The meniscus is a stabilizing pad made up of cartilage fibers that absorb synovial fluid. It is a source of nutrients.

The meniscus in the knee reduces the load in the joint and serves as a barrier, eliminating the possibility of bone contact.

There is a lateral meniscus (external) and medial (internal). The medial meniscus of the knee joint is shaped like a semicircle, while the lateral meniscus is shaped like the letter “C”. 60-70% of the meniscus consists of ordered collagen fibers arranged in a circle, about 16% is occupied by special proteins, another 0.6% is elastin.

The structure of both types of menisci is the same, including the anterior horn, posterior horn and body. With the help of a horn, the meniscus is attached to the bone or to the articular fossa. There is blood supply only in the outer part of the meniscus.

If the meniscus is damaged in this area, then cartilage restoration is possible without suturing. Over the years, the number of blood vessels decreases, so injuries take longer to heal. The medial meniscus of the knee joint works together with the lateral ligament of the knee joint. Therefore, damage to the medial meniscus of the knee joint and the ligament usually occurs simultaneously.

Causes of problems with menisci

• constant loads;
• mechanical impact, falling, jumping or a strong blow resulting in injury to the meniscus of the knee joint;
• complications after surgery;
• metabolic and blood supply disorders;
• oncological diseases, joint diseases;
• age;
• repeated injuries;
• incorrect rotation of the joint.

​Provoking factors for the development of meniscus disease:

• constant sharp extension movements;
• overweight;
• congenital or acquired ligament weakness.

Symptoms

Menisci are very susceptible to damage. Symptoms appear depending on the type of damage; the main diseases and their symptoms include:

• Inflammation of the meniscus. Determining inflammation of the meniscus is quite simple:
  • swelling is visible to the naked eye (see photo below);
  • palpable pain, which may subside over time (with increased stress and poor circulation, the pain syndrome intensifies);
  • restriction of movements;
  • clicking in the knee.

Inflammation of the meniscus

Symptoms of meniscal inflammation are often similar to a tear, so drawing conclusions and prescribing treatment on your own is not recommended.

• Meniscus tears. The main symptoms of a meniscal tear are:
  • inflammation of the meniscus;
  • persistent pain;
  • joint immobility;
  • crunching while moving;
  • Bleeding in the joint is a clear sign that the medial meniscus of the knee joint has been torn.

Knee meniscus tear

Symptoms of a meniscus tear do not differ depending on the location of the injury. Whether the lateral meniscus is damaged or the medial meniscus is torn, the sensations will be the same.

Classification of meniscal injuries

The American doctor Stoller identified several stages of meniscus damage. His technique allows you to accurately determine the diagnosis and prescribe treatment.

1. First degree The disease is characterized by damage to the posterior horn of the medial meniscus. Physiological reasons cause this disorder. The source of damage is located inside the meniscus; most often the person is not aware of the damage that has occurred in the joint. Typically, the initial degree of damage is discovered by chance during a routine examination and is in the nature of inflammation of the meniscus.
2. Stage 2 meniscus injury has a pronounced clinical picture. The general structure of bone tissue is not disturbed. The cartilage retains its original shape. In the second stage, damage to the internal meniscus occurs. A person feels discomfort in the knee joint. With the development of degenerative processes at the second stage, a meniscus rupture occurs.
3. The most severe 3rd degree The injury is characterized by a complete rupture of the meniscus of the knee joint. The anatomical structure is disrupted, and the cartilage is torn and displaced. The chronic form of the disease occurs precisely at this stage. It is characterized by the inability to make extension movements. At this stage, it is impossible to treat a torn meniscus of the knee joint without surgery.

Diagnostics

Non-instrumental studies:

• . The person lies on his stomach, the leg is bent at a right angle and pressure is applied to the heel, while the lower leg and foot are rotated. The test is considered positive if there is pain;
• McMurry test:
  • the person lies on his back. The knee is bent as far as possible and clasped with the hand. The shin is rotated outward, the knee is extended to a right angle. If there is a meniscus tear, the patient will feel pain on the inside of the joint;
  • being in the same position, the person bends the leg at the knee and hip joint at a right angle. One hand clasps the knee, the other makes circular movements of the lower leg in and out. A meniscal injury test is considered positive if clicking sounds are heard.

To confirm the symptoms of a knee meniscus tear, instrumental studies are used. These include Ultrasound, MRI, X-ray and arthroscopy:

• First of all, X-ray examination and ultrasound are prescribed. The meniscus is not visible on an x-ray; an examination is necessary to ensure that there is no fracture. Ultrasound is prescribed as an addition to x-rays.
• MRI makes it possible to examine the joint itself and the area around it. This method determines the presence of injury and the extent of damage. Thanks to the ability to comprehensively visualize the meniscus, the accuracy of MRI is 95%. Based on this method, a decision is usually made on how to treat the meniscus;
• computed tomography is effective for identifying inflammatory processes. The tomograph creates a series of images that allow us to draw conclusions about the condition of the joint at different depths. This method is most effective in confirming the source of pain, the presence of a fracture, and visualizing bleeding. The meniscus itself cannot be examined using tomography, so the technique is complementary to MRI;
• Diagnostic arthroscopy allows for an accurate diagnosis. The main advantage of the method is the ability to simultaneously diagnose and correct. The data obtained by the arthroscope is displayed on the monitor in real time, so the doctor can carry out the necessary manipulations to eliminate some of the consequences of the injury - remove accumulated blood, stitch the edges of the meniscus.

Meniscus treatment

Treatment for the knee depends on the cause of the meniscus inflammation or tear. First of all, the patient needs to ensure peace. Further, depending on the degree and nature of the damage, specific methods of treating a tear of the meniscus of the knee joint are prescribed.

Drug treatment (medicines)

Conservative treatment or, in other words, treatment of the meniscus without surgery is carried out using drugs of different effects:

• (Ibuprofen, Diclofenac).
• rubbing with ointment (Voltaren, Ketorol, Alezan).
• cartilage restoration is carried out with the help of products such as Chondroitin sulfate.
• Ostenil is prescribed to increase mobility and relieve pain inside the joint capsule. After the first injection, clear signs of improvement are visible. Usually 5 injections are prescribed.

Surgery

Treatment of the meniscus without surgery is rarely successful and only with minor injury or inflammation. Depending on the degree of damage to the meniscus of the knee joint, several surgical options are possible:

• Meniscectomy– used in case of meniscus tear or in the presence of complications. A positive result is observed in 65% of operations, and arthritis of the knees is also among the consequences. Recovery takes a month and a half.
• Recovery– a more gentle method, mainly used among patients no older than 45 years. An important condition for the operation is the stable condition of the cartilage tissue. This is due to the fact that in the presence of pathology, the menisci will be subject to further destruction. The rehabilitation period can last 4 months.
• Arthroscopy– the most progressive type of operation. Only the medial meniscus of the knee joint with a rupture of the posterior horn cannot be treated. The traumatism of this operation is minimal, and the scars after the operation are visible only upon closer examination. Arthroscopy is prescribed when it is impossible to accurately determine the nature of the damage to the meniscus of the knee joint. 2 punctures are made for the arthroscope and surgical instruments. The arthroscope allows the surgeon to reach the most remote areas. The meniscus is sutured with non-absorbable threads made of silk, nylon or polypropylene. A positive result is observed in 90% of operations. Contraindications: open knee injury, inflammation of the skin at the puncture sites, exacerbation of chronic infections, low joint mobility, low level of recovery of internal organs. Rehabilitation after surgery takes 4 weeks; on the first day, the doctor prescribes exercises with minimal stress. From the second day, exercises are prescribed that help start the processes of restoration of damaged tissues and the function of the knee joint.
• Internal fixation of the meniscus– treatment of meniscal tears using this method began to be used relatively recently. Minimal trauma and the absence of direct surgical intervention are the main advantages of this operation. Its essence lies in the use of fixators without an incision, due to which rehabilitation takes less time than usual.
• Transplantation– the most expensive operation. The essence of this method is to completely remove the meniscus and replace it with a donor or artificial implant. This operation is recommended in case of complete destruction of the meniscus and there is no possibility of stitching it, and also when the patient’s age does not exceed 40 years. Contraindications: diabetes mellitus, severe heart and vascular diseases, old age, polyarthritis and atherosclerosis. Both the lateral and medial menisci must be replaced. The peculiarity of the operation is that you have to wait a long time for the implant, since it must fit the patient perfectly. But if the operation is successful, the risk of rejection is minimal. The duration of the operation is no more than 3 hours. The postoperative period lasts 6 weeks, after which you can return to your normal rhythm of life.

Complementary and alternative treatments without surgery at home.

To reduce discomfort when the meniscus of the knee joint is damaged and reduce pain, you can use folk remedies based on oils and herbs.

Tincture recipe:

• birch buds, violet and nettle leaves 1 tablespoon each;
• 500 ml boiling water.

Grind the ingredients, mix them and pour boiling water. Leave for 30 minutes, then strain. Take 4 times a day, dosage – 1⁄4 cup.

Antispasmodic anti-inflammatory agent. Take equal proportions of clove, camphor, menthol, eucalyptus and wintergreen oil, as well as aloe juice.

• mix all ingredients and heat in a water bath.

Apply the resulting mixture to the knee and apply a tight bandage. Repeat 2-4 times a day.

Compresses

Treatment of the meniscus without surgery at home is possible with the help of warm compresses. The following compresses give the maximum effect:

Compress based on honey.

First way:

• mix 1 tablespoon of aloe leaf pulp and 2 tablespoons of honey;
• lubricate the knee with the resulting mixture, wrap the affected area with cling film;
• Duration of the procedure is 1 hour.

This compress removes swelling and stops inflammation.

Second way:

• mix honey and alcohol in a 1:1 ratio;
• heat in a water bath and apply to the inflamed area;
• leave for 2 hours;
• repeat the procedure twice a day.

Burdock leaf compress.

Burdock leaves need to be wrapped around the knee and pressed tightly. You can also use dried leaves. They need to be crushed and steamed in boiling water. Then apply the resulting product and bandage. Keep the compress for 3 hours.

Compress based on herbal decoction.

You need to take 1 teaspoon each of St. John's wort, calendula, chamomile and sage, pour boiling water. After 1 hour you need to filter. Place a bandage or soft cloth moistened with herbal decoction on the knee for 30 minutes. Repeat 3 times a day.

Exercises

Using exercises as a treatment without surgery for a torn meniscus of the knee joint is strictly prohibited, since with this injury, first of all, the knee must be immobilized.

Exercises for the treatment of the meniscus are done only at the recovery stage; physical therapy has a positive effect:

• the first two days perform leg extension. You also need to squeeze the object between your legs, bent at the knees;
• from the third to the tenth, do a straight leg lift, the starting position is lying on your side and back. While sitting on a chair, you need to straighten your knee. Hold the straightened leg in a tense state for 2-3 seconds;
• in the third week it is recommended to walk 2-3 km and ride a bicycle. Exercise: circular and swinging movements of the leg.

Physiotherapy

Physiotherapy after surgery is prescribed to enhance cell regeneration, improve blood circulation and metabolism. Basic methods of physiotherapy:

• electrical stimulation;
• magnetic therapy;
• laser therapy;
• massage.

In order to increase efficiency, the patient is taught self-massage techniques; other procedures are carried out directly in the medical institution.

Prevention

Injury to the meniscus of the knee joint does not require preventive measures. It is impossible to further influence the menisci, strengthen them or make them thicker. The doctor can give general recommendations: walk more carefully, avoid frequent wearing of heels, use protective knee pads while playing sports.

The knee meniscus is an important component of a full, healthy life. If there are the slightest symptoms of meniscus damage, there is no need to postpone the problem. You should consult a doctor immediately. Only timely diagnosis will reveal how damaged the menisci are. Based on this study, the doctor will decide which treatment method should be used in a particular case.

Prognosis after treatment

Most often, treatment of menisci has a positive outcome. There are several factors that influence recovery:

• patient's age. After 40 years, the rate of tissue restoration decreases, which means the rehabilitation period will take longer;
• weak ligaments can become a factor in re-injury, as the cartilage is subject to displacement;
• place of rupture. A lacerated injury is much more difficult to stitch than an injury in one plane, and the healing process takes longer;
• freshness of knee meniscus injury. Advanced cases, when the patient has been self-medicating for a long time, take much longer to recover.

Complications may occur - purulent inflammation, hemorrhage into the joint or cutting of sutures. There is no need to wait for the discomfort to disappear; you should immediately contact a specialist. To avoid complications, it is necessary to completely avoid heavy physical activity after surgery.

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Sooner or later, every person will wonder what the meniscus of the knee joint is. In fact, joint injuries are not so rare, and occur not only in older people, but also in young people, so it is very important to figure out how to prevent them, and, if necessary, treat them. In this article we will look at what the meniscus of the knee joint is, as well as what types of injuries there are and methods for diagnosing them.

What is a meniscus?

So, the meniscus is a layer of cartilage that is located inside the knee joint itself and has the shape of a crescent. In the human body, this part of the cartilage tissue is very important, as it performs a shock-absorbing function while walking. It is very important to understand what the meniscus of the knee joint is in order to protect yourself from knee injuries. Most often, meniscus diseases occur as a result of injury, excessive physical activity, degeneration, and also ruptures. According to statistics, meniscus diseases most often affect representatives of the stronger sex between the ages of eighteen and forty.

In fact, the knee joints contain two menisci: the inner and the outer. Their main purpose is shock absorption during walking and other movements. Such layers, consisting of cartilage tissue, prevent friction in the joints themselves, while reducing the load on them during running, walking, jumping and other sports exercises. The internal meniscus is not very mobile, which is why it is injured much more often than the external one. A knee meniscal injury (treatment described below) is the most common knee injury. Very often, athletes who play sports professionally face this problem.

Main causes of damage

We have already looked at what the meniscus of the knee joint is. Now it’s worth understanding for what reasons pathologies can arise. Very often, the meniscus is damaged as a result of a strong blow to the knee itself, or due to an injury during which the knee sharply turns outward, or, conversely, inward. It can also occur as a result of excessive extension of the knee joint from a flexed position. Very often, the first meniscus injury leads to a chronic condition, so after the incident you need to treat your joints with extreme caution.

People with chronic diseases of the knee joints are at particular risk. For example, athletes who suffer persistent knee injuries will be more susceptible to meniscus damage. With each damage, the cartilage tissue will become thinner and thinner. It will begin to delaminate, erosion and cracks will appear on it, which will increase in size every day. The meniscus itself begins to deteriorate, so shock absorption during walking and movement will become impossible.

Very often, the meniscus is damaged in overweight people, as well as in those who engage in heavy physical labor or work in a standing position.

People involved in football, running, figure skating, hockey and other outdoor sports have a huge risk of meniscus injuries. Damage to the meniscus can be a consequence of pre-existing diseases such as gout and arthritis. If treatment is not started in time, this can lead to the knee joint simply losing its functions.

How can you tell if your knee meniscus is damaged?

Most often, only one knee is damaged. It is very rare that damage to both joints occurs at once. The meniscus of the knee joint (symptoms and treatment are described in this article) during the injury is either torn or pinched between the cartilage tissue of the knee itself. At the moment of the injury itself, a person will notice a strong click in the knee, followed by severe pain. The pain is so sharp and strong that the affected person usually cannot move and simply stops. Such severe pain lasts for several minutes, after which the human body gets used to such severe pain. The person can already move a little, but still experiences discomfort and burning pain.

Damage to the meniscus of the knee joint is always very painful. Symptoms only intensify on the second day after the injury. It is almost impossible to make any movements with the leg, and pain makes itself felt even with the slightest attempt to move. However, if you are at rest, the pain will not be so severe. According to doctors, the younger the patient, the more difficult it will be for him to endure the injury. Elderly people have less elastic joints, so damage to them is usually not accompanied by such severe pain.

Usually, already on the second or third day after the injury, the knee becomes very swollen. In fact, this body reaction is protective. Articular fluid begins to be produced in excessively large quantities, intra-articular pressure increases, so the articular surfaces will try to free the pinched meniscus. Unfortunately, most often the human body is unable to cope with this problem on its own. But still, in some cases with minor damage this is possible.

Usually the disease is acute for about two to three weeks. After this, the patient usually notices improvements. Pain sensations decrease and swelling subsides. A torn meniscus of the knee joint, the treatment of which must begin immediately, is a very dangerous disease, and in some cases leads to a complete loss of joint mobility. Therefore, it is very important to consult a doctor for diagnosis and prescribing the correct course of treatment.

What are the types of meniscal injuries?

The meniscus of the knee joint (symptoms and treatment are described in detail in this article) is not so difficult to damage. This can be done not only by athletes, but also by ordinary people in everyday life. The most common types of damage to the cartilaginous knee area are:

• complete separation of the meniscus from its attachment site;
• rupture of the intermeniscal ligaments, leading to excessive joint mobility;
• chronic knee injury;
• presence of cysts;
• a combination of several types of damage.

Each injury mentioned above is very dangerous and therefore requires immediate treatment. It is better to see a doctor on the same day.

What is the danger?

A rupture of the meniscus of the knee joint, the treatment of which must be prescribed in a timely manner, is very dangerous for human health. A rupture can lead to a blockage in the joint, so it will be impossible to make any movements with the leg. In addition, the joint itself will also be damaged, which, without reliable shock absorption, will simply deform over time.

And damage to such an important cartilage layer as the meniscus can lead to problems in the future. People who frequently injure their knees are prone to developing arthrosis.

Diagnostic methods

Meniscus of the knee joint (symptoms are described in this article) is very important to start treating correctly and on time. To do this, you need to undergo a timely diagnosis. An accurate diagnosis can only be made if you understand the reasons for the injury. The specialist will offer the patient to undergo a comprehensive diagnosis, which will help to accurately establish the diagnosis. First of all, he will undergo simple and contrast arthrography, as well as ultrasound scanning. If necessary, the doctor will also perform arthroscopy, MRI and thermopolarography.

Arthroscopy is a very effective method for examining damaged joints. Arthrography is also a very effective procedure. During this procedure, oxygen is injected into the joint itself, allowing you to get good pictures in several projections. Thanks to such images, an experienced specialist will be able to determine the presence of injury and select the correct treatment methods.

Meniscus of the knee joint: treatment with conservative methods

Treatment of meniscal injuries can be carried out using several methods, depending on the type and degree of injury. Conservative or surgical treatment is usually used.

The first treatment method is used to reduce the load on the joint, relieve pain, and eliminate inflammatory processes in the body. During such treatment, doctors strongly recommend performing special gymnastics and strengthening the leg muscles.

If this method of treatment does not give the desired results, then you need to resort to surgical intervention.

Surgery on the meniscus of the knee joint

Only a doctor can say for sure whether it is possible to manage with conservative treatment methods for damaged meniscus, or whether it is worth undergoing surgery. Most often, patients hope that after treatment with ointments and tablets, surgery may not be necessary at all. However, in real life everything is far from being like that. According to experts, surgery on the knee joint for meniscus damage will be most effective if it is performed immediately after the injury. This way the joint will recover much faster, and there will be a much lower chance of developing complications.

Typically, surgical intervention is indicated for patients in cases where meniscus tears become significant, or cartilage tissue is crushed or torn off.

Today, surgery can be performed using two methods: open and closed. During the first of them, specialists will open the joint cavity. But the second method is safer and more gentle. In modern medicine it is called arthroscopy. This technique has the following advantages:

• a specialist will be able to diagnose the type of damage as accurately as possible;
• Moreover, this method causes little trauma to surrounding tissues;
• During the operation there is no need to make large incisions in the joint capsule;
• After surgery, the leg can not be fixed in one position, which is very comfortable for the patient. In addition, the length of hospital stay will be significantly reduced.

How is meniscus repair performed?

It is possible to restore the meniscus in the presence of fresh injuries to the knee joint. In this case, special sutures will be placed on the damaged area using the arthroscopic method. Typically, this procedure is performed for people under the age of forty if there are indications such as a minor tear of the meniscus or its vertical tear. This procedure can only be carried out if there are no degenerative processes in the cartilage tissue.

Very often, surgery on the meniscus of the knee joint is performed using various devices that dissolve over time. They allow you to fix the meniscus in the desired position.

Removal and transplantation

Surgery on the knee joint for damaged meniscus may also involve complete or partial replacement of cartilage tissue. Such surgical intervention is performed if the cartilage tissue is crushed, or complications arise after undergoing surgical or conservative treatment. Modern medicine deals with partial removal of the meniscus, while simultaneously straightening the damaged tissue. But complete removal is very rare and is done only in extreme cases, since there is a high risk of developing postoperative complications.

It is very important to treat a knee meniscus injury correctly. If the injury was serious enough, then specialists use the transplantation method. For this purpose, both synthetic and donor tissues are used. The graft will be inserted into a small incision. It is very important to accurately determine its size so that complications do not arise after the operation.

Rehabilitation period after surgery

Damage to the meniscus of the knee joint is always a serious pathology that is not so easy to cope with. If the patient was treated surgically, then it is very important to undergo a proper rehabilitation period. Usually it is divided into several stages, each of which must be completed. Immediately after the operation, outpatient treatment is carried out, which consists of the use of antibacterial and antithrombotic drugs. Experts also recommend undergoing a special lymphatic drainage massage. If necessary, painkillers and anti-inflammatory drugs can be used. A very important rehabilitation stage is performing special gymnastic exercises. Moreover, at the initial stage, all of them should be carried out under the strict supervision of a specialist.

The next stage of rehabilitation is late recovery. If the previous recovery stage lasted about two months, then this stage may take much longer. The tasks of late recovery include establishing the functioning of the joint, restoring its position and toning the muscle tissue of the lower extremities.

Good results can also be achieved using physiotherapy methods. They allow you to speed up the recovery process in cartilage tissue, and also normalize blood circulation and regenerate the soft tissue surrounding the damaged joint. The most effective physiotherapeutic procedures are massage, electrophoresis, as well as laser and magnet therapy. Of course, all procedures should be carried out by an experienced clinic worker, but massage can also be done at home. The main thing is to do it correctly, without putting too much pressure on the damaged joint.

The meniscus of the knee joint, the treatment of which is described in the article, is a very important cartilage tissue in the human body that performs a shock-absorbing function. Therefore, if there is any damage to the meniscus, it is very important to consult a doctor in a timely manner. The medial meniscus of the knee joint requires urgent treatment, surgical intervention is also possible, so it is better not to delay and contact the clinic in time. If the doctor reports the need for surgical intervention, you should not refuse, because very often conservative treatment does not give the desired results.

M26.3 is the ICD code for damage to the meniscus of the knee joint. According to this code, you can learn everything about the treatment of meniscal pathologies, taking into account global treatment features.

Conclusions

I would like to say that moderation is good in everything. Most often, knee injuries occur in athletes, so try to be more responsible about your health. The ICD-10 code “Damage to the meniscus of the knee joint” allows patients to become familiar with the features of the disease in detail. Experts strongly recommend consuming vitamins and microelements to keep joints in good shape. Be healthy and take care of yourself!

There are more than 200 bones in the human body, which are connected to each other in a fixed, semi-movable and movable manner. The last connection is called a joint. Being constantly exposed to stress, there is a high risk of injury.

The joint is formed by bones, numerous ligaments and formations that serve for shock absorption - menisci. Most often, knee pain is caused by their pathologies. In people under the age of forty, injuries occupy the leading place, and after 50, degenerative changes in the skeletal system already affect them. The most serious pathology is rupture; symptoms; treatment will be discussed in the article.

What is a meniscus?

The meniscus is a cartilaginous plate located between the thigh and lower leg bones that serves as shock absorption during walking. It consists of a body and horns. The meniscus is similar to a crescent, the horns of which are attached to the intercondylar eminences. There are two types of menisci:

The causes and symptoms of a meniscus tear will be discussed below.

Purpose of menisci

These cartilaginous formations perform the following functions:

The lateral parts of the meniscus receive their blood supply from the capsule, and the body from the intracapsular fluid. There are several areas for supplying the meniscus with nutrients:

1. The red zone is located in close proximity to the capsule and receives maximum blood supply.
2. The intermediate zone receives little nutrition.
3. The white zone is deprived of blood supply from the capsule.

If a medial meniscus tear occurs in the knee joint, treatment is selected depending on the area of ​​damage.

Causes of meniscus injury

Most often, a meniscus tear can be caused by:

1. Traumatic impact.
2. Sharp abduction of the lower leg.
3. Sharp and maximum extension in the knee joint.
4. A blow to the knee.

After 50 years, a meniscus tear can be caused by bones.

Types of meniscus damage

A tear of the medial meniscus of the knee joint is one of the most common injuries. Most often found in athletes, professional dancers, and those who engage in heavy physical labor. Depending on the type of damage, there are:

• vertical gap;
• oblique;
• degenerative rupture, when large-scale destruction of meniscus tissue occurs;
• radial;
• horizontal break;
• injury to the horns of the meniscus.

As a result of the injury, damage to the outer or inner meniscus or both can occur.

Symptoms of a meniscus tear

If we take into account the nature of the cause of the rupture, they are divided into two types:

1. Traumatic rupture of the meniscus of the knee joint has characteristic symptoms and is acute.
2. The degenerative rupture is characterized by a chronic course, so the symptoms are smoothed out and there are no obvious clinical manifestations.

Acute meniscus injury manifests itself:

1. Sharp and severe pain.
2. Edema.
3. Impaired joint mobility.

But only a doctor can make a correct diagnosis, because such symptoms can indicate many injuries, for example, a dislocation or rupture of ligaments. If you do not take any measures, then after a couple of weeks the symptoms of a tear of the meniscus of the knee joint, the photo demonstrates this, already manifests secondary symptoms, which include:

1. Accumulation of fluid in the joint cavity.
2. The knee is locked in a bent position.
3. The thigh muscles lose tone.
4. Sometimes you can feel the meniscus in the joint space.

If a knee meniscus tear occurs, treatment will depend on the severity of the injury.

Severity of meniscus tear

Taking into account how serious the meniscus injury is, the doctor will prescribe therapy. The degrees of damage are as follows:

1. 1st degree, when a small rupture occurs, the pain is insignificant, and there is swelling. Symptoms disappear on their own after a couple of weeks.
2. 2nd degree of moderate severity. It manifests itself as acute pain in the knee, swelling, and limited movements. At the slightest load, pain appears in the joint. If there is such a rupture of the meniscus of the knee joint, it can be cured without surgery, but without appropriate therapy the pathology becomes chronic.
3. Grade 3 rupture is the most severe. There is not only pain and swelling, but also bleeding into the joint cavity. The meniscus is almost completely crushed; this degree requires mandatory surgical treatment.

Making a diagnosis

If you suspect a meniscus injury, you should definitely consult a doctor. After a detailed examination, the surgeon will determine the severity of the injury and its location, but in order to accurately recognize a meniscus tear, it is necessary to undergo a series of studies:

1. X-ray examination is the easiest way to diagnose. Due to the fact that the menisci are not visible in the image, the study is carried out using a contrast agent.
2. Arthroscopy allows you to look inside the joint and determine the severity of the damage.

After confirming the diagnosis, the doctor can prescribe effective treatment.

Types of treatment for meniscus injury

If the diagnosis of a meniscus tear is confirmed without surgery, it includes the following directions:

1. Conservative therapy.
2. Treatment using traditional methods.

If there is a large tear in the meniscus of the knee joint, treatment without surgery will not help. It is impossible to do without the help of competent surgeons.

Conservative treatment

This type of therapy includes the following:

1. Providing first aid, which consists of the following:

• Ensuring complete peace.
• Using a cold compress.
• Use of painkillers.
• If fluid accumulates, you will have to resort to puncture.
• Applying a plaster cast, although some doctors consider this inappropriate.

2. Bed rest.

3. Applied for a period of at least 2-3 weeks.

4. Remove the blockade of the knee joint.

5. Application of physiotherapeutic methods and therapeutic exercises in treatment.

6. Inflammation and pain are relieved with the help of non-steroidal anti-inflammatory drugs: Diclofenc, Ibuprofen, Meloxicam.

7. Chondroprotectors: “Glucosamine”, “Chondratin sulfate” help speed up the restoration of cartilage tissue.

8. Using external remedies in the form of ointments and creams will help you recover faster from injury. The most commonly used are “Ketoral”, “Voltaren”, “Dolgit” and others.

If the treatment is chosen correctly, then after 6-8 weeks recovery occurs.

Surgical intervention

If a rupture occurs, some symptoms may be an indication for surgery:

• meniscus tissue is crushed;
• the meniscus has been displaced or torn into pieces;
• presence of blood in the joint cavity;
• no results from treatment.

Surgical intervention can be performed using several methods:

1. If a rupture of the meniscus of the knee joint manifests symptoms acutely due to the almost complete decomposition of the cartilage tissue, then removal of the meniscus or part of it is indicated. The operation is quite traumatic and can relieve pain only in 50-60% of cases.

2. Restoration of the meniscus. Surgeons usually undertake such manipulation when they perform an operation on young people, and then only under certain conditions:

• longitudinal gap;
• peripheral rupture;
• if the meniscus is torn from the capsule;
• peripheral rupture with displacement;
• in the absence of degenerative changes.

With such an intervention, it is important to take into account the location of the rupture and the duration of the injury.

3. The arthroscopic method is less traumatic and modern. With this intervention, minimal disruption of adjacent tissue occurs. To suture the meniscus, special needles are used, the seam is strong.

4. Use of special clamps to secure the meniscus. This method allows the operation to be performed without additional incisions and devices. For this method, second-generation fixatives are used, which quickly dissolve and reduce the risk of complications.

5. Meniscus transplantation is carried out in cases where it is no longer possible to do anything. This method also has its contraindications:

• degenerative changes;
• old age;
• general somatic diseases;
• knee instability.

Which method of surgical intervention to prefer is decided in each specific case by the doctor.

Rehabilitation after surgery

Not only is it important to perform the surgery correctly, but the success will depend on the recovery period. After surgery, it is important to follow some recommendations:

1. Perform special exercises under the guidance of an experienced mentor that will help develop the joint.
2. It is mandatory to take chondroprotectors and anti-inflammatory drugs.
3. Physiotherapy and massage will greatly help in recovery.
4. No physical activity for at least six months, and preferably all 12 months.

Traditional methods of treatment

If the symptoms of a torn meniscus of the knee joint are not so acute, treatment with folk remedies along with conservative methods of therapy may well provide effective help. Here is a list of the most popular recipes:

1. In the first hours and days after injury, apply ice to the sore spot.
2. Be sure to be completely at rest and the leg should be located above the level of the heart.
3. You can use a warm compress with honey; it will not only remove the inflammatory process, but also relieve pain. You can prepare it like this: combine the same amount of alcohol and honey, mix well, moisten a napkin and apply to the sore spot. Wrap a warm scarf on top and keep for several hours.
4. Grind a fresh onion using a blender, mix the pulp with 1 teaspoon of sugar and apply on a napkin to the injured knee. Wrap the top with plastic wrap and secure. Leave it in this state overnight. This manipulation must be done every day; if the meniscus is not displaced, it should recover.
5. Burdock can also help if crushed and applied to the sore spot. Secure with a bandage and keep for 3 hours, then change.

If the symptoms of a knee meniscus tear are severe enough and treatment does not help, then you will have to resort to surgery.

Consequences of meniscus damage

If a meniscus tear occurs, the injury is considered quite serious. Most often, joint pathologies do not go away without leaving a trace, even with appropriate treatment. If a knee meniscus tear has been diagnosed, the consequences may be as follows:

1. Repeated break. This occurs quite often even after surgery. That is why, after the rehabilitation period, you will still have to take good care of your knees; it is necessary to limit active sports activities.
2. Formation of hematomas. They may remain after surgery and cause pain. Such consequences need urgent elimination; the patient will have to undergo a long period of rehabilitation and complex drug treatment.
3. The development of an inflammatory process, which often occurs if you do not try to eliminate the remaining hematomas or there is an unsuccessful surgical intervention. Even if the treatment was successful, this does not guarantee the absence of problems in the future, so it is necessary to periodically visit a doctor for examination.
4. It is also necessary to remember that after the operation there will be swelling of the joint, but after a while this will all go away; if not, then you need to inform the doctor.
5. Discomfort remains for some time after discharge from the hospital, but it becomes less and less as you take medications. But if it does not subside, but becomes more intense, then this may indicate that a complication is developing in the form of hemorrhage into the joint or a purulent inflammatory process. In such situations, you cannot do without the help of a doctor.

How to prevent meniscus injury?

Absolutely anyone can get such an injury, but it is better to prevent a meniscus tear or reduce its likelihood. Knee training is perfect for this. But this does not mean the use of heavy loads; it is enough to regularly ride a bicycle, walk, or run to strengthen the meniscus, then the likelihood of a rupture will be minimal.

We looked at how a torn meniscus of the knee joint manifests symptoms, what methods of therapy are used, but it is better to prevent such injuries. Take more care of yourself and your health.

Perelman's symptom is pain and instability of the knee joint when going down stairs.

McMurray's sign - with maximum flexion of the knee joint, the posterointernal part of the articular line is palpated with one hand, while the other hand brings and maximally rotates the tibia outward, after which the tibia is slowly extended - at the moment when the internal condyle of the femur passes over the damaged area a click or crunch is heard or felt by palpation of the internal meniscus. To study the condition of the external meniscus, the posterolateral part of the joint space is palpated, the tibia is abducted and rotated inwards as much as possible, after which it is slowly extended.

From additional examination methods, valuable information can be obtained by using various arthroradiography with contrast - arthropneumography, positive arthroradiography, “double contrast”, which allows, based on the characteristics of the distribution of a contrast agent or gas throughout the joint, to establish the presence of a meniscus tear and suggest its anatomical type.

MRI of the knee joint is highly accurate; this non-invasive method can detect more than 90% of cases of meniscal injuries.

On MRI, the meniscal tissue is homogeneous, dark, without additional internal signals. Manifestations of degenerative changes in the meniscus begin with the appearance of areas with increased signal. The most common sign of a meniscus tear is a horizontal split in the projection of the meniscal shadow or a defect in the meniscus tissue in the place of its normal location with the presence of one in an atypical place. The first type is characteristic of degenerative meniscus tears, and the second type is characteristic of traumatic injuries.

MRI can also be easily used in patients with acute knee injuries. It replaces the need for examination under anesthesia, X-ray examination techniques with contrast, and in some cases arthroscopy, since the resulting contrast image of soft tissue structures allows in vivo assessment of the stage of internal meniscal degeneration, which can lead to rupture. Perimeniscal cysts are well defined and differentiated from other fluid formations.

The final stage of the examination is diagnostic arthroscopy. Using arthroscopy, a variety of types of meniscal injuries have been proven, which cause different clinical symptoms. By direct inspection, endoscopy allows you to determine the luster and density of the meniscal tissue, establish the shape, size and location of the tear, its type, extent, the presence of associated injuries, depending on this, clarify the indications for non-operative and surgical treatment, plan the stages of its implementation and rehabilitation therapy.

Compliance with the technique of endoscopic intervention ensures up to 98.6% accuracy in diagnosing meniscal lesions. Performed technically competently, arthroscopy is associated with a minimal risk of complications and leads to a rapid restoration of patients’ ability to work.

Thus, to increase the reliability of diagnosing meniscus injuries, it is necessary to use the entire arsenal of tools at the disposal of an orthopedic traumatologist.

Treatment

To this day, the debate continues about the indications for surgery and the timing of its implementation for meniscus tears.

Most domestic and foreign traumatologists in the “acute” period recommend non-operative treatment, including puncture of the joint and evacuation of spilled blood, removal of the blockade, immobilization and elimination of load on the limb for 1-3 weeks, a set of physiotherapeutic procedures, exercise therapy. This tactic is based on experimental studies and clinical experience that have proven the possibility of healing meniscus tears localized in the blood supply zone.

Indications for surgical intervention in the “acute” period are unresolved or recurrent blockades and tears of both menisci of one joint.

The question of indications for surgery for chronic injuries remains unresolved. Previously, it was believed that a diagnosed meniscus tear should entail early surgical treatment. This tactic was justified by the high degree of correlation between cartilage damage detected during the intervention and poor long-term results, and the destruction of articular cartilage was associated with the long-term negative effect of damaged menisci on all articular structures. Currently, another point of view prevails, which is that both meniscus injury and meniscectomy significantly increase the risk of developing deforming arthrosis, therefore, the diagnosed injury is not a direct indication for surgical treatment, both in the acute and long-term periods. Indications for surgical treatment of patients with meniscus tears are:

repeated joint blockades with the development of synovitis;

joint instability;

pain and dysfunction that cause discomfort during everyday and professional activities or when playing sports.

The combination of these manifestations, corresponding to objective data and the results of additional research methods, gives grounds to assert the presence of meniscus damage and set indications for surgical intervention.

Total meniscectomy has long been the most commonly performed orthopedic procedure. The main stages of open meniscectomy are as follows:

medial or lateral arthrotomy;

mobilization of the anterior horn of the meniscus;

cutting it off paracapsularly within the meniscal tissue to the posterior horn without damaging the collateral ligaments;

movement of the mobilized meniscus into the intercondylar space;

transection of the posterior horn and removal of the meniscus.

Further study of the function of the menisci proved the feasibility of saving tactics in the treatment of their injuries; partial meniscectomy and suture were increasingly used as an alternative to complete removal.

The menisci contribute to the uniform distribution and transformation of up to 30-70% of the load on the articular surfaces of the femur and tibia. After partial resection, the contact area between the articular surfaces is reduced by approximately 12%, and after total meniscectomy - by almost 50%, and the pressure in the contact area between the articular surfaces increases to 35%. After partial resection, the remaining portion of the meniscus continues to absorb and evenly distribute loads on the articular surfaces, while the integrity of the peripheral circular fibers is very important. Thus, the meniscus is an important structure in distributing and absorbing loads in the knee joint; its absence contributes to the progression of degenerative processes in the joint, and their severity is directly proportional to the size of the removed part of the meniscus.

A comparative analysis of the results of partial and total meniscectomies performed during arthrotomy showed that the advantages of resection include rapid rehabilitation of patients, a reduction in the number of complications, a reduction in the duration of treatment with better functional results. It is indicated for flap tears or watering can handle injuries if the peripheral edge of the meniscus is intact.

The development of arthroscopy both abroad and in our country has made it possible to almost completely abandon arthrotomy for interventions on the meniscus. The technique of arthroscopic surgery has undoubted advantages, including significantly less trauma and a shorter rehabilitation period for patients.

The disadvantages of arthroscopic surgery include:

technical difficulty of performing the operation;

the need for extensive experience in the field of endoscopy;

difficulties in using arthroscopic instruments and the possibility of their breakdown;

high cost of arthroscopic equipment.

The general principles of arthroscopic meniscal resection are as follows:

Only unstable fragments are removed, which are displaced into the joint when palpated with a hook;

it is necessary to achieve a smooth contour of the edge of the meniscus, without sharp transitions, since the sharp edges left after resection of the damaged fragment are often subsequently subject to ruptures;

on the other hand, you should not achieve ideal smoothness of the contour of the free edge of the meniscus, since this is impossible due to its fibrous structure; after 6-9 months it smooths out on its own;

it is necessary to frequently use an arthroscopic hook in order to assess the degree of displacement and the structure of the remaining part of the meniscus and determine the usefulness of the resection;

it is useful to focus on your own tactile sensations - degenerative tissue is softer than normal tissue, therefore, if during the resection of the meniscus its density has changed, you need to palpate with a hook to determine the stability and integrity of the preserved part of the meniscus;

it is necessary to avoid deepening the resection into the area of ​​the meniscocapsular attachment, since the separation of the meniscofemoral and meniscotibial ligaments significantly reduces the stability of the joint;

if there is uncertainty about the sufficiency of resection, it is preferable to leave more of the peripheral part of the meniscus than to remove normal tissue, this is especially important in the posterior third of the lateral meniscus in front of the popliteus tendon;

If the arthroscopic meniscectomy cannot be completed within an hour, then it is reasonable to re-debride the skin and perform an arthrotomy.

Interest in more gentle methods of meniscectomy led in the late 70s of the last century to the development and introduction into practice of arthroscopic operations with laser and electric knives, which have such advantages as painless intervention, more accurate tissue dissection, and a lower risk of postoperative bleeding and synovitis.

The developed methods of open and arthroscopic suture showed their high efficiency, proven by repeated arthroscopy in the long-term period. DeHaven and Warren achieved healing of the meniscus after suturing in 90% of patients with a stable knee joint, whereas in 30-40% of patients with instability, fusion did not occur.

Less encouraging data is provided by Scott, who studied the long-term results of meniscus suture in 178 patients using arthrography and arthroscopy; he noted complete fusion in 61.8% of cases.

Currently, the operation of open or arthroscopic suture on the meniscus is considered indicated for longitudinal paracapsular and transchondral tears and for a patchwork tear of the meniscus width with a length of more than 7-10 mm with instability of the damaged part, determined by palpation with a hook. Some traumatologists prefer to resort to it only for fresh injuries in young patients, while others do not attach importance to these factors. There are also different attitudes towards the need to refresh the edges before suturing.

Stitching of a torn meniscus is performed by arthrotomy or under endoscopic control. In the first case, access is made to the site of the rupture in the projection of the injury, the edges of the rupture are refreshed and interrupted or U-shaped sutures are applied through both fragments, tying them to the fibrous capsule of the joint. Three different arthroscopic meniscus suture techniques are used:

"outside-in";

"from inside to outside";

"Everything is inside."

For arthroscopic suturing of the meniscus, additional tools are required: straight and curved needles with a mandrel, a mandrin with a metal loop at the end, straight and curved thread guides, a rasp. The first two techniques differ in the direction of the needle and thread; knots are tied on the fibrous capsule of the joint after accessing it. The “all inside” technique involves performing all stages of the operation intra-articularly without surgical access to the joint capsule.

To stimulate meniscus fusion, it is proposed to fix a flap from the synovial membrane on a pedicle to the suture area or to introduce an exogenous fibrin clot into the rupture site.

Meniscal injuries do not always cause the appearance of clinical symptoms, so some of them can heal on their own. Such damage includes cracks that do not penetrate the entire thickness of the meniscus, short tears that include its entire thickness, vertically or obliquely located, if the peripheral part of the meniscus is stable and does not move during palpation with a hook. Short radial tears may also be included in this group; most of these injuries are accidental arthroscopic findings. It is not difficult to determine the possibility of spontaneous healing of a rupture in these injuries, however, if the rupture identified during argroscopy is the only pathological finding, the surgeon must make the correct choice of treatment method by comparing the totality of both clinical data and arthroscopy results.

After completing arthroscopy of the knee joint, after treating the skin with an antiseptic solution, it is recommended to inject 2 ml of ketorolac, which belongs to the group of non-steroidal anti-inflammatory drugs and has predominantly analgesic activity with less pronounced anti-inflammatory and antipyretic properties, into the superior inversion of the knee joint. In most cases, a single intra-articular injection of 60 mg ketorolac provides a sufficient level of analgesia during the first 24 hours, without the need for additional parenteral or oral use of analgesics.

The problem of treating meniscal injuries accompanied by ACL rupture remains a subject of debate. Acute ACL injury is accompanied by damage to the meniscus in 25% of cases, and chronic injury in 62%, with the internal meniscus suffering 8-10 times more often than the external one.

ACL reconstruction for acute injury is recommended in young active patients under 30 years of age, especially in athletes. Physically less active individuals are more often prescribed a course of non-operative treatment and follow-up. If reconstructive surgery is indicated for a patient with an acute ACL rupture, it is preceded by diagnostic arthroscopy to assess the condition of the menisci. Initially, depending on the nature of the damage, meniscectomy or suturing is performed, and then reconstruction of the ligament.

If restoration of the ACL in the acute period is not indicated, then the condition of the meniscus is assessed using MRI or arthrography with contrast, only if there is a possibility of damage to the meniscus, arthroscopy is performed, then suture is applied to the meniscus or meniscectomy. Some orthopedists recommend combining meniscal surgery with ACL reconstruction in younger patients, especially after meniscus suture.

In patients with chronic ACL injury, careful assessment of clinical symptoms is critical to diagnosing meniscus injury. Meniscal tears may be the dominant cause of knee dysfunction or may only aggravate the clinical manifestations of ACL failure. In each specific case, the surgeon should take into account the patient’s age, level of physical activity, and the severity of damage to the knee joint. Although menisci stabilize the knee joint, surgical repair of meniscus damage in cases of severe ACL deficiency cannot be expected to provide good results. In such a situation, surgery on the damaged meniscus and ligament is indicated.

Experts, summarizing the experience of treating such patients, consider it necessary, first of all, to establish whether the clinical symptoms are associated with damage to the meniscus alone or with ACL failure or a combination of both. The first option shows intervention on the meniscus. If the patient is bothered by the symptoms of ACL insufficiency and a concomitant meniscal injury can be assumed, then restoration of the ligament and, if necessary, intervention on the meniscus are recommended.

Features of postoperative management

Despite the fact that, according to most traumatologists, arthroscopic resections or removal of menisci should be performed in a day hospital setting, postoperative management of patients is of utmost importance for treatment results. Inadequate postoperative treatment leads to poor results even with brilliantly performed surgery. Most authors indicate the need to immobilize the operated limb after arthrotomy with partial or complete meniscectomy for 5 to 10 days, and walking on crutches without support for up to 12-15 days. To prevent muscle wasting and the development of contracture, isometric contractions of the quadriceps muscle are indicated from the 2nd day, and active movements in the joint from the 6-7th day. After meniscectomy or meniscal resection performed arthroscopically, immobilization is not required. When the patient is in bed, the operated limb should be elevated approximately 10 cm above the level of the heart. 2-3 hours after arthroscopy, patients are allowed to stand up and walk with additional support on crutches and a dosed load on the lower limb. Excessive axial load on the operated limb and high motor activity in the early postoperative period negatively affect the recovery time of the knee joint. Therefore, depending on the severity of pain, synovitis and swelling of the knee joint, the load on the lower limb should gradually increase to full only by 3-7 days after surgery.

Cold on the knee joint area is used continuously during the first day, and then 3-4 times a day for 20 minutes, up to 72 hours after surgery. The analgesic effect of cold therapy is realized by reducing muscle spasm and reducing the conductivity of nerve fibers. In addition, vasoconstriction increases and the intensity of metabolism in tissues decreases, which helps reduce edema and prevent the development of hematomas and hemarthrosis.

The first dressing is performed the next day. When effusion accumulates in the joint cavity, as evidenced by the smoothing of the contours of the knee joint and the positive symptom of patellar balloting, it is advisable to perform a puncture of the knee joint under local anesthesia with evacuation of the exudate. The sutures are removed after the skin wounds have healed on the 7-10th day after arthroscopy. In the future, for 3 weeks after surgery, it is recommended to use an elastic bandage of the knee joint or wear a soft knee brace when walking.

The postoperative period after suture placement on the meniscus is characterized by prolonged immobilization and walking with additional support, without load on the operated limb. A dosed load is recommended after removing the plaster cast, full load – after another 2 weeks.

After meniscectomy, exercise therapy must be combined with physical therapy from 1-2 days after surgery. After the sutures are removed, patients are prescribed electrical myostimulation, ozokerite applications, hydrocortisone phonophoresis and other procedures.

Total meniscectomy

Initial stage.

Contraction of the muscles that form the crow's foot: sartorius, semitendinosus and tender. Starting position – sitting or lying on your back, knee joint bent at an angle of 170°. Resting both heels on the floor, the muscles of the back of the thigh are tensed for 5 seconds, followed by their relaxation. The exercise is performed 10 times without moving the knee joint.

Contraction of the quadruple femoris muscles. Starting position – lying on your stomach with a bolster under the ankle joint. By pressing the ankle joint onto the roller, the lower limb is extended as much as possible and held for 5 s, after which it is returned to the starting position - 10 repetitions.

Straight leg raise while lying on your back. The starting position is lying on your back, the contralateral knee joint is bent, the operated one is extended as much as possible. The operated leg is slowly raised 15 cm and held for 5 s. With each subsequent lift, the height is increased by 15 cm. After reaching the maximum height, the exercise is repeated in the reverse order until returning to the starting position - 10 times. As the strength of the thigh muscles increases, weights are added to the ankle joint area - a load of 450-500 g. By the 4th week after the operation, the load is gradually increased to 2 kg.

Contraction of the gluteal muscles. In the starting position - lying on your back with bent knee joints - the muscles of the buttocks are tensed for 5 seconds, then they are relaxed - 10 repetitions.

Standing straight leg raise. In a standing position, if necessary, holding the handrail with the opposite hand, the leg straightened at the knee joint is slowly raised up, and then returned to its original position. Repeat 10 times. As the strength of the thigh muscles increases, a weight of 450-500 g is added to the ankle joint area. By the 4th week after the operation, the load is gradually increased to 2 kg.

Intermediate stage.

Terminal extension of the knee joint while lying on the back. Starting position – lying on your back with a bolster under the back surface of the knee joint. The knee joint, resting on the roller, is slowly extended as much as possible and held in this position for 5 seconds, after which it is slowly returned to its original position - 10 repetitions. As extension increases, a weight of 450-500 g is added to the ankle joint area. By 4 weeks after surgery, the load is gradually increased to 2 kg.

Straight leg raise while lying on your back. The starting position is lying on your back, the contralateral knee joint is bent, the operated one is extended as much as possible due to the tension of the quadriceps femoris muscle. Slowly raise your leg 30 cm from the floor, then slowly lower it to the floor and relax the muscles - 5 sets of 10 repetitions. As the strength of the thigh muscles increases, a weight of 450-500 g is added to the ankle joint area. By the 4th week after surgery, the load is gradually increased to 2 kg.

Partial squat with additional support. Starting position - standing on your feet, holding the back of a chair or handrail at a distance of 15-30 cm from the support. Slowly perform a squat, while keeping your back straight and, having reached the bending of the knee joint at a right angle, stop for 5-10 seconds, then slowly return to the starting position and relax the muscles. Repeat 10 times.

Standing quadriceps thigh stretch. Starting position - standing on the healthy leg, bend the operated limb at the knee joint to an acute angle and, carefully helping with your hand, pull the toe, trying to press the heel to the buttock. Having achieved a feeling of slight stretching along the front surface of the thigh, hold for 5 s. Repeat 10 times. When performing this exercise, the other hand should rest against the wall.

The final stage.

Dosed flexion at the knee joint while standing on one leg. Starting position – standing on your feet with support on the back of a chair. The healthy leg is bent; to maintain balance, the big toe can touch the floor. Slowly perform a partial squat on the operated limb, without lifting the foot from the floor, followed by a return to the starting position - 10 repetitions.

One step forward. From the starting position, standing on your feet, with the affected leg, take a step forward one step, 15 cm high, followed by a return to the starting position - 10 repetitions. Gradually, the height of the step can be increased.

Step one step sideways. From the starting position, standing on your feet, step the affected leg sideways onto a step 15 cm high, followed by returning to the starting position - 10 repetitions. Gradually, the height of the step can be increased.

Seated knee extension. From the starting position, sitting on a chair with the operated limb lying on a bench of lower height, perform extension at the knee joint and lift the leg up with fixation at the top point for 5 s, after which a slow return to the starting position is performed - 10 repetitions.

: sartorial, semi-tendinous and tender, lying on the back. Starting position – lying on your back. The limb is bent at the hip and knee joints and the hands are clasped around the lower third of the thigh. The knee joint is slowly extended until a feeling of stretching is felt along its posterior surface and held for 5 s, after which a return to its original position follows. It is advisable to alternate repetitions with a similar exercise for the healthy leg. The sensation of stretching increases with increasing flexion at the hip joint. It is important to perform this exercise smoothly and slowly, without jerking.

Stretching the muscles that form the crow's foot: sartorial, semi-tendinous and tender, lying on the back with support on the wall. Starting position - lying on your back near the doorway, the heel of the operated leg, bent at the knee joint, is placed on the wall, after which, leaning on the healthy leg, the pelvis is moved closer to the wall. The bent leg is slowly extended at the knee joint with support on the wall until a feeling of stretching along the back surface of the knee joint is felt and held for 5 s, then returning to the starting position. The closer the pelvis is moved to the wall, the more pronounced stretching can be achieved. Repetitions should be alternated with a similar exercise for the opposite limb - 10 times.

Exercise bike. When exercising on an exercise bike, the seat should be raised to such a height that the foot of the operated limb, when performing a full rotation, can hardly touch the pedal in its lowest position. You should always start with light resistance and gradually increase it. The initial duration of the exercise is 10 minutes per day, then the duration is increased by 1 minute per day to 20 minutes.

Measured walking without additional support is indicated on average 2 weeks after arthroscopy, in shoes with well-cushioned soles.

The criteria for moving to the next stage of exercise therapy are the patient’s complete mastery of a set of exercises, achievement of the planned number of repetitions, positive dynamics of increasing the range of motion in the knee joint and muscle strength of the lower limb, and a decrease in the severity of pain.

Comprehensive rehabilitation treatment allows for rapid restoration of muscle tone and full range of motion in the knee joint. The period of temporary disability during endoscopic intervention on the knee joint is reduced by 2.5-3 times in comparison with arthrotomy. You can start playing sports after 6-8 weeks in the absence of pain and swelling of the knee joint.

The problem of early diagnosis and adequate treatment of local damage to hyaline cartilage resulting from injuries and diseases of the knee joint still causes difficulties in clinical traumatology and orthopedics. This is due to the fact that hyaline cartilage, being a unique tissue capable of withstanding intense repeated mechanical loads throughout an individual’s life, has a very limited reparative potential. Back in 1743, Hunter noted that even with minimal damage, articular cartilage is not fully restored.

Limited-area cartilage damage is a common cause of pain and dysfunction of the knee joint and is detected both isolated and in combination with other pathological changes in 14-26% of patients. Chondromalacia was first described by Budinger in 1906, and the term “chondromalacia” was used by Aleman in 1928 to describe degeneration of the patellar cartilage.

Structure and regeneration of articular cartilage

Like other mesenchymal tissues, hyaline cartilage is composed of cells and extracellular matrix. In normal hyaline cartilage there is only one type of cell - these are highly specialized chondrocytes, making up about 1% of the total tissue volume. Chondrocytes synthesize macromolecules such as collagens, of which 90-95% is type II collagen, proteoglycans and non-collagenous proteins, then collecting and organizing them into a highly ordered three-dimensional structure - the matrix. In addition, by producing the appropriate enzymes, chondrocytes control matrix remodeling. Proteoglycans are presented in the form of both monomers and aggregates connected to hyaluronic acid macromolecules through special proteins. The proteoglycan monomer consists of a central protein associated with sulfated glycosaminoglycans. Glycosaminoglycan chains are negatively charged, as a result of which they easily bind cations and are highly hydrophilic. In addition, due to the same charge, they repel each other, which causes the molecules to be in a “bloated” state. In hyaline cartilage, proteoglycans are compressed by a collagen framework and are only partially hydrated; however, water makes up 60% to 80% of the mass of the native tissue. This determines the mechanical properties of the fabric - strength and elasticity. For comparison, it should be noted that in solution proteoglycans occupy a volume several times greater than in articular cartilage. Theoretically, damage to collagen fibers allows proteoglycans to increase in volume and bind more water molecules, resulting in cartilage swelling similar to that seen in chondromalacia patellar.

Normally, during loading, interstitial fluid leaves the matrix, and after the load stops, it returns back. The low permeability of articular cartilage prevents its rapid extrusion from the matrix, resulting in the protection of collagen fibers, proteoglycans and other glycoproteins from high-intensity and rapidly occurring loads. During the first seconds, up to 75% of the load is absorbed by the bound fluid. After a long period of loading, the fluid begins to come out and the collagen framework with proteoglycans begins to bear the load.

The movement of water provides nutrition to chondrocytes, which occurs due to diffusion, therefore, if the elastic properties of the tissue are disrupted, their metabolism is disrupted. In turn, the composition of the matrix and its renewal depend on the functional state of chondrocytes.

It is known that as the body ages, the proliferative and metabolic activity of chondrocytes decreases.

Typically, four zones are distinguished in articular cartilage:

superficial;

intermediate;

deep;

zone of calcified cartilage.

Chondrocytes from different zones vary in size, shape and metabolic activity. The structure of the matrix varies zonally and depending on the distance to the cell.

There are two main options for the response of cartilage tissue to damage.

The first option is noted when a partial-thickness defect is formed, perpendicular or tangential to the surface of the cartilage. Necrosis of the wound edges develops, which leads to a short-term surge in the mitotic activity of chondrocytes and an increase in the biosynthesis of structural components of the matrix. However, since chondrocytes are enclosed in a dense collagen-proteoglycan matrix, they cannot migrate from the edges of the defect, and as a result, its restoration does not occur.

The second version of the reparative reaction occurs when full-thickness cartilage damage extends into the subchondral bone zone. In this case, a classic reparative reaction develops, which conventionally includes three phases: necrosis, inflammation and remodeling. In the necrotic phase, the resulting defect is filled with a fibrin clot. The source of cells in the newly formed tissue is undifferentiated plurinotent stem progenitor cells that migrate from the bone marrow in response to platelets and cytokines released. Proliferation and differentiation of migrated cells, as well as vascular invasion, occur sequentially. During the inflammatory phase, vasodilation and increased permeability of the vascular wall develop, which leads to the transudation of fluid and proteins, as well as the release of cells from the bloodstream into the damaged area. A dense fibrin network is formed, containing predominantly inflammatory and pluripotent cells. During the remodeling phase, the fibrin network is replaced by granulation tissue, followed by its maturation and metaplasia into hyaline-like chondroid tissue. In the deep layers, the subchondral bone plate is restored. After 2 weeks, chondrocytes producing type II collagen appear, but subsequently, unlike intact cartilage, the content of type I collagen remains very significant, the number of proteoglycans is reduced, and tangential collagen layers are not formed in the superficial zone. The collagen fibers of the new tissue remain poorly integrated into adjacent areas of cartilage. Chondrocyte lacunae in areas of cartilage adjacent to the area of ​​damage remain empty. Between 6 and 12 months. after damage, the cells and matrix become definitively similar to fibrocartilage.

The above structural features of newly formed tissue negatively affect its mechanical properties; over time, surface fibrillation and other degenerative changes develop.

The healing process is influenced by:

defect size;

passive movements in the joint contribute to the formation of morphologically and histochemically more complete tissue;

Thus, articular cartilage is a highly organized and complex three-dimensional structure that performs specific tasks. Therefore, for the restored area to function successfully, any tissue filling it must have a structure similar to normal cartilage.

Numerous classifications have been developed to assess the severity of acute and chronic articular cartilage damage. The systems proposed by Outerbridge and Bauer and Jackson are the most widely used in clinical practice due to their simplicity.

The knee joint is formed from patella And femoral tibia . The articular surface of the bone is covered with cartilage tissue with a number of strong ligaments. Sliding during flexion-extension of the knee is ensured by the presence joint fluid And synovial membrane . When moving, the stability of the joint depends on the ligaments, joint muscles and intra-articular cartilage - meniscus . often occur when joints are damaged, and in particular the menisci.

Meniscus - This is a cartilage lining between the joints that stabilizes the knee joint and acts as a kind of shock absorber. As you walk, the menisci shrink and change shape. Menisci are divided into two types. Outdoor or lateral , resembling the letter O, more mobile than the internal one and, therefore, less likely to be injured. Internal meniscus or medial , more static and connected to the lateral internal ligament of the knee joint, shaped like the letter C. The medial meniscus is more often subject to frequent injuries along with the ligament. The menisci are connected by a transverse ligament at the front of the joint.

Meniscal damage– this is the most common type of knee injury, most often found in men and athletes, less often in everyday life.

Symptoms of knee meniscus damage

Meniscal damage occurs acute And chronic Accordingly, the symptoms of meniscus damage differ depending on its type. Its main manifestations are listed below:

• the patient complains of sharp pain, initially in the entire knee, then the pain is localized, depending on which meniscus is damaged, on the outside or inside of the knee joint;
• movement is sharply limited, the patient does not feel or feels slight pain when the leg is bent, when trying to straighten the pain intensifies;
• the joint increases in volume, an indicator that treatment should be started immediately;
• upon extension, a clicking sensation appears; infiltration of the capsule and the resulting effusion into the joint cavity can be felt with the hand. These symptoms of meniscus damage appear after 2-3 weeks of illness;
• When fixing the knee joint at an angle of 150 degrees and trying to bend the leg, the patient feels a sharp pain.
• with chronic damage, the patient feels a dull pain in the knee joint, which intensifies when going down the stairs.

Diagnosis of meniscus damage

Diagnosis is based on detailed questioning of the patient and examination. Due to the transparency of the meniscus to X-rays, fluoroscopy is ineffective. Helps establish a diagnosis endoscopic arthroscopy or magnetic resonance imaging .

Treatment of knee meniscus damage

To provide first aid for injuries of the knee joint and meniscus, apply fixing splint , pain relief is performed and the patient is transported to a trauma hospital.

If necessary, blood is removed from the knee joint and conservative treatment. A plaster cast is applied for 4 weeks, after removal - rehabilitation therapy.

If conservative treatment is ineffective, MRI is recommended ( magnetic resonance imaging ). If necessary, arthroscopy of the knee joint is performed. This is a low-traumatic method of surgical intervention, which has become an integral part in the modern diagnosis and treatment of many forms of intra-articular pathologies; this method of treatment is currently considered the “gold standard”.

This diagnosis of meniscal injuries is also simultaneous therapy. Arthroscopy- this is an examination of the joint cavity using a special optical device, during which, if possible, the damaged meniscus is sutured. If suturing is impossible, as well as when the damage is localized in the extravascular part, complete or partial removal of the meniscus is performed. Meniscus removal or meniscectomy, most often, in 80% of cases, is possible during arthroscopy; in other cases, the surgeon is forced to resort to arthrotomy, i.e. open surgery.

In the absence of the ability to perform arthroscopy, it is performed puncture of the knee joint, at which the solution is introduced. Then, using special techniques, the pinched meniscus is reduced, while the patient must be in a lying position on an orthopedic table. The trauma surgeon must perform movements that are opposite to those movements that led to the injury. As soon as the meniscus is in place, all movements in the joint are immediately restored. Once the meniscus is repaired, treatment does not end. To fix the leg, a plaster cast is applied, and the injured leg is bent at a certain angle at the knee joint.

The period of immobilization, after treatment of the meniscus injury and application of plaster, is 3 weeks. After removing the plaster cast, physical therapy . In cases where the patient experiences repeated blockages of the joint, this condition is called chronic meniscus damage. With chronic damage to the meniscus, inflammation of the inner lining of the joint usually occurs, called constant aching pain in the joint, which intensifies when walking, and especially when going down stairs. It is possible to develop a concomitant disease that damages the knee joint, such as dissecting articular surfaces or. This condition almost always leads to frequent blockade of the joint. There is a need to remove " articular muscle » surgically. After the operation, a tight bandage or plaster cast is applied to the leg. An important condition for recovery is early exercise.

Doctors

Medicines

Prevention of meniscus damage

To prevent meniscus damage in everyday life, it is recommended to be careful when running, walking, going up and down stairs. Women are advised to wear more stable shoes. Athletes are recommended to use special fixing bandages when playing sports ( knee pads ), if it is not possible to use them, you can bandage the knee joints for insurance elastic bandage . Prevention of meniscus damage makes it possible to avoid injury in 9 out of 10 cases.

Complications of meniscal injuries

If complications occur, it may develop deforming arthrosis, premature wear of intra-articular cartilage or blockade of the knee joint. Sudden pain when moving. Treatment may require surgery.

Diet, nutrition for meniscus damage

List of sources

• Traumatology and orthopedics / Guide for doctors. In 3 volumes. v.2/ Ed. SOUTH. Shaposhnikova. - M.: Medicine, 1997. -592 p.
• Comprehensive rehabilitation of athletes after injuries of the musculoskeletal system, Bashkirov V.F. – Moscow: Physical culture and sport, 2004, - 240 p.
• Sports injuries. Clinical practice of prevention and treatment / ed. ed. Renström P.A.F.H. - Kyiv, “Olympic Literature”, 2003.

Education: Graduated from Vitebsk State Medical University with a degree in Surgery. At the university he headed the Council of the Student Scientific Society. Advanced training in 2010 - in the specialty "Oncology" and in 2011 - in the specialty "Mammology, visual forms of oncology".

Experience: Worked in a general medical network for 3 years as a surgeon (Vitebsk Emergency Hospital, Liozno Central District Hospital) and part-time as a district oncologist and traumatologist. Work as a pharmaceutical representative for a year at the Rubicon company.

Presented 3 rationalization proposals on the topic “Optimization of antibiotic therapy depending on the species composition of microflora”, 2 works took prizes in the republican competition-review of student scientific works (categories 1 and 3).