The meniscus is a cartilage pad, located between the joints and acting as a shock absorber.

During the movement of the meniscus are able to modify their shape, which ensures the smoothness of a person’s gait.

There are two menisci in the knee joint, one of which is external or lateral, the other meniscus internal, or medial.

Medial meniscus its structure has less mobility, and therefore is most often susceptible to various types of damage, up to tissue tear.

Conditionally meniscus can be divided into three components:

- anterior horn of meniscus
- posterior horn of meniscus
- body of the meniscus

Posterior horn of meniscus or its internal part does not have a blood supply system, nutrition occurs due to the circulation of articular synovial fluid.

It is for this reason damage to the posterior horn of the meniscus irreversible, tissues do not have the ability to regenerate. Posterior meniscus tear It is very difficult to diagnose, which is why to establish an accurate diagnosis, the doctor usually prescribes magnetic resonance imaging.

Symptoms of a rupture

Immediately after the injury, the victim feels sharp pain, and the knee begins to swell. In cases tear of the posterior horn of the meniscus the pain intensifies sharply when the victim goes down the stairs.

When there is a tear meniscus the torn part of it dangles inside the joint and interferes with movement. When small tears occur in the joint, painful clicking sounds are usually observed.

If the gap is large in area, blockage or wedging is observed knee joint.

This happens because the torn part meniscus moves to the center of the damaged joint and blocks the movement of the knee.

In case of rupture of the posterior horn meniscus Knee flexion is usually limited. When a meniscus ruptures, the pain is quite severe.

The victim cannot step on the injured leg at all. Sometimes the pain gets worse when bending the knee.

You can often observe degenerative tears that occur in people after 40 years of age as a result of age-related changes in cartilage tissue. In such cases, a rupture occurs even with the usual sudden rise from a chair; such a rupture is very difficult to diagnose.

Very often, ruptures of the degenerative form become protracted and chronic. A symptom of a degenerative tear is the presence of a dull, aching pain in the knee area.

Treatment of a tear in the posterior horn of the meniscus

After establishing an accurate diagnosis using testing and magnetic resonance imaging, the attending physician prescribes appropriate treatment, which is carried out in a hospital setting.

If the tears are minor, conservative treatment is prescribed. The patient is prescribed medication with anti-inflammatory and painkillers, as well as manual and physical therapy sessions.

In cases of serious damage, the doctor prescribes surgical treatment, the essence of which is that during performing surgery for a torn meniscus sutured, or in some cases when restoration is impossible, meniscus is removed, a meniscectomy is performed.

In modern clinics, such an operation is performed using the invasive method of arthroscopy, an operation that has a low-traumatic effect and has no complications in the postoperative period.

After the operation, the patient spends some more time in the hospital under the supervision of the attending physician. He is prescribed rehabilitation treatment, including therapeutic exercises, a course of antibiotics and other medications to prevent inflammatory processes.

The knee is a complex structure, which includes the patella, femur and tibia, ligaments, menisci, etc.

The menisci are a layer of cartilage tissue that is located between two bones. When moving, the knee constantly withstands heavy loads, so most injuries occur in this joint. One such injury is a tear of the posterior horn of the medial meniscus.

Damage to the knee joint is painful and dangerous in its consequences.

A tear of the posterior horn of the meniscus can occur in any active person or athlete, and can lead to severe damage in the future.

What is a meniscus

The meniscus is a part of the joint that is a curved strip of fibrous cartilage. They are shaped like a crescent with elongated edges. They are divided into several parts: the body, the posterior and anterior horns.

There are two menisci in the joint:

• lateral (outer);
• medial (internal).

Their ends are attached to the tibia.

The medial one is located on the inside of the knee and connects to the medial collateral ligament. Along its outer edge it is connected to the capsule of the knee joint, through which partial blood circulation passes.

Menisci perform important functions:

• cushion the joint during movement;
• stabilize the knee;
• contain receptors that control leg movement.

If this meniscus is removed, the area of ​​contact between the bones in the knee becomes 50-70% smaller, and the load on the ligaments becomes more than 100% greater.

Symptoms

There are two periods: chronic, acute.

The acute period lasts about a month and is characterized by a number of painful symptoms. With the injury itself in the knee area, a person feels severe pain and a sound like a cracking sound. Swelling quickly appears on the knee. Bleeding into the joint also often occurs.

Joint movements are severely or partially limited.

Characteristic symptoms of a medial meniscus tear

This type of injury has a number of characteristic signs. When the posterior horn of the internal meniscus in the knee area is damaged, intense pain appears on the inside. On palpation, it intensifies in the area where the horn attaches to the knee ligament.

This injury also blocks the movement of the joint.

It is determined when trying to make flexion movements when turning the shin outward and straightening the leg, the pain becomes stronger and the knee cannot move normally.

In terms of severity, damage can be minor, medium or severe.

Types of rupture

Longitudinal complete or partial rupture of this part is considered very dangerous. It develops from the posterior horn. With a complete rupture, the part that has separated can move between the joints and block their further movement.

There may also be a gap between the beginning of the posterior horn and the middle of the meniscus body.

There are often cases when such an injury is of a combined nature and combines different types of damage. They are developing in several directions at once.

A horizontal tear of the posterior horn begins from its inner surface and develops towards the capsule. It causes severe swelling in the joint space.

Treatment

Treatment can be carried out using both conservative and surgical methods.

Conservative therapy is used for mild or moderate injuries.

The operation is performed for severe injuries that block the functioning of the joint and cause severe pain.

Often, after injury to the structures located in the knee joint, a rupture of the posterior horn of the medial meniscus is diagnosed. To avoid negative consequences and complications after an injury, it is important to begin treating the injury. If the damage is partial, it will be possible to correct the situation with conservative therapy. When a complete rupture and destruction of cartilage is diagnosed, surgical intervention is indispensable.

Causes of damage

If damage to the posterior horns of the meniscus is diagnosed, most likely a complex fracture of the limb has occurred with damage to the integrity of the ligamentous apparatus, bone, and soft tissues.

The medial meniscus is a sedentary, cartilaginous formation located on the inside of the knee joint. Much less commonly diagnosed is a rupture of the outer cartilage, which is located on the outside of the knee, it is called lateral. However, in addition to injuries, rupture of the internal meniscus is provoked by:

• A degenerative disease of the musculoskeletal system that causes bone structures to become fragile and prone to fracture.
• Unsuccessful landing on your feet when jumping from a great height.
• Old, untreated damage to the internal meniscus of the knee joint.
• Congenital diseases that negatively affect the condition of joints.

Forms of tear of the posterior horn of the medial meniscus

Damage to the posterior horn of the medial meniscus can be of the following types:

Violations of the integrity of cartilage can be of different types.

• Radial or transverse. Often such a tear is partial, but if the cartilage is damaged obliquely, this provokes mobility of the meniscal body. Once in the interarticular space, the structure blocks the knee, causing the victim to be unable to move.
• A linear or horizontal tear of the posterior horn of the medial meniscus is characterized by peeling of the cartilage, but the body retains its shape and is not deformed. The main sign of such damage is the formation of edema.
• A vertical or longitudinal tear means the destruction of the internal structure of the cartilage in a straight line, while the marginal part of the body remains intact.
• A flap rupture of the meniscus indicates that the cartilaginous formation is completely destroyed and deformed. The consequence of such damage is the formation of fragments similar to shreds.

Degree of damage

There are 3 degrees of destruction of cartilage integrity:

• Easy stage. It has no clearly defined symptoms, the pain is often moderate, and the functioning of the knee joint is not impaired. The symptomatic picture worsens if the patient increases the load on the leg, and slight swelling also appears.
• Average. At this stage, the degenerative process becomes more pronounced, the person is bothered by acute pain in the knee, and the limb cannot be flexed or straightened. At first the block of the joint is incomplete, but after a couple of hours the mobility of the joint is completely impaired.
• Heavy. A rupture of the posterior horn of the internal meniscus in a severe stage is manifested by an acute unbearable pain symptom that does not go away even after complete immobilization of the limb and taking painkillers. Swelling forms, due to which the knee becomes 2 times larger. The temperature of the damaged area increases, and the skin becomes brownish-bluish in color.

Signs of violation

The symptom of injury is pain in the back of the knee.

If the horn of the medial meniscus is damaged, the first sign characterizing the violation will be severe pain in the popliteal part of the joint. But a rupture of the posterior horn of the lateral meniscus is manifested by the localization of pain from the outer part. On palpation, the signs intensify, the joint becomes immobile, swells and increases in size. To avoid complications, an integrated approach to treatment is needed, otherwise the victim faces complete or partial removal of the cartilage.

Diagnostics

In order for the treatment of the rupture to be adequate, it is important for the doctor to make an accurate diagnosis and find out the causes of the disorder. It is also important to determine where exactly the violation is localized, because with severe trauma, a rupture of the anterior horn of the medial meniscus can occur. To exclude bone tissue destruction, the patient is first sent for an X-ray examination. If the bones are intact, MRI diagnostics is additionally performed. Thanks to him, it will be possible to study the degree of damage to cartilage and other soft tissues, which will help determine treatment methods.

What treatment is used?

Conservative

If the posterior horn of the medial meniscus is not severely damaged, and the body of the cartilage is only partially destroyed, the doctor prescribes a course of drug therapy, which takes place in several stages:

To normalize the nutrition of the tissues of the knee joint, massage is prescribed.

• Relieving swelling, inflammation and pain using NSAIDs and analgesics.
• Restoration of cartilage structures using chondroprotectors.
• Normalization of joint functioning using reposition, manual therapy or traction.
• Training the muscular corset using physical therapy exercises and therapeutic gymnastics.
• Activation of blood supply and nutrition to the damaged area using physiotherapy, therapeutic massage, and folk remedies.

Damage to the posterior horn of the 2nd degree according to Stoller is a frightening and incomprehensible formulation of the diagnosis, which hides a common type of knee injury. There is one encouraging truth in such a diagnosis: joints can always be treated at any age.

Where is the meniscus and its posterior horn located?

The knee joint is the largest and most complex of all joints. The menisci, also known as interarticular cartilage, are located inside the articular capsule and connect the femur and tibia to each other. When walking or other movement, interarticular cartilage acts as a shock absorber and softens shock loads transferred to the body and in particular to the spine.

There are only two types of menisci in the knee joints: internal (scientifically medial) and external (lateral). The interarticular cartilage is divided into the body and the horn: anterior and posterior.

Important! Playing a shock-absorbing role, the menisci are not fixed and shift when the joint is flexed and extended in the required direction. Only the internal meniscus has impaired mobility, and therefore it is most often damaged.

The results (of the posterior horn of the medial meniscus) are irreversible in terms of regeneration, since these tissues do not have their own circulatory system and, therefore, do not have this ability.

How is the meniscus damaged?

Injury to the interarticular cartilage can occur in a variety of ways. Conventionally, damage is divided into two types.

Attention! Signs of knee damage may be similar across different illnesses or injuries. To make a more accurate diagnosis, you should consult a doctor; you should not self-medicate.

Degenerative damage to the internal meniscus

The meniscus is damaged as a result of the following factors:

1. Chronic microtraumas are mainly characteristic of athletes and people with physically difficult work.
2. Age-related wear of cartilage plates.
3. Getting injured two or more times.
4. Chronic diseases.

Diseases leading to degenerative damage to the internal meniscus:

• rheumatism;
• arthritis;
• chronic intoxication of the body.

A distinctive signal of this type of injury is the age of patients over 40 years old, excluding athletes.

Symptoms

The clinical picture of damage to the posterior horn of the meniscus has the following features:

1. Injury can occur spontaneously from any sudden movement.
2. Persistent, continuous aching pain that increases with joint movement.
3. Slow increase in swelling above the kneecap.
4. Locking of the knee joint is possible, resulting from a sudden movement, that is, flexion-extension.

The symptoms are expressed rather weakly, and the degree of degenerative changes in the cervical tumor according to Stoller can only be determined after an X-ray or MRI image.

Traumatic damage to the MRMM

Based on the name, it is not difficult to understand that the cornerstone is a knee joint injury. This type of injury is typical for the younger age category of people, that is, under 40 years of age. occur in the following cases:

• when jumping from high;
• when landing sharply on your knees;
• torsion on one leg leads to rupture;
• running on uneven surfaces;
• subluxation of the knee joint.

You can independently determine the injury of the cervical mucosa, regardless of the level of the pain symptom, using the following techniques together:

1. Bazhov's technique. During extension of the joint and when pressing on the back side of the kneecap, the pain intensifies.
2. Land's sign. In a supine position, the palm of the hand should pass under the injured knee with gaps - freely.
3. Turner's sign. The sensitivity of the skin around the knee increases.

Painful sensations come in three degrees of severity, with accompanying symptoms.

1. Mild 1st degree. There is no obvious pain, no restrictions in movement are felt, only with certain loads a slight increase in pain is felt, for example when squats. There is slight swelling above the kneecap.
2. Average 2nd degree of severity. Accompanied by severe pain. The patient walks with a limp, with periodic blocking of the knee joint. The position of the leg is only in a half-bent state; it is impossible to straighten the leg even with help. The swelling intensifies, the skin takes on a blue tint.
3. 3rd degree of severity. The pain is unbearable and sharp. The leg is bent and motionless, there is severe swelling of a purple-violet color.

Even with a detailed description of complaints and symptoms, the patient is sent for an image. It is possible to assign a Stoller grade to a meniscus injury only with the help of an MRI machine. This is due to the impossibility of direct inspection.

Degree of damage to ZRMM and Stoller classification

A tomographic examination using an MRI machine according to Stoller does not require special preparation. Despite the rather high cost, the method is informative, and this irreplaceable research cannot be neglected.

Important! MRI cannot be performed if you have a pacemaker or a metal artificial implant. All metal objects (piercings, rings) must be removed before the study. Otherwise, the magnetic field will force them out of the body.

Damage is classified into 3 degrees of change according to Stoller.

1. First degree. It is characterized by the appearance of a point signal in the interarticular cartilaginous plate. A slight violation in the structure of the meniscus.
2. The second degree includes a linear formation that has not yet reached the edge of the meniscus. ZRMM crack.
3. Third degree. Stage 3 is characterized by a tearing signal reaching the very edge of the meniscus, in other words it.

The accuracy of MRI data in diagnosing rupture of the spinal cord is 90-95%.

Treatment of damaged MRMM

Basically, temporary disability occurs during the treatment period. The sick leave period can last from several weeks to four months.
Basically, in case of rupture of the MRMM, it will not be possible without surgical intervention; treatment is carried out using the whole or a broken part of it. This operation is called meniscectomy. Only a few small incisions are made on the knee; open manipulation is performed in extremely rare cases.

In case of minor damage to the MRMM, the treatment cycle will look approximately as follows:

1. Long rest using elastic bandages and various compresses.
2. Surgery that corrects the functions of tissues and organs.
3. Physiotherapy.

The rehabilitation period is reduced to the relief of pain symptoms with an emphasis on reducing swelling and normalizing the motor activity of the injured organ. For a complete recovery, you need to be patient, as the rehabilitation period can last quite a long time.

Front horn

Treatment of a tear in the anterior horn of the medial (internal) meniscus

The medial meniscus differs from the lateral one in its larger circumference and greater distance between the horns (approximately two times). The anterior horn of the medial meniscus is attached in the area of ​​the anterior edge of the articular part of the tibia - in the so-called intercondylar fossa. The outer surface of the meniscus is tightly connected to the articular capsule, and the inner surface is tightly connected to the medial collateral ligament.

Normally, the anterior horn of the meniscus has a smooth surface and its edges are quite thin. The blood supply to the menisci is mainly localized in the anterior and posterior horns, but the blood vessels extend only 5-7 mm from the edge of the meniscus.

Statistics

It is estimated that medial meniscus injuries account for 60 to 80 percent of all knee injuries. Rupture of the anterior horn of the medial meniscus ranks first in frequency of occurrence. Longitudinal and flap tears are more typical for this injury.

Reasons

The main reason for rupture or separation of the anterior horn of the meniscus is a significant load on the knee joint, combined with fixation of the foot and rotational movement of the knee. At risk are young people leading an active lifestyle, as well as older men. Statistically, rupture occurs more often in men than in women.

Symptoms

Damage to the anterior horn of the medial meniscus is often combined with displacement of the torn part and its blocking between the internal surfaces of the joint. When the anterior horn is torn off with entrapment, symptoms such as blockade of the knee joint, knee pain and the inability to move independently appear. After treatment, the joint block is eliminated. Also, with an injury to the anterior horn of the meniscus, the patient can often slightly bend the knee, after which a blockade occurs.

With an injury to the anterior horn of the medial meniscus, the following symptoms may also occur:

• Feeling of pain inside the joint,
• Increased pain when trying to bend the leg at the knee,
• Flabbiness of the thigh muscles,
• Sensation of “lumbago” when the knee joint is tense,
• Pain in the area where the meniscus and ligament attach.

Species

It is customary to distinguish three types of rupture:

• Rupture of the immediate anterior horn (complete or partial).
• A meniscal tear with degenerative changes.
• Rupture of the ligament that secures the meniscus.

Conservative treatment

For minor meniscus injuries, conservative treatment is sufficient. In the first stages, the injured limb is fixed using a splint. A puncture of the joint can also be performed to get rid of the blood accumulated in the cavity and remove the blockage of the joint. The patient is advised to rest and the load on the leg should be limited. Subsequently, a course of physiotherapy, physical therapy, massage sessions and electrical myostimulation is recommended.

Surgical treatment

If there is a complete rupture of the anterior horn of the internal meniscus, surgical treatment is recommended. A meniscectomy is performed, that is, an operation to remove the torn fragment. Today, open surgery is almost never performed, as is complete removal of the meniscus. Instead, stitching or fragmentary removal is performed using arthroscopy. Due to the low invasiveness of the arthroscopic method, trauma to the knee joint and the rehabilitation period are significantly reduced. Performing such a procedure allows you to preserve functionally significant elements of the meniscus, which prevents the development of arthrosis and osteoporosis and allows the patient to quickly return to normal life.

In young patients, it is possible to undergo arthroscopic suturing of the meniscus. In this case, a rupture of the anterior horn of the meniscus is an indication for such suturing, since the anterior horn has a good blood supply, and its restoration occurs faster and more fully.

Rehabilitation

Arthroscopy can significantly reduce recovery time after a meniscal injury. After just a few days, it becomes possible to put a load on the limb, develop the knee joint and return to the usual rhythm of life. The essence of rehabilitation is to get rid of pain and restore mobility to the knee joint.