The knee joint has a rather complex structure. It consists of the femur and tibia, the patella (kneecap), and a system of ligaments that provides stability to the bones of the joint. Another part of the knee joint is the menisci - cartilage layers between the femur and tibia. When moving, a large load is placed on the knee, which leads to frequent injury to its elements. A tear of the posterior horn of the medial meniscus is one such injury.

Injuries to the knee joint are dangerous, painful and fraught with consequences. A rupture of the posterior horn of the meniscus, which can occur in almost any active person, is the most common and dangerous injury. It is dangerous primarily due to complications, and therefore requires timely detection and treatment.

What is meniscus

Menisci are very important structural units of the knee joint. They are curved strips of fibrous cartilage that sit between the bones of a joint. The shape resembles a crescent with elongated edges. It is customary to divide them into zones: the body of the meniscus (middle part); the elongated end parts are the posterior and anterior horns of the meniscus.

There are two menisci in the knee joint: medial (inner) and lateral (outer). Their ends are attached to the tibia. The medial one is located in the inner part of the knee and is connected to the internal collateral ligament. In addition, along the outer edge it is connected to the capsule of the knee joint, through which partial blood circulation is ensured.

The cartilaginous portion of the meniscus adjacent to the capsule contains a significant number of capillaries and is supplied with blood. This part of the medial meniscus is called the red zone. The middle region (intermediate zone) contains a small number of vessels and is very poorly supplied with blood. Finally, the inner region (white zone) has no circulatory system at all. The lateral meniscus is located on the outer area of ​​the knee. It is more mobile than the medial one, and its damage occurs much less frequently.

Menisci perform very important functions. First of all, they act as shock absorbers during joint movement. In addition, the menisci stabilize the position of the entire knee in space. Finally, they contain receptors that send operational information to the cerebral cortex about the behavior of the entire leg.

When the internal meniscus is removed, the contact area of ​​the knee bones is reduced by 50-70%, and the load on the ligaments increases by more than 100%. In the absence of an external meniscus, the contact area will decrease by 40-50%, but the load will increase by more than 200%.

Meniscus injuries

One of the characteristic injuries to the menisci is their rupture. Research shows that such injuries can occur not only in people involved in sports, dancing or heavy work, but also in accidental activities, as well as in older people. It has been found that meniscus tears occur in an average of 70 out of every 100,000 people. At a young age (up to 30 years), the damage is acute; With increasing age (over 40 years), the chronic form begins to predominate.

A torn meniscus can be caused by excessive lateral load combined with twisting of the tibia. Such loads are typical when performing certain movements (running over rough terrain, jumping on uneven surfaces, spinning on one leg, squatting for long periods of time). In addition, ruptures can be caused by joint diseases, tissue aging, or pathological abnormalities. The cause of damage can be a sharp, strong blow to the knee area or rapid extension of the leg. Based on the nature and location of the damage, several types of ruptures can be distinguished:

• longitudinal (vertical);
• oblique (patchwork);
• transverse (radial);
• horizontal;
• rupture of the anterior horn of the lateral or medial meniscus;
• rupture of the posterior horn of the meniscus;
• degenerative rupture.

Degenerative rupture is associated with changes in tissue due to disease or aging.

Symptoms of meniscus damage

When the meniscus of the knee joint is damaged, there are two characteristic periods - acute and chronic. The acute period lasts 4-5 weeks and is characterized by a number of painful symptoms. The moment of damage to the meniscus is usually determined by a sound resembling a cracking sound and sharp pain in the knee area. In the first period after the injury, a cracking sound and pain accompanies a person during exertion (for example, moving up the stairs). Swelling develops in the knee area. Often a meniscus tear is accompanied by hemorrhage into the joint.

During the acute period, movement of the leg in the knee joint in a person is limited or completely impossible. Due to the accumulation of fluid in the knee area, a “floating patella” effect can occur.

The chronic period of a meniscus tear is less painful. Attacks of pain occur only with sudden movements of the leg or increased stress. During this period, it is quite difficult to determine the fact of a meniscus tear. To diagnose injury, methods have been developed that rely on characteristic symptoms.

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Baikov's symptom is based on identifying pain when pressing with fingers on the outer side of the knee while simultaneously extending the lower leg. Landa's symptom determines the injury by the degree of straightening of the leg at the knee joint when the leg lies freely on the surface (in case of injury, the palm of the hand is placed between the surface and the knee). Turner's symptom takes into account increased sensitivity of the skin on the inner surface of the knee joint and the upper part of the lower leg on the inside. The symptom of blockade is a gap in the jamming of the knee joint when a person moves up the stairs. This symptom is characteristic of a rupture of the posterior horn of the internal meniscus.

Characteristic symptoms of a medial meniscus tear

A tear of the medial meniscus of the knee joint has a number of characteristic symptoms. Injury to the internal posterior horn of the meniscus causes intense pain on the inside of the knee. When you press with a finger in the area where the horn of the meniscus attaches to the knee ligament, a sharp pain appears. A rupture of the posterior horn causes blockage of movement in the knee joint.

The gap can be determined by performing flexion movements. It manifests itself in the form of sharp pain when straightening the leg and turning the lower leg outward. Pain also occurs when the leg is strongly bent at the knee. According to the severity of damage to the meniscus of the knee joint, they are divided into minor, moderate and severe. Small tears (partial), including the horns of the meniscus, are characterized by pain and slight swelling in the knee area. Such signs of injury cease to appear after 3-4 weeks.

With moderate severity of injury, all the considered symptoms of the acute period appear, but they are limited in nature and appear during physical activity, such as jumping, moving up inclined planes, and squatting. Without treatment, this form of injury becomes chronic. This degree is typical for some tears of the anterior and posterior horn of the medial meniscus.

With severe injury, pain and swelling of the knee become obvious; hemorrhage occurs into the joint cavity. The horn is completely torn off from the meniscus, and its parts end up inside the joints, which causes a blockage of movement. Independent movement of a person becomes difficult. Severe injury requires surgery.

Read also: Proper rehabilitation for a fractured patella

Mechanism of posterior horn rupture

A very dangerous longitudinal tear (complete or partial), as a rule, begins to develop from the posterior horn of the medial meniscus. With a complete rupture, the separated part of the meniscal horn can migrate into the cavity between the joints and block their movement.

Oblique tears often develop at the border between the middle of the meniscus body and the beginning of the posterior horn of the internal meniscus. This is usually a partial tear, but the edge may be embedded between the joints. This produces a sound similar to a cracking sound and painful sensations (rolling pain).

Often, a rupture of the posterior horn of the internal meniscus is of a combined nature, combining different types of damage. Such ruptures develop simultaneously in several directions and planes. They are characteristic of a degenerative mechanism of injury.

A horizontal tear of the posterior horn of the medial meniscus originates from its inner surface and develops in the direction of the capsule. Such damage causes swelling in the area of ​​the joint space (the pathology is also characteristic of the anterior horn of the lateral meniscus).

Conservative treatment methods

Treatment for a tear of the posterior horn of the medial meniscus (similarly to the anterior horn of the medial meniscus) depends on the site of injury and its severity. Based on this, the method is determined - conservative or surgical treatment.

The conservative (therapeutic) method is applicable for small and moderate ruptures. This treatment is based on a number of therapeutic measures and is often effective.

The first step is to provide assistance in case of injury. To do this, it is necessary to provide the victim with peace; apply a cold compress to the inside of the knee; administer an anesthetic injection; apply a plaster bandage. If necessary, fluid should be punctured.

Typically, the conservative method involves long-term treatment for 6-12 months. First, the knee joint is reduced (repositioned) if there is a blockade. Manual methods can be used to remove the blockade. For the first 3 weeks, rest should be ensured, and the knee joint should be immobilized using a plaster splint.

When cartilage is damaged, it is necessary to restore and fuse it. For this purpose, a course of taking chondroprotectors and hyaluronic acid is prescribed. The use of drugs containing chondroitin and glucosamine is recommended as protectors. Painful symptoms and inflammatory processes must be eliminated by taking non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, indomethacin) and others.

To eliminate swelling and accelerate healing, external agents in the form of ointments (amzan, voltaren, dollit and others) are used. The treatment process includes a course of physiotherapy and special therapeutic exercises. Therapeutic massage gives a good effect.

Surgical treatment

In severe cases of damage, surgical intervention becomes necessary. In case of crushing of the cartilage, severe rupture and displacement of the meniscus, or complete rupture of the anterior or posterior horns of the meniscus, surgery is necessary. Surgical treatment is divided into several types: removal of the meniscus or torn horn; recovery; suturing the tear site; fastening detached horns using clamps; meniscus transplantation.

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

Anatomical structure

The origin of various injuries in this particular area of ​​the leg is explained by its complex anatomical structure. The structure of the knee joint includes the bone structures of the femur and tibia, as well as the patella, a conglomerate of muscular and ligamentous apparatus, and two protective cartilages (menisci):

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

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

The meniscus is a cartilaginous body that is found in the intersecting bony structures of the knee. It ensures unhindered flexion-extension manipulations of the leg. It is structured by a body and an anterior and posterior horn.

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

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

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

Functional Features

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

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

The functional purposes of the menisci are different:

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

Forms of discontinuities

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

In modern traumatology, there are several types of ruptures:

1. Longitudinal.
2. Degenerative.
3. Oblique.
4. Transverse.
5. Rupture of the anterior horn.
6. Horizontal.
7. Lacerations of the posterior horn.

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

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

It happens:

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

A combined rupture is characterized by:

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

Signs of ruptures

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

The main symptoms include:

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

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

Causes and mechanisms

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

Injury occurs due to:

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

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

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

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

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

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

Diagnostics

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

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

1. X-ray, which is used when there are visible signs of rupture. It is considered not particularly effective and is used to exclude concomitant bone fractures.
2. Ultrasound diagnostics, the effect of which directly depends on the qualifications of the traumatologist.
3. MRI and CT, considered the most reliable way to determine a rupture.

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

Treatment tactics

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

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

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

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

Operation

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

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

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

Rehabilitation

The importance of the recovery period, compliance with all doctor’s instructions, and its correct implementation is difficult to overestimate, since the return of all functions, painless movements and complete recovery of the joint without chronic consequences directly depends on its effectiveness.

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

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

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

Consequences of injury

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

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

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

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

Content

You've probably heard a car being compared to a human body. The engine is called the heart, the fuel tank is the stomach, the engine is the brain. True, the anatomy of the “organisms” is similar. Is there a homosapien equivalent of shock absorbers? A whole bunch! For example, menisci. However, if for the car to drive well, this device, necessary for damping vibrations and “absorbing” shocks, needs to be changed every 70 thousand km traveled, then what kind of work does damage to the meniscus require?

What is the meniscus of the knee

The meniscus is a semilunar-shaped cartilage pad necessary for the joint to soften impacts and reduce stress. This protective layer of connective tissue is found in the right and left knee joints. Consists of a body and two horns, front and rear (see photo). The specific structure allows this “shock absorber” to compress and move in different directions when the knees move.

There are two types:

• lateral (outer) – the most mobile and widest of them;
• medial (internal) – a more “lazy” organ, because firmly attached to the joint capsule. It works in conjunction with the lateral ligament of the knee joint, so that they are injured together.

What is a knee meniscal tear?

If you experience acute pain in the bend of your leg, know that most likely the cause is the meniscus. In young people, injuries are associated with active sports and are accompanied by rotation of the tibia, when the cartilaginous disc does not have time to “escape” from compression by the condyles. Extreme damage - rupture - occurs while playing hockey, football, tennis, or skiing. “Elderly” menisci suffer due to degenerative changes in cartilage tissue, against the background of which very minor damage can lead to serious injury.

Degree of damage according to Stoller

An experienced traumatologist diagnoses a meniscus tear in 95% of cases based on just one symptom. The indicators are high, however, and the doctor may not be entirely experienced, and the patient may fall into the category of those 5%. So, to be on the safe side, doctors resort to additional studies, the most informative being an MRI. After it is carried out, the patient is given one of four degrees of damage according to the classification invented by sports doctor Stephen Stoller, a famous American orthopedist from New Jersey.

Classification according to Stoller:

• counting is carried out from zero degree - this is the norm, indicating that the meniscus is unchanged;
• first, second degrees - borderline lesions;
• the third degree is a true break.

Symptoms of a knee meniscus tear

If there is a rupture of the internal meniscus of the knee joint, then the symptoms include one or more signs:

• constant pain in the joint area;
• pain only during physical activity;
• instability in the injured area;
• crunching or clicking when bending the leg;
• the knee is noticeably increased in size due to swelling of the joints.

Degenerative changes

Symptoms of a degenerative or chronic meniscus tear increase as the cartilage tissue thins. The pain is intermittent and sometimes subsides completely. The injury most often occurs in elderly patients, but also occurs in young people with severe physical activity, excess weight, flat feet, rheumatism, tuberculosis or syphilis.

After a meniscus injury

Signs of damage to the cartilage layer that occur after a knee joint injury are similar to the symptoms of other pathologies, so consult a doctor without wasting time. If you ignore poor health, the symptoms may disappear in a week, but this is a false pause. Trauma will remind you of itself! With a severe tear, part of the meniscus can become trapped in the joint space, after which the knee begins to rotate to the side or does not bend at all.

Treatment without surgery

Therapy is chosen depending on the patient’s age, type of occupation, lifestyle, specific diagnosis and localization of the pathological process. Only a doctor will determine whether you have meniscitis of the knee joint (popularly “meniscosis”), a horizontal rupture of the posterior horn of the medial meniscus with displacement, a milder injury to the posterior horn of the medial meniscus, or a combined injury.

Conservative

If the damage to the meniscus is simple, it has been torn or partially ruptured, treatment can and should be done without surgery. Therapy methods:

1. The main treatment is reduction, which is done only by a “cool” surgeon, or hardware traction of the joint.
2. Symptomatic treatment – ​​elimination of swelling, pain relief.
3. Rehabilitation, which includes physiotherapy, massage and exercise therapy.
4. Restoring cartilage tissue is a long process, but mandatory for the prevention of arthrosis.
5. Fixation of the knee joint with a knee pad or plaster. Immobilization is needed for a period of 3-4 weeks.

Folk remedies

How to treat the knee meniscus if a surgeon or orthopedist (or even just a local therapist) is currently out of reach for you? Folk remedies. Key words: “at the moment”! Inflammation or cyst of the meniscus of the knee joint responds well to this therapy. But even in this case, if you don’t want to find yourself in a wheelchair, go to the doctor as soon as possible. Be attentive to your knee, it will be useful to you? Unpleasant consequences are very real. In the meantime, jot down these “green” recipes:

• Bile wrap

Buy a bottle (available in 100 and 200 ml) of medical bile at the pharmacy. 2 tbsp. Heat spoons of this unpleasant-looking liquid in a water bath, then smear it on the sore knee, wrapping it with a bandage and a warm scarf. Leave for a couple of hours. Carry out the procedure in the morning and evening.

• Honey tincture compress

Stir 1 tbsp. spoon of 95% medical alcohol and liquid honey. Melt the resulting “mead” in a water bath, cool so as not to get burned, and apply the mixture to your knee. On top there is polyethylene, on it there is a wool scarf. Carry out the procedure daily.

• Onion mixture

An excellent remedy for meniscus repair. To prepare it, grate two medium onions and add a tablespoon of sugar. Wrap the resulting paste in “dough” and apply it to your knee. Secure the top with film and a woolen scarf.

Indications for surgery:

• serious damage to the meniscus;
• crushing of cartilage tissue;
• damage to the horns of the meniscus;
• rupture of the posterior horn of the medial meniscus;
• damage to the internal meniscus of the knee joint;
• cyst of the knee joint, in case of ineffective conservative therapy or an old problem.

The price depends on the severity of the damage and the complexity of the surgical intervention. The cost can be 25 thousand rubles or 8 thousand euros. Knee replacement for Russian citizens in our country is carried out under the compulsory medical insurance policy.

Types of operation:

1. Restoring the integrity of the meniscus.
2. Removal of the meniscus, partial or complete.
3. Tissue transplantation – in case it is significantly damaged.
4. Meniscus suturing is performed for fresh injuries of the knee joint.

Video: how to treat knee meniscus

In the video below, the famous Russian orthopedic traumatologist, Candidate of Medical Sciences Yuri Glazkov will show what the knee joint looks like and talk about how any meniscal disease can be cured. And in this video you will see the process of the operation. Take a close look if you are undergoing surgery to understand how your treatment will proceed.

Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

A tear of the medial meniscus of the knee joint is a pathology that is common among professional athletes and ordinary people. Depending on the causes of occurrence, two types are distinguished: traumatic and degenerative.

In the absence of proper therapy, chronic damage to the medial meniscus of the knee joint transforms into an advanced form. This leads to irreversible degenerative changes in the joint.

The medial meniscus is C-shaped and consists of three parts. The gaps vary in location and relate to:

• posterior horn of the medial meniscus;
• middle part (body);
• anterior horn.

There is a classification based on the trajectory of the injury:

• longitudinal;
• transverse (radial);
• oblique;
• patchwork;
• horizontal tears of the posterior horn of the medial meniscus.

The inner cartilaginous layer is attached to the tibia from the back and to the articular capsule of the knee from the outside.

Note. Having two connection points, the medial meniscus is less mobile. This explains the high susceptibility to injury.

Characteristic signs of an internal meniscus tear

reading information

Damage to the medial meniscus most often occurs during physical exercise: running on terrain, spinning on one leg, sudden lunges and other situations.

Depending on the clinical manifestations, acute and chronic tears of the medial meniscus are distinguished. A distinctive feature of the first form is intense pain of a sudden nature, localized along the line of the joint fissure, where damage to the cartilaginous layer presumably occurred.

A torn meniscus of the knee is the most common injury among internal knee injuries.

Other typical symptoms of a medial meniscus tear in the knee include:

• severe limitation of motor ability (if the torn area blocks the movement of the joint);
• hemarthrosis (bleeding into the joint cavity);
• edema.

Note: When the knee is bent, a person does not always feel intense pain. It appears more often when trying to straighten the leg. This is a hallmark sign of injury to the inner part of the intercartilaginous spacer.

Surgery

Surgical procedures are performed arthroscopically or arthrotomically. The main task is to partially or completely remove the medial meniscus. Indications for surgery are:

• intense pain;
• significant horizontal tear of the medial meniscus;
• effusion (fluid accumulation in the knee joint);
• clicking sound when extending the knee;
• joint blockade.

When stitching, long surgical needles are used with ligatures fixed on them (absorbable or non-absorbable suture material). Techniques used to fix the meniscus are:

• sewing from inside to outside;
• seams from outside to inside;
• inside the joint;
• medial meniscus transplantation.

Note: Before choosing a specific technique, the doctor must consider the factors that bring benefit and harm to the patient.

Reconstructive technique

Reconstructive operations have lower statistics of negative outcomes compared to traditional methods of surgical intervention. They are also performed arthrotomically or arthroscopically. The main goal of such manipulations is to eliminate damage to the posterior horn and ensure fixation of the medial meniscus on the surface of the articular capsule.

For this purpose, absorbable and non-absorbable surgical devices (arrows, buttons and others) are used. Before fixation, preliminary treatment of the injured edges is required - excision of tissue to the capillary mesh. Then the prepared edges are combined and secured.

A medial meniscus tear must be detected early and treated promptly. The consequence of not seeing a doctor in a timely manner is disability.

A torn meniscus is one of the most common internal knee injuries. Professional athletes are often susceptible to it, but it is possible that this disorder may occur in people who are not associated with constant overstrain of the lower extremities. There are two types of meniscus: external (lateral) and internal (medial). Often this disease is diagnosed in people between the ages of eighteen and forty. The disorder is rare in children under fourteen years of age. A tear of the medial meniscus of the knee joint is more common than the outer meniscus. It is very rare for two menisci to tear at the same time.

The main reasons for the progression of this disorder are too sharp bending of the shin or a direct blow to the knee. Signs indicating damage are considered to be the occurrence of severe pain, significant limitation of joint movements of the damaged limb, swelling compared to the healthy leg. In the chronic form of the disease, the main symptoms such as moderate pain, repeated joint blockades, and effusion are expressed.

Diagnosis is carried out through examination by a specialist and palpation, instrumental examinations, in particular MRI of the joint, to indicate the localization of the disorder in the lateral or medial meniscus.

Treatment consists of ensuring complete rest of the injured limb, taking anti-inflammatory medications, physiotherapy and exercise therapy. If this therapy is not effective, an operation is performed to stitch the meniscus using sutures and special structures, as well as its complete or partial removal. During the period of restoration of limb mobility, after surgery, rehabilitation procedures of physiotherapy and therapeutic massage are prescribed.

Etiology

The most common cause of a meniscus tear is an injury in which the tibia is sharply rotated inward, in which case the lateral meniscus is damaged, or outwardly, the medial meniscus is torn. Other predisposing factors are:

• excessive bending of the knee under the influence of gravity;
• sharp abduction of the lower leg;
• and – the main causes of degenerative rupture, in which the formation of cysts is observed;
• secondary injuries, bruises or sprains;
• prolonged twisting on one leg;
• running on uneven surfaces;
• congenital abnormality of functioning in the form of weakness of joints and ligaments;
• inflammation in the knee of a chronic nature.

Varieties

As mentioned above, menisci are divided into:

• medial – located between the tibia and the articular capsule;
• lateral - consisting of an anterior and posterior horn, which connect it to the cruciate ligament. The external meniscus is injured several times less frequently than the internal one.

Depending on the type and location of the damage, a meniscus tear of the knee joint is divided into:

• longitudinal vertical;
• patchwork bias;
• horizontal;
• radial-transverse;
• with damage to the anterior or posterior horn;
• degenerative. The reasons for its occurrence are repeated injuries and aging processes in the body. Treatment is possible only through surgery.

In addition, damage to the meniscus can be complete or partial, with or without displacement. Rupture of the posterior horn of the medial meniscus is more common than the anterior horn. If the disease is chronic or not treated in a timely manner, damage to the cartilage and anterior cruciate ligament may occur. The recovery period will be much longer than with the acute form of the disease.

Symptoms

The symptoms are most pronounced in the acute course of the disease. This form lasts for about a month. Characterized by the sudden appearance of such symptoms as:

• unbearable pain;
• swelling of the affected area;
• significant limitation of joint mobility;
• the appearance of a crunching sound during squats indicates that a person has a rupture of the posterior horn of the medial meniscus;
• bleeding into the joint - often this symptom is accompanied by a tear of the medial meniscus.

With an old form of rupture, the disease occurs with less pain. Significant pain occurs only when performing physical activity. Often there is a complete inability to perform independent movements. This is considered severe and surgery is prescribed to eliminate it. This nature of the disease is also distinguished by the fact that it is quite difficult to diagnose the rupture, which makes it difficult to begin any treatment (the symptoms of a meniscus tear are somewhat similar to the signs of other pathologies of the musculoskeletal system).

Complications

The lack of adequate therapy or complete elimination of the meniscus entails several unpleasant consequences:

• – as the disease progresses, the cartilage is completely erased;
• limitation of passive joint movements;
• complete immobility of the joint - for this reason the person completely loses motor function.

Such consequences can cause disability.

Diagnostics

The diagnosis of a meniscus tear is established based on the patient’s complaints, the degree of manifestation of symptoms, and examination by a specialist of the damaged area of ​​the limb. In addition, it is necessary to inform the doctor about the possible causes of the disease. To confirm this particular disease, instrumental examinations are carried out:

• radiography with contrast;
• Ultrasound – makes it possible to detect degenerative processes, tears of the anterior or posterior horn of the medial meniscus, assess joint mobility and the degree of meniscus tear;
• MRI is the most informative method for diagnosing a meniscus tear of the knee joint. Makes it possible to detect this disorder by the shape of the damaged meniscus, as well as the location of the disease - the lateral or medial meniscus;
• arthroscopy - allows you to determine the cause of the disease. It can be used not only as a diagnostic method, but also used for treatment.

During diagnostic measures, a specialist needs to differentiate this disease from other disorders that have symptoms similar to a meniscus tear. Such ailments include cruciate ligament rupture, reflex contracture, osteochondritis dissecans, and fractures of the tibia condyles.

Treatment

If the first signs of a meniscus tear occur, you should immediately contact a medical facility or call an ambulance. While waiting for the doctors to arrive, you need to provide first aid to the victim - ensure complete immobilization of the affected limb, apply ice to the knee, but for no more than thirty minutes. If the pain does not decrease, give an anesthetic. In most cases, patients consult a doctor with significant damage to the meniscus and the presence of consequences, which is why not only treatment, but also rehabilitation will take a lot of time.

The choice of treatment method largely depends on the diagnostic results. There are several treatment methods:

• conservative;
• surgical operation.

The basis for the conservative elimination of the disease is physiotherapy, during which the human body is exposed to an ultra-high frequency electric field. Therapeutic exercise has no less positive effect and can be carried out using special equipment. General strengthening exercises affect all muscle groups. In addition, the complex treatment includes a course of massage aimed at improving blood supply, eliminating swelling and pain. As the mobility of the injured limb stabilizes, the intensity of the massage is increased. If the joint and cartilage are damaged, the doctor prescribes the use of chondroprotectors necessary for tissue restoration. With proper and timely treatment, as well as in the absence of consequences of the disease, the period of rehabilitation and complete recovery is several months.

Medical intervention is sought only when other methods of therapy have not given the expected effect, as well as in the case of an old course of the disease. Depending on the patient’s age group, the presence of consequences, location and nature of the course, one of the following operations is prescribed:

• meniscectomy – complete or partial removal of a damaged meniscus. Such intervention is necessary if there is significant destruction of cartilage, degeneration or consequences of the disease;
• meniscus restoration – an operation to preserve the structure and functionality of the meniscus;
• Arthroscopy is the safest method of medical intervention for the patient. To treat the disorder, diagnostic arthroscopy and suturing of cartilage tissue are performed. This technique is not used to repair a tear in the posterior horn of the medial meniscus;
• transplantation – applicable when cartilage is completely destroyed or other methods are ineffective;
• internal fastening of the meniscus - due to the fact that this method does not involve making an incision, but is carried out using special clamps, the rehabilitation period is significantly reduced.

Approximately a few days after any type of surgery, the patient is prescribed a course of physical therapy. The period of rehabilitation to restore the mobility of the knee joint is carried out under the full supervision of specialists. The main techniques used after surgery are exercise therapy and massage.

There is often a favorable prognosis for a rupture of the lateral or medial meniscus, provided timely treatment and no consequences. The pain completely disappears, but sometimes there may be unsteadiness of gait, slight lameness and painful spasms when putting stress on the leg.