Treatment of rupture of the anterior horn of the medial (internal) meniscus. Characteristic symptoms and treatment of rupture of the posterior horn of the medial meniscus

An intact knee joint has 2 cartilaginous inlays: lateral and medial. These tabs look like a crescent. The outer meniscus has a fairly dense base, it is more mobile, so it is much less likely to be injured. The medial meniscus is not flexible enough, so damage to the medial meniscus occurs most frequently.

Rupture of the posterior horn of the medial meniscus.

At the present time, qualified specialists name one main reason for the origin of the gap dorsal horn medial meniscus. This reason is acute injury. There are also a couple of additional factors that contribute to the occurrence of the above injury.
- A strong jump, which is done on a very flat surface.
- Rotation on one leg, without taking off the foot.
- Too active walking or prolonged sitting on squats.
- Injury, which is obtained as a result of a disease of the joints.
- Pathology in the form of weak joints or ligaments.
When the posterior horn of the medial meniscus is torn, the patient immediately feels severe pain, which lasts for a long time. Before feeling pain, the person hears a clicking sound. The patient may be blocked inner meniscus, this symptomatology occurs as a result of clamping between the bones of a torn meniscus particle. The patient develops hemarthrosis. After a short amount of time, the patient develops swelling of this joint.

Damage to the posterior horn of the medial meniscus.

Damage to the posterior horn of the medial meniscus occurs due to the incorrect position of the parts of the joints during the formation of damage. Qualified specialists strongly recommend that you know the first symptoms of damage to the above part of the knee, especially for people who are at risk. There are two types of damage to the above part.
- Traumatic tear occurs as a result, if the joint is slightly bent, a rotating movement occurs in this joint.
- Degenerative rupture usually occurs in age group from 45 to 50 years old. Often damage to this form occurs due to repeated microtrauma.

Posterior horn of the medial meniscus, methods of treatment.

If the rupture of the above type of meniscus is mild or moderately severe, then the treatment is prescribed in a conservative way. The patient is strongly advised not to do strong physical exertion on the affected knee. To do this, the patient is assigned crutches, it is necessary to minimize long walks on fresh air. Compliance with bed rest is not necessary, a person can quite easily do all the housework. In order to relieve pain and swelling, the patient is advised to apply ice packs to the injured area for 15-20 minutes at least 3 times a day. It is forbidden to keep ice for a long time, due to the fact that damage to the skin can occur.
A person with this injury must wear an elastic bandage. The bandage will not only help the swelling go down faster, but also significantly limit the mobility of the knee. Specialists should show the patient how to adjust the bandage. While watching TV or reading, the leg should be slightly higher than the heart. If you are worried about severe pain, it is allowed to use paracetamol or non-steroidal medicines.
If conservative treatment does not show the desired result, the patient is prescribed surgery. There are several types of surgical intervention.
1. Restoration of the meniscus. This type intervention is quite sparing and is performed on patients under forty years of age, due to the fact that their cartilage tissue is healthy.
2. Removal of the meniscus, is prescribed if there is severe damage to the cartilage tissue. This operation is prescribed extremely rarely, since the complete removal of the meniscus can provoke complications.
3. Meniscus transplantation, is prescribed if it is not possible to restore a damaged meniscus. The transplant is made of artificial material or there is a donor.
A couple of days before the operation, the medical staff conducts a conversation with the patient, telling in detail about the course of the operation. A few weeks before the scheduled date of surgery, the patient is strongly advised to completely eliminate the use of tobacco and alcohol, as this will significantly reduce the risk of blood clots. The success rate increases if the operation is performed within 2 months of the injury.
After the operation, the patient is prescribed a course of physiotherapy. The time it takes a person to return to normal life is directly related to how well the operation went and how long the postoperative period lasts.

The meniscus is a cartilaginous lining 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 in its structure, it has less mobility, and therefore it is most often subject to various kinds of damage up to tissue tear.

Conditionally meniscus can be divided into three parts:

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

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

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

Rupture symptoms

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

When tearing meniscus the torn off part of it dangles inside the joint and interferes with movement. When the breaks small size painful clicks are usually observed in the joint.

If the gap is large in area, there is a blockade or wedging knee joint .

This is 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 the meniscus is torn, the pain is quite strong.

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

You can often observe gaps of a degenerative nature that occur in people after 40 years of age as a result of age-related changes cartilage tissue. In such cases, the gap occurs even with the usual abrupt getting up from the chair, such a gap is very difficult to diagnose.

Very often breaks degenerative form become protracted chronic. A symptom of a degenerative rupture is the presence of a blunt aching pain in the knee area.

Treatment of a torn posterior horn of the meniscus

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

If the gaps are minor, conservative treatment is prescribed. The patient is prescribed medication with anti-inflammatory and analgesic drugs, as well as manual and physiotherapy sessions.

In cases of serious damage, the doctor prescribes surgical treatment, the essence of which is that during torn meniscus surgery sutured, or in some cases where recovery is not possible, meniscus is removed undergoing a meniscectomy.

In modern clinics, such an operation is performed by an 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 time in the hospital under the supervision of the attending physician. He is prescribed rehabilitation rehabilitation treatment, including therapeutic exercises, a course of antibiotics and other medications to prevent inflammatory processes.

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's why long-standing gap meniscus 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 inner (medial) and outer (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.

These methods are not always effective, because long time 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 likely need to wear a bandage and take regular necessary medicines. 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. Also popular endoscopic surgery(you can walk and move your knee almost immediately) and open surgeries. 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 extra fluids 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 meniscal damage is 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

Meniscus injury involves different treatment 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 in more appear in the elderly.

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 in 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 greater chance that part of the torn meniscus will interfere with joint movement and cause pain up to blockade of the joint. Combined type meniscal tears occur 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. It doesn't happen that often anterior horn 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, 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. When pain in the joint space, the test can be considered positive.

Rupture treatment

A torn meniscus is treated with both conservative and surgically(resection of the meniscus, both complete and partial, and its restoration). With development innovative technologies Meniscus transplantation is gaining popularity.

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 more positive result, as the cause of their symptoms is often degenerative tears and arthritis. 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 a meniscus rupture with outside knee joint and further into the articular 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.

Often correct diagnosis can be identified 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 there is damage to the posterior horn of the medial meniscus, appears sharp pain, 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 tears occupy a large area, the torn part of the meniscus begins to move to the center of the damaged joint, resulting in blocking of the knee movement. 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, you will need to do physical therapy and walking with various means support.

Minor damage to the posterior horn of the lateral meniscus or an incomplete tear of the anterior horn can be treated conservative method. 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. better recovery subject to the living zone of the cartilage.

There was a time when experts believed that as a result complete removal damaged meniscus, the patient will be relieved of all 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 the cushioning of 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 pinching of the meniscus between the tibia and femur. The rupture is often accompanied by other knee injuries, so differential diagnosis is 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 sign 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, therefore true reason pain you can find out only after the diagnosis of 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 trauma, the cartilage tissue is multifibered, there is swelling from the accumulation of synovial fluid, and nearby cartilage is often damaged as well.

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

When not timely 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 therapeutic methods. Naturally, injuries occur when the patient needs emergency surgery, but in most cases conservative treatment is sufficient. Therapeutic measures for this injury, 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. Great help manual therapy, 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 who spend 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

Be healthy!

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Characteristic signs of a torn internal meniscus

Damage to the medial meniscus most often occurs with exercise: running on terrain, spinning on one leg, lunges 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.

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 hallmark injury to the inner part of the intercartilaginous lining.

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

• pain sensations of varying intensity, arising from physical activity, 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, surgery 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.

AT acute phase limbs should be kept calm. Intensive pain syndrome treated with anesthetics and anti-inflammatory nonsteroidal drugs with 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 motor activity lower limbs.

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.

Rupture of the posterior horn of the medial meniscus 3 degrees

The knee joint is one of the largest and most complex in the human body. It has many different ligaments, cartilage and few soft tissues that can protect it from injury. The knee joint, like the hip joint, bears the entire load of the human body when walking, running and playing sports.

Content:

The structure of the knee with a description

This leads to frequent injuries in the area of ​​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, back 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

Menisci perform the following functions:

1. depreciation and reduction of loads on the surface of the bones of the knee;
2. an increase in the area of ​​​​contact of the surfaces of the bones, which helps to reduce the load on these bones;
3. knee stabilization;
4. 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 the number one internal damage knee joint. It is more common in athletes, people involved in heavy physical labor, professional dancers and the like. More than 70% is due to a rupture of the medial meniscus, about 20% - to lateral meniscus and about 5% - rupture of both menisci.

Damaged knee joint

According to the type of damage, there are:

• 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;
• horizontal gap;
• damage to the front or rear horns 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 meniscus of the knee joint is most often an indirect traumatic effect, which leads to the fact that the lower leg sharply turns inward or outward, which causes a rupture 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, acute pain appears, 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, it is necessary to conduct x-ray examination.

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 ( hypersensitivity 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 inside 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:

1. A small torn meniscus - accompanied by minor pain and swelling in the knee. Symptoms go away within a few weeks.
2. Gap medium degree 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.
3. 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 or without physical activity visible reasons pain in the knee, swelling, gait disturbance and other symptoms of meniscus damage appear.

Diagnosis of meniscus rupture

Diagnosis is based on 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-rays, therefore, studies are carried out using contrast agents or use more modern methods research.

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

Choice medicinal products 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

1. Providing first aid to the patient:
   • complete rest;
   • applying a cold compress;
   • - anesthesia;
   • puncture - to remove accumulated fluid;
   • plaster cast.
2. Bed rest.
3. Imposition of a plaster splint for up to 3 weeks.
4. Elimination of blockade of the knee joint.
5. Physiotherapy and therapeutic exercises.
6. Taking non-steroidal anti-inflammatory drugs - diclofenac, ibuprofen, meloxicam.
7. Taking chondroprotectors that help restore cartilage tissue, accelerate the regeneration and fusion of cartilage - chondratin sulfate, glucosamine and others.
8. External means - use various ointments and creams for rubbing - Alezan, Ketoral, Voltaren, Dolgit and so on.

At proper treatment, no complications, recovery occurs within 6-8 weeks.

Indications for surgical treatment meniscus tear:

1. crushing the cartilaginous tissue of the meniscus;
2. rupture and displacement of the meniscus;
3. the presence of blood in the cavity;
4. detachment of the horns and body of the meniscus;
5. no effect from conservative therapy within a few weeks.

In these cases, surgical intervention is prescribed, which can be carried out by such methods:

1. Removal of the meniscus or meniscectomy - removal of part of the meniscus or the entire meniscus is indicated with complete decomposition of the cartilage tissue, tearing off a significant part of the meniscus, and complications. Such an operation is considered too traumatic, causes arthritis, maintains inflammation and effusion in the knee joint, and leads to relief from joint pain in only 50-70% of cases.
2. Meniscus repair - meniscus plays important role in the biomechanics of the knee joint, surgeons today strive to preserve the meniscus and, if possible, restore it. This operation is usually carried out by young, active people and under certain conditions. It is possible to restore the meniscus in such cases as:
   • longitudinal vertical rupture of the meniscus,
   • peripheral tear,
   • detachment of the meniscus from the capsule,
   • peripheral rupture of the meniscus with its possible displacement to the center,
   • absence degenerative changes in cartilage,
   • young age of the patient.

   In this operation, it is necessary to take into account the prescription and localization of the gap. Fresh trauma and localization in the red or intermediate zone, the patient's age up to 40 years increase the chances of successful implementation operations.

3. Arthroscopic is the most modern and atraumatic method of surgical intervention. An arthroscope is used to visualize the site of injury and surgical intervention. The advantages of this method are the minimal disruption of the integrity of the surrounding tissues, as well as the possibility of performing interventions inside the knee. To suture the meniscus from the inside, special needles with non-absorbable suture material are used to connect the gap in the cavity of the knee joint through the cannula of the arthroscope. Seams with this method can be applied tightly, perpendicular to the line of the gap, which makes the seam stronger. This method is suitable for ruptures of the anterior horn or body of the meniscus. In 70-85% of cases, there is a complete fusion of cartilage tissue and restoration of the functions of the knee joint.
4. Fastening the meniscus with special arrow-shaped or dart-shaped retainers. This allows you to fasten the meniscus without additional incisions or the use of special devices, such as an artoscope. Apply absorbable fixatives of the first and second generation. The first generation fixators were made from a material that took longer to dissolve, they had more weight, and in connection with this, complications occurred more often in the form of inflammation, granuloma formation, effusion, damage to the articular cartilage, and the like. Second-generation fixators absorb faster, have a more rounded shape, and the risk of complications is much lower.
5. Transplantation of the meniscus - today, thanks to the development of transplantology, it becomes possible to carry out a complete replacement of the damaged meniscus and restore its functions. Indications for surgery are complete crushing of the meniscus, the impossibility of recovery in other ways, a significant deterioration in the patient's standard of living, and the absence of contraindications.

Contraindications for transplantation:

• degenerative changes;
• knee instability;
• elderly age;
• the presence of somatic diseases.

Rehabilitation

It is important recovery period after injury. It is necessary to carry out a whole range of rehabilitation measures:

• conducting special training and exercises aimed at developing the knee joint;
• the use of chondroprotectors, non-steroidal anti-inflammatory drugs;
• massage and physiotherapy;
• lack of physical activity for 6-12 months.

The consequences of rupture of the meniscus of the knee joint with proper and timely treatment are practically absent. Pain on exertion, unsteady gait, and the possibility of recurrence of injury may persist.

It is necessary to perform a set of special exercises that the doctor should prescribe, taking into account the location, severity of the injury, the presence or absence of complications, the age of the patient and other related circumstances.

Stages of rehabilitation after a rupture of the meniscus of the knee joint

Rehabilitation after such an injury consists of 5 stages. Once you reach your goals, you can move on to the next stage. The task of any rehabilitation program is to restore the normal functioning of the damaged organ.

• Stage 1 - its duration is 4-8 weeks, during this time it is necessary to expand the range of motion in the damaged joint as much as possible, reduce the swelling of the joint and start walking without crutches.
• Stage 2 - up to 2.5 months. It is necessary to restore the full range of motion in the joint, completely remove swelling, regain control over the knee joint when walking and start training muscles weakened after an injury.
• Stage 3 - to achieve a complete restoration of the range of motion in the knee joint during sports, training and running, to restore muscle strength. At this stage, they begin to actively conduct physical therapy classes and gradually return to the usual rhythm of life.
• Stage 4 - training, its goal is to achieve the opportunity to play sports, run, give a full load on the joint without any pain. Increasing the strength of the muscles of the injured limb.
• Stage 5 - restoration of all lost functions of the knee joint.

After the stages of rehabilitation, it is necessary to reduce the load on the injured joint, try to avoid situations in which there is a risk of injury and carry out preventive actions. These include exercises to strengthen muscle strength, with the help of special exercises, taking chondroprotectors and drugs that improve peripheral circulation. When playing sports, the use of special knee pads is recommended, which reduce the risk of injury.

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