conclusion

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

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