The structure of the meniscus includes the body of the meniscus and two horns - anterior and posterior. The cartilage itself is fibrous, the blood supply comes from joint capsule, so the blood circulation is quite intense.
Meniscus injury is the most common injury. The knees themselves - weakness in the human skeleton, because the daily load on them begins from the very moment when the child begins to walk. Very often they occur during outdoor games, when playing contact sports, with too sudden movements or with falls. Another cause of meniscal tears is injuries sustained in an accident.
Treatment of a posterior horn rupture can be surgical or conservative.
Conservative treatment
Conservative treatment consists of adequate pain relief. If blood accumulates in the joint cavity, it is punctured and the blood is pumped out. If a joint blockade occurs after an injury, it is eliminated. If it occurs combined with other knee injuries, then a plaster splint is applied to provide complete rest to the leg. In this case, rehabilitation takes more than one month. To restore knee function, gentle physical therapy is prescribed.
With an isolated rupture of the posterior horn medial meniscus recovery period less. In these cases, plaster is not applied, 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 surgical treatment. Also, indications for surgical treatment are the occurrence of mechanical symptoms: clicks in the knee, pain, the occurrence of joint blockades with limited range of motion.
The following types of operations are currently performed:
Arthroscopic surgery.
The operation is performed through two very small incisions through which the arthroscope is inserted. During the operation, the separated small part meniscus The meniscus is not completely removed because its functions in the body are very important;
Arthroscopic suture of the meniscus.
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 transplantation.
Replacement of the meniscus with a donor one is carried out when the cartilage of one’s meniscus is completely destroyed. But such operations are carried out quite rarely, because in scientific community There is no consensus yet on the advisability of this operation.
Rehabilitation
After treatment, both conservative and surgical, it is necessary to undergo a full course of rehabilitation: develop the knee, increase leg strength, train the quadriceps femoris muscle to stabilize the damaged knee.
Pathology of the musculoskeletal system includes a rupture of the posterior horn of the medial meniscus. This injury is a consequence of indirect trauma to the lower limb. The human knee joint is very complex. Each of them contains 2 menisci. They are formed by cartilage tissue. They consist of a body, posterior and anterior horns. Menisci are essential for shock absorption, limiting range of motion, and matching bone surfaces.
Types of breaks
A type of tear of the posterior horn of the medial meniscus is called closed injury joint This pathology is most often found in adults. This type of injury is rare in children. 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 combined damage to both menisci is observed.
The relevance of this problem is due to the fact that such an injury often requires surgical intervention and long period recovery.
After surgical treatment, patients move on crutches. There are complete and incomplete rupture fabrics The following options are known:
- longitudinal;
- vertical;
- patchwork bias;
- radial-transverse;
- horizontal;
- degenerative with tissue crushing;
- isolated;
- combined.
Isolated Gap posterior diagnosed in 30% of all cases of this injury.
Causes of damage
The development of this pathology is based on strong extension of the lower leg or its sharp outward rotation. The longitudinal gap is due to several reasons. Main etiological factors are:
- falling onto a hard surface;
- bruises;
- road traffic accidents;
- blows;
- degenerative processes against the background of gout and rheumatism;
- sprains;
- microtraumas.
A rupture of the posterior horn of the meniscus is most often caused by indirect and combined trauma. This usually happens in winter when there is ice. Lack of precautions, haste, condition alcohol intoxication and fighting all contribute to injury. Often, rupture occurs when the joint is in fixed extension. Athletes face a similar problem. The risk group includes football players, figure skaters, gymnasts and hockey players.
Permanent damage causes meniscopathy. Subsequently, when making sharp turns, a rupture occurs. Degenerative damage is highlighted separately. It occurs mainly in elderly people with repeated microtraumas. The cause may be intense loads during training or careless work activities. Degenerative horizontal rupture of the posterior horn of the medial meniscus often occurs against the background of rheumatism.
He was promoted earlier previous sore throat and scarlet fever. Damage to the meniscus due to rheumatism is caused by impaired blood supply to tissues due to edema and other pathological changes. The fibers become less elastic and durable. They are not able to withstand heavy loads.
Less commonly, the cause of rupture is gout. Tissue traumatization occurs due to crystals uric acid. Collagen fibers become thinner and less durable.
How does a gap manifest itself?
If there is damage to the posterior horn of the medial meniscus, the following symptoms are possible:
- pain in the knee area;
- restriction of movements;
- cracking sound when walking.
In the acute period, reactive inflammation develops. The intensity of the pain syndrome is determined. If it is incomplete, then the symptoms are mild. Clinical signs lasts 2–4 weeks. A moderate flap rupture is characterized by acute pain and limited extension of the limb at the knee.
The sick person can walk. If proper treatment is not carried out, then this pathology becomes chronic. Severe pain combined with tissue swelling is characteristic of a severe rupture. In such people, small blood vessels in the knee area. Developing. In the cavity knee joint blood accumulates.
It is difficult to support your leg. 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, Baykova and Shteiman-Bragarda. In the degenerative form of this meniscus pathology, complaints may appear only during work.
Patient examination plan
It is necessary to treat a linear break after clarifying the diagnosis. The following studies will be needed:
- 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. Arthroscopy is performed according to indications. This endoscopic method research. A knee examination can be performed for both therapeutic and diagnostic purposes. Arthroscopy can be used to visually assess the condition of the knee joint. Before the procedure, you must undergo a series of tests. The study can be carried out on an outpatient basis.
Treatment tactics
Partial damage to the meniscus requires conservative therapy. The main aspects of treatment are:
- plaster application;
- use of painkillers;
- puncture of the knee joint;
- maintaining peace;
- applying cold compresses;
- massage;
- physiotherapy.
If the cause is degenerative-dystrophic processes, then chondroprotectors are prescribed. These are medications that strengthen the cartilage tissue of the joints. They contain chondroitin sulfate and glucosamine. Chondroprotectors include Artra, Teraflex, Dona and. To eliminate pain, NSAIDs are prescribed (Ibuprofen, Movalis, Diclofenac Retard). These medications are taken orally and applied to the skin in the joint area.
External agents are used after the plaster is removed. Patients must maintain motor rest. To accelerate the healing of the medial meniscus, physiotherapy (electrophoresis, UHF therapy, exposure to magnetic fields) is performed. A puncture is often required. A needle is inserted into the joint. If there is a small amount of blood, the puncture is not performed.
Analgesics and anti-inflammatory drugs may be administered during the procedure. In severe cases, radical treatment is required. Indications for the operation are:
- separation of the horns and body of the medial meniscus;
- lack of effect from conservative therapy;
- displacement rupture;
- tissue crushing.
Reconstructive surgical interventions are most often performed. A complete meniscectomy is performed less frequently. This is due to the fact that removal of the medial meniscus in the future can lead to the development of deforming gonarthrosis. Special designs are used for tissue restoration. In the case of peripheral and vertical tears, the meniscus may be sutured.
Such an intervention is justified only if there are no degenerative changes in cartilage tissue. A complete meniscectomy can only be performed if there is a large tear and severe damage to the meniscus. Currently, arthroscopic operations are widely used. Their advantage is less trauma. After the operation, painkillers, physiotherapy and exercises are prescribed. Patients need to rest for up to a year.
Forecast and preventive measures
Prognosis for a ruptured posterior horn internal meniscus knee is most often favorable. It worsens with severe hemarthrosis, combined lesions and not timely treatment. After therapy, pain disappears and range of motion is restored. In some cases, gait instability and discomfort while walking are observed.
The accumulation of large amounts of blood in the knee joint, without proper care, can cause arthrosis.
In old age, treatment can be difficult due to the impossibility of surgery. Rupture of the horns of the medial meniscus can be prevented. To do this, you need to adhere to the following recommendations:
- avoid sudden movements of the legs;
- observe safety precautions while working at work and at home;
- stop drinking alcohol;
- do not get into fights;
- wear knee pads when playing sports;
- give up traumatic activities;
- be careful during icy conditions;
- in winter weather, wear shoes with threads;
- give up extreme sports;
- promptly treat arthritis and arthrosis;
- diversify your diet;
- move more;
- take vitamins and mineral supplements;
- treat rheumatism in a timely manner and.
A meniscus tear is a very common pathology in adults and adolescents. In case of a fall or injury and pain, you should go to the emergency room.
The meniscus is a lining of cartilage tissue in the knee joint. Performs the function of a shock absorber, located between the femur and tibia bones of the knee, which bears the heaviest 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 synovial fluid.
Classification of injury
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, they are distinguished:
- 1st degree injury to the posterior horn of the meniscus. Characteristic is focal disruption of the cartilage surface. The entire structure does not undergo changes.
- 2nd degree. The changes become significantly pronounced. There is a partial disruption of the structure of the cartilage.
- 3rd degree. The painful condition worsens. The pathology affects the posterior horn of the medial meniscus. Painful changes occur anatomical structure.
Considering the main causative factor that led to the development of the pathological condition of the cartilage of the knee joint, the bodies of the lateral meniscus are distinguished between traumatic and pathological damage posterior horn of the medial meniscus. According to the criterion of how long ago the injury was suffered or pathological disorder The integrity of this cartilaginous structure reveals fresh and old damage to the posterior horn of the medial meniscus. Combined damage to the body and posterior horn of the medial meniscus was also identified separately.
Types of breaks
In medicine, there are several types of meniscal tears:
- Longitudinal vertical.
- Patchwork bias.
- Horizontal gap.
- Radial-transverse.
- Degenerative rupture with tissue crushing.
- Oblique-horizontal.
Tears can be complete or incomplete, isolated or combined. The most common are ruptures of both menisci; isolated injuries to the posterior horn are diagnosed less frequently. The portion of the inner meniscus that has become torn may remain in place or become displaced.
Causes of damage
A sudden movement of the shin, a strong outward rotation are the main causes of damage to the posterior horn of the medial meniscus. The pathology is provoked by the following factors: microtraumas, falls, stretch marks, road 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 people seek help in winter, during icy conditions.
Injuries are caused by:
- Alcohol intoxication.
- Fights.
- Haste.
- Failure to comply with precautions.
In most cases, the rupture occurs during fixed extension of the joint. Hockey players, football players, gymnasts, and figure skaters are especially at risk. Frequent ruptures often lead to meniscopathy, a pathology in which the integrity of the internal meniscus of the knee joint is disrupted. Subsequently, with each sharp turn, the gap is repeated.
Degenerative damage is observed in elderly patients with repeated 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 interferes with the blood circulation of the tissues due to swelling. Fibers, losing strength, cannot withstand the load. A rupture of the posterior horn of the medial meniscus can be caused by tonsillitis and scarlet fever.
Symptoms
Characteristic signs of a rupture of the posterior horn are:
- Sharp pain.
- Swelling.
- Joint block.
- Hemarthrosis.
Painful sensations
The pain is acute in the first moments of injury and continues for several minutes. Often the onset of pain is preceded by a characteristic click in the knee joint. Gradually the pain subsides, the person can step on the limb, although he does it with difficulty. When lying down, during night sleep, the pain intensifies unnoticed. But by morning, my knee hurts so much, as if a nail had been stuck into it. Flexion and extension of the limb increases the pain syndrome.
Swelling
The manifestation of swelling is not observed immediately; it can be seen several hours after the rupture.
Joint block
Joint wedging is considered the main sign of a tear in the posterior horn of the medial meniscus. A blockade of the joint occurs after the separated part of the cartilage is clamped by the bones, and the motor function of the limb is impaired. This symptom can also be observed with sprained ligaments, 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 the pathology, they are distinguished:
- Acute rupture. Hardware diagnostics show sharp edges and the presence of hemarthrosis.
- Chronic rupture. Characterized by swelling caused by the accumulation of fluids.
Diagnostics
If there is no blockage, diagnose a meniscus tear in acute period very hard. In the subacute period, a diagnosis of meniscus tear can be made based on the manifestation of local pain syndrome, compression symptoms, and extension symptoms. If a meniscus tear has not been diagnosed, with treatment the swelling, pain, and effusion in the joint will go away, but with the slightest injury or careless movement, the symptoms will manifest themselves again, which will mean that the pathology has become chronic.
Patients are often diagnosed with a knee joint bruise, a parameniscal cyst, or a sprain.
X-ray
X-rays are prescribed to rule out bone damage from fractures and cracks. X-rays cannot 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 view layer-by-layer images of the internal structure of the knee. This allows you not only to see the gap, but also to obtain information about the extent of its damage.
Ultrasound
Makes it possible to visualize the tissues of the knee. Using ultrasound, the presence of a degenerative process and an increased volume of intracavitary fluid are determined.
Treatment of injuries to the posterior horn of the meniscus
After receiving an injury, it is necessary to immobilize the limb immediately. Treating a blockage victim yourself is dangerous. Prescribed by a doctor complex treatment includes conservative therapy, surgical intervention, rehabilitation.
Therapy without surgery
In case of partial damage to the posterior horn of the medial meniscus of 1-2 degrees, conservative therapy is carried out, including drug treatment and physiotherapeutic procedures. Physiotherapeutic procedures have been successfully used:
- Ozokerite.
- Electrophoresis.
- Mud therapy.
- Magnetotherapy.
- Electrophoresis.
- Hirudotherapy.
- Electromyostimulation.
- Aerotherapy.
- UHF therapy.
- Massotherapy.
Important! During treatment of a 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 surgery. During surgical therapy, doctors are aimed at preserving the organ and its functions. When the posterior horn of the meniscus is torn, the following types of operations are used:
- Cartilage suturing. The operation is performed using an arthroscope - a miniature video camera. It is injected at the puncture site of the knee. The operation is performed for fresh meniscus tears.
- Partial meniscectomy. During the operation, the damaged area of the cartilage layer is removed and the remaining part is restored. The meniscus is trimmed to an even 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 a saline solution. The second hole makes it possible to perform the necessary manipulations with the knee joint.
- Arthrotomy. Complex meniscus removal procedure. The operation is performed if the patient has extensive damage to the knee joint.
A modern method of therapy with a low morbidity rate
Rehabilitation
If the operations were performed with a small volume of interventions, rehabilitation will require a short period of time. Early rehabilitation in postoperative period includes elimination inflammatory process in the joint, normalization of blood circulation, strengthening of the thigh muscles, limiting the range of motion. Therapeutic exercises may only be performed with the permission of a physician in different positions body: sitting, lying, standing on a healthy leg.
Late rehabilitation has the following goals:
- Elimination of contracture.
- Normalizing 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 – dangerous pathology. To reduce the risk of injury, you should take precautions seriously: take your time when moving up stairs, exercise your muscles, exercise regularly prophylactic appointment chondroprotectors, vitamin complexes, use knee pads during training. It is necessary to constantly monitor your weight. In case of injury, call a doctor immediately.
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The medial (internal) meniscus in the modern medical interpretation is an internal cartilaginous lining that acts as a kind of shock absorber in the joint and stabilizes the designated structure as a whole.
Severity of damage
Damage to the meniscus of the knee joint is a fairly common phenomenon, which provokes various degenerative-dystrophic processes of the corresponding structure, which leads to partial destruction, and sometimes complete separation of the body or horns of the cartilaginous component.
The medial meniscus is generally injured less frequently than the lateral one, but almost always the pathology is accompanied by various complications, for example, damage to the ligamentous apparatus, tendons, and intra-articular bursa.
One of the common classifications of the degrees of tear of the internal meniscus of the knee joint is the Stoller gradation.
This technique refers to monitoring the condition of the cartilage structure by performing magnetic resonance imaging. The basic principles of classification are based on the MRI technique in the form of layer-by-layer scanning in an inductive magnetic field.
In general, the degree of damage to the meniscus is classified based on the criterion of the severity of the destruction of cartilage tissue by the appearance of the intensity of changes in luminosity during the diagnostic process, which indicates the presence of chronic degenerative or acute pathological processes.
Zero
Zero degree corresponds to absence pathological changes during MRI diagnostics (normal). If the diagnostician establishes a zero degree of damage to the meniscus, then this indicates the absence of any pathologies of the above-mentioned cartilaginous structure, or they are so insignificant that they are not visualized by modern research methods.
First
In general, grade 1 corresponds to minor injury. On MRI, the diagnostician sees a small, single, strictly localized focus of increased signal intensity, which does not reach the surface of the cartilage. In this situation, the injury can be easily cured with standard methods of conservative therapy and proper short-term rehabilitation.
Second
Generally consistent with moderate medial meniscus injury. MRI visualizes a linear signal of increased intensity that does not reach the surface of the cartilaginous structure.
In this case, there may be several such foci; in different projections, fragmentary violations of the integrity of cartilaginous tissue are visible without degeneration of the general anatomical structure.
In such situations, conservative therapy is initially carried out. If the measures are not effective, the doctor may recommend surgical intervention, as well as long-term rehabilitation until the meniscus is fully functional.
Third
A grade 3 medial meniscus tear is the most severe degree of injury. Associated with a systemic violation of the anatomical structure, in particular the separation of cartilaginous tissue. On MRI it appears as a pronounced systemic appearance of a linear signal of increased intensity reaching the cartilage tissue.
In this case, the pathology is often accompanied by a displacement of part of the internal meniscus, as well as a tear of individual cruciate ligaments with the formation of other negative complications.
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Signs of a rupture of the posterior horn of the medial meniscus of the knee joint
As modern clinical practice When the posterior horn of the internal meniscus of the knee joint ruptures, the victim quickly develops acute pain immediately after receiving the injury. In this case, the knee joint significantly increases in size due to volumetric swelling.
With grade 3 ruptures, a blockage of the knee as a whole can form; accordingly, the joint becomes jammed in one position without the possibility of flexion or extension of the lower limb.
The victim has difficulty moving and often cannot do it on his own. In this case, the leg is initially in a bent position, the pain syndrome manifests itself quite weakly, but in the case of extension of the limb, the pain intensifies many times, and a characteristic clicking sound is also heard.
With absence necessary treatment a few weeks after the injury, compactions appear in the structure of the knee joint, revealed by simple palpation. The above symptoms refer to acute conditions traumatic in nature.
With chronic injuries of the medial meniscus, the basic symptom is exclusively pain in the joint, often aching.
But it increases with physical activity on lower limb. In the case of chronic damage to the internal meniscus, the patient may complain of frequent blockade of the joint and regular swelling of the knee caused by inflammatory processes in the periarticular bursa.
Types of ruptures of the posterior horn of the internal meniscus of the knee joint
There is quite a large number various types tears of the medial meniscus, and for their specific designation, gradation is used both according to the direct volumetric location of the pathology in the form of a partial tear or complete rupture, and the nature of the problem, which includes longitudinal, radial, horizontal, flap and other types of destruction.
Horizontal
By the term horizontal rupture of the posterior horn of the medial meniscus, modern diagnosticians mean a classic violation of the integrity of the above-mentioned internal structure in the central part of the cartilaginous tissue parallel to the main plane of the corresponding meniscus. In this problem, the emerging destruction separates the upper and lower parts of the component.
In this case, within the framework of communication with the peripheral edges of the planes, synovial fluid can flow into the gap itself and provoke the formation of temporary and permanent cysts.
As modern clinical practice shows, in 9 out of 10 cases, a horizontal tear of the internal meniscus of the knee joint is combined with the latter types of pathologies, and in a number of situations their removal requires surgical intervention.
Standard treatment protocols for a horizontal tear of the posterior horn of the medial meniscus may include, in addition to possible surgical intervention, also conservative therapy, physiotherapy, massage and exercise therapy. The last three are recommended within rehabilitation period.
Longitudinal
By the term longitudinal rupture of the posterior horn of the medial meniscus, modern diagnosticians mean the development of the corresponding pathology not in the central part of the cartilaginous structure, but at its edges.
As practice shows, these types of problems have vague symptoms and are diagnosed only using magnetic resonance imaging.
The length of the rupture line is usually insignificant and the pathology, in the absence of complications, does not require active surgical intervention. The main emphasis in treatment is on conservative therapy, including the following:
- Non-steroidal anti-inflammatory drugs;
- Glucocorticosteroids;
- Chondroprotectors.
At the same time, minimally invasive methods of intra-articular administration of platelet mass are sometimes used as a supplement. The latter is complex biological drug
from saline solution and a suspension of donor platelets. Such systems are growth factors and induction of the regeneration process of connective and cartilaginous tissues.
By the term linear rupture of the posterior horn of the medial meniscus, specialized specialists mean the presence of pathology without a branched structure. Destructive changes are rare and are easily visualized during MRI as local focal signals of increased intensity that do not directly reach the surface of the cartilage tissue.
In most cases, such pathologies do not require surgical intervention and installation of an implant.
Conservative therapy in combination with basic rehabilitation measures in the form of physiotherapy, exercise therapy and massage is quite effective. with parallel reception:
- Chondroprotectors;
- Glucocorticosteroids;
- Painkillers;
- Vitamin and mineral complexes;
- Anti-inflammatory drugs in injection form.
By type of watering can handle
A watering can handle rupture of the medial meniscus is a rather complex structural pathological modification of cartilage tissue, which affects the predominant volume of the meniscus. A fairly long and wide tear line affects the avascular, vascular transition zones of the meniscus.
This, in turn, creates the need for active surgical intervention, since conservative therapy does not provide positive prospects in the vast majority of situations.
The complexity of this type of injury is also aggravated by the impossibility of modern minimally invasive surgical practice using an arthroscope.
In most cases it is required classic operation with opening of the joint cavity and, accordingly, surgery for various complications. It is also worth considering that standard plastic surgery for tears of the medial meniscus like a watering can handle is ineffective, so the only way to preserve the functionality of the structure as a whole remains transplantation of biomaterial using an artificial prosthesis or a donor structure.
Complex
A complex rupture of the posterior horn of the medial meniscus combines the main features of both horizontal and vertical ruptures, often with individual manifestations of longitudinal and radial destruction. Complex tears most often begin at the loose end of the cartilaginous structure and extend all the way to the main body of the component.
Almost always, treatment for a combined rupture of the posterior horn of the medial meniscus requires quite complex surgical intervention.
Moreover, if there is a rupture line more than 20 millimeters long with a distance from the capsule of more than 3 millimeters, the chances of favorable outcome surgical intervention are quite low.
In this case, the only method of restoring performance is donor meniscus transplantation, the effectiveness of which reaches 50% in the presence of the above-described unfavorable factors.
Patchwork
Flap rupture of the medial meniscus occurs exclusively on the body of the internal cartilaginous structure. The pathology is located between the middle and posterior parts of the cartilaginous component, while the size of the gap itself is small.
The torn part of the meniscus often ends up in the space between the articular surfaces and creates the preconditions for complete blockade of the joint.
If the damage is small, conservative therapy is effective, but if the flap is large enough, then surgical intervention with excision of the torn part is necessary.
Another feature of a flap tear of the medial meniscus is the great difficulty in identifying it. magnetic resonance imaging methods. In most cases, arthroscopy with direct visual examination of the articular cavity and its elements is required to confirm the diagnosis.
Degenerative
A degenerative tear of the medial meniscus of the knee is chronic form pathology, which is the proliferation of connective tissues of the cartilaginous structure. Such formations can be diagnosed both on the horns of the meniscus and in its central part.
Degenerative rupture of the posterior horn of the medial disc is a complex and rather complex pathology of a chronic nature, which is expressed in the massive proliferation of connective tissues and cartilaginous structure.
The problem itself develops against the background of a number of negative circumstances, for example the presence of previous injuries to cartilage tissue that were not properly treated, various problems of the musculoskeletal system such as arthritis and arthrosis, etc.
In the absence of the necessary therapy, cartilage structures are replaced by compactions and unusual connective tissues, provoking not only thickening of the structure of the cartilaginous component, but also repeated ruptures of a nonlinear nature, accompanied by the influence of a number of unfavorable factors.
Conservative therapy in this situation is ineffective, however, at the acute stage, surgical intervention for degenerative ruptures of the posterior horn of the medial disc is prohibited.
Treatment of a degenerative tear of the posterior horn of the medial meniscus is carried out according to an individual therapeutic regimen developed by a traumatologist, orthopedist or surgeon. In some situations, surgical intervention may be required with resection, plastic surgery, or complete replacement of the meniscus with an implant.
Partial
Most often, with partial ruptures of the posterior horn of the medial meniscus, radial or transverse forms of pathology are formed. The rupture lines run perpendicular to the main axis of the cartilaginous structure. In this case, the predominant localization of the rupture creates the prerequisites for the need to visualize the presence of pathology in the coronal projection (MRI).
In the vast majority of cases partial rupture the posterior horn of the medial disc can be treat with conservative therapy methods:
- Complex procedures rehabilitation in the form of: physical therapy, physiotherapy and massage:
- By taking a series medications , in particular: glucocorticosteroids, chondroprotectors and non-steroidal anti-inflammatory drugs, as well as vitamin and mineral complexes, accelerating the process of tissue regeneration.
Diagnostic measures
To the list of main diagnostic measures includes the following procedures:
- Initial examination. Includes recording the patient’s subjective complaints, palpation, taking an anamnesis, conducting manual express methods for identifying joint stability;
- Radiography. Produced x-rays knees in two projections. The method allows you to identify gross changes in the structure of the joint and can be used in the context initial diagnosis pathologies of traumatic injuries;
- CT scan. A relatively new imaging method with layer-by-layer scanning of tissue, performed using X-ray radiation on a special modern installation. The obtained result is processed by a computer program and allows you to get a complete picture pathological process with a sufficiently high resolution;
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- Ultrasonography. Basic visualization is formed based on the reflected signals of a sound wave when passing through media with different densities. Ultrasound can reveal the inflammatory process, as well as the presence of fluid in the joint cavity;
- Magnetic resonance imaging.“Gold standard” for diagnosing internal meniscus injury. Produced on special equipment using the method of layer-by-layer scanning in a magnetic field with the formation of the effect nuclear resonance. Specific response disturbances are recorded by a special sensor and a high-definition image is constructed through digital processing;
- Arthroscopy. A minimally invasive research technique involving direct puncture of the corresponding structure and guidance of the arthroscope.
Magnetic resonance imaging for pathology
As modern diagnostic practice shows, a normal meniscus on MRI resembles two triangles looking at each other. Most important signs, which indicate the presence of pathology, are local structural disturbances with an increase in signal intensity and changes in the basic shape of the component.
In this case, the gradation of the severity of the problem is carried out in four degrees. As part of the event, it is possible not only to detect basic pathologies in the form linear breaks, but also to identify complex ruptures that combine signs of several subtypes of injuries.
Treatment of the pathological process
The procedure for treating a tear of the posterior horn of the medial meniscus of the knee joint is a whole complex of measures, a horizontal tear of the internal meniscus
- Conservative therapy. As part of standard treatment regimens, non-steroidal anti-inflammatory drugs, glucocorticosteroids, chondroprotectors and vitamin-mineral complexes are prescribed;
- Physiotherapy. Complex measures are used, including ozokerite applications, electrophoresis, magnetic therapy, balneological procedures, UHF and so on;
- Rehabilitation. During the rehabilitation period, the main activities are massage and training in the exercise therapy complex;
- Surgery. It is a method of radical treatment of a tear of the internal meniscus of the knee joint. It is prescribed individually if appropriate and indicated, most often with a complete rupture of the internal meniscus. The main methods of implementation are classical open invasive surgery and arthroscopy. As part of the surgical intervention possible procedures includes resection of the meniscus, its suturing, plastic surgery and complete replacement with an artificial or donor implant.
Possible consequences of injury
With mild and moderate degrees of injury to the medial meniscus and the presence of appropriate qualified treatment, the risk of developing various complications is minimal or completely absent. Severe degrees of pathology are often accompanied by secondary negative consequences in the medium term. The most typical consequences of a tear of the internal meniscus of the knee joint:
- Degenerative-dystrophic meniscus lesions. They are formed in the long term against the background of old injuries. Often accompanied by a violation of the integrity of nearby structures, in particular tendons and cruciate ligaments;
- Secondary bacterial infections. If the integrity of the joint is compromised, the likelihood of secondary infection increases internal cavities and the development of a powerful generalized inflammatory process, requiring the use of broad-spectrum antibiotics and other medicines if necessary;
- Problems after surgery. Often when severe forms injuries of the internal meniscus there is a need for surgical intervention. At the same time, short- and long-term complications within the framework of various post-surgical syndromes include hemarthrosis, deep vein thrombosis, damage to ligaments and nerves, ischemia of muscle structures, compartment syndromes, disorders of intra-articular structures, regional pain syndromes and symptom complexes of patellar contracture;
- Disability. In the absence of proper qualified treatment with the formation of prerequisites for degenerative-dystrophic processes against the background of a number of complications and negative circumstances, even surgical intervention does not guarantee complete restoration of the functionality of the cartilaginous structure in particular and the joint in general, which ultimately becomes one of the factors of permanent disability of the victim.
A 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, as well as in elderly people suffering from other concomitant diseases (for example, arthrosis).
To find out what the features of such damage are, you need to understand what the meniscus actually is. This concept refers to a specific cartilage layer in the knee joint that performs shock-absorbing functions. It includes the posterior horn, the anterior horn, the body, and is not only medial (internal), but also lateral (external). But an injury to the medial meniscus (more specifically its posterior horn) is the most dangerous, as it is fraught with serious complications and serious consequences.
Both cartilaginous layers - external and internal - are C-shaped and differ significantly from each other. Thus, the lateral meniscus has an increased density, it is quite mobile, due to which it is not injured so often. As for the inner inlay, it is rigid, therefore, rupture (or other injuries) of the medial meniscus are much more common.
Part of the meniscus includes a capillary network that forms the “red zone”. This part, located on the edge, is characterized by high density. In the center there is the thinnest area (“white zone”), in which there are no vessels at all. When a person injures the meniscus, the first thing to do is determine which element was torn. By the way, the “living” area of the meniscus recovers better.
Note! Doctors once believed that removing a torn meniscus could save a person from all troubles. But now it has been proven that both menisci play very important role in the joint - they protect it, absorb shocks, and complete removal one of them leads to early arthrosis.
The main reasons for the appearance
Now experts point to only one reason for the gap - acute injury. This is explained by the fact that no other impact on the joint can cause damage to the cartilage responsible for shock absorption.
It is also worth noting that there are the following factors risks predisposing to rupture:
- congenital joint weakness;
- regular jumping, running on uneven surfaces;
- injuries resulting from degenerative diseases;
- rotational movements performed on one leg without lifting it off the ground;
- long-term squatting;
- intense walking.
The posterior horn of the medial meniscus can be damaged for reasons other than acute trauma.
Symptoms of damage
Treatment of the described injury can be conservative or surgical. Let's look at the features of each of them.
Conservative treatment
Primary meniscus injury is treated therapeutic methods. Of course, in some cases after injury, patients require emergency surgery, but often conservative therapy is quite sufficient. The treatment procedure itself in this case consists of several stages (we repeat - if the gap is not chronic).
Stage 1. Reposition. If a joint is blocked, it must be realigned. Particularly effective here manual therapy or, as an option, hardware traction.
Stage 2. Elimination of edema. For this, doctors prescribe a course of anti-inflammatory medications.
Stage 3. Rehabilitation. The rehabilitation course includes massages, physical therapy and physical therapy.
Rehabilitation course
Stage 4. Recovery. The most important, but also the longest stage of treatment. Often, chondroprotectors and hyaluronic acid are prescribed to restore the meniscus. The long course can last from three to six months, it is carried out once a year.
Note! Rupture of the posterior horn is accompanied by sharp pains, 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 plaster is determined by the doctor in each specific case. After realignment of the knee joint for a long time Immobilization is carried out at the required angle, and rigid fixation in this case helps to maintain the correct position.
Surgical methods of treatment
At surgical treatment specialists are guided by one principle - we are talking about the safety of the organ and its functionality. Surgery done only when other treatments are ineffective. First, the organ is tested to see if it can be sutured (this is often relevant in cases of “red zone” injury).
Table. Types of operations used for meniscal tears
| Name | Description |
|---|---|
| Arthrotomy | A rather complex procedure aimed at removing the meniscus. If possible, it is advisable to avoid arthrotomy, especially since many modern doctors have abandoned it altogether. This surgery is actually necessary if the patient has extensive damage to the knee. |
| 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. We also note that this operation is performed only on “fresh” injuries. |
| Partial meniscectomy | Removal of the damaged area of the cartilage layer, as well as restoration of the remaining part. The meniscus is trimmed to an even state. |
| Transfer | There is nothing special to explain here - the patient is transplanted with an artificial or donor meniscus. |
| Most modern method treatment characterized by low morbidity. The procedure consists of making two small punctures in the knee, through one of which the above-mentioned arthroscope is inserted (at the same time, saline solution is injected). Using 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 joint functionality. 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 to promote faster restoration of damaged tissues.
Note! The rehabilitation course can take place at home, but it is advisable to do it in a hospital setting, where there is equipment for physical therapy.
In addition to exercises, during the rehabilitation period massages and hardware recovery methods are prescribed, associated with dosed loads on the joint. This helps stimulate muscle tissue and develop the limb. As a rule, functionality is restored within a few months after surgery, and you can return to your previous life even earlier (even a month later).
The main difficulty of the rehabilitation period is considered to be intra-articular swelling, due to which it is impossible fast recovery functions. Swelling is eliminated with lymphatic drainage massage.
Note! In summary, 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.
