Damage to the anterior horn of the medial meniscus of the knee joint. Rupture of the posterior horn of the medial meniscus: causes, symptoms and treatment
In its structure, the knee joint is complex, since in addition to numerous components, it includes menisci. These elements are necessary to divide the articular cavity into two parts.
During movements, the meniscus plays the role of an internal stabilizer - together with the articular surfaces, it moves in the right direction.
When walking or running, menisci are needed as shock absorbers, as they soften shocks, as a result of which the human body practically does not feel shocks.
However, it is this ability of the menisci that causes them frequent injuries. In 90% of cases of injury, damage to the internal or medial meniscus.
The meniscus is a dense cartilage plate located inside the joint cavity. The knee has two such elements - the lateral and medial menisci. Them appearance resembles a semicircle, and in the context they have the shape of a triangle. The meniscus consists of a posterior section (horns) and a central section (body).
The structure of these plates differs from the tissue of ordinary cartilage. It contains a huge amount of collagen fibers arranged in a strict order. The horns of the meniscus contain the largest accumulations of collagen. This explains the fact that the inner and central parts of the meniscus are more prone to injury.
These structures do not have specific attachment points, therefore, during movements, they are displaced inside the joint cavity. Restrictions in mobility exist at the medial meniscus, they are provided by the presence of an internal collateral ligament and fusion with the joint membrane.
These features often lead to degenerative or traumatic damage. inner meniscus.
Meniscus injury and its characteristic features
This pathology occurs as a result of trauma knee joint. The injury can be direct, such as a sharp blow to the inner surface of the knee joint or a jump from a height. The joint cavity at the same time sharply decreases in volume, and the meniscus is injured by the end surfaces of the joint.
Injury by indirect variant is predominant. A typical mechanism for its occurrence is a sharp flexion or extension of the knee, while the leg is slightly tucked inward or outward.
Since the medial meniscus is less mobile, its separation from the collateral ligament and capsule occurs from a sharp displacement. When displaced, it is subjected to bone pressure, as a result of which it breaks and turns out.
The severity of the symptoms of pathology depends on the degree of damage to the cartilage plate. Displacement of the meniscus, the size of its rupture, the amount of blood flowing into the joint - these are the main changes that an injury entails.
There are three stages of rupture:
- The mild stage is characterized by mild or moderate pain in the knee joint. Movement disorders are not observed. The pain is aggravated by jumping and squatting. Slightly noticeable swelling above the kneecap.
- The middle stage is expressed by severe pain in the knee, which is similar in intensity to a bruise. The leg is always in a bent position, and extension is impossible even by force. When walking, lameness is noticeable. From time to time there is a "blockade" - complete immobility. Puffiness increases, and the skin becomes cyanotic.
- In the severe stage, the pain becomes so acute that the patient simply cannot tolerate it. The most painful area is the kneecap area. The leg is in a motionless half-bent state. Any attempt at displacement leads to increased pain. The swelling is so severe that the affected knee can be twice the size of a healthy one. The skin around the joint is bluish-purple in color.
If the injury occurred in the medial meniscus, the symptoms of injury are always the same, regardless of its degree.
- Turner's symptom - the skin around the knee joint is very sensitive.
- Bazhov's reception - if you try to straighten your leg or press it on the kneecap with inside- the pain intensifies.
- Land's sign - when the patient lies in a relaxed position, the palm freely passes under the knee joint.
To confirm the diagnosis, the doctor prescribes an x-ray to the patient, in which a special fluid is injected into the cavity of the diseased joint.
Today, MRI is widely used to diagnose meniscal injuries, where the degree of damage is determined by Stoller.
Degenerative changes in the meniscus
At the core of change dorsal horn medial meniscus often lie different chronic diseases and prolonged microtrauma. The second option is typical for people of hard physical labor and professional athletes. The degenerative wear of the cartilage plates, which occurs gradually, and the reduction in the possibility of their regeneration provokes a sudden damage to the internal meniscus.
To general diseases causing include rheumatism and gout. With rheumatism due to inflammatory process blood supply is disrupted. In the second case, salts accumulate in the joints uric acid.
Since the nutrition of the menisci occurs due to intra-articular exudate, the processes described above cause them to "starve". In turn, due to damage to collagen fibers, there is a decrease in the strength of the menisci.
This damage is typical for people over forty years of age. Pathology can occur spontaneously, for example, a sharp rise from a chair. Unlike trauma, the symptoms of the disease are rather mild and may not be determined.
- A constant symptom is a slight aching pain, which increases with sudden movements.
- A slight swelling appears above the patella, which slowly but gradually increases, while the color of the skin remains unchanged.
- Mobility in the joint is usually preserved, but from time to time "blockades" occur, which can be provoked by sharp flexion or extension.
In this case, it is difficult to determine the degree of degenerative changes in the medial meniscus. Therefore, X-ray or MRI is prescribed for diagnosis.
Diagnostic methods
For a correct assessment of the changes that have occurred in the cartilaginous plates, the identification of symptoms and the collection of detailed complaints are insufficient measures. Menisci are not available for direct inspection because it is located inside the knee joint. Therefore, even the study of their edges by palpation is excluded.
To begin with, the doctor will prescribe a radiography of the joint in two projections. Since this method only shows the state bone apparatus of the knee joint, it carries little information to determine the degree of damage to the meniscus.
To assess the intra-articular structures, air is introduced and contrast agents. Additional diagnostics is carried out using MRI and ultrasound.
Despite the fact that Stoller MRI is today a completely new and expensive method, its expediency in terms of studies of degenerative changes is undeniable. The procedure is not required special training. The only thing that is needed from the patient is patience, since the study is quite lengthy.
There should be no metal objects on the patient’s body and inside (rings, piercings, earrings, artificial joints, pacemaker, etc.)
Depending on the severity of the changes, according to Stoller, four degrees are distinguished:
- Zero - a healthy, normal meniscus.
- The first is that a point signal appears inside the cartilaginous plate, which does not reach the surface.
- The second is a linear formation, but it does not yet reach the edges of the meniscus.
- Third - the signal reaches the very edge and violates the meniscus integrity.
The technique of research by ultrasonic waves is based on different tissue densities. Reflecting from the internal knee structures, the sensor signal demonstrates degenerative changes in the cartilaginous plates, the presence of blood inside the joint and detached fragments. But this signal cannot see through the bones, therefore, when examining the knee joint, the field of its visibility is very limited.
Signs of rupture in case of damage are the displacement of the meniscus and the presence of heterogeneous zones in the plate itself. To additional symptoms include violations of the integrity of the ligaments and joint capsule. The presence of inclusions in the synovial fluid indicates a hemorrhage into the cavity.
The choice of treatment method is based on changes in the meniscus plate. With a mild and moderate degree of degenerative changes (without violating integrity), a complex is prescribed conservative therapy. In the case of a complete rupture, surgical treatment is carried out to preserve the function of the limb, in particular, arthroscopy is prescribed - an operation with minimal trauma.
Although the bones of the knee joints are the largest in human skeleton, but it is the knee that accounts for the majority of injuries. Injury occurs due to high loads on this part of the limb. Let's talk about such an injury as damage to the posterior horn of the medial meniscus and methods to eliminate its consequences.
Appointment of the meniscus
The limb joint refers to a complex structure, where each element solves a specific problem. Each knee is equipped with menisci that bisect the articular cavity, and perform the following tasks:
- stabilizing. During any physical activity, the articular surfaces are displaced in the right direction;
- act as shock absorbers, softening shocks and shocks while running, jumping, walking.
Injury to shock-absorbing elements occurs with various articular injuries, precisely because of the load that these articular parts take on. Each knee has two menisci, which are made up of cartilage:
- lateral (outer);
- medial (internal).
Each type of shock-absorbing plate is formed by a body and horns (rear with front). Shock-absorbing elements move freely during physical activity.
The main damage occurs to the posterior horn of the internal meniscus.
Why injury happens
A common injury to the cartilage plate is a tear, complete or incomplete. Professional athletes and dancers are often injured, and whose specialty is associated with high loads. Injuries occur in the elderly, and as a result of accidental, unforeseen stress on the knee area.
Damage to the body of the posterior horn of the medial meniscus occurs for the following main reasons:
- increased, sports loads (jogging over rough terrain, jumping);
- active walking, prolonged squatting position;
- chronic, articular pathologies in which inflammation of the knee region develops;
- congenital articular pathology.
These causes lead to injuries of the meniscus of varying severity.
Classification
Symptoms of trauma to the cartilage elements depend on the severity of the damage to the cartilage tissue. There are the following stages of internal meniscal damage:
- Stage 1 (mild). Movement of the injured limb is normal. Pain is weak, and becomes more intense during squats or jumps. There may be slight swelling above the kneecap;
- 2 degree injury is accompanied by severe pain. It is difficult to straighten the limb even with outside help. You can move with a limp, but at any moment the joint can become blocked. Puffiness gradually becomes more and more, and the skin changes shade;
- damage to the posterior horn of the medial meniscus 3 degrees accompanied by pain syndromes of such intensity that it is impossible to endure. It hurts the most at the location of the kneecap. Any physical activity impossible. The knee becomes larger in size, and the skin changes its healthy color to purple or cyanotic.
If the medial meniscus is damaged, the following symptoms exist:
- pain intensifies if you press on the patella from the inside and at the same time straighten the limb (Bazhov's technique);
- the skin of the knee area becomes too sensitive (Turner's symptom);
- when the patient lies down, the palm passes under the injured knee without problems (Land's symptom).
After the diagnosis is made, the doctor decides which medical technique apply.
Horizontal gap
Depending on the location of the injured area and the general characteristics of the damage, there are types of injury to the medial meniscus:
- walking along;
- oblique;
- passing across;
- horizontal;
- chronic form of pathology.
Peculiarities horizontal damage the posterior horn of the medial meniscus is:
- with this type of tearing of the internal shock-absorbing plate, injury occurs, directed to the joint capsule;
- there is swelling in the area of the joint gap. This pathological development common signs with damage to the anterior meniscus horn of the external cartilage, therefore, special attention is needed when diagnosing.
When horizontal, partial damage, the cavity begins to accumulate excess synovial fluid. Pathology can be diagnosed by ultrasound.
Treatment of a horizontal rupture of the posterior horn of the medial meniscus, during timely presentation for medical assistance, is prescribed as a complex, traditional therapy, because with this type of injury there is no blockage of the joint. First prescribed non-steroidal medical preparations to eliminate pain and swelling. Then the injured knee is fixed with a plaster cast. traditional method treatment can last from six months to 12 months. During the first 3 months, the joint is immobilized with a plaster splint.
After the removal of the first symptoms, a complex of special measures is developed for each patient. gymnastic exercises. Physiotherapy and massage sessions are prescribed.
If a traditional methods treatment does not give a positive result, then surgery is indicated.
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Synovitis due to trauma to the medial meniscus
Against the background of damage to the posterior horn of the medial meniscus, synovitis may begin. This pathology develops due to structural cartilage changes that occur in the tissues during injury. When ruptured, synovial fluid begins to be produced in large volume, and fills the joint cavity.
As synovitis (fluid buildup) develops, it becomes increasingly difficult to move. If there is a transition to the degenerative course of the pathology, then the knee is constantly in a bent position. As a result, muscle spasm develops.
Advanced forms of synovitis lead to the development of arthritis. Therefore, at the time of diagnosis, the symptoms of a torn meniscus are similar to chronic arthritis.
If synovitis is not treated in time, the cartilaginous surface will completely collapse. The joint will no longer receive nutrition, which will lead to further disability.
Therapeutic techniques
With any articular injury, treatment should be started in a timely manner, without delay. If you postpone the appeal to the clinic, then the trauma passes to a chronic course. The chronic course of the pathology leads to changes in the tissue structure of the joints, and further deformation of the damaged limb.
Treatment for damage to the posterior horn of the medial meniscus can be conservative or surgical. In the treatment of such injuries, traditional methods are often used.
Complex, traditional therapy in case of injury to the internal meniscus, includes the following measures:
- articular blockade is performed using special medical preparations, after which the motor ability of the joint is partially restored;
- anti-inflammatory drugs are prescribed to remove puffiness;
- recovery period, including a set of special gymnastic exercises, physiotherapy and massage sessions;
- then comes the reception of chondoprotectors (drugs that help restore the structure of the cartilage). Hyaluronic acid is present among the active components of chondoprotectors. The course of admission can last up to six months.
During the entire course of treatment, painkillers are present, because damage to the ligaments is accompanied by constant pain. To eliminate pain, drugs such as Ibuprofen, Diclofenac, Paracetamol are prescribed.
Surgical intervention
When the meniscus is injured, the following points serve as indications for surgical manipulations:
- severe injuries;
- when cartilage is crushed and tissues cannot be restored;
- severe injuries of the meniscus horns;
- tear of the posterior horn;
- articular cyst.
The following types of surgical procedures are performed in case of damage to the posterior horn of the shock-absorbing cartilage plate:
- resection broken elements, or meniscus. This kind of manipulation is performed with incomplete or complete anguish;
- recovery destroyed tissues;
- replacement destroyed tissue by implants;
- stitching menisci. Such surgery is performed in case of a fresh injury, and immediate appeal for medical help.
Let's take a closer look at the varieties surgical treatment knee injury.
Arthrotomy
The essence of arthrotomy is reduced to the complete resection of the damaged meniscus. Such an operation is performed in rare cases when the articular tissues, including blood vessels, are completely affected and cannot be restored.
Modern surgeons and orthopedists have recognized this technique as ineffective, and is practically not used anywhere.
Partial meniscectomy
During the surgical intervention, the torn, dangling parts of the damaged meniscus are resected, and the surviving elements are restored.
When repairing the meniscus, the damaged edges are trimmed so that there is a flat surface.
Endoprosthetics
A donor organ is transplanted to replace the damaged meniscus. This type of surgical intervention is not often performed, because the rejection of donor material is possible.
Stitching of damaged tissue
Surgical treatment of this type aims to restore the destroyed cartilage tissue. Surgical intervention this type gives positive results if the injury has affected the thickest part of the meniscus, and there is a possibility of fusion of the damaged surface.
Stitching is performed only with fresh damage.
Arthroscopy
Surgery using arthroscopic techniques is considered the most modern and effective method of treatment. With all the advantages during the operation, trauma is practically excluded.
To perform the operation, several incisions are made in the articular cavity. small size, through which the instrumentation is introduced along with the camera. Through the incisions, during the intervention, a saline solution is supplied.
The technique of arthroscopy is remarkable not only for its low traumatism during the procedure, but also for the fact that you can simultaneously see the true state of the damaged limb. Arthroscopy is also used as one of the diagnostic methods when making a diagnosis after damage to the meniscus of the knee joint.
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Very often, athletes and people who are constantly engaged in physical labor complain of disorders in the functioning of the joints. The most common cause of pain and discomfort is a tear in the meniscus of the knee.
It is quite possible to deal with this problem. Treatment, if a rupture of the meniscus of the knee joint is diagnosed, is expressed in a wide range activities ranging from surgery to folk methods treatment at home.
What is a meniscus
The meniscus of the knee joint is a cartilaginous formation that has the shape of a crescent and is located between the thigh and lower leg in the knee joint. The knee meniscus performs a stabilizing and shock-absorbing function, the horizontal cartilage gap softens the friction of the surfaces, limiting joint mobility, which prevents injuries.
In the process of movement, the meniscus contracts and stretches, changing its shape, as can be seen in the photo. There are two menisci in the joint:
- lateral meniscus (external),
- medial meniscus (internal).
Sports doctors say that injuries and bruising are a common problem among:
- skiers,
- skaters,
- figure skaters,
- ballet dancers,
- footballers.
Meniscus disease and the need for surgery in the future may also appear in those who are engaged in strenuous physical labor. The risk group includes men aged 17 to 45 years.
Among children, rupture of the posterior horn of the internal meniscus or displacement is extremely rare. Until the age of 14, this cartilage formation is very elastic, so damage almost never occurs.
Main shock absorber in the knee joint
Sometimes a rupture of the meniscus of the knee joint or its bruising is observed at an older age. So, at the age of 50-60, degenerative changes in the joints affect the condition.
The rupture of the posterior horn of the medial meniscus occurs under the influence of trauma. This is especially true for the elderly and athletes. Arthrosis is also common cause meniscus injury.
Rupture of the posterior horn of the medial meniscus is always accompanied by damage to the ligament that connects the meniscus to the knee joint.
Thus, the meniscus changes under the influence of:
- loads,
- injuries,
- degenerative age-related changes,
- congenital pathologies that gradually damage tissues.
In addition, some diseases that damage statics also make their own negative adjustments.
Flat feet can be cited as an example of the consequences of violations.
Orthopedists differentiate damage to the knee meniscus into several types:
- pinching,
- rupture of the posterior horn of the medial meniscus and a rupture of the posterior horn of the internal meniscus,
- separation.
AT last case meniscus treatment is the most difficult process. Education is required to be completely separated from the attachment area. This type injury requires performance surgical operation, it is quite rare.
In most cases, diagnose:
- injury,
- pinching,
- tear,
- tear of the medial meniscus
- rupture of the posterior horn of the meniscus.
These injuries are characterized sharp pain in the knee area, inability to perform movements, numbness, difficulty in flexion and extension of the joint. After a few hours, the symptoms of a torn meniscus subside, mobility is restored, and the person can forget about the injury.
The consequences of an injury, damage to the meniscus of the knee joint, eventually make themselves felt, for example, the pain returns again. A rupture of the medial meniscus is a complex injury that requires intervention. The intensity of the pain syndrome depends on the strength and nature of the damage.
Baykov's symptom is known: when the joint is bent to an angle of 90 degrees, and a finger is pressed on this area of the joint space, producing a slow extension of the lower leg, the pain increases very much.
In addition, it is difficult to go up or down the stairs, there is pain when crossing the limbs and situational numbness. In some severe cases, the consequences become extremely dangerous, we are talking about atrophy of the muscles of the leg and thigh.
Professional athletes often suffer from characteristic microtraumas of the meniscus. It can be a bruise, infringement or small tears.
Degrees of meniscus injury and surgery
With cartilage injuries, the diseases become chronic. Sharp pain is not observed, the joint retains its mobility most of the time. However, periodically in the knee area, a person feels discomfort. These may be: slight tingling, numbness, or clicking. Atrophy of the thigh muscles is recorded.
A rupture in the area of the meniscus of the knee joint in severe cases involves the separation of its capsule, and the need for surgery appears. The detached part of the meniscus can be removed partially or completely. If there is a tear or tear, then the patient may be offered a form of surgery such as suturing.
The choice of type of operation depends on the age of the patient, his condition and the nature of the injury. The younger the person, the faster the consequences pass, and the recovery process accelerates.
As a rule, the recovery period takes about 4-6 weeks, during which the person stays on an outpatient basis.
To restore joint mobility, mud therapy and restorative therapeutic exercises can be recommended.
Conservative treatment of the meniscus in hospital and at home
For micro-ruptures, chronic injuries and infringements of the meniscus of the knee joint, a more moderate conservative treatment is recommended.
If the meniscus is pinched, then it is necessary to reposition, that is, reduce the joint. The procedure is performed by a traumatologist, chiropractor or an orthopedist in a medical facility.
It will take 3-4 procedures to fully reset the joint. There is another type of meniscus repair - traction of the knee joint or hardware traction. This is a long procedure carried out in stationary conditions.
To restore cartilage tissue, intra-articular injections of preparations that contain hyaluronic acid are necessary. If there is swelling and the patient suffers from pain, intra-articular injections are necessary:
- nimulida,
- voltarena,
- corticosteroids.
After these measures, long-term drug therapy is indicated to restore the required amount of joint fluid.
The most commonly prescribed are chondroitin sulfate and glucosamine. It is not recommended to self-medicate, the exact dosage of the drug is prescribed only by a doctor.
As a rule, restorative drugs need to be taken for about three months daily.
Along with the use of drugs, it is necessary to turn to massage and therapeutic gymnastics so that there is no need for surgery.
Treatment of the meniscus with folk remedies
Various rubbing and compresses are considered especially effective. They reduce pain and return the joint to normal mobility.
Before treating meniscus disease at home, you should consult your doctor. It is necessary to take into account the nature of the meniscus injury and individual characteristics. For example, honey compress may be contraindicated if the person is allergic to bee products.
Treatment can be done with a compress of fresh burdock leaves. The patella area should be wrapped with a sheet and a restraining bandage applied. The compress should be kept on the body for about 4 hours.
The procedure should be carried out every day, while the meniscus hurts. If fresh burdock is not available, dried leaves can be used after soaking them in a small amount of hot water.
Raw materials must be evenly distributed over the tissue, and then apply a compress to the joint. The compress stays on the damaged joint for 8 hours.
A honey compress on the knee helps relieve pain in the patella area. After some time, the lost mobility of the joint returns.
It is necessary to take in equal proportions natural bee honey and purified alcohol, mix and slightly warm. Apply a warm mixture to the knee area, wrap it well with a woolen cloth and secure with a bandage.
To speed up the recovery process after a meniscus injury, you need to make a honey compress 2 times a day. Keep the compress for at least two hours.
Treatment of meniscus disease folk remedies lasts, as a rule, several months.
An effective remedy for the meniscus of the knee joint is a tincture of wormwood. Would need big spoon chopped wormwood, which must be poured with a glass of boiling water and insisted for 1 hour.
After that, the liquid is filtered and used for compresses. A cloth soaked in liquid should be applied for half an hour to the damaged joint. A traumatologist will tell you in detail about problems with the meniscus in the video in this article.
Treatment of the meniscus of the knee joint without surgery
Injuries and treatment of the medial meniscus of the knee joint
If we feel pain in the knee, then, as a rule, this means that the meniscus hurts. Since the meniscus is a layer of cartilage, it is most at risk of rupture or damage. Knee pain can indicate several types of damage and meniscal dysfunction. During sprain of the intermeniscal ligaments, chronic injuries, as well as when the meniscus is torn, different symptoms, and the options for dealing with them are also different.
- Damage symptoms
- meniscus tear
- Rupture of the posterior horn of the meniscus
- Rupture of the posterior horn of the lateral (outer) meniscus
- Rupture symptoms
- How is a meniscus tear treated?
Damage symptoms
The meniscus is a cartilage formation that is located in the cavity of the knee joint and serves as a shock absorber of movement, as well as a stabilizer that protects the articular cartilage. There are two menisci in the knee, the outer (lateral) and the inner (medial). Damage to the inner meniscus happens much more often due to its less mobility. Damage to the meniscus of the knee joint manifests itself in the form of pain in this area, limited mobility, and in chronic situations, the development of arthrosis of the knee is also possible.
Swelling of the joint, acute cutting pain, painful crunching and difficult movements of the limbs indicate that you have a damaged meniscus. These symptoms appear immediately after the injury and may indicate other joint damage. More pronounced symptoms of damage appear one month after the injury. With these injuries, a person begins to feel local pain in the gap of the knee joint, weakness of the muscles of the outer surface of the thigh, “blockade” of the knee, and accumulation of fluid in the joint cavity are manifested.
Precise signs of damage to the medial meniscus are detected using various surveys. There are special tests for extension of the knee joints (Rocher, Baykov, Landa, etc.), when, with a certain extension of the knee, pain symptoms. The technology of rotational tests is based on the detection of damage during rolling movements of the knee (Shteiman, Bragard). Meniscal injury can also be identified by MRI, mediolateral tests, and compression symptoms.
Damage to the medial meniscus various treatments which takes into account the type and severity of the injury. With the traditional method of getting rid of damage, it is possible to distinguish the main types of exposure that are used for any injuries.
To begin with, it is necessary to relieve the pain, therefore, first of all, the patient is given an anesthetic injection, then they take a puncture of the joint, remove the accumulated fluid and blood from the cavity, and, if necessary, remove the blockade of the joints.
After these procedures, the knee needs rest, for which a splint is applied or gypsum bandage. As a rule, one month of immobilization is sufficient, but in difficult situations sometimes even up to 2 months. In this case, it is necessary to apply local cold and nonsteroidal drugs to relieve inflammation. Over time, you can add different types physiotherapy, walking with aids, exercise therapy.
Surgery is required in severe situations, for example, chronic damage to the meniscus of the knee joint. One of the most popular types of surgery today is arthroscopic surgery. This type of surgical intervention has become common due to the careful attitude to tissues. The intervention is only a resection of the damaged area of the meniscus and polishing of defects.
With such damage as a torn meniscus, the surgical operation is performed closed. With the help of two holes, an arthroscope is inserted into the knee joint with instruments to determine the damage, then a decision is made on the possibility of sewing up the meniscus or its partial resection. Inpatient treatment lasts up to approximately 4 days, due to the low invasiveness of this type of operation. At the rehabilitation stage, it is recommended to limit the load on the knee to one month. In special situations, wearing a knee brace and walking with support is recommended. After 7 days, you can start therapeutic exercises.
meniscus tear
The most common injury to the knee joint is a tear in the medial medial meniscus. There are degenerative and traumatic tears menisci. The latter appear, as a rule, in people aged 18-45 years and athletes, with untimely treatment, they turn into degenerative tears, which most often appear in elderly people.
Taking into account the localization of damage, there are several main types of ruptures:
At the same time, meniscus tears are also divided by shape:
- oblique;
- longitudinal;
- transverse;
- degenerative;
- combined.
Traumatic ruptures usually appear in young age and they occur vertically in the longitudinal or oblique direction. Combined and degenerative usually occur in the elderly. Watering can-shaped or vertical longitudinal tears can be incomplete or complete and usually begin with damage to the posterior horn.
Rupture of the posterior horn of the meniscus
This type of tear is the most common, as most of the vertical, longitudinal, and watering hole tears occur in the posterior horn. During a long tear, there is a good chance that part of the torn meniscus will prevent the knee from moving and cause severe pain, up to and including blockage of the knee joint. The combined type of tears passes, capturing several planes, and usually forms in the posterior horn of the meniscus and for the most part appears in elderly people who have degenerative changes in them.
During damage to the posterior horn, which does not lead to displacement of the cartilage and longitudinal cleavage, the person always feels the threat of blockade of the joint, but this never happens. Rarely does a break occur. anterior horn knee joint.
Rupture of the posterior horn of the lateral (outer) meniscus
This gap happens 8-10 times less often than the medial one, but it has no less negative consequences. The internal rotation of the lower leg and its movement are the main causes that cause a rupture of the external lateral meniscus. The main sensitivity in these lesions falls on outside at the back horn. Rupture of the arch of the external meniscus with displacement, as a rule, creates a restriction of movements at the final stage of extension, and sometimes can cause blockade of the joint. The rupture of the external meniscus is determined by the characteristic clicking during rotational movements inside the knee joint.
Rupture symptoms
With injuries such as a torn meniscus, symptoms vary. A meniscus tear can be:
- old;
- chronic;
- spicy.
The main sign of a rupture is blockage of the knee joint, in its absence it is very difficult to determine a rupture of the lateral or medial meniscus in the acute period. After a certain time, early period rupture can be identified by local pain, infiltration in the area of the joint space, as well as by pain tests that are suitable for any type of injury.
Pronounced symptom of rupture are pain while probing the line of the gap of the knee joint. There are special tests for diagnosis, such as the McMurry test and the Epley test. The McMurry test is performed in two ways.
In the first case, the patient is laid on his back, the leg is bent at the hip and knee joint to a right angle. Then they grab the knee with one hand, and with the other hand they perform rotational movements of the lower leg, first outward, and then inward. When cracking or clicking, it is possible to consider the infringement of the injured meniscus between the surfaces of the joint, this test is positive.
The other way is called bending. It is carried out in this way: with one hand they grab the knee, as in the first version, after the leg is bent as much as possible at the knee. The lower leg is then rotated outward to determine the tear. Under the condition of slow extension of the knee joint to approximately 90 degrees and rotational movements of the lower leg, then during the rupture of the meniscus, the patient will feel pain on the surface of the joint from the inside back side.
During the Epley test, the patient is placed on the stomach and the leg is bent at the knee, creating an angle of 90 degrees. With one hand, it is necessary to press the person on the heel, and with the second, rotate the lower leg and foot. When pain occurs in the joint space, the test is positive.
How is a meniscus tear treated?
The tear may be treated or surgically(resection of the meniscus, both partial and its restoration, and complete), or conservative. With the advent of new technologies, meniscus transplantation has become increasingly popular.
Conservative treatment is usually used to treat minor lesions of the posterior horn. Very often, these injuries are accompanied by severe pain, but do not lead to pinching of the cartilage tissue between the surfaces of the joint and do not create a sensation of rolling and clicking. This type of damage is characteristic of strong joints.
The treatment consists in liberation from such sports, in which sharp jerks and movements that leave one leg in place are indispensable, these activities aggravate the condition. In the elderly, this treatment leads to a better outcome, since arthritis and degenerative tears are often the cause of their symptoms.
A slight longitudinal tear (less than 1 cm), a tear of the upper or lower surface that does not penetrate the entire thickness of the cartilage, transverse injuries of no more than 2.5 mm usually heal on their own or do not bother.
Also, the treatment of the gap provides another option. Sewing from the inside out. For this method of treatment, long needles are used, which are inserted perpendicular to the rupture line from the joint cavity to the outer part of the strong capsular area. And the seams are made quite tightly, one by one. This is the main advantage of this treatment option, although it increases the risk of nerve and vascular damage during the withdrawal of the needle from the joint cavity. This method is excellent for treating damage to the posterior horn and a tear that runs from the cartilage itself to the posterior horn. During damage to the anterior horn, difficulties may arise in the passage of the needle.
In cases where a rupture of the anterior horn occurs, it is best to use the suturing method from the outside to the inside. This option is safer for blood vessels and nerves, in this case the needle is passed through the gap on the outside of the knee joint and then into its cavity.
With the development of technology, seamless fastening inside the joint is gradually gaining popularity. The process itself takes a little time and takes place without the participation of such complex devices as an arthroscope, but now it still does not have even a 75% chance of successful healing of the meniscus.
The main indications for surgery are pain and effusion, which cannot be eliminated using conservative methods. Blockade of the joint or friction during movement are also indications for surgical intervention. Meniscus resection (meniscectomy) was once considered safe operation. But with the help of recent research, it turned out that meniscectomy most often leads to the development of arthritis. This fact influenced the main methods of treatment of rupture of the posterior horn. Today, grinding of damaged parts and partial removal of the meniscus is very popular.
The success of recovery after injuries such as a torn medial and lateral meniscus will depend on many factors. For a quick recovery, factors such as the location of the damage and its age are important. The probability of a full-fledged treatment is reduced if the ligamentous apparatus is not strong enough. If the patient's age is not more than 45 years, then he has a better chance of recovery.
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The knee is a complex structure, which includes the patella, femur and tibia, ligaments, menisci, etc.
Menisci are a layer of cartilage that is located between two bones. When moving, the knee constantly withstands heavy loads, so most of the injuries occur in this joint. One such injury is a tear in the posterior horn of the medial meniscus.
Injuries to the knee joint are painful and dangerous in their consequences.
A tear in the posterior horn of the meniscus can happen to anyone. active person or an athlete, and may result in serious injury later on.
What is a meniscus
The meniscus is a part of the joint that is a curved band of fibrous cartilage. In shape, they look like a crescent with elongated edges. They are divided into several parts: body, back and front horns.
There are two menisci in a joint:
- lateral (outer);
- medial (internal).
Their ends are attached to the tibia.
The medial is located on the inside of the knee and connects to the medial lateral ligament. Along the outer edge, it is connected with the capsule of the knee joint, through which partial blood circulation passes.
Menisci perform important functions:
- cushion the joint during movement;
- stabilize the knee
- contain receptors that control leg movement.
If this meniscus is removed, the area of contact between the bones in the knee becomes 50-70% smaller, and the load on the ligaments becomes more than 100%.
Symptoms
There are two periods: chronic, acute.
The acute period lasts about a month and is characterized by a number of painful symptoms. With the injury itself in the knee area, a person feels severe pain and a sound similar to crackling. Swelling quickly appears on the knee. Hemorrhage into the joint also often occurs.
Joint movements are sharply or partially limited.
Typical symptoms of a medial meniscus tear
This injury has a number of characteristic features. If the posterior horn of the internal meniscus is damaged, intense pain appears on the inside of the knee. On palpation, it increases in the area of attachment of the horn to the knee ligament.
Also, such an injury blocks the movement of the joint.
It is determined when trying to make flexion movements when turning the lower leg outward and straightening the leg, the pain becomes stronger and the knee cannot move normally.
In terms of severity, there can be small, medium and severe injuries.
Gap types
A longitudinal complete or partial rupture of this part is considered very dangerous. It develops from the posterior horn. At complete break, the part that has separated can move between the joints and block their further movement.
Also, a gap can be between the beginning of the posterior horn and the middle of the body of the meniscus.
Often there are cases when such an injury has a combined character and combines different types of damage. They are developing in several directions at once.
The horizontal rupture of the posterior horn starts from the side of its inner surface and develops towards the capsule. It causes severe swelling in the joint space.
Treatment
Treatment can be carried out by both conservative and surgical methods.
Conservative therapy is used for injuries of the lungs or medium degree gravity.
The operation is performed with severe injuries that block the work of the joint and cause severe pain.
The pathology of the musculoskeletal system includes a rupture of the posterior horn of the medial meniscus. This injury is the result of an indirect injury. lower limb. The human knee joint is very complex. Each of them has 2 menisci. They are made up of cartilage. They consist of a body, back and front horns. Menisci are essential for cushioning, limiting range of motion, and matching bone surfaces.
Types of breaks
A rupture of the posterior horn of the medial meniscus is called a variety closed injury joint. This pathology is most often found in adults. In children, this injury is rare. Women suffer from this disease 2 times more often than men. The gap is often combined with.
This is the most common joint injury. Complex rupture is diagnosed mainly in people from 18 to 40 years old. This is due to an active lifestyle. Sometimes there is a combined damage to both menisci.
The relevance of this problem is due to the fact that often such an injury requires surgical intervention and long period recovery.
After surgical treatment, patients move on crutches. Distinguish between complete and incomplete tissue rupture. The following options are known:
- longitudinal;
- vertical;
- patchwork oblique;
- radial transverse;
- horizontal;
- degenerative with crushing of tissues;
- isolated;
- combined.
An isolated rupture of the posterior kind is diagnosed in 30% of all cases of this injury.
Causes of damage
The development of this pathology is based on a strong extension of the lower leg or its sharp turn outward. Longitudinal break due to several reasons. The main etiological factors are:
- falling on a hard surface;
- bruises;
- traffic accidents;
- blows;
- degenerative processes against the background of gout and rheumatism;
- stretching;
- microtrauma.
Rupture of the posterior horn of the meniscus is most often caused by indirect and combined trauma. This usually happens in winter in ice. Failure to take precautions, haste, drunkenness and fighting all contribute to injury. Often, rupture occurs with fixed extension of the joint. Athletes face the same problem. The risk group includes football players, figure skaters, gymnasts and hockey players.
Permanent damage causes meniscopathy. Subsequently, with sharp turns, a gap occurs. Separately allocated degenerative damage. It occurs mainly in elderly people with repeated microtraumas. The reason may be intense exercise during training or careless labor activity. Degenerative horizontal break the posterior horn of the medial meniscus often occurs against the background of rheumatism.
It is facilitated by previously transferred angina and scarlet fever. At the heart of damage to the menisci on the background of rheumatism is a violation of the blood supply to tissues with edema and other pathological changes. The fibers become less elastic and strong. They are not able to withstand a large load.
Less commonly, the cause of the rupture is gout. Traumatization of tissues by uric acid crystals occurs. Collagen fibers become thinner and less durable.
How does the gap manifest?
If there is damage to the posterior horn of the medial meniscus, then the following symptoms are possible:
- pain in the knee area;
- restriction of movements;
- crackling while walking.
In the acute period develops reactive inflammation. The intensity of the pain syndrome is determined. If it is incomplete, then the symptoms are mild. Clinical signs persist for 2-4 weeks. A patchwork rupture of moderate severity is characterized by acute pain and limited extension of the limb at the knee.
The sick person can walk. If proper treatment is not given, then this pathology becomes chronic. Strong pain in combination with tissue edema, it is characteristic of a severe rupture. In such people, small blood vessels in the knee area can be damaged. Developing. Blood accumulates in the cavity of the knee joint.
Supporting the leg is difficult. In severe cases, the local temperature rises. The skin takes on a bluish tint. The knee joint becomes spherical. After 2-3 weeks from the moment of injury, a subacute period develops. It is characterized by localized pain, effusion, and blockages. typical specific symptoms Roche, Baikov and Shteiman-Bragard. At degenerative form of this pathology of the meniscus, complaints can appear only during work.
Patient examination plan
It is necessary to treat a linear rupture after clarifying the diagnosis. The following research will be required:
- general clinical tests;
- CT or MRI;
- radiography;
- arthroscopy.
Differential diagnosis is carried out in the following cases:
- arthritis of various etiologies;
- gonarthrosis;
- softening of cartilage tissue;
If the posterior horn of the meniscus is damaged, treatment begins after assessing the condition of the joint tissues. Magnetic resonance imaging is very informative. Its advantage is the absence of radiation exposure. According to the indications, arthroscopy is performed. This is endoscopic method research. Examination of the knee can be carried out for both therapeutic and diagnostic purposes. Arthroscopy can be used to visually assess the condition of the knee joint. Before the procedure it is necessary to pass a number of tests. The study can be carried out on an outpatient basis.
Medical tactics
Partial damage to the meniscus requires conservative therapy. The main aspects of treatment are:
- plaster overlay;
- the use of painkillers;
- puncture of the knee joint;
- keeping calm;
- setting cold compresses;
- massage;
- physiotherapy.
If the cause was degenerative-dystrophic processes, then chondroprotectors are prescribed. These are drugs that strengthen the cartilage of the joints. They contain chondroitin sulfate and glucosamine. Chondroprotectors include Artra, Teraflex, Dona and. To eliminate the pain syndrome, NSAIDs are prescribed (Ibuprofen, Movalis, Diclofenac Retard). These medicines are taken orally and applied to the skin around the joint.
External means are used after removal of the plaster. Patients need to observe motor rest. To accelerate the healing of the medial meniscus, physiotherapy is performed (electrophoresis, UHF therapy, exposure to magnetic fields). Often a puncture is required. A needle is inserted into the joint. With a small amount of blood, the puncture is not performed.
During the procedure, analgesics and anti-inflammatory drugs may be administered. medications. In severe cases, radical treatment is required. The indications for the operation are:
- detachment of the horns and body of the medial meniscus;
- lack of effect from conservative therapy;
- displaced rupture;
- crushing of tissues.
The most frequently organized recovery surgical interventions. Complete meniscectomy is less common. This is due to the fact that the removal of the medial meniscus in the future can lead to the development of deforming gonarthrosis. Special structures are used to restore tissues. In the case of peripheral and vertical tears, the meniscus can be sutured.
Such an intervention is justified only if there are no degenerative changes in the cartilage tissue. A complete meniscectomy can be performed only with a large detachment and severe damage to the meniscus. Arthroscopic surgery is now widely used. Their advantage is less trauma. After the operation, painkillers, physiotherapy and gymnastics are prescribed. Up to a year, patients need to remain calm.
Forecast and preventive measures
The prognosis for a rupture of the posterior horn of the internal meniscus of the knee is most often favorable. It worsens with severe hemarthrosis, concomitant lesions and untimely treatment. After therapy, the pain syndrome disappears and the range of motion is restored. In some cases, gait instability and discomfort during walking are observed.
Cluster a large number blood in the knee joint in the absence of proper assistance can cause arthrosis.
In the elderly, treatment is difficult due to the impossibility of the operation. Rupture of the horns of the medial meniscus can be prevented. To do this, you must adhere to the following recommendations:
- avoid sudden foot movements;
- observe safety precautions while working at work and at home;
- stop drinking alcohol;
- do not get into fights;
- wear knee pads when playing sports;
- to refuse traumatic activities;
- be careful during ice;
- in winter weather, wear shoes with thread;
- refuse to engage in extreme sports;
- timely treat arthritis and arthrosis;
- diversify the diet;
- move more;
- take vitamin and mineral supplements;
- treat rheumatism in a timely manner and.
A torn meniscus is a very common pathology in adults and adolescents. In case of a fall or bruise and pain syndrome, you need to contact the emergency room.