Damage to the posterior horn of the internal meniscus. Rupture of the posterior horn of the meniscus Signs of the posterior horn of the medial meniscus

The structure of the knee joint determines not only the stabilization of the knee or its shock absorption under loads, but also its mobility. Dysfunction of the knee due to mechanical damage or degenerative changes, resulting in stiffness in the joint and loss of normal amplitude of flexion-extensor movements.

The anatomy of the knee joint distinguishes the following functional elements:

The patella or patella, located in the tendons of the quadriceps femoris, is mobile and serves as an external protection of the joint from lateral displacements of the tibia and femur;

The internal and external lateral ligaments fix the femur and tibia;

The anterior and posterior cruciate ligaments, as well as the lateral ligaments, are intended for fixation;

In addition to the tibia and femur connected to the joint, the fibula is distinguished in the knee, which serves to implement the rotation (turning movements) of the foot;

Meniscus - crescent-shaped cartilage plates designed to cushion and stabilize the joint, the presence of nerve endings allows the brain to signal the position of the knee joint. There are external (lateral) and internal (medial) meniscus.

The structure of the meniscus

The menisci are cartilaginous, supplied with blood vessels allowing for nutrition, as well as a network of nerve endings.

In their form, the menisci look like plates, in the form of a crescent, and sometimes a disk, in which the back and anterior horn of the meniscus as well as his body.

Lateral meniscus, also called external (external) is more mobile due to the lack of rigid fixation, this circumstance is the reason that when mechanical injuries it is displaced, which prevents injury.

Unlike the lateral medial meniscus has a more rigid fixation by means of attachment to the ligaments, therefore, in case of injuries, it is damaged much more often, also in most cases damage to the inner meniscus is of a combined nature, that is, it is combined with trauma to other elements of the knee joint, in most cases directly to the lateral and cruciate ligaments associated with injuries dorsal horn meniscus.

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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 medial meniscus happens 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 skin covering 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:

1. Pain is aggravated by pressure on the kneecap inside and simultaneous extension of the limb (Bazhov's technique);
2. the skin of the knee area becomes too sensitive (Turner's symptom);
3. 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.

Features of horizontal damage to the posterior horn of the medial meniscus are as follows:

• 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 development of the pathology has common features with damage to the anterior meniscus horn of the external cartilage, so special attention is needed when diagnosing.

With horizontal, partial damage, the cavity begins to accumulate excess synovial fluid. Pathology can be diagnosed by ultrasound.

After the removal of the first symptoms, a set of special gymnastic exercises is developed for each patient. Physiotherapy and massage sessions are prescribed.

If a traditional methods treatment does not give a positive result, then surgery is indicated.

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:

1. an articular blockade is performed using special medications, after which the motor ability of the joint is partially restored;
2. anti-inflammatory drugs are prescribed to remove puffiness;
3. recovery period, including a set of special gymnastic exercises, physiotherapy and massage sessions;
4. then comes the reception of chondoprotectors (drugs that help restore the structure of the cartilage). Among active ingredients chondoprotectors present Hyaluronic acid. The course of admission can last up to six months.

Throughout the course of treatment, painkillers are present, because damage to the ligaments is accompanied by constant painful sensations. 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:

1. resection broken elements, or meniscus. This kind of manipulation is performed with incomplete or complete anguish;
2. recovery destroyed tissues;
3. replacement destroyed tissue by implants;
4. stitching menisci. Such surgery is performed in case of a fresh injury, and immediate appeal for medical help.

Let us consider in more detail the types of surgical treatment of knee injuries.

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

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 tissues

Surgical treatment of this type aims to restore the destroyed cartilage tissue. This type of surgery 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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meniscus injury

In the structure of the meniscus, the body of the meniscus and two horns are distinguished - anterior and posterior. By itself, the cartilage is fibrous, the blood supply is carried out from the articular bag, so the blood circulation is quite intense.

A meniscal injury is the most common knee injury. The knees themselves are a weak point in the human skeleton, because the daily load on them begins from the very moment when the child begins to walk. Very often, damage to the meniscus occurs during outdoor games, when engaging in contact sports, with too sudden movements or during falls. Another cause of meniscus tears is knee injuries sustained in road accidents.

Treatment of a torn posterior horn of the medial meniscus can be surgical or conservative.

Conservative treatment

Conservative treatment consists in adequate pain relief. When blood accumulates in the joint cavity, it is punctured and blood is pumped out. If there is a blockade of the joint after an injury, then it is eliminated. If a meniscus tear occurs, combined with other knee injuries, then a plaster splint is applied to provide the leg with complete rest. In this case, rehabilitation takes more than one month. To restore the function of the knee, gentle physiotherapy exercises are prescribed.

With an isolated rupture of the posterior horn of the medial meniscus, the recovery period is shorter. Gypsum is not applied in these cases, because it is not necessary to completely immobilize the joint - this can lead to stiffness of the joint.

Surgery

If conservative treatment does not help, if the effusion in the joint persists, then the question arises of surgical treatment. Also indications for surgical treatment are the occurrence of mechanical symptoms: clicks in the knee, pain, the occurrence of blockades of the joint with limited range of motion.

Nowadays, there are the following types operations:

Arthroscopic surgery.

The operation is performed through two very small incisions through which the arthroscope is inserted. During the operation, the detached small part of the meniscus is removed. The meniscus is not completely removed, because its functions in the body are very important;

Arthroscopic meniscus suture.

If the gap is significant, then an arthroscopic suture technique is used. This technique allows you to restore damaged cartilage. Using one stitch, the incompletely separated part of the posterior horn of the meniscus is sutured to the body of the meniscus. The disadvantage of this method is that it can only be carried out in the first few hours after the injury.

Meniscus transplant.

Replacement of the meniscus with a donor one is performed when the cartilage of one's meniscus is completely destroyed. But such operations are carried out quite rarely, because in the scientific community there is still no consensus on the appropriateness of this operation.

Rehabilitation

After the treatment, both conservative and operative, it is necessary to undergo a full course of rehabilitation: develop the knee, increase leg strength, train the quadriceps femoris muscle to stabilize the injured knee.

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As a rule, a torn meniscus 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 cartilaginous tabs, external and internal, respectively, lateral and medial. Both of these tabs are crescent shaped. 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 specialists believed that as a result of the complete removal of the damaged meniscus, the patient would be spared all the problems associated with the injury. However, today it has been proven that both the external and internal menisci have very important functions for the cartilage of the joint and bones. The meniscus cushions and protects the joint and its complete removal will lead to arthrosis.

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

sufficiently active walking or long sitting 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 symptom is very characteristic of a rupture of the internal meniscus. Meniscus blockade 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 injury, the cartilage tissue is multifibered, there is swelling from the accumulation of synovial fluid, and nearby cartilage is often damaged.

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

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

Conservative treatment

Primary rupture of the posterior horn of the meniscus must be treated therapeutically. Naturally, injuries happen when the patient needs an emergency. surgical intervention However, 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, which are carried out for 3-6 months annually;

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

Be healthy!

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Types of breaks

The meniscus is a part of the knee joint that protects the bone tissue from friction and fixes the joint from the inside. The menisci are located between the bone epiphyses of the knee, stabilize its position.

The horns of the meniscus are called processes from connective tissue fixing the shape of the knee joint. They do not allow the position of the bones to change relative to each other. Between the horns, the extreme parts of the meniscus, there are denser areas - this is the body of the cartilage.

The medial meniscus is fixed by horns on the bone, it is located on the inside of the lower limb. Lateral is located in the outer part. lateral meniscus in more responsible for mobility. Therefore, its damage occurs less frequently. But the medial one stabilizes the articular joint and does not always withstand tension.
Meniscus tears are 4 out of 5 cases of all knee injuries. In most cases, they occur due to too strong loads or sudden movements.

Sometimes degenerative processes of the cartilaginous tissue of the joint become a concomitant risk factor. Osteoarthritis of the knee increases the likelihood of traumatic injury. This also applies excess weight, lack of habit of ligaments to loads.

The gap does not always occur instantly due to too much load, bumps and falls. Sometimes it develops over time. Symptoms may or may not be present in this situation. However, if the cartilaginous joint is left untreated, sooner or later its edges will rupture.

Damage to the posterior horn

Types of injuries:

Anterior horn injury

Damage anterior horn develops in general according to the same pattern as the posterior one:

1. The patient often loses the ability to move.
2. The pains are piercing, not allowing to bend and unbend the leg.
3. Muscles weaken, become flabby.

The anterior horn is torn more often than the posterior horn, as it is somewhat less thick. In most cases, damage is of the longitudinal type. In addition, the ruptures are stronger and more often form flaps of cartilage tissue.

signs

The main symptom of a torn meniscus is severe pain in the knee joint. When the posterior horn is torn, the pain is localized mainly in the popliteal region. If you touch the knee with palpable pressure, the pain increases dramatically. It is almost impossible to move because of the pain.

It is easiest to understand that a gap has occurred when trying to move. The most severe pain occurs if the victim tries to straighten the lower limb or carry out other movements with the lower leg.

After injury, symptoms change depending on how much time has passed. The first month and a half pains are quite strong. If the patient has not lost the ability to walk at the same time, the pain will intensify with the slightest exertion. In addition, even ordinary walking will be accompanied by unpleasant sounds, the meniscus will crack.

The knee joint will swell and lose stability. Because of this, doctors may advise not to stand up, even if the injured person is physically capable of it.

If the rupture is not traumatic, but degenerative in nature, the symptoms become chronic. Pain here is less pronounced and manifests itself mainly during tension. Sometimes pain does not develop immediately, and the patient does not visit a doctor for a long time. This can lead to acute traumatic violation of the integrity of the joint.

To diagnose an injury, a doctor may use the following specific symptoms:

• a sharp pain pierces if you press on the front of the knee while straightening the lower leg;
• the injured lower limb can straighten more than usual;
• the skin in the knee and upper leg becomes more sensitive;
• when trying to climb the stairs, the knee joint "jams" and stops working.

Degrees

Classification of the condition of the knee cartilage according to Stoller:

Treatment

If symptoms of the third degree of severity are obvious, you need to provide first aid and call an ambulance. Before the doctors arrive, the victim must not be allowed to move. Ice should be applied to relieve pain and avoid severe swelling.

When the paramedics arrive, they will give you an injection of painkillers. After that, it will be possible, without torturing the victim, to impose a temporary splint.

This is necessary to immobilize the knee joint and prevent damage from worsening. You may need to drain fluid and blood from the joint cavity. The procedure is quite painful, but necessary.

How to treat depends on the strength of the gap and localization. The primary task of the doctor is to choose between conservative therapy and surgical.

Options

If the edges of the cartilage are torn and the flaps are blocking movement, surgery will be required. You can’t do without it either if the position of the bones relative to each other is disturbed, or the meniscus is crushed.

The surgeon can carry out the following actions:

• sew up cartilage flaps;
• remove the entire joint or posterior horn;
• fix parts of the cartilage with fixing parts made of bioinert materials;
• transplant this part of the joint;
• restore the shape and position of the knee joint.

During the operation, an incision is made in the skin. A drainage tube, a light source and an endoscopic lens are inserted through it. These devices help make the operation less traumatic.

All manipulations with the meniscus, including removal, are carried out with thin instruments inserted through the incision. This provides not only less "bloody" operation, but in principle makes it possible. The region of the posterior horn is difficult to reach, and only in this way can it be influenced.

Conservative therapy and rehabilitation after surgery may include:

Damage to the external meniscus of the knee joint

Knee pain is a common reason for seeking medical attention. They can occur due to various pathologies, including damage to the menisci - special cartilage plates located between the articular surfaces. Them main task is cushioning and stabilization of the articulation. And in conditions of significant loads that the knee has to experience, this is extremely important.

The pathology of the menisci is more often traumatic in nature, manifesting itself either as an isolated injury or in combination with ruptures of the ligamentous apparatus. This is more typical for young people who are actively involved in sports. After 40 years, cases of degenerative changes predominate, which lead to a rupture of the menisci. It is possible to eliminate such problems of the knee joint after finding out their origin, clinical manifestations and severity.

Causes

Degenerative-dystrophic processes do not develop in healthy body. This must be preceded by violations at various levels: local and general. They have a clear relationship, which distinguishes the development of pathology from traumatic injuries, when only a mechanical effect on the knee joint is sufficient. Undoubtedly, injuries and prolonged excessive stress on the joints are the key points in the formation of degenerative changes, but there are other conditions that contribute to such processes:

• Dysplasia of the knee.
• Obesity.
• Gout.
• Rheumatoid arthritis.
• Rheumatism.
• Osteoarthritis.
• Infectious diseases (tuberculosis, brucellosis, yersiniosis).
• Connective tissue diseases (lupus erythematosus, scleroderma).
• Endocrine pathology (hypothyroidism).
• Systemic vasculitis.

Dystrophic processes in the knee joint are largely due to metabolic, immune, endocrine and vascular disorders, which can occur in conjunction with age-related changes that inevitably appear after 50 years.

Degenerative changes in the menisci develop due to many reasons. In most cases, there is a combined effect of adverse factors.

Symptoms

Damage of a degenerative-dystrophic nature - meniscopathy - does not occur suddenly. It takes time for the initiation and progression of pathological processes in the knee joint. The following symptoms may appear first:

• Feeling of fatigue in the joint.
• Crunching, rubbing and clicking in the knee.
• Periodic pain after intense exercise.

Over time, pathological changes appear not only in the menisci, but also in the adjacent articular surfaces, ligaments. Tissues become less durable, which contributes to their damage. As a result, ruptures of cartilage shock-absorbing pads can occur even without previous trauma - just an awkward movement, squatting or simply bending the leg is enough. In this case, the symptoms worsen, the following signs become characteristic:

• Swelling and redness in the joint space.
• Restriction of movements.
• Knee instability.
• Blocking (jamming) of the joint.

But most often, chronic damage, which is dystrophic in nature, occurs with the only symptom - pain, only occasionally manifesting itself as blocking the joint. The severity of symptoms varies from minimal to very strong, when it is impossible to even stand on one leg or make any movements. Unpleasant sensations can disturb only when going down the stairs or during squats. It depends on the degree of damage and what structures are involved. The concomitant pathology of the knee joint also plays a role: fractures of the condyles, torn ligaments, osteoarthritis.

According to their localization, the breaks can be located in the following zones:

• The body of the meniscus: internal (medial) or external (lateral).
• Anterior horn of the lateral meniscus.
• Posterior horn of the inner meniscus.
• Combined damage.

More often you can meet ruptures of the outer meniscus, because it has more mobility than the inner one. The latter is more often torn when combined with damage to the anterior cruciate ligament. Degenerative changes in the posterior horn of the medial meniscus are accompanied by less intense symptoms, signs of wedging are often absent. The anterior horn comes off much less frequently.

If the lesion affects the vascular zone, then the development of hemarthrosis (accumulation of blood) is likely. The joint swells significantly, which can be seen from the change in the shape of the patella zone. Palpation is characterized by pain in the joint space that occurs during tests with passive flexion and extension of the knee.

A lesion of the internal or external meniscus can be suspected clinically, but additional methods help confirm the diagnosis.

Diagnostics

To make a final conclusion about meniscopathy, it is necessary to conduct an imaging examination. This includes x-rays or magnetic resonance imaging. The latter method has significant advantages, since it allows you to accurately assess the state of intra- and periarticular soft tissues, and does not have radiation exposure. According to the results of tomography, the degree of damage to the meniscus is determined (according to Stoller):

• 1 - focal changes that do not reach the surface layer.
• 2 - linear changes that do not reach the surface layer.
• 3 - changes reach the surface of the meniscus.

One can speak of a true rupture only in last case. In addition, the picture clearly shows the dislocation of cartilaginous structures, a change in shape, and the detachment of one of the horns.

Treatment

It is necessary to treat meniscopathy of the knee joint in a complex manner. Apply conservative and operative methods. Depending on the severity of the disease, the effect of the drugs used may be different. To achieve maximum result, you should follow all the recommendations of the doctor. And first of all, it is necessary to reduce the load on the sore leg. You can wear an elastic bandage or a knee brace, but completely immobilizing the joint with a cast is fundamentally wrong - this will not improve its function, but will lead to contractures.

Degenerative-dystrophic changes in the menisci require persistent and intensive care, which can take quite long time.

Medical therapy

Pathology of the knee joint, including meniscus lesions, requires the use of medications. Drugs are especially needed for acute ruptures, but chronic processes cannot be effectively corrected without drugs. At dystrophic changes it is important to normalize the biochemical processes in the body. To improve the condition of the meniscus and reduce symptoms, use the following medicines:

• Non-steroidal anti-inflammatory.
• Chondroprotectors.
• metabolic.
• Vascular.
• Vitamins.

All drugs should be taken according to the recommendations of a specialist. Self-medication is not allowed.

They also use the possibilities of physiotherapy to restore the integrity of the meniscus. For this purpose, some procedures are used: electro- and phonophoresis, laser and wave treatment, magnetic, paraffin and balneotherapy. Which of them are indicated in each case, the doctor will determine. But a pronounced effect from the isolated use of physiotherapy should not be expected - it is used only in combination with other methods.

Physiotherapy

Even with meniscus ruptures, exercise therapy is indicated. It should include exercises aimed at strengthening the thigh muscles - the anterior and posterior groups. This allows you to stabilize the knee and eliminate its instability. But still, you should be careful during classes, exclude sudden movements, especially rotational ones.

Conservative measures are good for small tears, as well as for the elderly, who often have signs of osteoarthritis.

Operation

If the damage to the internal or external meniscus reaches 3 degrees according to Stoller, they are of considerable size and are accompanied by severe symptoms, as well as with the ineffectiveness of previous therapy, that is, all indications for surgical intervention. Only a doctor can determine when the operation should begin, but you should not hesitate with this.

The most common surgical treatment is arthroscopic surgery. This is a minimally invasive technology that can be used to perform a meniscectomy (partial removal), suture, transplant or meniscus arthroplasty.

Pain in the knee may appear due to the development of degenerative processes and rupture of the meniscus. It is important to carry out treatment in a timely manner in order to restore damaged tissues. What is better to use - conservative therapy or surgery - is determined by the clinical situation.

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 to the lower extremity. 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 rupture is often combined with damage to the cruciate ligament of the knee.

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 such an injury often requires surgical intervention and a long recovery period.

After surgical treatment, patients move on crutches. Distinguish between complete and incomplete tissue rupture. The following options for rupture of the medial meniscus 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. The longitudinal gap is due to several reasons. 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, degenerative damage is highlighted. It occurs mainly in elderly people with repeated microtraumas. The reason may be intense exercise during training or careless work. Degenerative horizontal rupture of 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 crystals occurs uric acid. 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. Intensity pain syndrome determined by the degree of discontinuity. If it is incomplete, then the symptoms are mild. Clinical signs persist for 2-4 weeks. Flap rupture of moderate severity is characterized by acute pain and limited extension of the limb in 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. Hemarthrosis develops. 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. Specific symptoms of Roche, Baykov and Steiman-Bragard are typical. 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:

• Koenig's disease;
• arthritis of various etiologies;
• gonarthrosis;
• Hoff's disease;
• softening of cartilage tissue;
• osteoporosis.

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;
• physiotherapy;
• 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 Chondrogard. 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 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. 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 common are reconstructive surgeries. 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.

The accumulation of a large amount of 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 and gout in a timely manner.

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.

Rupture of the posterior horn of the medial meniscus of the knee joint - treatment, symptoms, complete analysis of the injury

One of the most complex structures of the human body parts are joints, both large and small. The structural features of the knee joint allow us to consider it the most susceptible to various injuries, such as fractures, bruises, hematomas, arthrosis, rupture of the posterior horn of the medial meniscus.

This is justified by the fact that the bones of the joint (femur, tibia), ligaments, menisci and patella, working together, provide normal flexion when walking, sitting and running. However, heavy loads on the knee, placed on it during various manipulations, can lead to a rupture of the posterior horn of the meniscus.

Rupture of the posterior horn of the internal meniscus is an injury to the knee joint caused by damage to the cartilage layer located between the femur and tibia.

Anatomical features of the cartilage tissue of the knee

The meniscus is the cartilaginous tissue of the knee, located between two adjacent bones and ensuring the sliding of one bone over the other, ensuring unimpeded flexion/extension of the knee.

The structure of the knee joint includes two types of menisci:

1. External (lateral).
2. Internal (medial).

The most mobile is considered external. Therefore, its damage is much less common than damage to the internal.

The inner (medial) meniscus is a cartilaginous lining connected to the bones of the knee joint by a ligament located on the side of the inner side, it is less mobile, therefore, people with a lesion of the medial meniscus more often turn to traumatology. Damage to the posterior horn of the medial meniscus is accompanied by damage to the ligament that connects the meniscus to the knee joint.

By appearance it looks like a crescent moon lined with a porous cloth. The body of the cartilage pad consists of three parts:

• Anterior horn;
• middle part;
• Back horn.

The cartilages of the knee perform several important functions, without which a full-fledged movement would be impossible:

1. Cushioning while walking, running, jumping.
2. Stabilization of the knee at rest.
3. Permeated with nerve endings that send signals to the brain about the movement of the knee joint.

Knee injury is not uncommon. At the same time, not only people who lead an active lifestyle can get injured, but also those who, for example, sit on squats for a long time, try to rotate on one leg, and make long jumps. Tissue destruction occurs and over time, people over 40 are at risk. Damaged knees in young age over time, they begin to wear the chronic nature of the disease in old age.

The nature of its damage may be different depending on exactly where the rupture occurred and what shape it has.

Break shapes

Cartilage ruptures can be different in nature and form of the lesion. Modern traumatology distinguishes the following groups of ruptures of the internal meniscus:

• Longitudinal;
• degenerative;
• oblique;
• transverse;
• Rupture of the posterior horn;
• horizontal;
• Rupture of the anterior horn.

Rupture of the posterior horn

Rupture of the posterior horn of the medial meniscus is one of the most common groups of knee injuries. This is the most dangerous damage.

Tears in the posterior horn can be:

1. Horizontal, that is, a longitudinal gap, in which the separation of tissue layers from one another occurs, followed by blocking the mobility of the knee joint.
2. Radial, that is, such damage to the knee joint, in which oblique transverse tears of cartilage tissue appear. The edges of the lesion look like rags, which, falling between the bones of the joint, create a crack of the knee joint.
3. Combined, that is, bearing damage to the (medial) internal meniscus of two types - horizontal and radial.

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Symptoms of an injury to the posterior horn of the medial meniscus

The symptoms of the resulting injury depend on what form it wears. If this acute form, then the signs of injury are as follows:

1. Sharp pain even at rest.
2. Hemorrhage within the tissue.
3. Blockage of the knee.
4. Arthroscopy tissue has smooth edges.
5. Swelling and redness.

The chronic form (an old rupture) is characterized by the following symptoms:

• Cracking of the knee joint during movement;
• Accumulation of synovial fluid;
• The tissue during arthroscopy is stratified, similar to a porous sponge.

Treatment of cartilage damage

In order for the acute form not to become chronic, it is necessary to immediately begin treatment. If treatment is started late, then the tissue begins to acquire significant destruction, turning into tatters. Tissue destruction leads to cartilage degeneration, which in turn leads to knee arthrosis and his immobility.

Stages of conservative treatment

The conservative method is used in the acute non-started stage on early dates the course of the disease. Therapy by conservative methods consists of several stages.

• Relieve inflammation, pain and swelling with non-steroidal anti-inflammatory drugs (NSAIDs).
• In cases of “jamming” of the knee joint, reposition is used, that is, reduction with the help of manual therapy or traction.
• Physiotherapy.
• Massotherapy.
• Physiotherapy.

• Treatment with chondroprotectors.
• Joint treatment with hyaluronic acid.
• Treatment with folk remedies.
• Pain relief with analgesics.
• Plaster cast (on doctor's recommendation).

Stages of surgical treatment

The surgical method is used only in the most extreme cases, when, for example, the tissue is so damaged that it cannot be restored, or if conservative methods have not helped.

Surgical methods for repairing torn cartilage consist of the following manipulations:

• Arthrotomy - partial removal of damaged cartilage with extensive tissue damage;
• Meniscotomy - complete removal of cartilage tissue; Transplantation - moving the donor meniscus to the patient;
• Endoprosthetics - the introduction of artificial cartilage into the knee;
• Stitching of damaged cartilage (performed with minor damage);
• Arthroscopy - knee puncture in two places in order to carry out the following cartilage manipulations (for example, stitching or arthroplasty).

After the treatment is carried out, regardless of what methods it was carried out (conservative or surgical), the patient will have a long course of rehabilitation. The patient is obliged to provide himself with complete rest throughout the entire time while the treatment is being carried out and after it. Any physical activity after the end of therapy is contraindicated. The patient must take care that the cold does not penetrate to the limbs, and the knee is not subjected to sudden movements.

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Conclusion

Thus, knee injury is an injury that occurs much more often than any other injury. In traumatology, several types of meniscal injuries are known: ruptures of the anterior horn, ruptures of the posterior horn, and ruptures of the middle part. Such injuries can be different in size and shape, so there are several types: horizontal, transverse, oblique, longitudinal, degenerative. Rupture of the posterior horn of the medial meniscus is much more common than that of the anterior or medial meniscus. This is due to the fact that the medial meniscus is less mobile than the lateral one, therefore, the pressure on it when moving is greater.

Treatment of injured cartilage is carried out both conservatively and surgically. Which method will be chosen is determined by the attending physician based on how severe the damage is, what form (acute or chronic) the damage has, what condition the cartilage tissue of the knee is in, what kind of rupture is present (horizontal, radial or combined).

Almost always, the attending physician tries to resort to the conservative method, and only then, if he turned out to be powerless, to the surgical one.

Treatment of cartilage injuries should be started immediately, otherwise the chronic form of the injury can lead to complete destruction of the articular tissue and immobility of the knee.

To avoid injury lower extremities, you should avoid turns, sudden movements, falls, jumps from a height. After treatment of the meniscus, physical activity is usually contraindicated. Dear readers, that’s all for today, share in the comments about your experience in treating meniscus injuries, in what ways did you solve your problems?

The meniscus is the lining of cartilage in the knee joint. It acts as a shock absorber, located between the femur and tibia of the knee, which bears the greatest load in the musculoskeletal system. The rupture of the posterior horn of the medial meniscus is irreversible, since it does not have its own blood supply system, it receives nutrition through the circulation of the synovial fluid.

Injury classification

Damage to the structure of the posterior horn of the medial meniscus is differentiated according to various parameters. According to the severity of the violation, there are:

• 1st degree injury to the posterior horn of the meniscus. Characterized by focal damage to the surface of the cartilage. The overall structure does not change.
• 2 degree. The changes are becoming more pronounced. There is a partial violation of the structure of the cartilage.
• 3 degree. The disease state worsens. Pathology affects the posterior horn of the medial meniscus. There are painful changes in the anatomical structure.

Considering the main causative factor that led to the development pathological condition cartilage of the knee joint, the body of the lateral meniscus, traumatic and pathological damage to the posterior horn of the medial meniscus is distinguished. According to the criterion of prescription of the trauma or pathological violation of the integrity of this cartilaginous structure, fresh and chronic damage to the posterior horn of the medial meniscus is distinguished. Combined damage to the body and the posterior horn of the medial meniscus is also highlighted separately.

Types of breaks

In medicine, there are several types of meniscus ruptures:

• Longitudinal vertical.
• Patchwork braid.
• Horizontal break.
• Radially transverse.
• Degenerative rupture with tissue crush.
• Oblique-horizontal.

Breaks can be complete and incomplete, isolated or combined. The most common ruptures of both menisci, isolated injuries of the posterior horn are diagnosed less frequently. The part of the inner meniscus that has come off may remain in place or move.

Causes of damage

A sharp movement of the lower leg, a strong outward rotation are the main causes of damage to the posterior horn of the medial meniscus. Pathology is provoked by the following factors: microtraumas, falls, stretch marks, traffic accidents, bruises, blows. Gout and rheumatism can provoke the disease. In most cases, the posterior horn of the meniscus suffers due to indirect and combined trauma.

Especially many injured seek help in winter, during ice.

Injuries contribute to:

• Alcohol intoxication.
• Fights.
• Haste.
• Failure to take precautions.

In most cases, the tear occurs during fixed extension of the joint. Hockey players, football players, gymnasts, and figure skaters are at particular risk. Frequent ruptures often lead to meniscopathy - a pathology in which the integrity of the internal meniscus of the knee joint is violated. Subsequently, with each sharp turn, the gap is repeated.

Degenerative damage is observed in elderly patients with the repetition of microtraumas caused by strong physical exertion during labor activity or irregular training. Rheumatism can also provoke a rupture of the posterior horn of the medial meniscus, since the disease disrupts the blood circulation of tissues during edema. Fibers, losing strength, cannot withstand the load. Rupture of the posterior horn of the medial meniscus can provoke tonsillitis, scarlet fever.

Symptoms

The characteristic signs of a torn posterior horn are:

• Sharp pain.
• Puffiness.
• Joint block.
• Hemarthrosis.

Pain

The pain is acutely manifested in the first moments of injury, lasts for several minutes. Often, the appearance of pain is preceded by a characteristic click in the knee joint. Gradually, the pain subsides, a person can step on a limb, although he does this with difficulty. When lying down, during a night's sleep, the pain intensifies imperceptibly. But by morning, the knee hurts so much, as if a nail had been stuck into it. Flexion and extension of the limb increases pain.

puffiness

The manifestation of puffiness is not observed immediately, it can be seen a few hours after the rupture.

Joint block

Jamming of the joint is considered the main sign of rupture of the posterior horn of the medial meniscus. There comes a blockade of the joint after clamping the separated part of the cartilage by the bones, while there is a violation of the motor function of the limb. This symptom can also be observed with sprains, which makes it difficult to diagnose the pathology.

Hemarthrosis (accumulation of blood inside a joint)

Intra-articular accumulation of blood is detected when the "red zone" of the cartilage layer, which performs a shock-absorbing function, is damaged. According to the time of development of pathology, there are:

• Acute break. Hardware diagnostics shows sharp edges, the presence of hemarthrosis.
• Chronic rupture. It is characterized by swelling caused by the accumulation of fluids.

Diagnostics

If there is no blockage, diagnosing a meniscal tear in the acute period is very difficult. In the subacute period, a meniscus tear can be diagnosed based on the manifestation of local pain, compression symptoms, and extension symptoms. If a meniscus rupture has not been diagnosed, the swelling, pain, and effusion in the joint will disappear during treatment, but with the slightest injury, careless movement, the symptoms will manifest themselves again, which will mean the transition of the pathology to a chronic form.

It is not uncommon for patients to be diagnosed with a knee bruise, parameniscal cyst, or sprain.

x-ray

Radiography is prescribed to rule out damage to the bones of fractures and cracks. X-rays are not able to diagnose soft tissue damage. To do this, you need to use magnetic resonance imaging.

MRI

The research method does not harm the body, like radiography. MRI makes it possible to consider layered images of the internal structure of the knee. This allows not only to see the gap, but also to obtain information about the extent of its damage.

ultrasound

Allows visualization of knee tissue. With the help of ultrasound, the presence of a degenerative process, an increased volume of intracavitary fluid is determined.

Treatment of damage to the posterior horn of the meniscus

After injury, it is necessary to immediately immobilize the limb. It is dangerous to treat a victim of a blockage on your own. Doctor's prescription complex treatment includes conservative therapy, surgery, rehabilitation.

Therapy without surgery

With partial damage to the posterior horn of the medial meniscus of 1-2 degrees, conservative therapy is carried out, including drug treatment and physiotherapy. Of the physiotherapy procedures successfully applied:

• Ozokerite.
• Electrophoresis.
• Mud cure.
• Magnetotherapy.
• Electrophoresis.
• Hirudotherapy.
• Electromyostimulation.
• Aerotherapy.
• UHF therapy.
• Massotherapy.

Important! During the treatment of rupture of the posterior horn of the medial meniscus, it is necessary to ensure the rest of the knee joint.

Surgical methods

An effective method of treating pathology is surgical intervention. During surgical therapy, doctors are aimed at the preservation of the organ and its functions. When the posterior horn of the meniscus is torn, the following types of operations are used:

• Cartilage stitching. The operation is performed using an arthroscope - a miniature video camera. It is injected at the site of the knee puncture. The operation is performed with fresh ruptures of the meniscus.
• Partial meniscectomy. During the operation, the area of ​​damage to the cartilage layer is removed, and the rest is restored. The meniscus is cut to a smooth state.
• Transfer. A donor or artificial meniscus is transplanted.
• Arthroscopy. 2 small punctures are made in the knee. An arthroscope is inserted through the puncture, along with which saline enters. The second hole makes it possible to perform the necessary manipulations with the knee joint.
• Arthrotomy. Complicated meniscus removal procedure. The operation is performed if the patient has an extensive lesion of the knee joint.

A modern method of therapy, characterized by a low rate of trauma

Rehabilitation

If the operations were carried out with a small amount of interventions, a short period of time will be required for rehabilitation. Early rehabilitation in the postoperative period includes elimination of the inflammatory process in the joint, normalization of blood circulation, strengthening of the thigh muscles, and limitation of the range of motion. Therapeutic exercises are allowed to be performed only with the permission of the doctor in different positions of the body: sitting, lying, standing on a healthy leg.

Late rehabilitation aims to:

• Elimination of contracture.
• Correction of gait
• Functional restoration of the joint
• Strengthening the muscle tissue that stabilizes the knee joint.

The most important

Rupture of the posterior horn of the medial meniscus is a dangerous pathology. To reduce the risk of injury, precautions should be taken seriously: do not rush when moving up the stairs, exercise muscles with physical activity, regularly take prophylactic chondroprotectors, vitamin complexes, and use knee pads during training. You need to constantly monitor your weight. In case of injury, a doctor should be called immediately.

The knee joint has a rather complex structure. It consists of the femur and tibia, the patella (patella), as well as the ligament system that ensures the stability of the bones of the joint. Another part of the knee joint is the menisci - cartilage between the femur and tibia. When moving, a large load is placed on the knee, which leads to frequent injury to its elements. A tear in the posterior horn of the medial meniscus is one such injury.

Injuries to the knee joint are dangerous, painful and fraught with consequences. Rupture of the posterior horn of the meniscus, which can occur in almost any active person, is the most common and dangerous injury. It is dangerous primarily due to complications, therefore, it requires timely detection and treatment.

What is a meniscus

Menisci are very important structural units of the knee joint. They are curved strips of fibrous cartilage that sit between the bones of a joint. The shape resembles a crescent with elongated edges. It is customary to divide them into zones: the body of the meniscus (middle part); elongated end parts - the posterior and anterior horns of the meniscus.

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

The cartilaginous portion of the meniscus adjacent to the capsule contains significant amount capillaries and is supplied with blood. This part of the medial meniscus is called the red zone. The middle region (intermediate zone) contains a small number of vessels and is very poorly supplied with blood. Finally, the inner region (white zone) has no circulatory system. The lateral meniscus is located in the outer region of the knee. It is more mobile than the medial, and its damage occurs much less frequently.

Menisci perform very important functions. First of all, they play the role of shock absorbers during the movement of the joint. In addition, the menisci stabilize the position of the entire knee in space. Finally, they contain receptors that send operational information to the cerebral cortex about the behavior of the entire leg.

When the inner meniscus is removed, the area of ​​contact of the knee bones decreases by 50-70%, and the load on the ligaments increases by more than 100%. In the absence of an external meniscus, the contact area will decrease by 40-50%, but the load will increase by more than 200%.

meniscal injury

One of the characteristic injuries of the menisci is their rupture. Studies show that such injuries can occur not only in people involved in sports, dancing or hard work, but also in casual activities, as well as in the elderly. It has been established that a meniscal tear is diagnosed in an average of 70 out of every 100,000 people. At a young age (up to 30 years), the damage is acute; with increasing age (over 40 years), the chronic form begins to predominate.

The cause of a torn meniscus can be an excessive lateral load along with twisting of the lower leg. Such loads are typical when performing certain movements (cross-country running, jumping on uneven surfaces, rotation on one leg, prolonged squatting). In addition, ruptures can be caused by joint diseases, tissue aging, or pathological abnormalities. Damage can be caused by sudden swipe in the knee area or quick extension of the leg. According to the nature and location of the damage, several types of ruptures can be distinguished:

• longitudinal (vertical);
• oblique (patchwork);
• transverse (radial);
• horizontal;
• rupture of the anterior horn of the lateral or medial meniscus;
• rupture of the posterior horn of the menisci;
• degenerative rupture.

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

Symptoms of a meniscus injury

In case of damage to the meniscus of the knee joint, two characteristic periods are distinguished - acute and chronic. The acute period lasts 4-5 weeks and is characterized by a number of painful symptoms. The moment of damage to the meniscus, as a rule, is determined by the sound, resembling a crack, and a sharp pain in the knee area. In the first period after an injury, cracking and pain accompanies a person during exertion (for example, walking up stairs). Swelling develops in the knee area. Often, a meniscus tear is accompanied by hemorrhage into the joint.

In the acute period, the movement of the leg in the knee joint in a person is limited or completely impossible. Due to the accumulation of fluid in the knee area, the effect of a “floating patella” may occur.

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

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

Typical symptoms of a medial meniscus tear

Rupture of the medial meniscus of the knee joint has a number characteristic symptoms. Injury to the internal posterior horn of the meniscus causes intense pain in the knee area from the inside. When you press your finger in the area where the meniscus horn is attached to knee ligament there is a sharp pain. A tear in the posterior horn causes blockage of movement in the knee joint.

You can determine the gap by making flexion movements. It manifests itself in the form of a sharp pain when the leg is extended and the lower leg is turned outward. The pain also pierces with strong bending of the leg at the knee. According to the severity of damage to the meniscus of the knee joint are divided into small, moderate and severe degree. Small tears (partial), including the horns of the meniscus, are characterized by pain and slight swelling in the knee area. Such signs of injury cease to appear after 3-4 weeks.

With a moderate degree of injury, all the considered symptoms of the acute period appear, but they are limited and manifest themselves during physical exertion, such as jumping, moving up inclined planes, and squatting. Without treatment, this form of injury becomes chronic. This degree is characteristic of some ruptures of the anterior and posterior horns of the medial meniscus.

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

Read also: Proper rehabilitation for a fracture of the patella

Mechanism of rupture of the posterior horn

A very dangerous longitudinal tear (complete or partial), as a rule, begins to develop from the posterior horn of the medial meniscus. At complete break the detached part of the meniscus horn can migrate into the cavity between the joints and block their movement.

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

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

A horizontal rupture of the posterior horn of the medial meniscus originates from its inner surface and develops in the direction of the capsule. Such damage causes swelling in the joint space (pathology is also characteristic of the anterior horn of the lateral meniscus).

Conservative treatments

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

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

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

Usually the conservative method involves long-term treatment for 6-12 months. Initially, reduction (reposition) of the knee joint is performed in the presence of a blockade. Manual methods can be used to remove the blockade. For the first 3 weeks, rest should be ensured, and the knee joint should be immobilized with a plaster splint.

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

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

Surgical treatment

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

Rupture of the posterior horn of the medial meniscus is a consequence of an injury that occurs both in athletes or those who lead an active lifestyle, and in people in advanced years suffering from other concomitant diseases (for example, arthrosis).

To find out what the features of such damage are, you need to figure out what the meniscus is in general. This concept means a specific cartilaginous layer in the knee joint, which performs shock-absorbing functions. It includes the posterior horn, anterior, body, it is not only medial (internal), but also lateral (external). Here are just an injury to the medial meniscus (more specifically, its posterior horn) is the most dangerous, since it is fraught with serious complications and serious consequences.

Both cartilage layers - external and internal - are C-shaped and differ significantly from each other. So, the lateral meniscus has an increased density, it is quite mobile, due to which it is not injured so often. As for the inner tab, it is rigid, therefore, a rupture (or other injury) of the medial meniscus is much more common.

Part of the meniscus includes a capillary network that forms the "red zone". This part, located on the edge, is highly dense. In the center is the thinnest area (“white zone”), in which there are no vessels at all. When a person injures a meniscus, the first thing to do is determine which element was torn. By the way, the "living" area of ​​the meniscus recovers better.

Note! Once upon a time, doctors believed that removing a torn meniscus could save a person from all troubles. But now it has been proven that both menisci play a very important role in the joint - they protect it, absorb shocks, and the complete removal of one of them leads to early arthrosis.

The main reasons for the appearance

Now experts point to only one reason for the appearance of a gap - acute injury. This is explained by the fact that no other impact on the joint can cause damage to the cartilage responsible for depreciation.

It is also worth noting that there are the following risk factors that predispose to rupture:

• congenital weakness of the joints;
• regular jumping, running on uneven surfaces;
• injuries resulting from degenerative diseases;
• rotational movements performed on one leg without taking it off the ground;
• long-term squatting;
• strenuous walking.

The posterior horn of the medial meniscus may be damaged for reasons other than acute trauma.

Symptoms of damage

Treatment of the described injury can be conservative and surgical. Consider the features of each of them.

Conservative treatment

Primary damage to the meniscus is treated with therapeutic methods. Of course, in some cases, after an injury, patients require emergency operation, but often quite enough and conservative therapy. The treatment procedure itself in this case consists of several stages (we repeat - if the gap is not chronic).

Stage 1. Reposition. When blocking the joint, it must be set. Manual therapy or, alternatively, hardware traction is especially effective here.

Stage 2. Elimination of edema. For this, doctors prescribe a course of anti-inflammatory medications.

Stage 3. Rehabilitation. The rehabilitation course includes massages, physiotherapy exercises and physiotherapy.

Rehabilitation course

Stage 4. Recovery. The most important, but at the same time the longest stage of treatment. Often, in order to restore the meniscus, chondroprotectors and hyaluronic acid. A long course can be from three to six months, it is held once a year.

Note! The rupture of the posterior horn is accompanied by acute pain, so the patient is also prescribed painkillers. There are quite a lot of them - ibuprofen, paracetamol and others. As for the dosage, it should be prescribed exclusively by the attending physician!

In some cases, a cast is applied to the injured knee. The need for gypsum is determined by the doctor in each case. After repositioning the knee joint, immobilization is carried out for a long time at the required angle, and rigid fixation in this case helps to maintain the correct position.

Surgical treatments

In surgical treatment, specialists are guided by one principle - we are talking about the safety of the organ and its functionality. Surgery performed only when other treatments have failed. First, the organ is tested, it is checked whether it can be sutured (this is often relevant in cases of trauma to the “red zone”).

Table. Types of operations used in meniscus rupture

Name	Description
Arthrotomy	A rather complicated procedure aimed at removing the meniscus. If possible, it is desirable to avoid arthrotomy, especially since many modern doctors have abandoned it altogether. This operation is actually necessary if the patient has extensive knee involvement.
Cartilage stitching	The operation is performed using a miniature video camera (arthroscope), which is inserted through a puncture in the knee. An effective outcome is possible only in a thick “living” area, i.e., where the probability of fusion is high. Also note that this operation is done only on "fresh" lesions.
Partial meniscectomy	Removal of the damaged area of ​​the cartilage layer, as well as restoration of the remaining part. The meniscus is trimmed to a flat state.
Transfer	There is nothing much to explain here - the patient is transplanted with an artificial or donor meniscus.
	Most modern method treatment with low trauma. The procedure consists in making two small punctures in the knee, through one of which the arthroscope mentioned above is inserted (in parallel, saline is injected). With the help of the second hole, the required manipulations with the knee joint are performed.

Video - Arthroscopy of the medial meniscus

Rehabilitation

One of the most important stages of treatment is the restoration of the functionality of the joint. You need to know that rehabilitation should take place exclusively under medical supervision. A doctor - an orthopedist or a rehabilitation specialist - individually prescribes a set of measures that contribute to a faster recovery of damaged tissues.

Note! The rehabilitation course can take place at home, it is advisable to do this in a hospital where there is equipment for physiotherapy exercises.

In addition to exercises, during the rehabilitation period, massages and hardware recovery methods are prescribed, associated with dosed loads on the joint. This contributes to the stimulation of muscle tissue and the development of the limb. As a rule, functionality is restored within a few months after the operation, and you can return to your previous life earlier (even a month later).

The main difficulty of the rehabilitation period is considered to be intra-articular swelling, which makes it impossible to quickly restore functions. Puffiness is eliminated with the help of lymphatic drainage massage.

Note! As a result, we note that with proper and - more importantly - timely treatment, the prognosis for rupture of the posterior horn is very favorable. And this is not surprising, because in modern orthopedics there are many effective methods.