Article publication date: 01/20/2013

Article updated date: 12/01/2018

Today medical terms" " or "ruptured Achilles tendon" are repeated in the sports section of football news as often as penalties and goals. Of course, football is a contact game, and without injuries lower limbs cannot be avoided, and during matches the risk of injury is much higher than in training.

And the cause of the injuries is obvious: high speeds, rapid changes in direction of movement and sharp impacts. To reduce the risk of injury, to play without pain, fatigue, and just to play comfortably, properly selected shoes, knee bandaging and accurate calculation of your strength help.

The human knee joint is the most complex in its structure, and for us the most important. Knees experience enormous stress throughout life. But a person, and an athlete in particular, demands from his knee joint sometimes impossible. Here is the desire to be first, and big money, and exorbitant workloads.

So, let's take a closer look at the problem.

The photo on the left shows a healthy knee joint. On the right - meniscus damage

Causes of meniscus problems

In the cavity of the knee joint there are two cartilaginous formations - the menisci of the knee. Their main purpose is shock absorption during movement and protection of articular cartilage. They limit excess mobility and reduce friction in the knee joint.

Causes of rupture or tear of the meniscus: a sharp glancing blow to the knee with a heavy object, a fall on the edge of a step kneecap or injury accompanied by a sharp rotation of the tibia outward or inward.

Repeated injuries or bruises lead to chronic meniscopathy, and subsequently to meniscal rupture. As a result of chronic microtrauma, gout, rheumatism, and general intoxication of the body develop. During an injury, the meniscus ruptures and ceases to fulfill its main purpose, becoming almost a foreign body for the body. And this body will slowly destroy the articular surface. An untreated injury turns into deforming arthrosis, and the person often becomes disabled.

Football players and athletes are more susceptible to this disease game types sports, people spending most of their working time on their feet.

It happens that the meniscus can also be damaged as a result of a combined injury when a fall falls on the knee. swipe and the lower leg turns sharply inward or outward.

For injuries, immediately apply ice (or something cold)

Symptoms of damage

Often at the initial stage there is a disease such as meniscus of the knee joint - the symptoms are similar in manifestation to other joints. Only after 2-3 weeks, when the reactive phenomena subside, can we speak specifically about a meniscus tear.

• Sharp pain of diffuse nature, after some time it is located on the inner or outer surface of the knee.
• Difficulty going up and down stairs.
• Trophic muscle tissue decreases sharply.
• When the joint is bent, a characteristic click occurs.
• The joint is increased in volume. With this symptom, treatment begins immediately.
• Pain when playing sports.
• Increased temperature in the joint area.

Symptoms of injury are often nonspecific, but the same symptoms may occur with severe bruises, sprains, arthrosis, so the doctor requires a thorough examination of the patient.

Depending on the injury, the meniscus may tear away from the capsule, tear transversely or longitudinally, and may be compressed. The outer meniscus is quite mobile, so it is more often compressed, and tears occur in the meniscus fixed in the cavity of the knee joint.

Naturally, if the knee joint is damaged, your movements are severely constrained.

Meniscus treatment

As a result of injury, the meniscus can tear or rupture completely. Depending on the severity of the condition, the patient’s age and his vital activity, the doctor chooses a method of treating the knee meniscus: conservative or surgical.

But first aid, regardless of the severity of the injury, the victim is given immediate complete rest, cold compress and applying an elastic bandage to the knee joint area. To prevent or relieve swelling, the patient's leg is placed slightly above chest level.

The doctor at the clinic recommends that the patient take an X-ray to make sure the bones are intact. And to exclude the presence of internal damage, an ultrasound is performed. When diagnosing meniscal injuries, computed tomography and magnetic resonance imaging play a special role. But the full picture of the damage can be seen by arthroscopy of the knee joint.

If only the meniscus has been displaced, then an experienced traumatologist will be able to quickly deal with the problem. Then a cast is applied for about three weeks, after which rehabilitation therapy is prescribed.

Traditional treatment of the disease includes non-steroidal painkillers: Meloxicam, Ibuprofen, Diclofenac.

Recovery cartilage tissue, which improve metabolism in the repair tissue and intra-articular fluid - these are Glucosamine, Chondroitin sulfate. Biologically active additive Collagen ultra prevents inflammatory processes and participates in the restoration of cartilage, increases its water-retaining properties.

Drug treatment

To rub the joint, use ointments Alezan, Ketoral, Dolgit, Voltaren, and Toad Stone balm.

For limited mobility and pain, the drug Ostenil is injected into the joint capsule. Improvement occurs after the first injection. A course of treatment requires at least five ampoules.

If possible, you can use bee stings or Tentorium cream, which contains bee venom.

Physiotherapy

For full recovery knee joint the patient is prescribed physiotherapy with an exercise therapy instructor, a course of physiotherapy and massage.

Myostimulation relaxes and strengthens the thigh muscles. Laser therapy and magnetic therapy improve microcirculation and metabolic processes in muscle cells.

Physiotherapy is one of the components of complex treatment

And at home you can do exercises:

• Place a small rubber ball under your knee, bend your knee, squeezing the ball and straighten your knee without dropping the ball.
• Walking on all fours, enduring slight pain.

Traditional methods

• A compress of honey and alcohol in a 1:1 ratio is applied to the joint for two hours and secured elastic bandage and covers himself with a warm scarf.
• A compress of grated onion and a spoon of sugar can be applied overnight, after wrapping it in cling film and a warm scarf.
• Apply a compress of medical bile for ten days.
• Malakhov recommends making compresses from children's urine, which relieves swelling well.
• A compress of burdock leaves is kept on the knee for up to 8 hours.

All traditional methods, as well as physical exercise- you can use it at home.

If everything has been tried conservative methods treatment, but there is no improvement, then we have to talk about surgical intervention.

Operation?

If you have knee meniscus pain, is surgery really necessary?

Indications for surgical intervention is:

• Meniscus crush.
• Meniscus tear and displacement.
• Hemorrhage into the joint cavity.
• Complete separation of the horns and body of the meniscus.

There is insufficient blood circulation in the area of ​​the meniscus body, so a rupture of the meniscus body very rarely heals, so in this case the patient will have to undergo complete or partial resection of the meniscus.

Arthroscopy is performed not only to diagnose the condition of the joint, but also to treat meniscus of the knee joint.

The most common operations are suturing and removal of the meniscus; in exceptional cases, meniscus transplantation is performed, i.e. The damaged part is removed and replaced with a graft. Artificial or donor menisci take root well, but it takes 3-4 months to restore functionality.

Arthroscopy surgery has several advantages:

• Small incisions are made on the patient's skin, leaving no scars.
• The duration of the intervention is short, no more than two hours.
• No plaster cast.
• Fast postoperative rehabilitation.
• Shortened hospital stay
• The operation can be performed on an outpatient basis.

In young patients, even a torn meniscus can be saved. And after a month of sitting and bed rest we can start sports activities. Exercise bikes and swimming are best for this. With proper treatment, complete recovery occurs.

Professional athletes more often choose a drastic solution - surgery. To make the recovery process faster, you must strictly follow the doctor’s instructions and eat right.

Owner and responsible for the site and content: Afinogenov Alexey.

The knee joint has complex structure, its most important component is the meniscus. It performs the function of distributing the load, so it is most susceptible to traumatic injuries. What types of knee injuries can be identified? What are the features of diagnosis and treatment of such injuries?

Anatomy

Before considering the main injuries, the features of their diagnosis and treatment, you should familiarize yourself with the anatomy of the knee. The meniscus is a crescent-shaped cartilage, less often discoid. This is an important part of the knee joint, since these formations are responsible for shock absorption and load stabilization. Menisci slide along the surface tibia, which ensures optimal pressure distribution when moving. In total, there are two menisci in the knee joint, which are called medial and lateral. The meniscus itself consists of a body and horns - anterior and posterior. Injuries to the medial cartilage are more common, since it has low mobility due to its attachment with the internal meniscus. The lateral, unlike the medial, is very mobile and is less likely to be subject to traumatic effects.

Types of knee injuries

It is a very common injury and can be caused by many reasons. (the meniscus is damaged especially often), according to traumatology, they are more common in old age. What types of damage can be identified?

1. Violation of the attachment of the meniscus - its tearing. This phenomenon most often occurs in the area of ​​the anterior and posterior horn, less often in the body area, in the paracapsular zone.
2. Damage to the internal ligament, which is responsible for static medial meniscus. Its rupture makes the knee cartilage too mobile. This is a predisposing factor for the addition of additional injuries, which may result in more severe combined damage.
3. Rupture of the horns and body of the meniscus, which most often occurs in the transchordal region.
4. Cysts, which can be single-chamber or multi-chamber, as well as unilateral and bilateral. These formations have an oval or round shape.
5. Degenerative changes in the meniscus, which can occur due to chronic trauma, as well as due to abnormal structure or any systemic diseases. Most often, the fixed medial meniscus is susceptible to this, since the slightest traumatic movement can cause microtrauma (a person may not even notice it), followed by degenerative processes.

Etiology

The main cause of damage to the meniscus is injury, which can occur as a result of sudden extension of the joint, atypical rotational movements, as well as direct impact (impact, fall). The most dangerous is chronic traumatization, which is initial stages may not cause any discomfort, but may later cause degenerative changes. Some systemic diseases, such as gout, can also lead to them. chronic intoxication or rheumatism.

Symptoms

The acute period occurs immediately after damage to the knee joint. At this time, the patient is bothered by intense pain that limits the movements of the limb. In addition, blockade phenomena are possible - fixation of a limb in a certain position. The damage is accompanied by bleeding into the joint cavity, resulting in characteristic swelling in this area. Often, based on these symptoms, a diagnosis of “bruise” or “torn ligaments” is made. Conservative treatment temporarily alleviates the patient’s condition, but in the future the injury may make itself felt again.

Chronic period, which is the outcome acute lesion, characterized by renewed pain. This phenomenon may be caused by excessive load or sudden movement. The pain syndrome is not intense and occurs only when there is pressure on the joint. Movement is limited, and in some cases periodic blockades are possible. During this period, fluid accumulation in the cavity is possible, as well as muscle weakening.

Careful diagnosis and correct treatment. At the first signs you should consult a doctor.

Degree of meniscus damage

Breaks can be either complete or incomplete. The first ones are the most traumatic and dangerous; they require long-term treatment and recovery. The anterior horn or combined lesions of the horns are most often affected by changes. Also, all injuries can be divided into two groups - with and without displacement. Again, the former require longer rehabilitation.

Diagnostics

The diagnosis is made on the basis of complaints and data from special studies. Most often, patients report that bending the knee causes pain. In some cases, the pain syndrome bothers you even at rest. Soreness alone is not enough to draw up a treatment plan; a more thorough diagnosis is necessary. The collection of anamnesis is necessarily accompanied by obtaining data that allows identifying the Patient is asked whether there have been fractures, dislocations and other injuries of the lower extremity, and also identifies the presence of systemic diseases that can cause degenerative changes in the cartilage.

One of the methods is diagnostic test Epley, which is performed with the patient lying on his stomach. He is asked to bend his leg at the knee joint, the doctor at this time presses on the heel, and with the other hand makes gentle rotational movements of the lower leg and foot. Positive symptom is the occurrence pain.

The most accurate examination is an x-ray; it should be carried out if there is pain and discomfort, and also if More perfect method is an x-ray using a contrast agent that is injected into the cavity of the knee joint (contrast arthroradiography). This method allows you to track the slightest pathological changes meniscus and ligaments.

The first place in terms of information content is occupied by MRI (magnetic resonance imaging), which allows you to study the condition of the joint layer by layer.

Treatment

Diagnosis is followed by immediate treatment. What therapy is required for knee injuries? Meniscus - essential element knee joint, which acts as a shock absorber. If it is damaged, specialists, if possible, carry out conservative treatment, which occurs only with minor injuries.

It is necessary to reduce the load on the knee joint and provide it with relative rest, but complete immobilization is not recommended. Plaster application in the joint area is fraught with the formation of contracture, as a result there is a risk that the function of the knee will not be fully restored. Complete immobilization is required only if there is a fracture of the bones of the lower limb or rupture of ligaments (combined injury). In addition to these activities is drug therapy. At the very beginning of treatment, analgesics are often required to relieve pain. It is necessary to take chondroprotectors (glucosamine, chondroitin sulfate). These drugs accelerate the synthesis of cartilage tissue and also affect the intra-articular fluid.

More severe injuries require surgical treatment. Among the indications for it are:

• restriction of movement in the joint and clicking;
• severe pain syndrome;
• effusion in the joint cavity;
• significant meniscal tears;
• lack of effect from conservative treatment.

Adaptation

Complete restoration of the meniscus does not occur immediately. After therapeutic measures, it is recommended to perform physical exercises and light massage. This will reduce the duration of the adaptation period and eliminate the risk of contracture formation. Exercises should be performed regularly. The gymnastics complex should not contain sudden movements; exercises must be carried out slowly and smoothly. Also during this period it is required drinking plenty of fluids and taking multivitamins, which has a beneficial effect on the processes of cartilage tissue restoration.

Prevention

It is advisable to pay attention to preventive actions persons involved in sports. First of all, it is necessary to avoid sudden movements when running, squats and other exercises involving the knee joint. You should also pay attention to comfortable shoes, and when performing exercises, use fixing bandages on the knee joints. Such prevention will reduce the risk of injury several times.

Knee injuries (meniscus and other formations) require timely treatment. Early diagnosis will help avoid complications and limit conservative therapy. Therefore, at the first signs of damage, you should consult a doctor, even if you are only concerned slight discomfort. Modern methods They will help you create a correct picture of the disease and begin treatment in a timely manner.

Between articular surfaces The knee has two small glassy cartilaginous plates, gracefully curved in the shape of a crescent. They are called menisci. With these simple details, nature has ensured that the knee joint is adapted to complex rotational movements, loads and impacts. These little lenses are tireless workers, and their main job is to act as shock absorbers. In addition, the menisci maintain relative stability of the knee during serious injuries, for example, a ligament rupture. Just like muscles, menisci are connected to motor neurons in the central nervous system, which allows the brain to quickly assess the position of the knee and give it orders.

Despite the fact that the loss of one or even two menisci will not lead to the disappearance of the knee’s ability to move, normal long-term operation of the joint is impossible without these plates.

Very frequent injury all jumpers, runners, football players, as well as older people - this is a tear of the meniscus of the knee joint.

The meniscus consists of wavy collagen fibers intersecting in the circular and radial directions. The elasticity of its tissue is 50% greater than that of other cartilage.

Both pads are C-shaped, but the inner medial meniscus is more elongated.

Conventionally, we can distinguish in each lens a body and two horns (anterior and posterior), with which they are attached with the help of ligaments to the tibia. The medial meniscus is also additionally attached to articular capsule, which increases its rigidity and at the same time the risk of injury: most often, a rupture of the internal meniscus of the knee joint occurs.

Causes of meniscus tear

A meniscus tear or complete tear occurs due to mechanical and degenerative reasons.

Mechanical reasons

A mechanical tear of the meniscus can occur:

• during a sharp blow to the knee;
• jumping from a great height;
• when your foot hits an unexpected obstacle while running;
• knee rotation under axial load;
• fracture of the condyles and diaphysis of the tibia and femur;
• rupture of the anterior cruciate ligament, etc.

Mechanical damage occurs more often in youth.

Degenerative origins of meniscal tears

Meniscus - living tissue, penetrated by blood vessels. In infants, such a network covers the entire cartilage pad, but in an adult blood vessels concentrated mainly along the outer edge of the meniscus and occupy approximately a third of the entire plate. As we age, this life-giving red zone gradually shrinks. In the meniscus, as well as in the knee joint itself and periarticular tissues, the same degenerative processes occur, leading to the depletion of cartilage tissue. It is no longer an elastic plate and can collapse from heavy loads.

Another threat is an existing dystrophic degenerative joint disease (arthrosis), in late stage leading to complete destruction cartilage and cementation of all soft tissues.

Degenerative meniscal tears are more common in older people.

However, inflammatory processes such as rheumatism, rheumatoid, infectious, gouty arthritis also affects young people. They are accompanied by chronic synovitis, which leads over time to degeneration of the joint, its capsule and other soft tissues. The degenerative-dystrophic process does not bypass the cartilage pads of the knee.

What types of meniscal injuries are there?

Meniscus damage can be classified according to the extent and type of damage.

By degree:

• the appearance of a small internal hidden damage - 1st degree;
• enlargement of the source of damage, but it has not yet reached the surface - 2nd degree;
• tear - 3rd degree.

The extent of damage is determined using MRI by analyzing the intensity of the signals emitted by hydrogen nuclei in a magnetic field. A normal meniscus produces the weakest signal.

Types of breaks:

• longitudinal (I);
• horizontal (II);
• oblique (III);
• radial (IV).

A special form of rupture is in the form of a “watering can handle.”

Injuries can be either isolated or in combination with ligament rupture.

When the anterior cruciate ligament is injured, the stabilizing function of the internal medial meniscus is manifested: it holds the lower leg, preventing it from moving forward.

A torn anterior ligament usually initially pulls on the looser lateral meniscus, causing it to tear.

A tear to the inner cartilage pad can occur when the anterior cruciate ligament is completely torn.

Main signs of a meniscus tear

When a knee meniscus injury occurs, symptoms depend on the type, extent, and location of the injury:

1. With significant trauma, part of the meniscus can tear off, which interferes with walking, wearing away the cartilage of the joint, causing pain and clicking. If a piece of cartilage gets stuck between the contact surfaces, it can even lead to complete locking of the knee.
2. Pain from an injury can range from mild pain associated with walking up or down stairs to very intense pain that makes it impossible to put weight on your leg or make even the slightest movement.
3. Swelling during a rupture is greater, the more tissue is involved in the injury: a huge swollen knee indicates that most likely a simultaneous rupture of the meniscus and ligament occurred.
4. Hemarthrosis occurs if the outer edge of the meniscus, which enters the red zone of the blood supply, is torn.

Functional tests for meniscal damage

Symptoms of a meniscus tear, identified on the basis of an external examination and study of the patient’s pain, are confirmed using functional tests: the symptom of Fouche, Bragard, Shteiman, Payra, Epley, etc.

Fouche's sign

• The patient lies on his back with the affected leg bent to its maximum position.
• The attending physician holds the knee with one hand, and with the other rotates the foot in the outer and inner direction.
• In the position of extreme rotation, the doctor extends the knee joint to 90˚.
• A pain symptom when extending the knee, rotated to its extreme outer position, indicates an injury to the medial meniscus, and pain when turning the leg inward indicates an injury. lateral meniscus.
• Clicking in the joint maximum flexion the knee indicates a rupture of the posterior horn, and a click during 90˚ extension indicates a rupture of the middle part of the meniscus.

Using functional tests, an experienced specialist is able to diagnose a meniscal injury with a 90% probability, even without an x-ray.

Functional radiography allows you to diagnose an injury using three projections, in a standing position and legs bent at 45˚.

A very narrow joint space or its absence indicates a high degree of damage to the meniscus and, possibly, the futility of arthroscopy.

MRI is effective exact method research preferred for diagnosing soft tissues. It is consulted when there is an unspecified diagnosis or difficult access.

The preferred method of examining the knee joint is arthroscopy. Simultaneously with diagnosing the joint, the doctor may perform surgery to restore damaged tissue, if possible.

How to treat a meniscus injury

Treatment of a torn meniscus of the knee joint can be carried out conservatively and surgically.

Conservative treatment

Conservative treatment without surgery is possible:

• for minor radial tears;
• minor damage to the posterior horn;
• degenerative rupture in old age;
• if there is no pinching damaged meniscus and joint blocking;
• There are no clicks or rolls in the knee when moving.

Damage to its outer edges is favorable for the healing of the meniscus, since they are supplied with blood. If in the cartilage knee pad medial injury, independent healing is hardly possible.

Conservative treatment is also the first step for a combination of meniscal and ligament injuries.

The whole point of treating knee meniscus without surgery comes down to creating a favorable regime for the sore leg:

1. It is necessary to remove the stress from the knees, free them from heavy physical labor and sports training.
2. At the same time, it is necessary to strengthen the quadriceps and posterior femoral muscles with exercises to prevent shifting femur relative to the tibia.

Relieving heavy loads, taking care of maintaining the stability and mobility of the knee in conditions of injury - these are the complex tasks conservative treatment of meniscus injury.

A sore point about applying plaster:

Complete immobilization in case of a meniscus tear is not only not necessary, it can completely destroy the knee joint, leading to the closure of the joint space and the occurrence of contractures. Restoring the previous mobility of the knee after removing the cast is almost impossible.

Such “conservative treatment” can bring real disaster.

Surgery

Surgical treatment is carried out in the following situations:

• large scale damage to the meniscus;
• constant accumulation of fluid in the knee;
• joint blockade;
• friction of a flap of damaged lining on the surface of the joint;
• failure of conservative treatment.

You should not torture the patient by trying to treat the problem conservatively if the nature of the damage is such that it is better to immediately resort to surgery.

The meniscus is a strong and rather thick cartilage pad installed on one of the bones that is part of the joint structure. Its direct purpose is to improve the quality of sliding of the articular bone structure when the joint moves under varying degrees of stress, that is, when physical activity. In other words, the meniscus is a shock-absorbing part that eliminates mechanical or other types of bone trauma. Plus, it firmly connects the structure, stabilizing all components of the joints, preventing them from moving apart during movement or at rest.

As part of the human skeleton, the menisci are located between the acromion of the scapula and the collarbone (acromioclavicular joint), the sternum and the collarbone (sternoclavicular joint), temporal bone And lower jaw(temporomandibular joint), in hip joint and meniscus of the knee joint.

When injuries occur, the pads and ligaments tear, causing joint components to lose stability and integrity. They may diverge or even dislocation or bone fractures may occur.

The knee meniscus is often at risk of injury. Factual evidence is provided by statistics on the number of falls and mechanical injuries of the lower extremities. Meniscus tears are the result of physical vertical loads and sharp drops. Knee plate injuries are common in athletes, miners and loaders. Ballerinas and older people join this group.

Anatomical structure of the knee joint

What is a meniscus and why is it needed in a joint? The explanation is simple: it is a strong elastic lining between the bones that does not allow the bones to wear out and diverges, allowing them to slide on top of each other without damage. Thanks to the pad, a person easily and painlessly walks, runs and jumps, and also performs circular and flexion-extension movements. For the legs, it's very important detail, because they are constantly in motion and constantly exposed to stress.

The knee joint consists of the femur, tibia and patella. Their epiphyses are covered with a layer of cartilage. The joint is secured by muscles and tendons. What is the meniscus of the knee joint? These are mobile and elastic round (crescent-shaped) plates of connective tissue nature located inside the joint space. Between them are the cruciate tendons. The structure of the knee joints includes two types of meniscus: external (lateral) and internal (medial). Information about the meniscus of the knee joint and what it is from an anatomical point of view is briefly presented.

Important! The lateral meniscus is more mobile than the medial one and is less likely to rupture. Internal meniscus Almost does not move due to the collateral ligament, so it is susceptible to injury.

Biomechanics

The meniscus, more precisely the knee menisci (lateral and medial), can be subject to deformation during movement, as a result of braking of the tibia. In addition, the menisci equally distribute the vertical load over the entire surface of the joint, which contributes to excellent shock absorption during jumping, running and sharp turns. They protect the cartilaginous plates from abrasion and injury.

Connective tissue pads fit tightly to the tibia, on which the process of flexion, extension and rotation depends. The mobility of the menisci allows the joint to freely perform the most extreme movements without injuring the epiphyses of the bones. The knee, bending, moves the menisci back, and straightening, directs them forward. Rotation of the knee joint causes the intra-articular spacers to rotate, they follow the condyles of the femur. Lateral rotation of the knee pulls the lateral meniscus forward toward the lateral condyle of the bone, and internal rotation pulls the meniscus backward. Thus, biomechanical movements of the menisci occur, with free movement of the knee joints. When injured, biomechanics are disrupted, and the meniscus in the knee cannot maintain the integrity of the joint, limiting its movement.

Causes of meniscus problems

Mechanical shocks in the knee area lead to meniscus rupture. As for the rupture zone, its depth and scale, all this directly depends on the force of the impact and on the area of ​​injury (lateral, medial part of the knee, cup or back of the leg), as well as on the type of joint movement during the impact (rotation, flexion or joint extension). The type of injury depends on the impact surface that the knee (or knees) hit.

And so, the main causes of injury to the intra-articular menisci include:

• Falling from height.
• Impact with a blunt object.
• Constant vertical loads.
• Sudden lifting of weights.
• High and high jumps.
• Incorrect rotation of the joint.
• Concomitant diseases of the musculoskeletal system.
• Repeated injuries.
• Post-operative complications.
• Destructive or degenerative process in the bone apparatus.
• Diseases associated with metabolic disorders, innervation and blood supply.
• Arthrosis, arthritis, gout, cancer, rheumatism and diabetes.
• Age-related changes.

Attention! Repeated trauma to the knee joint and meniscus (impact, contusion, compression and open or closed bruises) contributes to the development of chronic meniscitis.

Related chronic diseases such as rheumatism, diabetes mellitus, hormonal imbalance and cancer lead to destruction of the meniscus and its complete rupture. The entire listed set pathological processes lead to deforming arthrosis and disability.

According to statistics, athletes (namely football players) and elderly people more often suffer from meniscus pathology. First of all, the meniscus of the knee is damaged, the symptoms of which are joint immobility and severe pain (read about the features of treating the meniscus at home). Repeated injury to a limb that was rehabilitated and was in care for many years satisfactory condition, is aggravated by a blow and a sharp turn of the knee inward or outward. This fact immediately leads to a meniscus tear.

In addition to these factors, there is a list of provoking causes of meniscal injury, such as:

1. forcing extension movements;
2. excess body weight and sudden movements;
3. unnatural rotation of the knee joint, walking on the tips of the toes;
4. weak ligamentous apparatus(congenital or acquired);
5. injury from a fall or being hit by a sharp object directly in the area of ​​the meniscus projection.

Trauma to the medial plates occurs during extension movements, and damage to the lateral meniscus occurs during internal rotation of the leg.

Types of mechanical injuries to the meniscus

According to the location and degree of damage to the meniscus, injuries differ from each other, so traumatologists have divided the tears into certain types of tears of the internal and external menisci.

Types of damage to cartilage pads:

Pinched meniscus

According to injury statistics, 40% of them are injuries to the meniscus of the knee joint, the treatment of which requires immediate assistance. When the meniscus is pinched, the function of the joint is blocked. Treatment consists of closed reduction of the meniscus; if reduction cannot be achieved, rapid surgery is recommended.

Partial damage (tear of some parts of the meniscus)

About 50% of patients who came to ambulance, suffer partial rupture meniscus Often a crack damages posterior horn, less often the middle, and even less often the anterior horn. Cracks have longitudinal, oblique, transverse, horizontal and internal appearance.

Complete rupture of the connective tissue plate

A complete tear involves the separation of the entire meniscus from its attachment site. There is also a tear in the form of a “watering can handle,” when the torn part is held behind the body of the plate.

Meniscus symptoms

On what basis is a knee meniscus injury diagnosed? Symptoms are the main evidence of this disease. But there is no need to confuse meniscus injury with other diseases of the knee joint such as fractures, joint degeneration, synovitis, bursitis and arthrosis. IN differential diagnosis Instrumental studies will help: X-rays, MRI and computed tomography.

Symptoms of traumatization knee meniscus is as follows:

1. Severe pain syndrome: unbearable pain during a fall or impact, accompanied by a bursting click. It is diffuse in nature and is further localized in the lateral or medial area of ​​the knee. After some time, the pain disappears or dulls, the movement of the joint is limited, it hurts to step, and when bending the knee it appears sharp pain. When at rest, the pain disappears.
2. Difficult or constrained movement: it is almost impossible to move, walk and squat if the tear is partial; walking is very difficult, and going up or down the stairs is difficult or even impossible (this applies to a complete tear of the meniscus).
3. Knee lock: occurs when the meniscus is pinched.
4. Inflammatory swelling: swelling begins on the 3rd day after injury, it is caused by the accumulation synovial fluid and inflammation of injured soft tissues.
5. Manifestation of hemarthrosis of the knee: Blood accumulates in the internal space of the joint. This symptom characteristic of a rupture of the red zone of the plate; it is in this zone that the meniscus is intensively supplied with blood.
6. Temperature increase: occurs 2-3 days after injury, temperature can vary from 38-40 degrees.

Diagnosis of meniscus damage

Diagnosis is based on external inspection And instrumental study injured limb. A meniscus injury can be diagnosed by performing X-ray knee joint (to exclude fractures and bone cracks), ultrasound, MRI, computed tomography and endoscopic arthroscopy.

To confirm a rupture of the meniscus of the knee joint, special tests or manipulations are used, which are confirmed by symptoms according to the author: Landau, Baikov, Perelman, McMurray, Shteiman, Chaklin and Polyakov, as well as by the main symptom - knee “blockade”.

Meniscus treatment

Treatment of knee meniscus is divided into conservative and surgical technique, but the entire treatment process depends on the severity. In some cases, surgery is started immediately, or joint blockade is removed, immobilization, administration non-steroidal drugs and chondroprotectors (this is the treatment of meniscus without surgery).

If the meniscus is displaced or pinched, the traumatologist realigns the meniscus and places a cast for 3 weeks or a month. During this time, drug therapy is prescribed for the treatment of the meniscus, which consists of prescribing:

• painkillers (Analgin, Baralgin or Promedol);
• non-steroidal drugs with a direct effect on selective inhibitors (COX1 and COX2): Ortofen, Diclofenac, Dikloberl, Movalis or Nimesil;
• vitamin therapy: vitamins C and B vitamins;
• antibiotic therapy: Lincomycin;
• chondroprotectors (for restoration of the meniscus and damaged cartilage of the epiphyses of bones): Chondroxide, Chondroitin sulfate and a special dietary supplement Collagen;
• performing physiotherapy, knee massage and exercise therapy.

Emergency treatment

In the case when the pathology is accompanied by crushing of the meniscus, its complete ruptures, displacement, profuse hemorrhage and separation cruciate ligaments, horns and body of the meniscus - urgent joint surgery is required.

An effective treatment method is arthroscopy. Using this surgical technology, restoration, partial or complete removal of the platinum is performed, as well as meniscal transplantation. An artificial or donor meniscus takes root quickly; cases of rejection are rare. After surgery on the meniscus, treatment is medicinal (the regimen corresponds to the above). Rehabilitation of the limb occurs within 4 months, and sometimes restoration of physiological and biomechanical functions lasts up to six months. Rehabilitation depends on age, general condition body, from immune system and from the patient’s concomitant diseases.

When a knee injury occurs, it is the meniscus of the knee joint that is most often affected. Treatment of such injuries often becomes a common procedure for athletes, ballerinas and climbers.

Meniscal damage is usually caused by excessive flexion or extension of the knee joint or direct damage meniscus when the knee hits a hard object (for example, falling onto a hard surface).

In this case, the meniscus can be damaged in different ways - torn off, torn, crushed, acquire excessive mobility due to stretching or rupture of the intermeniscal ligaments, etc. If the diagnosis is not made in a timely manner, damage to the meniscus of the knee joint can gradually develop into a chronic process, manifested by degeneration and degeneration of the meniscus.

What symptoms of knee meniscus bother the patient?

• Firstly, sharp pain. First the pain has general character, spreading over the entire knee, after some time it is localized in the corresponding area of ​​​​damage - from the outside or inside knee depending on which meniscus (external or internal) is damaged.
• Secondly, severe restriction of movements. It is easier for the patient to keep the leg bent; extension leads to an increase in the intensity of pain, sometimes this action is accompanied by a crunching or clicking sound.
• Increase in joint volume. With such a symptom of damage to the meniscus of the knee joint, treatment must begin immediately.
• A symptom of joint blockage is difficulty bending the joint through a certain range of motion.
• After the end of the acute period (2-3 weeks), the patient may be bothered Blunt pain in the knee, especially when going down stairs, as well as a feeling of an interfering object inside the joint.

Symptoms of knee meniscus damage are nonspecific and occur with many other lesions.- such as sprains or joint bruises, therefore require thorough examination and follow-up with a doctor.

Treatment of knee meniscus damage

The nature of the injury, the severity of the injury, as well as its location determine the treatment tactics in cases where the meniscus of the knee joint is damaged. Treatment, as a rule, begins with the elimination of pain. Next, it is determined how to treat this lesion of the meniscus of the knee joint.

Indications for surgical treatment of meniscus

If the amount of damage to the meniscus is large ( longitudinal gap tissues or their fragmentation) is required surgical intervention, which consists of suturing the damage or partial or complete removal damaged meniscus, depending on the severity of the injury, and in some cases, installation of an artificial implant.

Conservative treatment of meniscus

A small tear or tear is not the worst thing that can happen to the meniscus of the knee joint. Treatment in this case consists of rigid fixation of the knee joint, the use of physiotherapeutic procedures and taking medications that have a beneficial effect on cartilage tissue and promote rapid healing of the damaged meniscus.

If the meniscus had to be operated on, then fixation of the joint is also an inevitable component postoperative period. The next step is to restore joint mobility with the help of physiotherapy, physical therapy and reception necessary for further recovery drugs.

The following groups of drugs are used

1. Analgesics
2. Chondroprotectors
3. Anti-inflammatory
4. Auxiliary therapy - vitamins and dietary supplements

IN acute period analgesics are used. One of the leading drugs for damage to the meniscus of the knee joint are also chondroprotectors - glucosamine, teraflex, chondroitin sulfate. These drugs stimulate the synthesis of cartilage tissue and improve metabolism connective tissue and properties of intra-articular fluid.

In addition to this group, it is justified to prescribe chondroprotective dietary supplements, the main representative of which is is Collagen Ultra. This product contains collagen - the main structural substance cartilage, which, in fact, is the meniscus. Collagen treatment actively promotes the regeneration of cartilage tissue, increasing its water-retaining properties and preventing inflammation.

In addition, in order for the damaged meniscus to recover faster, it is necessary to prescribe vitamins A, C, and E.

The duration of treatment for a torn meniscus of the knee joint may vary, but since recovery period with this injury it is quite long, it is recommended to take maintenance medications, such as chondroitin, glucosamine or collagen, for 3-4 months.

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