Damage or rupture of the medial meniscus of the knee usually occurs in athletes and overly active people, this condition requires urgent treatment. In addition to them, people of retirement age are susceptible to this disease, especially those who have arthrosis or arthritis.

What is a meniscus, and where are its horns?

The meniscus is a cartilaginous tissue that consists of fibers and serves as a shock absorber for the knee joint. It looks like two crescents, their ends are called horns.

The small crescent is the outer (lateral) part of the meniscus, and the large crescent is the inner (medial).

Breaks are of different types:

vertical and horizontal;
oblique and transverse;
degenerative;
ruptures of the posterior and anterior horns of the meniscus.

But most often there is a rupture of the posterior horn of the inner meniscus, since it is less mobile.

What can cause damage to the posterior horn?

This disease always occurs as a result of an injury. The meniscus is not so fragile that it could be damaged by any kind of force. The most common reasons for a break are:

Excessive turns of the body, standing on one leg and keeping the foot on the floor.
Too vigorous jumping and steeplechase.
Very fast walking or, conversely, a long stay in the "squatting" position.
An injury received against the background of an already existing degenerative knee joint.
Insufficiently good development of joints and ligaments caused by congenital pathology.

In people of retirement and pre-retirement age, a rupture of the posterior horn occurs due to the fact that cartilage tissues are often already destroyed by arthrosis. Therefore, it is much easier to damage it.

How to recognize a gap?

Without a qualified diagnosis, it is impossible to say for sure whether there is damage to the fibrous cartilage tissue. But there are signs that suggest its presence:

When injured, a click is clearly heard, pain pierces the knee. Lasts about 5 minutes, then subsides a little. During this period, a person is able to move, overcoming pain. After a significant amount of time, about half a day, pain in the knee again occurs. This time, the sharp pain is accompanied by a burning sensation. Flexion and extension of the knee occurs with increased pain. Rest provides some relief.
If, however, there was a rupture of the medial meniscus, then a blockade of the knee joint occurs. Outside of medicine, this is called "jammed." This happens because part of the torn cartilage tissue of the meniscus is fixed by two bones, thereby the movement of the knee becomes limited. But this symptom does not always indicate a meniscus tear. It can also occur due to damage to the ligaments.
If in the body of the meniscus, where there are capillaries, then blood accumulates in the knee. They call it hemarthrosis.
A few hours after the rupture, swelling of the adjacent tissues occurs.

With the help of hardware research, it is possible to determine whether the gap is chronic or recently acquired. In an acute rupture, the edges are even, there is an accumulation of blood. Chronic rupture has fibrous, uneven edges, edematous tissues. It is not blood that accumulates around it, but synovial fluid.

A degenerative rupture of the posterior horn of the meniscus can be diagnosed by MRI or arthroscopy. Without these methods, this diagnosis is quite difficult to establish, since there are no: acute pain, blockade.

Treatment of rupture of the posterior horn of the medial meniscus of the knee joint

To treat this kind of injury, like any other, it is necessary immediately after the injury.

Important! If left untreated for a long time, the rupture can become chronic.

Treatment not taken in time can lead to destruction of the cartilage of the knee joint, inflammation, changes in its structure and arthrosis. To avoid these troubles, you should immediately visit a doctor as soon as an injury occurs.

A tear in the posterior horn of the knee joint is usually treated without surgery. With the exception of severe trauma that requires prompt assistance. Treatment takes place in several stages:

If there is a blockade of the joint, then it must be removed. This is done using manual methods or with hardware traction of the joint.
Edema is removed by anti-inflammatory drugs (Diclofenac, Indomethacin).
Pain relief with painkillers (Ibuprofen, Paracetamol).
After relieving pain and inflammation, it is necessary to start physical therapy, physiotherapy and massage.
The longest stage is the restoration of the cartilage that makes up the menisci. For this, preparations containing chondroitin sulfate and hyaluronic acid are prescribed.

It is necessary to take these medicines for a long time, one course can reach up to six months. It is necessary to repeat their intake annually to prevent deterioration of the cartilage.

In some cases, after stretching the joint, plaster is applied. This is done in order to provide the joint with peace and immobility for a certain time. But such a measure is not taken in all cases.

Operative methods of treatment

In the case when the above method of treatment does not have the desired effect on the damaged part, they resort to a surgical method of treatment. If the body of the meniscus itself is damaged, then most often it can be stitched.

There are several types of operations for the treatment of damage to the meniscus horn, but some of them are currently performed extremely rarely, as they are considered ineffective or even harmful. These include, for example, arthrotomy. This is the removal of damaged cartilage tissue, which is carried out with a full opening of the knee.

Surgical methods for the treatment of a torn meniscus of the knee joint are currently aimed at preserving or restoring it. They are of several types:

Partial meniscectomy. In this case, the edges of the meniscus are cut off at the site of the lesion, and their remaining part is restored.
. The operation, which is performed through three punctures in the knee joint. One of them introduces the tools necessary for manipulation. In the other, saline enters and washes away unnecessary particles of cartilage, accumulated blood, and so on. A camera is inserted into the third puncture, through which the surgeon can see everything that happens inside the knee, and thereby controls the entire process.
Transplantation. The donor's meniscus is transplanted to the patient.
Endoprosthetics. An artificial organ is implanted into the knee joint.

Regardless of the method of operation, after it, complete rest of the knee joint and protection from the effects of cold are necessary.

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

In the absence of proper therapy, chronic damage to the medial meniscus of the knee joint is converted into a neglected 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, refer to:

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

There is a classification according to the trajectory of the injury that occurred:

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

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

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

Characteristic signs of a torn internal meniscus

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Damage to the medial meniscus most often occurs during physical exercise: running on rough terrain, rotating on one leg, sharp attacks and other situations.

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

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

Other typical symptoms of a torn medial meniscus of the knee include:

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

Note: With a bent knee, a person does not always feel intense pain. It appears more often when trying to straighten the leg. This is a hallmark of injury to the interior of the intercartilaginous lining.

Surgery

Surgical manipulations are carried out by arthroscopic or arthrotomy method. The main task is to partially or completely remove the medial meniscus. The indications for surgery are:

intense pain;
significant horizontal rupture of the medial meniscus;
effusion (fluid buildup in the knee joint);
clicking when extending the knee;
blockade of the joint.

When stitching, long surgical needles are used with ligatures fixed on them (absorbable or non-absorbable suture material). Meniscus fixation techniques are used:

stitching from the inside out;
seams outside-in;
inside the joint
transplantation of the medial meniscus.

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

Reconstructive technique

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

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

A rupture of the medial meniscus must be detected in time and treated in a timely manner. Disability is a consequence of untimely access to a doctor.

Anterior horn

Treatment of a torn anterior horn of the medial (inner) meniscus

The medial meniscus differs from the lateral one in a larger circumference and a greater distance between the horns (approximately twice). The anterior horn of the medial meniscus is attached in the region 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 one to the medial lateral 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, however, the blood vessels extend only 5-7 mm from the edge of the meniscus.

Statistics

According to available data, injuries of the medial meniscus 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. For this injury, longitudinal and patchwork ruptures are more characteristic.

Causes

The main reason for the 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 who lead an active lifestyle, as well as older men. According to statistics, the gap 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 inner surfaces of the joint. When the anterior horn is torn off with infringement, symptoms such as blockade of the knee joint, pain in the knee, and the inability to move independently appear. After the treatment, the block of the joint is eliminated. Also, with an injury to the anterior horn of the meniscus, the patient can often bend the knee slightly, after which the blockade occurs.

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

Feeling pain inside the joint
Increased pain when trying to bend the leg at the knee,
Flabbiness of the thigh muscles,
Feeling of "shoot through" with tension of the knee joint,
Pain in the area of attachment of the meniscus and ligaments.

Kinds

There are three types of breaks:

Rupture of the directly anterior horn (complete or partial).
Rupture of the meniscus, in which degenerative changes are observed.
Rupture of the ligament that fixes the meniscus.

Conservative treatment

For minor injuries of the meniscus, conservative treatment is sufficient. At the first stages, the injured limb is fixed with a splint. A joint puncture may also be performed in order to get rid of the accumulated blood in the cavity and remove the blockage of the joint. The patient is advised to rest, the load on the leg should be limited. Subsequently, a course of physiotherapy, physiotherapy exercises, massage sessions and electromyostimulation were recommended.

Surgical treatment

If there is a complete rupture of the anterior horn of the internal meniscus, then 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 the complete removal of the meniscus. Instead, stitching or fragmentary removal by arthroscopy is performed. Due to the low invasiveness of the arthroscopic method, trauma to the knee joint and the rehabilitation period are significantly reduced. The implementation of this procedure allows you to save the 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 younger patients, it is possible to perform arthroscopic suturing of the meniscus. At the same time, a rupture of the anterior horn of the meniscus is an indication for such stitching, since the anterior horn has a good blood supply, and its recovery is faster and more complete.

Rehabilitation

Arthroscopy can significantly reduce the recovery time after a meniscus injury. Already after a few days, it becomes possible to load 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 return mobility to the knee joint.

The knee joint has a rather complex structure. It consists of the femur and tibia, the patella (patella), as well as the ligament system that ensures the stability of the bones of the joint. Another part of the knee joint is the menisci - cartilage 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 in the posterior horn of the medial meniscus is one such injury.

Injuries to the knee joint are dangerous, painful and fraught with consequences. 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, therefore, it requires timely detection and treatment.

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); elongated end parts - the posterior and anterior horns of the meniscus.

There are two menisci in the knee joint: medial (inner) and lateral (outer). They are attached to the tibia with their ends. The medial is located on the inside of the knee and is connected to the internal lateral ligament. In addition, it is connected along the outer edge with the capsule of the knee joint, through which partial blood circulation is provided.

The cartilaginous section 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 in the outer region of the knee. It is more mobile than the medial, and its damage occurs much less frequently.

Menisci perform very important functions. First of all, they play the role of shock absorbers during the movement of the joint. 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 inner meniscus is removed, the area of contact of the knee bones decreases 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%.

meniscal injury

One of the characteristic injuries of the menisci is their rupture. Studies show that such injuries can occur not only in people involved in sports, dancing or hard work, but also in casual activities, as well as in the elderly. It has been established that a meniscal tear is diagnosed 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.

The cause of a torn meniscus can be an excessive lateral load along with twisting of the lower leg. Such loads are typical when performing certain movements (cross-country running, jumping on uneven surfaces, rotation on one leg, prolonged squatting). 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 or a quick extension of the leg. According to 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 menisci;
degenerative rupture.

Degenerative rupture is associated with changes in tissues due to diseases or due to aging.

Symptoms of a meniscus injury

In case of damage to the meniscus of the knee joint, two characteristic periods are distinguished - 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, as a rule, is determined by the sound, resembling a crack, and a sharp pain in the knee area. In the first period after an injury, cracking and pain accompanies a person during exertion (for example, walking up stairs). Swelling develops in the knee area. Often, a meniscus tear is accompanied by hemorrhage into the joint.

In the acute period, the 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, the effect of a “floating patella” may occur.

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

Baikov's symptom is based on the detection of pain when fingers are pressed on the outer side of the knee with simultaneous extension of the lower leg. Land's symptom determines the injury by the degree of straightening of the leg in 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 the increased sensitivity of the skin on the inner surface of the knee joint and the upper part of the lower leg from the inside. The symptom of the blockade establishes a gap in the jamming of the knee joint when a person moves up the stairs. This symptom is characteristic of a torn posterior horn of the internal meniscus.

Typical symptoms of a medial meniscus tear

Rupture 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 in the knee area from the inside. When you press your finger in the area where the meniscus horn attaches to the knee ligament, a sharp pain appears. A tear in the posterior horn causes blockage of movement in the knee joint.

You can determine the gap by making flexion movements. It manifests itself in the form of a sharp pain when the leg is extended and the lower leg is turned outward. The pain also pierces with strong bending of the leg at the knee. According to the severity of damage to the meniscus of the knee joint are divided into small, 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 and manifest themselves during physical exertion, such as jumping, moving up inclined planes, and squatting. Without treatment, this form of injury becomes chronic. This degree is characteristic of some ruptures of the anterior and posterior horns of the medial meniscus.

With a severe degree of injury, pain and swelling of the knee become obvious; hemorrhage occurs in the joint cavity. The horn is completely detached from the meniscus, and its parts are inside the joints, which causes a blockade of movements. Independent movement of a person is difficult. Severe injury requires surgical intervention.

Mechanism of rupture of the posterior horn

What happens in the knee joint during an injury

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 meniscus horn can migrate into the cavity between the joints and block their movement.

On the border of the middle of the body of the meniscus and the beginning of the posterior horn of the inner meniscus, oblique tears often develop. This is usually a partial tear, but the edge may be embedded between joints. This produces a crackling sound and painful sensations (rolling pain).

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

A horizontal rupture 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 joint space (pathology is also characteristic of the anterior horn of the lateral meniscus).

Conservative treatments

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

The conservative (therapeutic) method is applicable for small ruptures and a rupture of moderate severity. Such treatment is based on a number of therapeutic interventions and is often effective.

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

Usually the conservative method involves long-term treatment for 6-12 months. Initially, reduction (reposition) of the knee joint is performed in the presence of 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 with a plaster splint.

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

To eliminate puffiness and accelerate healing, external agents are used in the form of ointments (Amzan, Voltaren, Dolgit and others). The treatment process includes a course of physiotherapy and special therapeutic exercises. A therapeutic massage gives a good effect.

Surgical treatment

With severe damage, there is a need for surgical intervention. With crushing of the cartilage, severe rupture and displacement of the meniscus, complete breakage of the anterior or posterior horns of the meniscus, a surgical operation is necessary. Surgical treatment is divided into several types: removal of a meniscus or detached horn; recovery; suturing the place of the rupture; fastening detached horns with clamps; meniscus transplant.

Recovery is possible with a longitudinal rupture of the horn, separation of the horn from the capsule, local rupture without complete separation, and in some other cases (if degenerative changes have not occurred in the tissues of the meniscus).

After the surgical intervention, rehabilitation measures are carried out. They include a set of exercises to develop the knee joint; therapeutic massage and physiotherapy methods; taking chondroprotectors and nonsteroidal drugs. The patient for up to 12 months should be protected from physical exertion.

Rupture of the meniscus of the knee joint and other injuries

Rupture of the meniscus of the knee joint ranks first among all other injuries of the knee. Moreover, damage to the meniscus of the knee joint accounts for about 75% of all other knee injuries. This frequency is due to the peculiarities of the biomechanics of the knee.

Causes

Menisci are a kind of cartilage lining between the articular surfaces of the femur, tibia and fibula. They are designed to reduce the enormous mechanical load on the articular surfaces of the knee, and at the same time increase the congruence (correspondence to each other) of these articular surfaces. The menisci are C-shaped, and therefore they have a body, anterior and posterior horns. There are two menisci in the knee joint - the inner, medial, and the outer, lateral. The lateral meniscus is more mobile, while the medial is fused to the lateral ligament.

In this regard, damage to the medial meniscus occurs several times more often than the lateral one. Most often, the posterior horn or body of the meniscus is injured. Damage by nature can be transverse, longitudinal, complete, incomplete, median, marginal. A characteristic type of damage is the so-called. rupture of the medial meniscus according to the “handle of a watering can”, when a transverse rupture maintains a connection between the torn fragment and the rest of the meniscus.

The leading causes of a meniscus tear are injuries.

The main contingent of victims are young people involved in sports. Meniscal tears often occur as a result of sudden movements in the knee, jumping, falling on the knee, direct blows with damage to the knee structures. Another common rupture mechanism is a sharp rotation of the lower limb around the longitudinal axis with a fixed foot. When turning outward, the inner meniscus is damaged, and when turning inward, the outer meniscus is damaged.

In addition to injuries, damage to the meniscus of the knee joint can be the result of various degenerative processes in the knee joint. These include rheumatism, gout, deforming osteoarthritis. Chronic damage to the meniscus often develops in individuals whose activities are associated with long walking, carrying heavy loads. Often, damage to the menisci is a consequence of external and internal (varus and valgus) curvature of the knee, which can be congenital or acquired.

Symptoms

Traumatic damage to the meniscus includes an acute and chronic period, each of which has its own signs. The main symptoms of the acute period are a sharp pain caused by the injury itself, and a decrease in the range of motion, mainly extension. Often, a meniscus rupture is combined with other types of damage - hemarthrosis (bleeding into the joint), ligament rupture, intra-articular fractures.

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With uncomplicated meniscal injuries, the pain subsides over time or disappears altogether. This is the period of the so-called. imaginary prosperity. To a large extent, pain relief is facilitated by ongoing therapeutic measures - local cold, immobilization (immobilization of the knee), painkillers.

But after 2-3 weeks. symptoms of pain and movement disorders reappear. This is already a chronic period of injury, because a fragment of a damaged meniscus injures the surrounding tissues, and, above all, the articular cartilage and joint capsule. Inflammation of the latter (synovitis) leads to hydrarthrosis - the accumulation of inflammatory fluid (exudate) in the joint cavity. In addition, secondary swelling of the soft tissues of the knee joins the inflammation. All this leads to the fact that the knee joint increases in volume.

At the same time, the patient complains of local pain and the inability to make full movements in the knee - the so-called. joint block. Although in some cases, the symptoms of pain and joint block disappear as suddenly as they began. With certain influences and types of movements, a fragment of the meniscus slips out from under the articular surfaces, and the state of health improves. However, at any moment, with the next careless movement, it is infringed again, and the symptoms of meniscus damage return. Over time, pain, joint blockage, and local inflammation worsen. Chronic inflammatory and degenerative-arthritis changes develop in the knee joint. Not only the knee itself atrophies, but also the muscles of the thigh and lower leg.

Diagnosis and treatment

First aid for a traumatic rupture includes immobilization of the knee with a plaster splint, cold on the knee, and the use of painkillers (Analgin, Renalgan). Although it is very difficult to carry out a full diagnosis of meniscus damage at first. The fact is that the cartilaginous tissue of the menisci is not visible on radiographs. And even more advanced methods, ultrasound and computed tomography are not always informative. And only magnetic resonance imaging in most cases allows us to establish the truth.

The choice of further tactics, conservative treatment or surgery, depends entirely on the nature of the damage, and in each case is carried out strictly individually. The bottom line is that the outer marginal zones of the meniscus, especially the medial one, are fused with the articular knee capsule, and are fed by its vessels. Therefore, the processes of regeneration, fusion, proceed relatively quickly here, while they are practically absent in the inner parts of the menisci. Partial injuries, without displacement of meniscal fragments, may well be treated conservatively. But the “handle of the watering can” definitely requires surgical intervention.

Conservative treatment involves long-term immobilization with a plaster splint for up to 4-6 weeks using painkillers and non-steroidal anti-inflammatory gels and ointments with Indomethacin, Diclofenac, Ibuprofen. If an effusion has formed in the knee, it is removed, and steroid hormones (Kenalog, Hydrocortisone) are injected into the joint cavity. After an acute inflammatory period, they proceed to physiotherapeutic procedures, including a magnet, phonophoresis, paraffin and ozocerite.

Surgical treatment involves stitching a torn meniscus. Previously, for this, an incision was made in the knee joint - a very traumatic and painful operation. Now surgery is carried out by endoscopic access, when an optical device (endoscope) and the necessary working tools are inserted through small holes. Removal of part of the meniscus (resection) and the entire meniscus (meniscectomy) are carried out in extreme cases - with massive traumatic injuries or crush injuries with a complete detachment of the meniscus.

Prevention of meniscus injuries is aimed primarily at preventing injuries. In this regard, attention should be paid to the technique of sports training, during which sudden movements, blows, and other provoking factors should be avoided. The same applies to behavior at home and at work. Persons suffering from chronic degenerative-inflammatory diseases of the knee joint need high-quality treatment of these diseases using medicines, physical procedures, massage and orthopedic devices.

How to treat the meniscus - conservatively or surgically?

The knee meniscus is a cartilaginous layer with a collagen microstructure located between the tibia and the femur, which acts as a shock absorber and stabilizer. In total, the knee has two such plates, resembling transparent lenses in the shape of a crescent:

Internal (medial), more reminiscent of an elongated mirror letter C
External (lateral), shaped like a semicircle

Frequent damage to the meniscus of the knee joint - tear or tear. Their treatment is carried out mainly with the help of surgery.

The meniscus in the knee plays an important cushioning and stabilizing role.

Surgical treatment of the meniscus of the knee joint

How is the meniscus attached to the joints?

The attachment of the lateral outer meniscus is looser than that of the medial inner

The lateral meniscus is freer and is attached:

to the tibia, fusing with it at two close points located in the middle part of the bone
to the condyle (protrusion) of the femur with the help of the anterior and posterior menisco-femoral ligaments connecting the posterior horn of the meniscus with the thigh (they pass behind and in front of the posterior cruciate ligament)
to the synovial capsule in thin bundles extending from the tendon of the popliteal muscle (thus, the mobility of the lateral meniscus relative to the capsule is preserved)

The medial is fixed more rigidly:

At two extreme points on the front and back of the tibia
The outer edge to the thickening on the capsule with the help of the coronary ligament (capsular thickening is formed by the collateral tibial ligament)

Due to the rigid attachment, it is the medial meniscus that is most susceptible to injury.

The role of the meniscus in the knee joint

Cartilage pads increase the bearing surface of the joint, thereby evenly distributing the load on it
They have half the elastic properties of normal cartilage.
Due to the free attachment of the lateral pads, they act as shock absorbers during jumps, pushes and impacts.
The medial internal menisci perform a stabilizing function:
- Even with a damaged anterior cruciate ligament, they prevent the tibia from moving forward relative to the femur.
- Such stability is largely determined by the peculiarity of the fibrous structure - the intersection of circular and radial fibers

Damage to the meniscus of the knee joint

Due to their stability, cartilage lenses are rarely damaged in normal daily life. The exception is meniscal injury due to knee osteoarthritis, which can occur in older people.

In the late stage of deforming arthrosis, spontaneous destruction of the cartilage lining can occur, and any sudden movement or fall can also contribute to this.

At a young age, damage to the meniscus in injuries of the knee joint occurs in physically active people, for example, in athletes after:

Overextension of the knee due to jumping from a great height
Simultaneous landing with knee twist
Strong blow to the knee and other causes

Menisci can be damaged both by themselves and in combination with other injuries:

Ligament tears
Fractures of the condyles and diaphyses of the femur and tibia

Pre-existing cruciate ligament tears increase the risk of meniscus injury.

In case of injury, either the meniscus is detached from the attachment site, or it is torn.

Types and symptoms of a torn meniscus

By type of breaks are radial, oblique, horizontal, transverse

The gaps have a different shape and direction:

radial, oblique, horizontal, transverse
gaps are often found in the medial plates, shaped like a watering can handle

There are more and less favorable injuries, depending on the location of the gap:

The most favorable is the rupture of the outer edge, since it is through the peripheral red zone connected to the capsule that the blood supply to the meniscus occurs. And since there is a blood supply, it means that recovery after an injury is possible.
The closer the gap is displaced to the white zone, the fewer blood vessels and less chance of healing.

Rupture symptoms:

Sudden sharp pain (with a degenerative tear, it may be intermittent and not very severe)
Blockade of the joint (sharp limitation of movements):
This occurs after a piece of cartilage that has come off falls between the joints.
Pain on going up and down (not always)
Severe swelling above the kneecap:
This can happen after hemarthrosis (bleeding from the meniscus)
Pain symptoms when pressing on the interarticular space
Positive tests for extension (Baykov, Landy, Rocher) and rotation (Steiman, Bragard)
With an old injury, effusion occurs due to synovitis (fluid buildup in the joint)

Diagnostics

Rupture of the meniscus of the knee on x-ray

For diagnostic purposes, carry out:

Panoramic functional radiography in direct, lateral and axial projection:
- x-rays are taken in a standing position and with legs bent
- due to the transparency of the cartilage lens, x-rays with contrast are used
MRI of the knee joint:
Using MRI, the degree of rupture is determined by the intensity of the focal signal - from zero (normal meniscus) to third (complete rupture)
Arthroscopy of the knee

Consequences of a break

If the rupture is not treated, then this can then lead to chondromalacia - the gradual destruction of the cartilaginous surface of the knee joint by a torn meniscus flap, which creates friction on the joint during movement.

Chondromalacia is a gradual process that also goes through four stages, like osteoarthritis.

To prevent chondromolation, it is necessary to carry out timely treatment of the gap.

Chondromalacia is the abrasion of the cartilage of a joint with a meniscus flap.

Why is conservative treatment of the meniscus rare?

Conservative treatment without surgery is justified only in such cases:

For minor tears in the cartilage pads without compromised joint stability
In complex combined injuries, when the cruciate ligaments are also damaged

Treatment of an unstable isolated injury to the meniscus by immobilizing the joint (casting) is a gross medical error:

Large median tears still won't heal
Small ones can be eliminated with a minimally invasive operation - arthroscopy
Complete immobilization due to the cast itself is painful plus leads to persistent contractures

Often it turns out that after such a conservative treatment, it is immediately necessary to carry out a surgical operation.

Types of surgical treatment of the meniscus

The most preferred and less traumatic method of treatment is arthroscopy.

Complete removal (meniscectomy) is rarely resorted to:

It is recognized as a harmful and ineffective operation, carried out at a time when the remarkable role of these plates was still little studied.

Today it is already clear that the removal of the meniscus subsequently leads to the development of arthrosis and arthritis, so after this radical operation there is a decrease in the articular contact surface and an increase in the load on the joint

The following types of operations are recognized as effective:

Partial meniscectomy
Restoration of the cartilage lining by stitching
Recovery by transplantation

Partial meniscectomy

The operation is carried out as follows:

A torn or dangling piece of cartilage is removed
After that, the edges are trimmed
If signs of chondromalacia are found, then preparations with hyaluronic acid (ostenil, duralan, etc.) are injected into the joint cavity.

In the figure below, a more complex case of the operation, when the gap is large, occurs like a "watering can handle" and stitching is impossible.

Stages of the operation of meniscectomy with a rupture of the "handle of a watering can"

It can be seen how the torn flap clings to the tool, cut at the base, and then twisted

A suture can be applied if the rupture is located in the red or red-white zone of the meniscus, close to its outer edges, that is, where there are blood vessels

Stitching in the white zone does not lead to healing and threatens to rupture again.

Meniscus transplant

Such an operation is offered with significant damage to the meniscus and the impossibility of restoring it in another way.

There are three types of transplants:

Own tissues (use large healthy tendons of the patient)
Donor menisci
Allogenic materials:
- bone matrix grafts
- artificial substitutes

Learn more about arthroscopy here.

Rehabilitation after meniscus surgery

The duration of rehabilitation depends on the complexity and type of operation. Throughout the recovery, exercises and physiotherapy are mandatory, the choice of which is made by a surgeon or a rehabilitation specialist.

For different types of surgery, their own rehabilitation scheme is selected

Recovery for minor surgeries

Gentle load on the operated knee is possible already on the second day
Crutches are used intermittently to unload the knee during the week
After one or two weeks, you can carefully begin to work
After another week, you can try to increase the load with an exercise bike
More dynamic sports (football, running, volleyball, tennis) possible after 3-4 weeks

Rehabilitation after stitching the meniscus

Regular knee loading regime is introduced in the fifth week

Sports (with the permission of the doctor) - after two months of rehabilitation

Sports activities with a load - only after six months

Transplant rehabilitation

Partial load period - 5 - 6 weeks
Eligible sports - in eight - weeks

It is necessary to coordinate with the rehabilitation specialist or surgeon each period of rehabilitation after meniscus surgery, as each patient has his own recovery resources.

Video: Rehabilitation after knee surgery (arthroscopy)

Rehabilitation

The structure of the knee with a description

This leads to frequent injuries in the knee joint. Tears of the lateral and cruciate ligaments, fractures of the condyles of the femur and tibia, fracture of the kneecap can occur, and the most common type of injury is a meniscus tear.

What is a meniscus and what is the reason for its increased injury

The menisci of the knee joint are cartilaginous plates that are located between the bones of the knee apparatus and serve as shock absorbers when walking.

The meniscus is a semicircular cartilaginous plate located between the femur and tibia. It consists of a body, posterior and anterior horns. Each meniscus is a semicircle, where the middle is the body of the meniscus, and the edges of the semicircle are the horns. The anterior horn attaches to the intercondylar eminences in the anterior part of the knee joint, and the posterior horn to the posterior ones. There are two types of menisci:

external, or lateral - located on the outside of the knee joint, more mobile and less prone to injury;
the inner, or medial, meniscus is less mobile, is located closer to the inner edge and is associated with the internal lateral ligament. The most common type of injury is a torn medial meniscus.

Injury to the meniscus of the knee

depreciation and reduction of loads on the surface of the bones of the knee;
an increase in the area of contact of the surfaces of the bones, which helps to reduce the load on these bones;
knee stabilization;
proprioceptors - located in the meniscus and give signals to the brain about the position of the lower limb.

The menisci do not have their own blood supply, they are fused with the capsule of the knee joint, so their lateral parts receive blood supply from the capsule, and the internal parts only from the intracapsular fluid. There are three zones of blood supply to the meniscus:

red zone - located next to the capsule and receiving the best blood supply,
intermediate zone - located in the middle and its blood supply is insignificant;
white zone - does not receive blood supply from the capsule.

Depending on the zone in which the damaged area is located, the treatment tactics are chosen. The tears located next to the capsule grow together on their own, due to the abundant blood supply, and the tears in the inner part of the meniscus, where the cartilage tissue is nourished only by the synovial fluid, do not grow together at all.

Incidence of meniscal tears

This injury is in the first place among internal injuries of the knee joint. It is more common in athletes, people involved in heavy physical labor, professional dancers and the like. More than 70% are medial meniscus tears, about 20% are lateral meniscus tears, and approximately 5% are both meniscus tears.

Damaged knee joint

vertical longitudinal gap - according to the type of "watering can handle";
oblique, patchwork rupture of the meniscus;
degenerative rupture - massive reproduction of meniscus tissue;
radial - transverse rupture;
damage to the anterior or posterior horns of the meniscus;
other types of breaks.

Also share isolated damage to the internal or external meniscus or combined damage.

Causes of meniscus tears

The cause of a rupture of the menisci of the knee joint is most often an indirect traumatic effect, which leads to the fact that the lower leg turns sharply inward or outward, which causes a rupture of the knee ligaments and menisci. Also, a meniscus rupture is possible with a sharp abduction or adduction of the lower leg, excessive extension at the knee, or direct injury - a sharp blow to the knee.

Meniscus tear clinic

A torn meniscus of the knee has characteristic symptoms. There are acute and chronic periods of the disease.

Acute period - lasts up to 4 - 5 weeks, meniscus rupture is accompanied by a characteristic crack, immediately after injury there is acute pain, an increase in size, swelling, inability to move, hemorrhage into the joint cavity. Characteristic is the symptom of "floating patella" - from the accumulation of fluid in the cavity of the knee joint.

Meniscus tear - options

These symptoms are common to all injuries of the knee joint, in order to accurately determine the type of injury, an x-ray examination is necessary.

When the acute period passes into the chronic one, characteristic symptoms appear that allow confirming the diagnosis of meniscus rupture.

The symptoms of a torn meniscus are:

Baikov's symptom is the appearance of pain during palpation in the knee area in front and simultaneous extension of the lower leg.
Land's symptom - or the "palm" symptom - in a lying patient, the leg is bent at the knee and a palm can be placed under it.
Turner's symptom - hyper-il hapeesthesia (increased sensitivity of the skin) under the knee and in the upper third of the lower leg.
Perelman's symptom - the occurrence of pain and instability of the gait when descending the stairs.
Chaklin's symptom, or "tailor's" symptom - when raising a straight leg, atrophy of the quadriceps femoris muscle and a strong tension of the tailor muscle are visible.
The symptom of blockade is one of the most important symptoms in the diagnosis of a torn medial meniscus. With a load on the sore leg - climbing stairs, squatting - there is a “jamming” of the knee joint, the patient cannot fully straighten the leg, pain and effusion appear in the knee area.

Symptoms of damage to the medial meniscus:

the pain is more intense in the inner side of the knee joint;
when pressing on the place of attachment of the ligament to the meniscus, point pain occurs;
"blockade" of the knee;
pain during hyperextension and turning of the lower leg outward;
pain with excessive bending of the leg.

Symptoms of damage to the lateral meniscus:

when the knee joint is strained, pain occurs, radiating to the outer section;
pain during hyperextension and rotation of the lower leg inside;
weakness of the muscles of the front of the thigh.

Severity of meniscus injury

Knee injury

Depending on the severity, the doctor prescribes treatment. There are the following degrees:

A small torn meniscus - accompanied by minor pain and swelling in the knee. Symptoms go away within a few weeks.
Rupture of moderate severity - there is acute pain in the knee joint, pronounced swelling appears, movements are limited, but the ability to walk is preserved. With physical exertion, squats, climbing stairs, there is a sharp pain in the knee. These symptoms are present for several weeks, if treatment is not carried out, the disease becomes chronic.
Severe rupture - severe pain and swelling of the knee joint, possibly bleeding into its cavity. It is characterized by complete crushing of the meniscus or separation of parts, fragments of the meniscus fall between the articular surfaces, which causes stiffness of movements and the inability to move independently. Symptoms worsen over several days and require surgery.

With frequent microtrauma in the elderly, a chronic or degenerative stage of the disease occurs. Cartilage tissue under the influence of numerous damages loses its properties, undergoing degeneration. With physical exertion or for no apparent reason, knee pain, swelling, gait disturbance, and other symptoms of meniscus damage appear.

Diagnosis of meniscus rupture

The diagnosis is established by the characteristic clinical picture, examination data and laboratory research methods. To make such a diagnosis, an X-ray examination, MRI or arthroscopy of the knee joint is necessary.

X-ray examination of the meniscus

The main symptom of a meniscus tear is pain and swelling of the knee. The severity of this symptom depends on the severity of the injury, its location and the time that has elapsed since the injury. An orthopedic surgeon conducts a detailed examination of the injured joint and performs the necessary diagnostic procedures.

X-ray examination is a fairly simple method of diagnosis. Menisci are not visible on X-ray images, therefore, studies are carried out using contrast agents or more modern research methods are used.

Arthroscopy is the most informative research method. With the help of a special device, you can look inside the damaged knee, accurately determine the location and severity of the rupture, and, if necessary, perform medical procedures.

Medical and surgical treatment

The choice of therapeutic agents depends on the location of the rupture and the severity of the injury. In case of rupture of the meniscus of the knee joint, treatment is carried out conservatively or surgically.

Conservative treatment

Meniscus of the knee joint: symptoms, treatment of damage and rupture

In this article, we will talk about the meniscus of the knee joint - a structure located between the lower leg and thigh and consisting of fibrocartilage. There are two menisci of the knee joint: medial and lateral. The main function of both menisci is cushioning in the joint. In addition, they take on the function of stabilizers, limit mobility in the joint, and also increase the congruence of its surfaces and reduce friction.

Injury to the meniscus of the knee joint is a fairly common phenomenon in our time, usually associated with types of injuries received in sports, both amateur and professional - while running, playing basketball, football, etc. Knee meniscus is torn (damaged) with a sharp load at the time of simultaneous extension and rotation of the joint. There may also be degenerative changes due to gradual wear. Injuries to the meniscus of the knee joint are of two types: injuries of the lateral and medial menisci, respectively. Injuries to the lateral (outer) meniscus occur much less frequently than the medial (inner) meniscus, since the mobility of the latter is significantly limited by the connection with the internal lateral ligament of the joint.

In traumatic injuries, inflammation of the tissues is noted. Typically, a meniscus tear (and subsequent inflammation of the meniscus) occurs as a result of strong flexion or extension of the joint, as well as as a result of direct physical impact on the lower leg. We can assume that inflammation of the meniscus is a kind of signal. If it is not timely to establish a rupture of the tissues of the meniscus of the knee joint, this can lead to the fact that the disease passes into a chronic stage, manifested by degeneration and cystic degeneration.

To diagnose damage to the meniscus of the knee, the following are performed: clinical examination, instrumental examination, examination of a meniscus tear and its symptoms, as well as MPT of the joint. In this case, the most effective diagnosis can be carried out only during the operation. An untimely operation on the meniscus can lead to damage to the cartilage tissue. Even in the absence of severe pain, a damaged knee meniscus can provide uneven friction between the articular surfaces of the bones, which, in turn, can lead to more serious diseases (arthrosis, etc.).

In the presence of chronic damage at the base of the meniscus, the so-called. ganglion (cyst). Sometimes a cyst forms when there is a longitudinal or relatively minor injury to the meniscus of the knee joint. In this case, diagnostic arthroscopic surgery is necessary.

Meniscus tear: symptoms

Next, we will talk about the consequences of a meniscus rupture, we will describe the symptoms separately. Usually, at the initial stage, the symptoms of the disease are similar in their manifestation to other diseases of the knee joint. Only a few weeks later, when the reactive manifestations subside, one can speak directly about a meniscus rupture, in any case, at the first pain in the knee, it is better to contact a good specialist, he will definitely be able to make a diagnosis.

So, the symptoms of a torn or damaged meniscus:

increased body temperature in the joint area;
sharp pain (usually diffuse, but for some time located on the outer or inner surface of the knee);
when the joint is bent, a characteristic click is heard;
Difficulty going up and down stairs
the joint is enlarged. If you have this symptom, you should immediately contact a specialist.

Meniscus rupture, the symptoms of which are often not specific, similar manifestations can also be observed with arthrosis of the knee joint, sprains and severe bruises, so the specialist in this case requires the most thorough examination of the patient. The external meniscus is characterized by high mobility, therefore it is usually compressed, and ruptures, as a rule, are observed in the meniscus fixed in the articular cavity.

Meniscus of the knee joint: treatment

Now let's talk about the treatment of the meniscus of the knee joint. So, how to treat it? To date, there are two ways: conservative therapy and surgical intervention. In general, the treatment of the meniscus directly depends on a number of factors, the age of the patient, occupation, lifestyle, as well as the degree of physical and sports activity matter. Only a specialist can choose methods of treatment. We will briefly try to tell you how to treat a meniscus, its rupture or inflammation.

Treatment usually includes the following steps:

physiotherapy procedures;
reconstructive surgery.
meniscectomy;

Meniscectomy, or removal of the meniscus, is usually done through arthroscopy. Much less often, when removing the meniscus, arthrotomy is used - that is, an open operation. However, in the absence of other injured structures, meniscus resection is usually not performed. In some cases, the treatment of the meniscus can be surgical, with such a development of events, the operation is performed according to the method of arthroscopy with minimal surgical intervention using minimally invasive endoscopy.

The meniscus is operated on using a special endoscopic unit, the main components of which are a camera, a monitor, a fluid pump, and a light source. The operation is carried out with the obligatory constant washing of the joint cavity with a special solution, the examination is carried out using an arthroscope, a camera lens and a light guide.

Meniscus arthroscopy has many significant benefits, including:

the ability to avoid large incisions,
no need to immobilize the limb with a special plaster cast,
reduction of the patient's stay in a hospital,
the possibility of performing an operation on an outpatient basis,
fast postoperative recovery.

Arthroscopy of the meniscus can also be used to diagnose injuries.

Meniscus treatment without surgery

Many people ask: how to treat a meniscus without surgery? And is it possible? In fact, if there are no serious tears, then conservative methods without surgery using such examples may well be applied.

The peculiarity of the knee joint is that it easily adapts to atypical conditions for it. Trauma, damage, meniscus tears, cartilage cracking - all this causes acute pain only at first. Then the symptoms subside, which makes the patient think that everything has passed. He is in no hurry to see a doctor, continuing to live a normal life. That is why a chronic meniscus tear is a fairly common diagnosis. Another reason for this condition is misdiagnosis. If there are no pronounced symptoms, and a competent examination was not carried out, then the injury is taken for a normal sprain or bruise, which is why ineffective treatment is prescribed. It only temporarily relieves the symptoms, without eliminating the disease itself.

signs

As a person gets used to the aching pain in the knee, he may not notice the characteristic symptoms. An old meniscus injury is indicated by:

frequent pain in the joint, aggravated after long standing and physical exertion;
relief after rest;
restriction in movement - there are difficulties when trying to fully bend or straighten the leg;
from time to time there is a reactive inflammation of the joint, which is accompanied by redness, swelling. Possible synovitis.

If treatment is still not provided, then the articular cartilage is gradually destroyed, which invariably leads to post-traumatic arthrosis. Restoring the joint in such cases is almost impossible. The person loses the ability to walk normally, uses a cane or a wheelchair.

Kinds

Since there are two menisci in the knee joint, there are ruptures of the internal (medial) and external (lateral) ones. Each has its own symptoms. Chronic damage to the medial meniscus of the knee joint is more often diagnosed. This is due to the fact that he is less mobile and more prone to injury. Tears are possible in different places of the cartilage:

meniscus body;
anterior horn;
back horn.

It is also necessary to establish the cause of the injury. The treatment of pathology will depend on this. There are traumatic ruptures and degenerative ones. The latter develop against the background of existing joint diseases and are caused by a weakening of the cartilage structure. As a rule, they occur in older people against the background of a general weakening of the musculoskeletal system.

Treatment

An old meniscal injury is treated conservatively and surgically. In the first case, a set of traditional measures is assumed to restore the motor functions of the joint and ensure its mobility. That means:

taking chondroprotectors, anti-inflammatory and pain medications;
massage and physiotherapy;
exercise and exercise.

Far from always, these methods are effective, because for a long time the cartilage "gets used" to its condition. It is especially difficult to cure an old rupture of the posterior horn of the medial meniscus in a conservative way. Much depends on the size of the injury and the severity of the injury. You will most likely need to wear a bandage and take the necessary medications regularly. Joint restoration is a long process and can take 1-1.5 years.

Operation

An operation is prescribed if it is impossible to eliminate the damage in a conservative way. Today, surgical intervention in most cases is carried out using arthroscopy, which is characterized by a quick rehabilitation period and a small number of complications. Endoscopic surgery (you can walk and move your knee almost immediately) and open surgeries are also popular. The latter is associated with high trauma and is carried out only in the absence of alternatives.

During a surgical operation, the doctor performs various procedures:

stitches the torn edges of the meniscus;
removes parts that cannot be restored;
removes excess fluid from the joint;
collects biomaterial for its further study.

If an old meniscus injury is treated surgically, the effect is noticeable immediately after the rehabilitation period. However, the patient is advised to refrain from heavy physical exertion for some time. The recovery period involves taking medication and doing simple exercises.

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Symptoms of a meniscus injury

The menisci of the knee are called cartilaginous formations located in the joint cavity, serving as shock absorbers of movement, stabilizers that protect the articular cartilage. There are two menisci, an inner (medial) and an outer (lateral) meniscus. Damage to the internal meniscus of the knee joint occurs much more often, due to its lesser mobility. Damage to the meniscus manifests itself in the form of limited mobility, pain in the knee, and in chronic cases, it can also be the development of arthrosis of the knee joint.

Sharp cutting pain, swelling of the joint, difficulty in moving the limbs and painful clicks indicate that the meniscus is damaged. These symptoms occur immediately after an injury and may be indicative of other joint damage. More reliable symptoms of meniscus damage appear 2-3 weeks after the injury. With such injuries, the patient feels local pain in the joint space, fluid accumulates in the joint cavity, “blockade” of the knee, weakness of the muscles of the anterior surface of the thigh.

More reliable signs of damage to the meniscus are determined using special tests. There are tests for extension of the joints (Landy, Baikov, Roche, etc.), with a certain extension of the joint, pain symptoms are felt. The technique of rotation tests is based on the manifestation of damage during the scrolling movements of the joints (Bragard, Shteiman). Meniscal injury can also be diagnosed by compression symptoms, mediolateral tests, and MRI.

Damage treatment

A meniscal injury involves different treatments, depending on the severity and type of injury. With the classical type of getting rid of ailments, it is possible to distinguish the main types of exposure used for any damage.

First of all, it is worth relieving pain, therefore, to begin with, the patient is given an anesthetic injection, after which they take a puncture of the joint, remove accumulated blood and fluid from the joint cavity, and, if necessary, eliminate the blockade of the joints. After these procedures, the joint needs rest, to create which a gibs bandage or a splint is applied. In most cases, 3-4 weeks of immobilization is enough, but in severe cases, the period can be up to 6 weeks. It is recommended to apply local cold, non-steroidal drugs that relieve inflammation. Later, you can add physiotherapy exercises, walking with supports, various types of physiotherapy.

Surgery is recommended in severe cases, such as an old meniscus injury. One of the most popular surgical methods today is arthroscopic surgery. This type of surgery has become popular due to its careful attitude to tissues. The operation is a resection of only the damaged part of the meniscus and polishing of defects.

With such injuries as a meniscus tear, the operation is performed closed. Through two holes, an arthroscope with instruments is inserted into the joint to study the damage, after which a decision is made on partial resection of the meniscus or the possibility of sewing it up. Inpatient treatment lasts about 1-3 days, due to the low trauma of this type of operation. At the recovery stage, limited physical activity is recommended for up to 2-4 weeks. In special cases, walking with supports and wearing a knee brace is recommended. From the very first week, you can already begin rehabilitation physical education.

Rupture of the meniscus of the knee joint

The most common knee injury is a tear in the medial meniscus. Distinguish between traumatic and degenerative ruptures of the menisci. Traumatic injuries occur mainly in athletes, young people aged 20-40 years, if left untreated, they transform into degenerative tears, which are more pronounced in older people.

Based on the localization of the rupture, several main types of meniscal rupture are distinguished: a rupture resembling a watering can handle, transverse rupture, longitudinal rupture, flap rupture, horizontal rupture, damage to the anterior or posterior horn of the meniscus, paracapsular injuries.

To the same ruptures of the menisci are classified according to the form. There are longitudinal (horizontal and vertical), oblique, transverse and combined, as well as degenerative. Traumatic ruptures, occur mainly at a young age, run vertically in an oblique or longitudinal direction; degenerative and combined - more common in older people. Longitudinal vertical tears, or watering can-handle tears, are complete or incomplete, and often begin with a tear in the posterior horn of the meniscus.

Consider a tear in the posterior horn of the medial meniscus. This type of tear is the most common, as most longitudinal, vertical, and watering-handle tears begin with a tear in the posterior horn of the meniscus. With long tears, there is a high chance that part of the torn meniscus will interfere with the movement of the joint and cause pain, up to joint blockage. The combined type of meniscus rupture occurs, covering several planes, and most often localized in the posterior horn of the meniscus of the knee joint and in the bulk occurs in older people with degenerative changes in the menisci. In case of damage to the posterior horn of the medial meniscus, which does not lead to longitudinal splitting and displacement of the cartilage, the patient constantly feels the threat of blockade of the joint, but it never occurs. Not so often there is a rupture of the anterior horn of the medial meniscus.

Rupture of the posterior horn of the lateral meniscus occurs 6-8 times less often than the medial one, but carries no less negative consequences. Adduction and internal rotation of the lower leg are the main causes of rupture of the lateral meniscus. The main sensitivity in this kind of damage falls on the outer side of the posterior horn of the meniscus. Rupture of the arch of the lateral meniscus with displacement in most cases leads to limitation of movements in the final stage of extension, and sometimes causes blockade of the joint. A rupture of the lateral meniscus is recognized by a characteristic click during rotational movements of the joint inward.

Rupture symptoms

With injuries such as a torn meniscus of the knee joint, the symptoms can be quite different. There is an acute and chronic, inveterate meniscus tear. The main sign of a rupture is the blockade of the joint, in the absence of which it is quite difficult to determine the rupture of the medial or lateral meniscus in the acute period. After some time, in the subacute period, the rupture can be identified by infiltration in the joint space, local pain, as well as with the help of pain tests suitable for any type of damage to the meniscus of the knee joint.

The main symptom of a meniscus rupture is pain when probing the line of the joint space. Special diagnostic tests have been developed, such as the Epley test and the McMurry test. The McMurry test is produced in two types.

In the first variant, the patient is placed on his back, the leg is bent to an angle of about 90 ° in the knee joint and the hip joint. Then, with one hand, they wrap around the knee, and with the other hand, rotational movements of the lower leg are made, first outward and then inward. With clicks or crackles, we can talk about the infringement of the damaged meniscus between the articular surfaces, such a test is considered positive.

The second version of the McMurry test is called flexion. It is produced as follows: with one hand they clasp the knee as in the first test, then the leg at the knee is bent to the maximum level; after which, the lower leg is rotated outward to identify ruptures of the internal meniscus. Under the condition of slow extension of the knee joint up to about 90 ° and rotational movements of the lower leg with a rupture of the meniscus, the patient will experience pain on the surface of the joint from the back of the inner side.

During the Epley test, the patient is placed on the stomach and the leg is bent at the knee, forming an angle of 90 °. With one hand, you need to press on the heel of the patient, and at the same time rotate the foot and lower leg with the other. If pain occurs in the joint space, the test can be considered positive.

Rupture treatment

Meniscus rupture is treated both conservatively and surgically (resection of the meniscus, both complete and partial, and its restoration). With the development of innovative technologies, meniscus transplantation is becoming increasingly popular.

A conservative type of treatment is mainly used to heal small tears in the posterior horn of the meniscus. Such injuries are often accompanied by pain, but they do not lead to infringement of the cartilaginous tissue between the articular surfaces and do not cause clicks and rolling sensations. This type of tear is characteristic of stable joints. The treatment is to get rid of such sports activities, where you can not do without quick jerks from the defender and movements that leave one leg in place, such activities worsen the condition. In the elderly, such treatment leads to a more positive result, since degenerative tears and arthritis are often the cause of their symptoms. A small longitudinal rupture of the medial meniscus (less than 10 mm), a rupture of the lower or upper surface that does not penetrate the entire thickness of the cartilage, transverse ruptures of no more than 3 mm often heal on their own or do not appear at all.

Also, meniscus rupture treatment provides for another way. Sewing from the inside out. For this type of treatment, long needles are used, which are passed perpendicular to the line of damage from the joint cavity to the outside of the strong capsular area. In this case, the seams are superimposed one after the other quite tightly. This is one of the main advantages of the method, although it increases the risk of damage to blood vessels and nerves when the needle is removed from the joint cavity. This method is ideal for treating a torn posterior horn of the meniscus and a torn that runs from the body of the cartilage to the posterior horn. If the anterior horn is torn, it may be difficult to pass the needles.

In cases where damage to the anterior horn of the medial meniscus occurs, it is more correct to use the suturing method from the outside to the inside. This method is safer for nerves and blood vessels; in this case, the needle is passed through the meniscus rupture from the outside of the knee joint and further into the joint cavity.

Seamless fastening of the meniscus inside the joint is gaining more and more popularity with the development of technology. The procedure takes little time and takes place without the participation of such complex devices as an arthroscope, but today it does not give even an 80% chance of healing the meniscus.

The first indications for surgery are effusion and pain, which cannot be eliminated by conservative treatment. Friction during movement or blockade of the joint also serve as indicators for surgery. Resection of the meniscus (meniscectomy) used to be considered a safe intervention. Recent studies have shown that most meniscectomy results in arthritis. This fact influenced the main methods of treatment of injuries such as rupture of the posterior horn of the internal meniscus. Nowadays, partial removal of the meniscus and grinding of deformed parts has become more popular.

Sequelae of a torn meniscus

The success of recovery from injuries such as lateral meniscus injury and medial meniscus injury depends on many factors. For a speedy recovery, factors such as the duration of the gap and its localization are important. The probability of complete recovery is reduced with a weak ligamentous apparatus. If the patient's age is not more than 40 years, then he has a better chance of recovery.

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meniscus injury

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

The meniscus itself is divided into 3 parts:

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

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

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

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

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

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

If not such painful clicking sounds are felt, then the gaps have occurred, but they are small in size. When the ruptures occupy a large area, the torn part of the meniscus begins to move to the center of the damaged joint, as a result, the movement of the knee is blocked. There is a twisting of the joint. When the posterior horn of the internal meniscus has ruptured, it is practically impossible to bend the knee, and the sore leg will not be able to withstand the load from the body.

Symptoms of a knee meniscus injury

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

pain, which over time will concentrate in the joint space;
there is weakness of the muscles in the anterior surface of the thigh;
accumulation of fluid in the joint cavity begins.

As a rule, a degenerative rupture of the posterior horn of the meniscus in the knee occurs in people of pre-retirement age due to age-related changes in cartilage tissue or in athletes whose load falls mainly on the legs. Even a sudden awkward movement can lead to a break. Very often, ruptures of the degenerative form acquire a protracted chronic character. A symptom of a degenerative rupture is the presence of a dull aching pain in the knee area.

Treatment of damage to the medial meniscus

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

But first of all, when damage has occurred, it is necessary to relieve pain. In this case, an anesthetic injection and tablets that reduce inflammation help, and cold compresses will help.

You need to be prepared for the fact that doctors will take a puncture of the joint. Then it is necessary to clean the articular cavity from the blood and fluid accumulated there. Sometimes you even have to apply the blockade of the joints.

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

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

How is damage treated? As a rule, surgery is usually unavoidable. Especially if it is an old medial meniscus of the knee joint. The surgeon is faced with the task of suturing the damaged meniscus, but if the damage is too serious, it will have to be removed. A popular treatment is arthroscopic surgery, thanks to which whole tissues are preserved, only the resection of damaged parts and the correction of defects are performed. As a result, there are very few complications after surgery.

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

Then make an incomplete biting out of the meniscus. This must be done at the base of the posterior horn, leaving a thin "bridge" to prevent displacement. The next stage is cutting off the torn fragment from the body or the anterior horn. Parts of the meniscus then need to be given the original anatomical shape.

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

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As a rule, a meniscus tear haunts football players, dancers and other people whose lives are connected with sports. But you should be prepared for the fact that a disease of this kind can overtake you, so it is important to know the symptoms and methods of treatment.

Rupture of the posterior horn of the medial meniscus is the result of an injury that can be received not only by athletes or overly active individuals, but also by older people who suffer from other diseases along the way, such as arthrosis.

So what is a meniscus tear? To understand this, you need to know, in general, what a meniscus is. This term implies a special fibrous cartilage tissue, which is responsible for cushioning in the joint. In addition to the knee joint, such cartilage is also found in the joints of the human body. However, it is the injury of the posterior horn of the meniscus that is considered the most frequent and dangerous injury, which threatens with complications and serious consequences.

A little about menisci

A healthy knee joint has two cartilage tabs, external and internal, respectively, lateral and medial. Both of these tabs are shaped like a crescent. The lateral meniscus is dense and sufficiently mobile, which ensures its safety, that is, the external meniscus is less likely to be injured. As for the inner meniscus, it is rigid. Thus, damage to the medial meniscus is the most common injury.

The meniscus itself is not simple and consists of three elements - the body, the posterior and anterior horn. Part of this cartilage is penetrated by a capillary mesh, which forms a red zone. This area is the most dense and is located on the edge. In the middle is the thinnest part of the meniscus, the so-called white zone, which is completely devoid of blood vessels. After an injury, it is important to correctly identify exactly which part of the meniscus has been torn. The best restoration is the living zone of the cartilage.

There was a time when specialists believed that as a result of the complete removal of the damaged meniscus, the patient would be spared all the problems associated with the injury. However, today it has been proven that both the external and internal menisci have very important functions for the cartilage of the joint and bones. The meniscus cushions and protects the joint and its complete removal will lead to arthrosis.

To date, experts speak of only one obvious cause of such an injury as a rupture of the posterior horn of the medial meniscus. An acute injury is considered such a cause, since not any aggressive impact on the knee joint can lead to damage to the cartilage responsible for cushioning the joints.

In medicine, there are several factors that predispose to cartilage damage:

vigorous jumping or running on uneven ground;

torsion on one leg, without lifting the limb from the surface;

fairly active walking or long squatting;

trauma received in the presence of degenerative diseases of the joints;

congenital pathology in the form of weakness of the joints and ligaments.

Symptoms

As a rule, damage to the medial meniscus of the knee joint occurs as a result of the unnatural position of the parts of the joint at a certain point when the injury occurs. Or the rupture occurs due to a pinched meniscus between the tibia and femur. The rupture is often accompanied by other knee injuries, so differential diagnosis can be difficult at times.

Doctors advise people who are at risk to be aware of and pay attention to symptoms that indicate a meniscus tear. Signs of injury to the internal meniscus include:

pain that is very sharp at the time of injury and lasts for several minutes. Before the onset of pain, you may hear a clicking sound. After a while, the sharp pain may subside, and you will be able to walk, although it will be difficult to do so, through the pain. The next morning you will feel pain in your knee, as if a nail was stuck there, and when you try to bend or straighten your knee, the pain will intensify. After rest, the pain will gradually subside;

jamming of the knee joint or in other words blockade. This symptom is very characteristic of a rupture of the internal meniscus. Blockade of the meniscus occurs at the moment when the detached part of the meniscus is sandwiched between the bones, as a result of which the motor function of the joint is impaired. This symptom is also characteristic of damage to the ligaments, so you can find out the true cause of the pain only after diagnosing the knee;

hemarthrosis. This term refers to the presence of blood in the joint. This happens when the gap occurs in the red zone, that is, in the zone penetrated by capillaries;

swelling of the knee joint. As a rule, swelling does not appear immediately after a knee injury.

Nowadays, medicine has learned to distinguish between an acute rupture of the medial meniscus from a chronic one. Perhaps this was due to hardware diagnostics. Arthroscopy examines the condition of cartilage and fluid. A recent rupture of the internal meniscus has smooth edges and accumulation of blood in the joint. While in chronic injury, the cartilage tissue is multifibered, there is swelling from the accumulation of synovial fluid, and nearby cartilage is often damaged.

A rupture of the posterior horn of the medial meniscus must be treated immediately after injury, as over time, unhealed damage will become chronic.

With untimely treatment, meniscopathy is formed, which often, in almost half of the cases, leads to changes in the structure of the joint and, consequently, to degradation of the cartilaginous surface of the bone. This, in turn, will inevitably lead to arthrosis of the knee joint (gonarthrosis).

Conservative treatment

Primary rupture of the posterior horn of the meniscus must be treated therapeutically. Naturally, injuries occur when the patient needs emergency surgery, but in most cases conservative treatment is sufficient. Therapeutic measures for this damage, as a rule, include several very effective steps (of course, if the disease is not running!):

reposition, that is, the reduction of the knee joint during blockade. Manual therapy helps, as well as hardware traction;

elimination of swelling of the joint. For this, specialists prescribe anti-inflammatory drugs to the patient;

rehabilitation activities such as exercise therapy, massage, physiotherapy;

the longest, but at the same time the most important process is the restoration of the menisci. Usually, the patient is prescribed courses of chondroprotectors and hyaluronic acid, which are carried out for 3-6 months annually;

do not forget about painkillers, since damage to the posterior horn of the meniscus is usually accompanied by severe pain. There are many analgesics used for these purposes. Among them, for example, ibuprofen, paracetamol, diclofenac, indomethacin and many other drugs, dosage

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Characteristic signs of a torn internal meniscus

Damage to the medial meniscus most often occurs during physical exercise: running on rough terrain, rotating on one leg, sharp attacks and other situations.

Other typical symptoms of a torn medial meniscus of the knee include:

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

Note: With a bent knee, a person does not always feel intense pain. It appears more often when trying to straighten the leg. This is a hallmark of injury to the interior of the intercartilaginous lining.

Degenerative damage to the medial meniscus of the knee joint is a chronic form of pathology.. Common symptoms in this case are:

pain sensations of varying intensity that occur both during physical exertion and at rest;
less often - jamming of the joint;
damage to adjacent cartilage (femur or tibia);
swelling of the affected area.

Read also the article "Inflammation of the meniscus of the knee joint" on our portal.

Note: the lack of specificity of clinical manifestations often makes it difficult to independently detect pathology. Therefore, if there are suspicious signs, you should consult a rheumatologist.

Basic therapeutic measures

The choice of methods of therapeutic influence depends on the nature of the injury and its severity. Treatment of damage to the medial meniscus of the knee joint is carried out by two main methods:

conservative (with the help of medications, physiotherapy, physiotherapy exercises);
radical, i.e. surgical (complete, partial meniscectomy, reconstructive surgery).

Note: in addition to partial or complete removal of the medial meniscus of the knee joint, surgical treatment involves suturing or transplanting the damaged area. However, these methods of solving the problem are not always effective and appropriate.

Non-surgical treatment of the medial meniscus of the knee

Indications for the use of conservative therapeutic methods are:

minor rupture of the posterior horn of the medial meniscus;
radial type of injury;
lack of infringement of the cartilaginous lining between the surfaces of the joint.

Therapy involves, first of all, a decrease in the intensity of physical activity.

Note: you should not completely exclude movement, if there are no strict contraindications, as blood circulation in the joint will be disturbed. Casting and other incorrect techniques can lead to fusion of the ligaments, limited or complete loss of motor function of the knee.

In the acute phase, rest should be provided to the limbs. Intensive pain syndrome is stopped with the help of anesthetics and anti-inflammatory non-steroidal drugs that have an analgesic effect (Ibuprofen, Nurofen and others).

A slight longitudinal rupture of the posterior horn of the medial meniscus (up to 1 cm), transverse (up to 0.3 cm), as a rule, grows together independently and practically does not cause concern. Therefore, it is important to limit, but not completely eliminate the motor activity of the lower extremities.

Surgery

Surgical manipulations are carried out by arthroscopic or arthrotomy method. The main task is to partially or completely remove the medial meniscus. The indications for surgery are:

intense pain;
significant horizontal rupture of the medial meniscus;
effusion (fluid buildup in the knee joint);
clicking when extending the knee;
blockade of the joint.

When stitching, long surgical needles are used with ligatures fixed on them (absorbable or non-absorbable suture material). Meniscus fixation techniques are used: