Causes and treatment of rupture of the posterior horn of the medial meniscus of the knee joint. Rupture of the posterior horn of the medial meniscus of the knee joint - treatment, symptoms, complete analysis of the injury. Horn of the meniscus

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

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

• external, or lateral – located on the outside of the knee joint, more mobile and less susceptible to injury;
• the internal, or medial meniscus is less mobile, located closer to the inner edge and is connected to the internal collateral ligament. The most common type of injury is a medial meniscus tear.

Knee meniscus injury

Menisci perform the following functions:

1. depreciation and reduction of loads on the surface of the knee bones;
2. increasing the contact area between bone surfaces, which helps reduce the load on these bones;
3. knee stabilization;
4. proprioceptors - located in the meniscus and send signals to the brain about the position of the lower limb.

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

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

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

This problem is faced by athletes and people leading an active lifestyle. The meniscus of the knee joint is a shock absorber consisting of cartilage tissue.

It contracts as it moves. There are two layers of cartilage in the knee - the outer (lateral) and the inner (medial).

If the second one is damaged, fusion is more difficult. Without diagnosis, it is difficult to distinguish a rupture from a bruise.

Damage can be traumatic (due to sudden movement) or degenerative (due to age). The torn part of the cartilage tissue interferes with walking, causing pain.

Causes of meniscus tear

Damage to cartilage pads occurs at any age and is divided into two types:

• Meniscus injuries typical for active people aged 10-45 years.
• Degenerative changes- common in people over 40 years of age.

Traumatic ruptures are the result of combined injuries. Outward rotation of the tibia leads to damage to the medial layer, and internal rotation affects the external layer.

Rarely, direct injury occurs - a bruise of the meniscus, for example, when hitting the edge of a step during a fall.

Side impacts to the knee (knee joint) provoke displacement and compression of the pad, which is often found in football players. Landing on your heels with shin rotation is a common example of injury. However, injuries in people under 30 years of age occur only with extremely serious falls and impacts.

Asymptomatic lesions are often found on MRI in middle-aged or elderly patients. A tear in the meniscus leads to arthrosis, but also due to degenerative changes, spontaneous weakening of the structure of the cartilage pads occurs.

Degeneration in middle and old age is a sign of the early stage of osteoarthritis. Arthrosis, gout, overweight, weakness of the ligamentous apparatus, muscle atrophy and working in a standing position increase the risk of illness.

Degenerative lesions become part of the aging process when collagen fibers break down, reducing structural support. By the way, due to aging, not only the risk of disease increases, but also complications after a knee joint injury.

Internal drying of cartilage begins closer to the age of 30 and progresses with age. The fibrocartilaginous structure becomes less elastic and pliable,

This is what a meniscus tear looks like

therefore, a breakdown can occur with minimal unusual load. For example, when a person squats.

A meniscus tear can take on a variety of geometric patterns and any

location. Injuries exclusively to the anterior horns are isolated and exceptional cases. Usually the posterior horns of the meniscus of the knee joint are affected, and then the deformities spread to the body and anterior zones.

If a meniscus fracture runs horizontally, simultaneously affecting the upper and lower segments, this does not lead to joint blocking.

Radial or vertical lesions cause displacement of the meniscus, and moving fragments can cause joint pinching and pain.

The plate can tear off from the attachment area and become excessively mobile when the ligaments are damaged.

The structure and anatomical features of the location of the menisci cause a high incidence of pathologies in different age categories. At risk are athletes who are susceptible to ruptures, damage and cystosis.

Possible causes of cartilage lining tears:

• improper formation or sprain of ligaments;
• flat feet;
• improperly formed knee joint;
• the presence of gout, syphilis, tuberculosis, rheumatism and other diseases that can affect the joints;
• excess weight.

Most often, a meniscus tear can be caused by:

1. Traumatic impact.
2. Sharp abduction of the lower leg.
3. Sharp and maximum extension in the knee joint.
4. A blow to the knee.

After 50 years, a meniscus tear can be caused by degenerative changes in the composition of the bones.

All causes of meniscus tear are divided into two groups:

• traumatic injuries;
• degenerative damage.

Young people experience injuries due to indirect or combined injuries.

Provoking factors are:

Meniscus tear

• forced extension movements;
• increased load on the knee;
• long-term static position of the joint;
• unnatural movements in the form of torsion, walking on toes, goose steps;
• ligament weakness;
• direct injury due to a fall or blow to the knee.

In this case, damage to the medial meniscus occurs during extension actions, and rupture of the external meniscus occurs during internal rotation of the tibia.

Older patients are characterized by chronic and degenerative tears of the medial meniscus.

Among traumatic pathologies of the articular system, knee injuries occupy a special place in terms of frequency, complexity and significance of the consequences, due to its complex structure and the smaller amount of soft tissue that protects the bony part of the joint from damage.

Most a common diagnosis there is a tear in the meniscus of the knee joint.

The injury is widespread among athletes and occurs due to uncontrolled loads on the legs, accompanying pathologies, in older patients with developed arthrosis.

Anatomy and functions of the meniscus

The meniscus is a small cartilage, similar in appearance to a crescent, with a fibrous structure, located in the space between the articular surfaces of the femur and tibia.

Of the functions, the most important is the shock absorption of movements; the meniscus also reduces joint friction and ensures complete contact of the joint surfaces.

There are two menisci in the knee joint:

• external, also called lateral;
• internal, also called medial.

The lateral meniscus, more mobile and dense in structure, is injured to a lesser extent, the medial one is attached by a ligament to the bone and joint capsule, and is more susceptible to damage.

The anatomy of the meniscus includes a body that merges into two horns. The margin, or red area, is the densest part of the organ, with a dense network of blood vessels, and recovers faster from damage than the central white area, the thin part devoid of capillaries.

Classification and causes of meniscus injuries

Depending on the strength of the injury and the point of application of its impact, damage may be as follows:

• Tear of the posterior horn of the medial meniscus, can be internal, transverse or longitudinal, patch-like, fragmented. The anterior horn is hit less often. Depending on the degree of complexity, the gap can be complete or partial.
• Avulsion at the point of attachment to the joint, in the body area in the pericapsular region, and a horizontal tear of the posterior horn. It is considered the most serious injury to the meniscus cartilage and requires surgical intervention to avoid pinching the meniscus, locking the joint and destroying adjacent cartilage.
• Pinched meniscus - this occurs in almost 40% of cases of cartilage rupture or separation, when part of the meniscus blocks the joint from moving.
• Combined injuries.
• Chronic cartilage degeneration, permanent trauma and degeneration into a cyst.
• Pathological mobility caused by injury to the meniscus ligaments or degenerative processes of its tissue structures.

A torn meniscus is most often caused by acute trauma. At risk are athletes and people with high physical activity. The age of occurrence is from 18 to 40 years. In childhood, injury is rare due to the anatomy of the body.

Provoking factors:

1. Spinning on one leg without leaving the surface.
2. Intense running, jumping on an unsuitable surface.
3. Prolonged squatting position, intense single file walking.
4. Congenital or acquired weakness of the articular apparatus of the knee.
5. Cartilage degeneration, when even a minor injury can cause rupture.

Types of treatment for meniscus injury

A tear of the medial meniscus of the knee joint is one of the frequent injuries. Most often found in athletes, professional dancers, and those who engage in heavy physical labor. Depending on the type of damage, there are:

• vertical gap;
• oblique;
• degenerative rupture, when large-scale destruction of meniscus tissue occurs;
• radial;
• horizontal break;
• injury to the horns of the meniscus.

As a result of the injury, damage to the outer or inner meniscus or both can occur.

If the diagnosis of a knee meniscus tear is confirmed, treatment without surgery includes the following directions:

1. Conservative therapy.
2. Treatment using traditional methods.

If there is a large tear in the meniscus of the knee joint, treatment without surgery will not help. It is impossible to do without the help of competent surgeons.

Severity of meniscus tear

Taking into account how serious the meniscus injury is, the doctor will prescribe therapy. The degrees of damage are as follows:

1. 1st degree, when a small rupture occurs, the pain is insignificant, there is swelling. Symptoms disappear on their own after a couple of weeks.
2. 2nd degree of moderate severity. Manifests acute pain in the knee, swelling, movement is limited. At the slightest load, pain appears in the joint. If there is such a rupture of the meniscus of the knee joint, it can be cured without surgery, but without appropriate therapy the pathology becomes chronic.
3. Grade 3 rupture is the most severe. There is not only pain and swelling, but also bleeding into the joint cavity. The meniscus is almost completely crushed; this degree requires mandatory surgical treatment.

Symptoms and signs

With a pathology such as a traumatic rupture of the meniscus of the knee joint, the symptoms are expressed:

1. Severe pain that occurs immediately after injury. Damage is accompanied by a specific click. With time sharp pain subsides and manifests itself during moments of stress on the joint. It is difficult for the patient to make flexion movements.
2. Problems with movement. Walking with damage to the external meniscus of the knee joint is difficult. When the internal meniscus is torn, it is problematic to climb stairs; this symptom is also often found with direct injuries to the meniscus.
3. Joint blockade. These signs of damage occur when a piece of cartilage radically changes its location and interferes with normal joint movement.
4. Swelling. This symptom appears a couple of days after injury and is associated with the accumulation of intra-articular fluid.
5. Hemarthrosis. Intra-articular accumulation of blood is a sign of a rupture of the red zone of the meniscus, which has its own blood supply.

Symptoms of degenerative damage are associated with specific

underlying disease that led to the injury, and may manifest:

• pain of varying intensity; (we cannot talk about pain as one, single symptom; rather, the symptom itself in the form of pain can be different, depending on the nature of it).
• inflammatory process (this symptom is accompanied by swelling);
• impaired motor abilities;
• accumulation of intra-articular fluid;
• degenerative changes in structure.

With an old rupture of the meniscus of the knee joint, the process has a chronic form, which is accompanied by mild pain.

The pain makes itself felt during certain movements with unpredictable exacerbations. What is especially dangerous about a rupture of the meniscus of the knee joint is that it can cause complete blockades.

Symptoms of a meniscus tear

Symptoms of a meniscus injury depend on the location of the tears.:

• knee flexion is painfully limited when the posterior horn is affected;
• knee extension is painful with lesions of the body and anterior horn.

If the internal cartilage is damaged, the person experiences the following symptoms:

The pain is localized inside the joint, especially on the inside;

Noticeable pain when bending too hard;

- the muscles of the anterior thigh weaken;

Shootings during muscle tension;

Pain in the tibial ligament when bending the knee and turning the shin outward;

Joint block;

Accumulation of joint fluid.

Damage to the outer cartilage is characterized by the following signs :

Pain in the fibular collateral ligament radiating to the outer part of the knee;

Muscle weakness in the front of the thigh.

If we take into account the nature of the cause of the rupture, they are divided into two types:

1. Traumatic rupture of the meniscus of the knee joint has characteristic symptoms and is acute.
2. The degenerative rupture is characterized by a chronic course, so the symptoms are smoothed out and there are no obvious clinical manifestations.

Acute meniscus injury manifests itself:

1. Sharp and severe pain.
2. Edema.
3. Impaired joint mobility.

The meniscus of the knee joint is a cartilaginous formation that has a crescent shape. The main task of the meniscus is to perform a shock-absorbing function and stabilize the knee joint.

The meniscus also takes part in the nutrition of hyaline cartilage. During movements in the knee joint, sliding movements of the menisci occur along the surface of the tibia, and their shape may change slightly.

There are two menisci in the knee joint:

• medial (internal);
• lateral (outer).

The knee joint is one of the largest in the human body. It has a rather complex structure and includes many cartilages and ligaments.

Along with this, this part of the body contains little soft tissue that could protect it from damage.

That is why knee injuries are diagnosed quite often, and one of the most common injuries is a meniscus tear.

The structure of the meniscus

The meniscus is a crescent-shaped cartilaginous formation. It is located between the lower leg and thigh and is a kind of lining between the articular ends of the bones.

The meniscus performs a number of functions, the main of which is to cushion movement and protect articular cartilage. In addition, it performs a stabilizing function, which is aimed at increasing the mutual conformity of all articular surfaces in contact with each other.

The meniscus also helps to significantly reduce friction in the joints.

There are two menisci in the knee joint:

1. outer;
2. interior.

The outer meniscus is more mobile and therefore damaged much less frequently than the inner one.

The blood supply to the meniscus also has certain features. The fact is that newborn babies have blood vessels permeating their entire tissue, but already at nine months the vessels completely disappear from the inner part.

As you get older, the blood supply to the meniscus deteriorates. From this point of view, two zones are distinguished - white and red.

Damage classification

There are the following types of injuries to the meniscus of the knee joint:

• Detachment from the attachment site. This can occur in the area of ​​the meniscal body in the paracapsular zone or in the area of ​​the anterior and posterior horns.
• Meniscus body tears. This can occur in the transchondral region, as well as in the posterior and anterior horns.
• All possible combinations of such damage.
• Excessive mobility of the menisci. This could be meniscus degeneration or ligament rupture.
• Chronic degeneration or trauma of the meniscus, cystic degeneration.

Meniscus tears can also have several varieties:

• longitudinal;
• transverse;
• patchy;
• fragmented.

Depending on the degree of complexity, there are complete and incomplete breaks.

Diagnosis of meniscal tears

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

X-ray examination of the meniscus

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

X-ray examination is a fairly simple diagnostic method. The menisci are not visible on X-ray images, so studies are performed using contrast agents or more modern research methods are used.

Arthroscopy is the most informative research method. Using a special device, you can look inside the damaged knee, accurately determine the location and severity of the tear, and, if necessary, carry out treatment procedures.

During the initial examination, the surgeon or traumatologist performs provocative tests to identify characteristic signs of a meniscus tear:

• The McMurray test shows an increase in pain when the doctor presses on the inner area of ​​​​the joint space of the bent knee and simultaneously straightens and rotates the leg outward, holding the foot.
• The Apley test is performed while lying on your stomach: the doctor presses on the foot of the leg bent at the knee and turns it around. In case of external rotation, an injury to the lateral cartilage is diagnosed, and in case of internal rotation, a trauma to the medial cartilage is diagnosed.
• Baikov's test - when pressing on the joint space and straightening the knee, the pain intensifies.

Detected pain in the knee when going down the stairs indicates Perelman's symptom and the need to diagnose problems.

Diagnosis of the disease can be done using the following studies:

1. Magnetic resonance imaging;
2. CT scan;
3. Radiography;
4. Diagnostic arthroscopy.

The diagnosis of meniscal injury is most often made based on patient complaints and objective examination of the damaged area. To specify the diagnosis, the severity and nature of the damage, instrumental studies are prescribed.

It is considered inappropriate to prescribe a simple x-ray of the knee joint, since the meniscus is not visible on a regular x-ray. X-rays with contrast of the knee joint can help make a more accurate diagnosis, however, this method has lost its relevance compared to more modern diagnostic methods.

The main methods by which meniscus damage can be detected are:

Ultrasonography

The principle of operation of ultrasound is based on the fact that different tissues of the body transmit and reflect ultrasound waves differently. The ultrasound machine sensor receives reflected signals, which then undergo special processing and are displayed on the device screen.

Advantages of the ultrasound research method:

• harmlessness;
• efficiency;
• low cost;
• ease of reading results;
• high sensitivity and specificity;
• non-invasiveness (tissue integrity is not compromised).

No special preparation is required to perform an ultrasound of the knee joint. The only requirement is that intra-articular injections should not be performed several days before the study.

For better visualization of the menisci, the examination is carried out in a reclining position with the legs bent at the knee joints.

Pathological processes in the menisci that are detected by ultrasound:

• ruptures of the posterior and anterior horns of the menisci;
• excessive mobility;
• the appearance of meniscus cysts (pathological cavity with contents);
• chronic injury and degeneration of the menisci;
• separation of the meniscus from its attachment in the area of ​​the posterior and anterior horns and the body of the meniscus in the paracapsular zone (the area around the joint capsule).

Also, ultrasound of the knee joint can find not only pathological processes, but also some signs that indirectly confirm the diagnosis of a meniscus tear.

Symptoms that indicate meniscus damage during ultrasound examination knee joint:

• violation of the meniscus contour line;
• the presence of hypoechoic areas and stripes (areas of low acoustic density that appear darker on ultrasound compared to surrounding tissues);
• the presence of effusion in the joint cavity;
• signs of edema;
• displacement of the lateral ligaments.

CT scan

Computed tomography is a valuable method in the study of injuries to the knee joint, but it is lesions of the meniscus, ligamentous apparatus and soft tissues that are determined on CT at a not very high level.

These tissues are better visible on MRI, so in case of meniscus damage, it is more advisable to prescribe magnetic resonance imaging of the knee joint.

Magnetic resonance imaging

MRI is a highly informative method for diagnosing meniscal injuries. The method is based on the phenomenon of nuclear magnetic resonance. This method allows you to measure the electromagnetic response of nuclei to their excitation by a certain combination of electromagnetic waves in a constant high-intensity magnetic field. The accuracy of this method in diagnosing meniscal injuries is up to 90–95%. The study is usually not required special training. Immediately before the MRI, the subject must remove all metal objects (glasses, jewelry, etc.)

). During the examination, the patient should lie straight and not move. If the patient suffers from nervousness or claustrophobia, then he will first be given

sedative Classification of the degree of change in menisci visualized on MRI (according to Stoller):

1. normal meniscus (no changes);
2. the appearance of a focal signal of increased intensity in the thickness of the meniscus, which does not reach the surface of the meniscus;
3. the appearance in the thickness of the meniscus of a casting signal of increased intensity, which does not reach the surface of the meniscus;
4. the appearance of a signal of increased intensity that reaches the surface of the meniscus.

Only third-degree changes are considered a true meniscus tear. The third degree of changes can also be divided into degrees 3-a and 3-b.

Grade 3-a is characterized by the fact that the tear extends only to one edge of the articular surface of the meniscus, and grade 3-b is characterized by the spread of the tear to both edges of the meniscus.

You can also diagnose a meniscus injury based on the shape of the meniscus. In normal photographs, in the vertical plane, the meniscus has a shape that resembles a butterfly. A change in the shape of the meniscus may be a sign of damage.

A sign of meniscus damage can also be the “third cruciate ligament” symptom. The appearance of this symptom is explained by the fact that as a result of displacement, the meniscus ends up in the intercondylar fossa femur and is practically adjacent to the posterior cruciate ligament.

Choice of treatment method

The choice of treatment depends on the location of the rupture and the severity of the injury. If the meniscus of the knee joint is torn, treatment is carried out conservatively or surgically.

Conservative treatment

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

With proper treatment and no complications, recovery occurs within 6-8 weeks. Indications for surgical treatment of a meniscus tear:

1. rupture and displacement of the meniscus;
2. presence of blood in the cavity;
3. separation of the horns and body of the meniscus;
4. lack of effect from conservative therapy for several weeks.

In these cases, surgical intervention is prescribed, which can be performed using the following methods:

To answer the question: “how to treat inflammation and damage?” The surgeon conducts a thorough diagnosis. For minor tears, a splint is applied for three weeks, the patient undergoes a course of anti-inflammatory therapy and joint support with chondroprotectors.

Sometimes a puncture is required to remove accumulated fluid. Complete restoration of the joint occurs in 6-8 weeks, subject to well-chosen exercise therapy and courses of physiotherapeutic procedures.

The indication for surgical treatment is:

• crushing of cartilage;
• displacement rupture;
• detachment of body or horn;
• accumulation of blood in the joint cavity;
• ineffectiveness of conservative treatment.

Repeated knee blocks are an indication for surgery.

The degree of damage determines the choice of surgical intervention:

After diagnostics and confirmation of the diagnosis, the specialist prescribes complex therapeutic methods, including a set of such measures:

• performing a puncture from the knee joint;
• prescription of physiotherapy: phonophoresis, UHF, iontophoresis, ozokerite;
• prescribing analgesics, drugs containing narcotic substances (Promedol), NSAIDs, chondroprotectors (provide the body with substances that help restore the damaged area of ​​the meniscus).

For 2 weeks, a splint is applied to the straightened leg, which ensures fixation of the joint in the desired position. In case of ruptures, chronic dystrophy, joint dysplasia, surgical intervention is performed.

If gout or rheumatism is present, the underlying disease that triggered the process of degenerative changes is also treated.

The main treatment method for knee cartilage pathologies is surgery. Arthroscopy is performed, the operation is carried out through two incisions one centimeter long.

The torn part of the meniscus is removed, and its inner edge is aligned. After such an operation, the recovery period depends on the patient’s condition, but on average it ranges from 2 days to several weeks.

The choice of treatment method depends on the degree of meniscus damage that was identified during diagnostic examination knee joint using ultrasound or MRI. The traumatologist chooses a more rational type of treatment in each individual case.

The following methods are used to treat meniscus damage:

• conservative treatment;
• surgery.

Conservative treatment

Conservative treatment consists of removing the blockade of the knee joint. To do this, you need to punctuate (

make a puncture

) knee joint, evacuate the contents of the joint (

effusion or blood

) and introduce 10 ml of a 1% procaine solution or 20 - 30 ml of a 1% novocaine solution. Next, the patient is seated on a high chair so that the angle between the thigh and lower leg is 90º. 15–20 minutes after the administration of procaine or novocaine, a procedure is performed to eliminate the blockade of the knee joint.

Manipulation to eliminate joint blockade is performed in 4 stages:

• First stage. The doctor performs traction (traction) of the foot down. Traction of the foot can be done manually or using an improvised device. To do this, put a loop of bandage or thick fabric, covering the lower leg from behind and crossing on the back of the foot. The doctor performs traction by inserting the leg into the loop and pressing down.
• The second stage is to perform a deviation of the tibia in the direction opposite to the pinched meniscus. In this case, the joint space expands, and the meniscus can return to its original position.
• Third stage. At the third stage, depending on the damage to the internal or external meniscus, rotational movements of the lower leg are performed inward or outward.
• The fourth stage involves free extension of the knee joint to its fullest extent. Extension movements should be carried out without effort.

In most cases, if this manipulation was carried out correctly at all stages, the blockade of the knee joint is eliminated. Sometimes, after the first attempt, the joint blockage remains, and then this procedure can be repeated, but no more than 3 times.

If the blockade is successfully removed, it is necessary to apply a posterior plaster splint, starting from the toes and ending with the upper third of the thigh. This immobilization is carried out for a period of 5–6 weeks.

Conservative treatment is performed according to the following scheme:

• UHF therapy. UHF or ultra-high frequency therapy is a physiotherapeutic method of influencing the body with an ultra-high or ultra-high frequency electric field. UHF therapy increases the barrier ability of cells, improves regeneration and blood supply to meniscal tissue, and also has a moderate analgesic, anti-inflammatory and anti-edematous effect.
• Physiotherapy. Therapeutic exercise is a set of special exercises without or with the use of specific equipment or apparatus. During the period of immobilization, it is necessary to perform general developmental exercises that cover all muscle groups. To do this, perform active movements with the healthy lower limb, as well as special exercises - tensing the femoral muscles of the injured leg. Also, to improve blood supply to the injured knee joint, it is necessary to a short time lower the limb and then raise it to give it an elevated position on a special support (this procedure avoids venous stasis in the lower limb). During the post-immobilization period, in addition to general strengthening exercises, active rotational movements of the foot, in large joints, as well as alternate tension of all muscles of the injured lower limb (thigh and lower leg muscles) should be performed. It should be noted that in the first few days after removing the splint, active movements should be performed in a gentle manner.
• Massotherapy. Therapeutic massage is one of the components of complex treatment for injuries and tears of the meniscus. Therapeutic massage helps improve blood supply to tissues, reduces pain sensitivity of the damaged area, reduces tissue swelling, and also restores muscle mass, muscle tone and elasticity. Massage should be prescribed in the post-immobilization period. This procedure should begin from the anterior femoral surface. At the very beginning, a preparatory massage is carried out (2 - 3 minutes), which consists of stroking, kneading and squeezing. Next, they move on to more intense stroking of the injured knee joint, after placing a small pillow under it. After this, straight and circular rubbing of the knee is carried out for 4 to 5 minutes. In the future, the intensity of the massage should be increased. When performing a massage on the back surface of the knee joint, the patient should lie on his stomach and bend his leg at the knee joint (at an angle of 40 - 60º). The massage must be completed by alternating active, passive movements with movements with resistance.
• Taking chondroprotectors. Chondroprotectors are medical supplies, which restore the structure of cartilage tissue. Chondroprotectors are prescribed if the doctor has determined not only damage to the meniscus, but also damage to the cartilage tissue of the knee joint. It is worth noting that the use of chondroprotectors has an effect on both traumatic and degenerative meniscal tears.

Chondroprotectors used to restore cartilage tissue

Drug name	Pharmacological group	Mechanism of action	Mode of application
Glucosamine	Correctors of metabolism (metabolism) of bone and cartilage tissue.	Stimulates the production of cartilage tissue components (proteoglycan and glycosaminoglycan), and also enhances the synthesis of hyaluronic acid, which is part of the synovial fluid. Has a moderate anti-inflammatory and analgesic effect.	Orally 40 minutes before meals, 0.25 - 0.5 g 3 times a day. The course of treatment is 30–40 days.
Chondroitin		Improves the regeneration of cartilage tissue. Helps normalize phosphorus-calcium metabolism in cartilage. Stops the process of degeneration in cartilage and connective tissue. Increases the production of glycosaminoglycans. Has a moderate analgesic effect.	Apply externally to the skin 2 – 3 times a day and rub until completely absorbed. The course of treatment is 14–21 days.
Rumalon	Repairants and regenerants (restore damaged areas of cartilage and bone tissue).	Contains extract of cartilage and bone marrow of young animals, which helps accelerate the process of regeneration of cartilage tissue. Enhances the production of sulfated mucopolysaccharides (components of cartilage tissue), and also normalizes metabolism in hyaline cartilage.	Intramuscularly, deep. On the first day, 0.3 ml, on the second day, 0.5 ml, and then 1 ml 3 times a week. The course of treatment should be 5–6 weeks.

With proper and comprehensive conservative treatment, as well as in the absence of complications (

repeated blockade of the knee joint

) the recovery period usually lasts from one and a half to two months.

Surgery

Surgical treatment is indicated in cases where the blockade of the knee joint cannot be eliminated or in cases of repeated blockades. Surgical treatment is also used in the chronic period.

Indications for surgical treatment for meniscal tears:

• crushing of the cartilage tissue of the meniscus;
• hemarthrosis;
• rupture of the anterior or posterior horn of the meniscus;
• rupture of the meniscal body;
• meniscal rupture with its displacement;
• repeated blockade of the knee joint over several weeks or days.

Depending on the nature and type of damage, the presence of complications, and the age of the patient, surgical treatment can be carried out in various ways.

Surgical treatment can be carried out using the following methods:

This type of therapy includes the following:

1. Providing first aid, which consists of the following:

• Ensuring complete peace.
• Using a cold compress.
• Use of painkillers.
• If fluid accumulates, you will have to resort to puncture.
• Applying a plaster cast, although some doctors consider this inappropriate.

2. Bed rest.

3. A plaster cast is applied for at least 2-3 weeks.

4. Remove the blockade of the knee joint.

5. Application of physiotherapeutic methods and therapeutic exercises in treatment.

6. Inflammation and pain are relieved with the help of non-steroidal anti-inflammatory drugs: Diclofenc, Ibuprofen, Meloxicam.

7. Chondroprotectors: “Glucosamine”, “Chondratin sulfate” help speed up the restoration of cartilage tissue.

8. Using external remedies in the form of ointments and creams will help you recover faster from injury. The most commonly used are “Ketoral”, “Voltaren”, “Dolgit” and others.

If the treatment is chosen correctly, then after 6-8 weeks recovery occurs.

If the symptoms of a meniscus tear in the knee joint are not so acute, treatment folk remedies along with conservative methods of therapy, it may well provide effective help. Here is a list of the most popular recipes:

1. In the first hours and days after injury, apply ice to the sore spot.
2. Be sure to be completely at rest and the leg should be located above the level of the heart.
3. You can use a warm compress using honey, it will not only remove inflammatory process, but will also relieve pain. You can prepare it like this: combine the same amount of alcohol and honey, mix well, moisten a napkin and apply to the sore spot. Wrap a warm scarf on top and keep for several hours.
4. Grind a fresh onion using a blender, mix the pulp with 1 teaspoon of sugar and apply on a napkin to the injured knee. Wrap the top with plastic wrap and secure. Leave it in this state overnight. This manipulation must be done every day; if the meniscus is not displaced, it should recover.
5. Burdock can also help if crushed and applied to the sore spot. Secure with a bandage and keep for 3 hours, then change.

If the symptoms of a meniscus tear in the knee joint are serious enough and treatment does not help, then you will have to resort to surgery.

First aid for suspected meniscus damage

The first thing to do if you suspect a meniscus injury is to ensure immobilization (

immobilization

) knee joint. As a rule, immobilization of the joint is carried out in the position in which the joint was blocked. To do this, you need to use a splint bandage or a removable splint (

special type of retainer

). It is strictly forbidden to try to remove the blockage of the knee joint on your own. This procedure can only be performed by a doctor who has the necessary qualifications.

A cold compress should be applied to the injured knee joint in the most painful place. This procedure will help narrow the superficial and deep vessels and prevent fluid from accumulating in the joint cavity (.

reduction of effusion

). Cold also helps to reduce the sensitivity of pain receptors and, as a result, reduce pain. The duration of use of a cold compress should be at least 10 - 15 minutes, but no more than 30 minutes.

If a combined injury occurs and the victim complains of severe unbearable pain, it is necessary to use

painkillers

Painkillers used to relieve pain

Drug name	Group affiliation	Mechanism of action	Indications
Ketoprofen	Nonsteroidal anti-inflammatory drugs. Non-selective inhibitors of cyclooxygenase 1 and 2 (an enzyme that is involved in the development of the inflammatory process).	They block the production of prostaglandins, which leads to a significant reduction in pain in intra-articular injuries of the knee joint. They have a significant anti-inflammatory and moderate analgesic effect.	Moderate degree pain syndrome due to damage to the capsular-ligamentous apparatus of the knee joint (including menisci). Orally, one tablet 2 – 3 times a day.
Indomethacin
Diclofenac
Naproxen
Diclofenac
Promedol	Opioid receptor agonists (substances that regulate pain).	It blocks mu receptors (receptors located mainly in the brain and spinal cord), and also activates the body's antinociceptive system (painkiller), which leads to disruption of the transmission of pain impulses. It has a pronounced analgesic, moderate antishock, and mild hypnotic effect.	Severe pain syndrome due to a meniscus tear in combination with another intra- or extra-articular injury. Orally 25–50 mg, intramuscularly 1 ml of 1% solution or 2 ml of 2% solution.

If you suspect a meniscus injury, you should consult a traumatologist to clarify the exact diagnosis. Also, only a doctor can prescribe treatment (

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

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

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

Internal and external collateral ligaments provide fixation of the femur and tibia;

The anterior and posterior cruciate ligaments, as well as the collateral ligaments, are designed for fixation;

In addition to the tibia and femur connected into a joint, the knee is distinguished fibula, which serves to carry out rotation (rotational movements) of the foot;

The meniscus is a crescent-shaped cartilage plate designed to cushion and stabilize the joint; the presence of nerve endings allows it to function as a signal to the brain about the position of the knee joint. There are external (lateral) and internal (medial) meniscus.

The structure of the meniscus

Menisci have a cartilaginous structure, equipped with blood vessels that allow nutrition, as well as a network of nerve endings.

In their shape, the menisci look like plates, crescent-shaped, and sometimes disc-shaped, in which the posterior and anterior horn of 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 moves, which prevents injury.

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

Types of damage

The main factor when performing an operation is the type meniscal damage, since this circumstance affects the possibility or lack thereof while maintaining greater meniscus area, in connection with which, damages such as:

Separations from the place of attachment, in which separations are distinguished in the area of ​​the posterior or anterior horn, as well as the body of the meniscus;
Anterior and posterior ruptures horns and bodies of menisci;
A combination of separations and ruptures;
Breaks of intermeniscal connections (causes increased mobility and destabilization of the joint);
Old injuries and advanced degenerative meniscal injuries(meniscopathy);
Cystic formations.

To the most dangerous species meniscus injuries damage can be attributed posterior horn of the meniscus, having intermeniscal connections, which are also injured not only under the influence of mechanical forces, but also due to degenerative changes, often associated with rupture of the lateral or cruciate ligaments.

Presence in menisci blood vessels, cause the formation of profuse hematomas of the knee joint, as well as the accumulation of fluid, which can lead to loss of mobility.

When identifying meniscus injuries and preventing possible complications, immediate conservative or surgical treatment is required.

Damage to the meniscus of the knee joint is a constant companion for football players, hockey players and paratroopers. The insidious thing about a torn meniscus in the knee is that after 2-3 weeks the symptoms subside. But without appropriate treatment, cartilage undergoes dystrophy and degeneration. It loses its shock-absorbing ability, becomes thinner, which leads to chronic pain, the gradual development of contracture or deforming arthrosis (Nielsen A.B., Fauno P., Arthroscopic, 1992).

Types, classification

Depending on the mechanism, there are:

• Acute traumatic injuries. They occur as a result of excessive stress on the knee and last 2–3 weeks.
• Chronic degenerative damage meniscus of the knee joint. Characteristic of patients over 45 years of age with chronic joint pathology. Injury occurs even with normal daily activities.

According to the shape of the lines, they are distinguished:

By location they distinguish rupture of body and horns. The most common injury to the posterior horn of the medial meniscus is grade 3 according to Stoller. This injury is a partial or total separation of the horn from the body of the cartilage. It is explained by the close location of this part of the cartilage to the bone condyles, which “crush” it when the tibia is rotated unsuccessfully. A grade 3 tear of the posterior horn of the internal meniscus usually requires surgery.

If the tear line runs longitudinally through the body and both horns, such a meniscus tear in the knee is called. In this case, surgery is needed.

According to the classification of Strobel (2012), there are damage associated with congenital diseases or the shape of the cartilage:

• discoid meniscus;
• cystic changes;
• hypermobility.

Trauma can be either isolated or additive. Most often the anterior cruciate is injured or occurs. The situation when the torn part of the cartilage prolapses (protrudes) into the joint space is classified as dislocated meniscus. In this case, there is a blocking of movement in the joint, the inability to flex and straighten the knee.

Causes

The main causes of traumatic meniscus tear:

If there is degenerative damage to the meniscus due to advanced age, concomitant diseases or abnormal congenital structure, its rupture may even occur with light daily loads. Predisposing factors for this pathology are excess weight and flat feet, which contribute to increased stress on the knees.

Useful video about breakup

An orthopedic surgeon explains common causes and treatments for meniscus tears.

3 degrees of damage according to Stoller

Stoller classification(in the English literature known as the Lotysh staging system) is based on MRI readings for meniscus damage. Thanks to layer-by-layer visualization, this technique allows you to most accurately determine the severity of the injury. Normally, the meniscus is displayed in the image as a low-intensity signal (black). If there is damage, a signal of increased intensity (white) is visible. The condition of the cartilage is assessed using images in the sagittal (side view) and coronal projection (front view). Images taken from the injured knee are compared with images of the healthy joint.

• 0 degree– normal cartilage, completely displayed by a homogeneous, low-intensity signal;
• 1st degree– inside the cartilage there is a focal (spherical) signal of high intensity, which does not touch the edge (surface) of the cartilage;
• 2nd degree– a high-intensity linear signal is detected inside the cartilage, which does not reach its surface;
• 3rd degree– true meniscus tear, when the signal affects the surface of the cartilage:
  1. degree 3a– the signal reaches the surface of the cartilage only from one edge;
  2. degree 3b– the signal reaches the edges of the cartilage on both sides, that is, fragment separation is observed.

As Stoller's classification shows, damage can be divided into meniscus tear, the symptoms of which correspond to degrees 1 and 2, as well as gap(damage to the meniscus, grade 3 according to Stoller).

Degenerative damage to the medial (inner) meniscus

If cartilage damage occurs against the background of pre-existing changes, it is called degenerative. These include:

1. Discoid meniscus– a congenital developmental anomaly in which the cartilage has the shape of a discoid. The central part of the meniscus must resolve during embryogenesis. If this does not happen, already in the first year of life, before the child learns to walk, clicks in the knee joints are observed. Later, the patient may experience constant pain. Pathology occurs in 1–5% of cases, especially typical for Asians.
2. Hypermobility- rupture of the meniscal ligaments of the knee joint occurs. The medial and lateral cartilages are connected to each other by intermeniscal ligaments. When they are ruptured or congenitally absent, mobility increases and the risk of pinching and cartilage damage increases.
3. Cystic degeneration- the appearance of cavities with liquid or mucus in the cartilage. It is typical for people whose knees are constantly under stress (loaders, athletes). At the initial stage, the cyst manifests itself only as moderate pain. The second stage is characterized by the appearance of a protrusion in the knee area, which disappears when it is extended. At the third stage, the protrusion becomes dense and persists in any position of the joint. The danger of a cyst lies in its possible suppuration and rupture, compression of surrounding tissues and the likelihood of malignant degeneration.
4. Meniscopathies- dystrophic changes associated with concomitant diseases(arthrosis, gout, rheumatism, bone tuberculosis). The underlying disease causes metabolic disorders in cartilage tissue, which entails a decrease in its elasticity and strength. A rupture against the background of an existing pathology can occur even with normal household loads without lifting heavy objects or running.

How to identify a knee injury: symptoms

In the first days, the symptoms of a knee meniscus tear are very similar to the general symptoms of any knee injury. It is extremely difficult to distinguish between a meniscus tear and a knee ligament tear at this stage. General symptoms cartilage damage includes:

There are characteristic symptoms that can indicate the type of damage. Symptoms of a meniscus tear include a strong crunching sound and other pathological sounds when the knee moves. This symptom accompanies damage to the posterior horn of the internal meniscus, grade 3a according to Stoller, when the torn part of the cartilage moves freely in the joint cavity. In this case, the joint partially retains its function.

In the case when damage to the medial meniscus of grade 3 according to Stoller is accompanied by a complete separation of a section of cartilage (grade 3b), joint blockade is likely, since the displaced part is located between the articular surfaces. Degenerative damage is characterized by blunt aching pain, which intensifies with weather changes. The degenerative change is characterized by the symptom of knee numbness with prolonged absence of movement.

After 2–3 months, if treatment for a meniscus tear has not been carried out, more pronounced clinical manifestations appear.

Specific symptoms of damage to the meniscus of the knee joint:

• Reduction of the quadriceps muscle hips.
• Chaklin's symptom: clear contouring of the sartorius muscle when raising the straight leg up.
• Turner's symptom: increased or decreased sensitivity of the skin on the inside of the knee.



Baikov's sign for a meniscus tear

Baykov's symptom: pain occurs when you squeeze the joint space with two fingers and try to straighten the injured knee.

• Clicking symptom: Flexion and extension cause a sensation of rolling over an obstacle and a characteristic click. Occurs when the outer meniscus of the knee joint is torn.



Shteiman's sign for meniscal damage

Steinmann-Borchard's sign: When the knee is bent at 90 degrees, rotating the shin contributes to pain.

• Weinstein's symptom: The pain will intensify when the lower leg is straightened (Stoller grade 3 injury to the medial meniscus). If there is injury to the lateral cartilage, the pain will increase with abduction.
• "Galosh" symptom: increased pain with circular movements shin and foot.



Landau's sign due to meniscus tear

Landau's symptom: increased pain when trying to sit cross-legged. Occurs if there is degenerative damage to the posterior horn of the medial meniscus, grade 2 according to Stoller, or when it is completely ruptured.

• If pain increases as the kneecap moves upward and outward, a Stoller grade 3 medial meniscus tear may occur. Increased pain when moving inward is characteristic of damage to the lateral cartilage.

Photo

The gallery presents schematic images, as well as MRI images and photos taken during arthroscopy.

With the conservative method Running with a meniscus injury can be started within a month after starting exercises. But very carefully, on a flat surface, in short steps, with a gradual increase in duration.

If there was a resection operation, recovery is faster than with a suture. In this case, active training is possible within a month.

Remember:

1. If there is pain in the knee during rotational movements, or the inability to fully flex or extend, you should consult a traumatologist to rule out damage to the meniscus.
2. The only way to determine the extent of Stoller damage is to do an MRI.
3. The choice of treatment method depends on the patient’s age, the degree and location of the damage, and the requirements for the level of motor activity in the future.
4. Stoller grade 1 and 2 injuries are usually treated conservatively. Grade 3 tears and degenerative damage require surgery.
5. Active rehabilitation allows you to recover within 2–3 months after surgery.

The whole truth about: the posterior horn of the meniscus of the knee joint and other interesting information about treatment.

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).

Tear of the posterior horn of the medial meniscus

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.

Menisci of the knee

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.

Anatomical structure of the knee joint

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 (the “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.

The menisci of the knee joint are cartilaginous formations, crescent-shaped

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 a very important role in the joint - they protect it, absorb shocks, and complete removal of one of them leads to early arthrosis.

The main reasons for the appearance

Classification of meniscal tears

Now experts point to only one reason for the rupture – 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.

Acute trauma as a cause of rupture

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

The signs of a meniscus tear have already been discussed in more detail in one of the previous articles, so we will focus only on the main points. Typically, an injury occurs when parts of a joint are in an unnatural position at a specific moment (namely at the moment of rupture). Less commonly, this occurs as a result of pinched cartilage.

Determining the nature of the injury

Note! As a rule, a rupture is accompanied by other damage to the joint, which means that in some cases it - a rupture - is not so easy to identify during differential diagnosis.

1. Sharp pain. It is especially acute at the time of injury and lasts for several minutes. Sometimes you can hear a characteristic click in the knee before pain appears. After a while, the pain subsides and the person can walk again, but this is not easy for him.

   The first sign is acute pain

   The next morning, a different pain is felt - as if a nail had been stuck into the knee - which only intensifies when flexed/extended.

2. Swelling. Usually it does not appear immediately, but several hours after the injury.
3. “Jaming” of the joint (blockade). This is the main symptom of a medial meniscus tear, occurring after the separated part of the cartilage is pinched by the bones, and the motor functions of the limb are impaired. It is worth knowing that this symptom is also observed with sprained ligaments, so the true cause of the pain can be found out only after diagnosis.
4. Intra-articular accumulation of blood (hemarthrosis). This happens if the “red zone” of the shock absorber is damaged. cartilaginous layer.

   Hemarthrosis

Today, medicine differentiates between acute and chronic (advanced) ruptures, which is possible thanks to the use of hardware diagnostics. Thus, a “fresh” rupture has smooth edges and is accompanied by hemarthrosis. In cases of chronic injury, the cartilage is multi-fibered and there is swelling caused by the accumulation of fluids.

Puffiness and swelling of the knee

Features of treatment

If the posterior horn is damaged, treatment must begin immediately, otherwise it will develop into a chronic stage. We also note that in the absence of timely treatment, meniscopathy occurs, which in almost 50% of cases causes irreversible changes in the articular structure. And this, therefore, can cause the appearance of gonarthrosis.

A tear in the posterior horn of the medial meniscus requires immediate treatment.

Treatment of the described injury can be conservative or surgical. Let's look at the features of each of them.

Conservative treatment

Primary meniscal damage is treated with 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. Here, manual therapy or, alternatively, hardware traction is especially effective.

Reposition

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

Anti-inflammatory drugs

Nonsteroidal anti-inflammatory drugs in rheumatology

Stage 3. Rehabilitation. The rehabilitation course includes massages, physical therapy and physical therapy.

Rehabilitation course

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

Treatment with chondroprotectors

Note! A 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!

Ibuprofen photo

Dosage

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, immobilization is carried out for a long time at the required angle, and rigid fixation in this case helps to maintain the correct position.

Knee fixation

Surgical methods of treatment

During surgical treatment, specialists are guided by one principle - we are talking about the safety of the organ and its functionality. Surgery is performed only when other treatment methods 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

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.
Arthroscopy	The most modern treatment method, characterized by low trauma. 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.

Arthroscopy

Total knee replacement

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.

During the rehabilitation period, it is good to massage the knee

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).

Rehabilitation measures after knee surgery

Knee reconstruction

The main difficulty rehabilitation period intra-articular swelling is considered, due to which rapid restoration of functions is impossible. Swelling is eliminated with lymphatic drainage massage.

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

Rupture of the horn of the medial meniscus of the knee joint: treatment and symptoms

Very often, athletes and people who constantly engage in physical labor complain of problems with their joints. The most common cause of pain and discomfort is a torn meniscus in the knee.

It is quite possible to cope with this problem. Treatment, if a tear of the meniscus of the knee joint is diagnosed, is expressed in a wide range of actions: from surgical interventions to traditional methods of treatment at home.

What is meniscus

The meniscus of the knee joint is a cartilaginous formation that has the shape of a crescent and is located between the thigh and shin in the knee joint. The meniscus of the knee performs a stabilizing and shock-absorbing function; the horizontal cartilage gap softens the friction of surfaces, limiting the mobility of the joint, which prevents injuries.

During the movement, the meniscus contracts and stretches, changing its shape, as can be seen in the photo. There are two menisci in the joint:

1. lateral meniscus (outer),
2. medial meniscus (internal).

Sports doctors say that injuries and bruises are a common problem among:

• skiers,
• speed skaters,
• figure skaters,
• ballet dancers,
• football players.

Diseases of the meniscus and the need for surgery in the future may also occur in those who engage in strenuous physical labor. The risk group includes men aged 17 to 45 years.

Among children, rupture of the posterior horn of the internal meniscus or displacement occurs extremely rarely. Until the age of 14, this cartilaginous formation is very elastic, so damage practically does not occur.

Main shock absorber in the knee joint

Sometimes a rupture of the meniscus of the knee joint or its bruise occurs at an older age. So, at 50-60 years old, the condition is affected by degenerative changes in the joints.

A rupture of the posterior horn of the medial meniscus occurs due to trauma. This is especially true for older people and athletes. Osteoarthritis is also a common cause of meniscus damage.

A rupture of the posterior horn of the medial meniscus is always accompanied by damage to the ligament that connects the meniscus to the knee joint.

Thus, the meniscus changes under the influence of:

1. loads,
2. injuries,
3. degenerative age-related changes,
4. congenital pathologies that gradually damage tissue.

In addition, some diseases that damage statics also make their own negative adjustments.

An example of the consequences of violations is flat feet.

How to treat a torn meniscus

Orthopedic doctors differentiate knee meniscus injuries into several types:

• pinching,
• tear of the posterior horn of the medial meniscus and tear in the region of the posterior horn of the internal meniscus,
• separation

In the latter case, treatment of the meniscus is the most complex process. The formation must be completely separated from the attachment area. This type of injury requires surgery and is quite rare.

In most cases, they are diagnosed:

1. injury,
2. pinching,
3. tear,
4. medial meniscus tear
5. rupture of the posterior horn of the meniscus.

These injuries are characterized by sharp pain in the knee area, inability to perform movements, numbness, difficulty in flexing and straightening the joint. After a few hours, the symptoms of a meniscus tear subside, mobility is restored, and the person can forget about the injury.

The consequences of an injury, damage to the meniscus of the knee joint, make themselves felt over time, for example, pain returns again. A medial meniscus tear is a complex injury that requires intervention. The intensity of the pain syndrome depends on the strength and nature of the damage.

Baikov's symptom is known: when the joint is bent to an angle of 90 degrees, and a finger is pressed on this area of ​​the joint space, slowly extending the lower leg, the pain increases greatly.

In addition, it is difficult to go up or down stairs, there is pain when crossing limbs and situational numbness. In some severe cases, the consequences become extremely dangerous; we are talking about atrophy of the muscles of the lower leg and thigh.

Professional athletes often suffer from characteristic microtraumas of the meniscus. This could be a bruise, pinching or small tears.

Degree of meniscus damage and surgery

With cartilage injuries, the diseases become chronic. There is no sharp pain; the joint retains its mobility most of the time. However, periodically in the knee area a person feels discomfort. This may include: slight tingling, numbness or clicking. Atrophy of the thigh muscles is recorded.

A tear in the area of ​​the meniscus of the knee joint in severe cases involves separation of its capsule, and there is a need for surgery. The torn piece of the meniscus can be partially or completely removed. If there is a rupture or tear, the patient may be offered a form of surgery such as suturing.

The choice of type of operation depends on the age of the patient, his condition and the nature of the injury. The younger the person, the faster the consequences pass, and the recovery process accelerates.

As a rule, the recovery period takes about 4-6 weeks, during which time the person remains on an outpatient basis.

To restore joint mobility, mud therapy and restorative therapeutic exercises may be recommended.

Conservative treatment of meniscus in hospital and at home

For microtears, chronic injuries and impingement of the meniscus of the knee joint, more moderate conservative treatment is recommended.

If the meniscus is pinched, then it is necessary to carry out reposition, that is, realignment of the joint. The procedure is performed by a traumatologist, chiropractor or orthopedist in a medical facility.

To completely straighten the joint, 3-4 procedures will be required. There is another type of meniscus restoration – knee joint traction or hardware traction. This is a long procedure performed in a hospital setting.

To restore cartilage tissue, intra-articular injections of drugs that contain hyaluronic acid are necessary. If there is swelling and the patient suffers from pain, intra-articular injections are necessary:

• nimulida,
• Voltaren,
• corticosteroids.

After these measures, long-term drug therapy is indicated to restore the required amount of joint fluid.

The most commonly prescribed are chondroitin sulfate and glucosamine. It is not recommended to self-medicate; the exact dosage of the drug is prescribed only by a doctor.

As a rule, restorative drugs need to be taken daily for about three months.

Along with the use of medications, it is necessary to resort to massage and therapeutic exercises so that there is no need for surgery.

Treatment of meniscus with folk remedies

Various rubbing and compresses are considered especially effective. They reduce pain and return normal mobility to the joint.

Before treating meniscus disease at home, you should consult your doctor. It is necessary to take into account the nature of the meniscus injury and individual characteristics. For example, a honey compress may be contraindicated if a person is allergic to bee products.

Treatment can be done using a compress of fresh burdock leaves. The area of ​​the kneecap should be wrapped in a sheet and a retaining bandage applied. The compress should be kept on the body for about 4 hours.

The procedure should be carried out every day as long as the meniscus hurts. If you don't have fresh burdock, you can use dried leaves after soaking them in a small amount of hot water.

The raw materials must be evenly distributed over the tissue, and then a compress must be applied to the joint. The compress stays on the damaged joint for 8 hours.

A honey compress on the knee helps relieve pain in the kneecap area. After some time, the lost joint mobility returns.

You need to take natural bee honey and purified alcohol in equal proportions, mix and heat slightly. Apply the warm mixture to the knee area, wrap it well with a woolen cloth and secure with a bandage.

To speed up the recovery process after meniscus damage, you need to make a honey compress 2 times a day. The compress must be kept for at least two hours.

Treatment of meniscus disease with folk remedies usually lasts for several months.

An effective remedy for the meniscus of the knee joint is wormwood tincture. You will need a large spoon of crushed wormwood, which needs to be poured with a glass of boiling water and left for 1 hour.

After this, the liquid is filtered and used for compresses. A cloth soaked in liquid should be applied to the damaged joint for half an hour. A traumatologist will tell you in detail about problems with the meniscus in the video in this article.

If we feel pain in the knee, then, as a rule, this means that the meniscus hurts. Since the meniscus is a layer of cartilage, it is most at risk of rupture or damage. Knee pain can indicate several types of meniscus damage and dysfunction. During sprains of the intermeniscal ligaments, chronic injuries, as well as when the meniscus ruptures, different symptoms appear, and the options for dealing with them also differ.

• Symptoms of damage
  • How to cure the damage?
• Meniscus tear
  • Tear of the posterior horn of the meniscus
  • Symptoms of a rupture
• How is a torn meniscus treated?

Symptoms of damage

The meniscus is a cartilaginous formation that is located in the cavity of the knee joint and serves as a shock absorber for movement, as well as a stabilizer that protects the articular cartilage. There are two menisci in the knee, the outer (lateral) and the inner (medial). Damage to the internal meniscus occurs much more often due to its less mobility. Damage to the meniscus of the knee joint manifests itself in the form of pain in this area, limited mobility, and in long-standing situations, the development of arthrosis of the knee is possible.

Joint swelling, sharp cutting pain, painful crunching and difficulty moving your limbs indicate that you have a damaged meniscus. These symptoms appear immediately after the injury and may indicate other joint damage. More severe symptoms of injury appear one month after the injury. With these injuries, a person begins to feel local pain in the gap of the knee joint, muscle weakness appears outer surface hips, “blockade” of the knee, accumulation of fluid in the joint cavity.

The exact signs of damage to the medial meniscus are revealed through various examinations. Eat special tests for extension of the knee joints (Roche, Baikov, Landa, etc.), when pain symptoms are felt with a certain extension of the knee. The technology of rotation tests is based on identifying damage during rolling movements of the knee (Shteiman, Bragard). Meniscus damage can also be determined using MRI, mediolateral tests, and compression symptoms.

How to cure the damage?

Damage to the medial meniscus involves various treatments, which takes into account the type and severity of injury. At traditional way to get rid of damage, we can distinguish the main types of influence that are used for any injuries.

First, it is necessary to relieve the pain, therefore, first of all, the patient is given an anesthetic injection, then a puncture of the joint is taken, the accumulated fluid and blood are removed from the cavity, and, if necessary, the blockade of the joints is removed.

After these procedures, the knee requires rest, for which a splint or plaster cast is applied. As a rule, one month of immobilization is enough, but in severe situations the period sometimes reaches 2 months. In this case, it is necessary to apply local cold and non-steroidal drugs to relieve inflammation. After a while you can add different types physiotherapy, assisted walking, physical therapy.

Surgical intervention is required in severe situations, for example, old damage to the meniscus of the knee joint. One of the most popular methods of surgical intervention today is arthroscopic surgery. This type of surgical intervention has become widespread due to its careful treatment of tissues. The intervention consists only of resection of the damaged area of ​​the meniscus and polishing of the defects.

For damage such as a torn meniscus, surgery is performed closed. Using two holes, an arthroscope with instruments is inserted into the knee joint to determine the damage, then a decision is made on the possibility of suturing the meniscus or on its partial resection. Inpatient treatment lasts approximately 4 days, due to the low morbidity of this type of operation. At the rehabilitation stage, it is recommended to limit the load on the knee to one month. In special situations, wearing a knee brace and walking with support is recommended. After just 7 days, you can begin therapeutic exercises.

Meniscus tear

The most common injury to the knee joint is a tear of the medial meniscus. There are degenerative and traumatic meniscus tears. The latter appear, as a rule, in people aged 18-45 years and athletes; if not treated in a timely manner, they turn into degenerative ruptures, which most often appear in older people.

Taking into account the location of the damage, there are several main types of ruptures:

• transverse;
• in the shape of a watering can;
• patchwork;
• paracapsuar;
• longitudinal;
• damage to the posterior or anterior horn;
• horizontal.

At the same time, meniscal tears are divided according to their shape:

• oblique;
• longitudinal;
• transverse;
• degenerative;
• combined.

Traumatic ruptures appear, as a rule, at a young age and they occur vertically in the longitudinal or oblique direction. Combined and degenerative usually occur in older people. Watering can lacerations or vertical longitudinal tears can be incomplete or complete and usually begin with damage to the dorsal horn.

Tear of the posterior horn of the meniscus

This type of tear occurs most often because the majority of vertical, longitudinal, and watering can tears occur in the posterior horn. During a long tear, there is a good chance that part of the torn meniscus will impede the movement of the knee and cause severe pain, even blocking the knee joint. The combined type of tears occurs, covering several planes, and usually forms in the posterior horn of the meniscus and mostly appears in elderly people who have degenerative changes in them.

During damage to the posterior horn, which does not lead to displacement of the cartilage and longitudinal detachment, the person always feels the threat of blocking the joint, but this never happens. It is quite rare for the anterior horn of the knee to rupture.

Tear of the posterior horn of the lateral (outer) meniscus

This rupture occurs 8-10 times less frequently than the medial one, but has no less negative consequences. Internal rotation of the tibia and its motion are the main causes that cause a tear of the external lateral meniscus. The main sensitivity for these injuries is on the outer side of the posterior horn. A displaced rupture of the arch of the external meniscus, as a rule, creates a limitation of movements at the final stage of extension, and sometimes can cause blockade of the joint. A tear of the external meniscus is determined by a characteristic clicking sound during rotational movements inward of the knee joint.

Symptoms of a rupture

With injuries such as a torn meniscus, symptoms vary. A meniscus tear can be:

• old;
• chronic;
• spicy.

The main sign of a rupture is blocking of the knee joint; in its absence, it is very difficult to determine a rupture of the lateral or medial meniscus in the acute period. After a certain time, in the early period, a rupture can be determined by local pain, infiltration in the area of ​​​​the joint gap, as well as using pain tests that are suitable for any type of injury.

Pronounced symptoms of rupture are painful sensations while palpating the gap line of the knee joint. There are special tests for diagnosis, such as the McMurry test and the Epley test. The McMurry test is performed in two ways.

In the first case, the patient is placed on his back, the leg is bent at the hip and knee joints to a right angle. Then they grab the knee with one hand, and with the other hand they perform rotational movements of the lower leg, first outward and then inward. If there is a cracking or clicking sound, it can be considered that the injured meniscus is pinched between the surfaces of the joint; this test is positive.

The other method is called bending. It is carried out in this way: the knee is grabbed with one hand, as in the first option, after which the leg is bent at the knee as much as possible. The tibia is then externally rotated to determine the tear. Provided that the knee joint is slowly extended to approximately 90 degrees and the shin rotates, then during a meniscus tear the patient will feel pain on the surface of the joint on the inner back side.

During the Epley test, the patient is placed on his stomach and the leg is bent at the knee, creating an angle of 90 degrees. With one hand you need to press down on the person’s heel, and with the other, rotate the lower leg and foot. If pain appears in the joint space, the test is positive.

How is a torn meniscus treated?

The rupture can be treated either surgically (resection of the meniscus, either partial and its restoration, or complete), or conservatively. With the advent of new technologies, meniscus transplantation has become increasingly popular.

Conservative treatment is usually used to treat minor injuries to the posterior horn. Very often these injuries are accompanied severe pain, but do not lead to pinching of cartilage tissue between the surfaces of the joint and do not create a feeling of rolling and clicking. This type of damage is characteristic of strong joints.

Treatment consists of freeing oneself from sports in which one cannot do without sudden jerks and movements that leave one leg in place; these activities aggravate the condition. In older people, this treatment produces better results because arthritis and degenerative tears are often the cause of their symptoms.

A minor longitudinal tear (less than 1 cm), a tear of the upper or lower surface that does not penetrate the entire thickness of the cartilage, transverse injuries of no more than 2.5 mm usually heal on their own or do not bother them at all.

There is also another option for treating a rupture. Stitching from inside to outside. For this method of treatment, long needles are used, which are inserted perpendicular to the rupture line from the joint cavity to the outer part of the strong capsular area. Moreover, the seams are made quite tightly, one after the other. This is the main advantage of this treatment option, although it increases the risk of damage to nerves and blood vessels during removal of the needle from the joint cavity. This method is excellent for treating damage to the dorsal horn and a tear that runs from the cartilage itself to the dorsal horn. When the anterior horn is damaged, difficulties may arise in the passage of the needle.

In cases where the anterior horn ruptures, it is best to use the suturing method from the outside in. This option is safer for blood vessels and nerves, the needle in in this case passed through the gap on the outside of the knee joint and then into its cavity.

With the development of technology, seamless fastening inside the joint is gradually gaining popularity. The process itself takes a little time and occurs without the participation of such complex devices as an arthroscope, but currently it does not yet have a 75% chance of successful healing of the meniscus.

The main indications for surgery are pain and effusion, which cannot be eliminated using conservative methods. Joint blockage or friction during movement are also indications for surgery. Resection of the meniscus (meniscectomy) was once considered a safe procedure. But with the help of recent studies, it turned out that meniscectomy most often leads to the development of arthritis. This fact influenced the main methods of treating rupture of the posterior horn. Today, grinding of damaged parts and partial removal of the meniscus are very popular.

The success of recovery from injuries such as medial and lateral meniscus tears will depend on many factors. For quick recovery, factors such as the location of the damage and its duration are important. The likelihood of complete treatment is reduced if the ligamentous apparatus is not strong enough. If the patient’s age is no more than 45 years, then he has a better chance of recovery.

A characteristic feature of the knee joints is their frequent susceptibility to various injuries: damage to the posterior horn of the meniscus, disruption of bone integrity, bruises, hematoma formation and arthrosis.

Anatomical structure

The origin of various injuries in this particular area of ​​the leg is explained by its complexity. anatomical structure. The structure of the knee joint includes the bone structures of the femur and tibia, as well as the patella, a conglomerate of muscular and ligamentous apparatus, and two protective cartilages (menisci):

• lateral, in other words, external;
• medial or internal.

These structural elements visually resemble a crescent with the ends pushed slightly forward, in medical terminology called horns. Thanks to their elongated ends, the cartilaginous formations are attached to the tibia with great density.

The meniscus is a cartilaginous body that is found in the intersecting bony structures of the knee. It ensures unhindered flexion-extension manipulations of the leg. It is structured by a body and an anterior and posterior horn.

The lateral meniscus is more mobile than the internal meniscus, and therefore it is more often subjected to force loads. It happens that it cannot withstand their pressure and tears in the area of ​​the horn of the lateral meniscus.

The medial meniscus is attached to the inside of the knee and connects to the collateral ligament. Its paracapsular part contains many small vessels that supply blood to this area and form the red zone. Here the structure is denser, and closer to the middle of the meniscus it becomes thinner, since it is devoid of a vascular network and is called the white zone.

After a knee injury, it is important to accurately determine the location of the meniscus tear - in the white or red zone. Their treatment and recovery proceed differently.

Functional Features

Previously, doctors without special problems The meniscus was removed through surgery, considering it justified, without thinking about the consequences. Often, complete removal of the meniscus led to serious diseases such as arthrosis.

Subsequently, evidence was presented for the functional importance of leaving the meniscus in place, both for bone, cartilage, joint structures, and for the overall mobility of the entire human skeleton.

The functional purposes of the menisci are different:

1. They can be considered as shock absorbers during movement.
2. They produce uniform distribution loads on joints.
3. They limit the span of the leg at the knee, stabilizing the position of the knee joint.

Forms of discontinuities

The characteristics of meniscal injuries depend entirely on the type of injury, location and shape.

In modern traumatology, there are several types of ruptures:

1. Longitudinal.
2. Degenerative.
3. Oblique.
4. Transverse.
5. Rupture of the anterior horn.
6. Horizontal.
7. Lacerations of the posterior horn.

• The longitudinal form of the rupture occurs partial or complete. Complete is the most dangerous due to complete jamming of the joint and immobilization of the lower limb.
• An oblique tear occurs at the junction of the posterior horn and the middle of the body. It is considered “patchwork” and may be accompanied by a wandering pain sensation moving along the knee area from side to side, and is also accompanied by a certain crunching sound during movement.
• Horizontal gap the posterior horn of the medial meniscus is diagnosed by the appearance of soft tissue swelling, intense pain in the area of ​​​​the joint cracks, it occurs inside the meniscus.

Based on medical statistics, the most common and unpleasant knee injury is considered to be a rupture of the posterior horn of the medial meniscus of the knee joint.

It happens:

1. Horizontal or longitudinal, in which the tissue layers are separated from each other, further blocking the motor ability of the knee. A horizontal tear of the posterior horn of the internal meniscus appears on the inner side and extends to the capsule.
2. Radial, which appears on oblique transverse tears of the cartilage. The edges of the damaged tissue look like rags upon examination.
3. Combined, including double damage to the meniscus - horizontal and radial

A combined rupture is characterized by:

• ruptures of cartilaginous formations with tears of the thinnest particles of the meniscus;
• ruptures of the back or front of the horn along with its body;
• tears of some particles of the meniscus;
• the occurrence of ruptures in the capsular part.

Signs of ruptures

Typically, a rupture of the meniscus of the knee joint occurs due to an unnatural position of the knee or pinching of the cartilage cavity after injury to the knee area.

The main symptoms include:

1. Intense pain syndrome, the strongest peak of which occurs at the very moment of injury and lasts for some time, after which it may fade away - the person will be able to step on the leg with some restrictions. It happens that the pain precedes a soft click. After a while, the pain transforms into another form - as if a nail was stuck into the knee, it intensifies during the flexion-extension process.
2. Swelling that appears after a certain time after injury.
3. Joint blocking, jamming. This symptom is considered the main one during a rupture of the medial meniscus; it manifests itself after mechanical clamping of the cartilaginous part by the bones of the knee.
4. Hemarthrosis, manifested in the accumulation of blood inside the joint when the red area of ​​the meniscus is injured.

Modern therapy, combined with hardware diagnostics, has learned to determine whether the gap has occurred - acute or chronic. After all, with human power it is impossible to discern the true cause, for example, of a fresh injury characterized by hemarthrosis and smooth edges of the rupture. It is strikingly different from an advanced knee injury, where with the help of modern equipment it is possible to distinguish the causes of swelling, which consist in the accumulation of a liquid substance in the joint cavity.

Causes and mechanisms

There are many reasons for which a violation of the integrity of the meniscus occurs, and all of them most often occur as a result of non-compliance with safety rules or simple carelessness in our everyday life.

Forms of rupture

Injury occurs due to:

• excessive stress - physical or sports;
• twisting of the ankle area during games in which the main load is on the lower limbs;
• excessively active movement;
• prolonged squatting;
• deformations of bone structures that occur with age;
• jumping on one or two limbs;
• unsuccessful rotational movements;
• congenital articular and ligamentous weakness;
• sharp flexion-extension manipulations of the limb;
• severe bruises;
• falls from heights.

Injuries in which the posterior horn of the meniscus ruptures have their own symptoms and directly depend on its shape.

If it is acute, in other words, fresh, then the symptoms include:

• acute pain that does not leave the affected knee even at rest;
• internal hemorrhage;
• joint block;
• smooth structure of the gap;
• redness and swelling of the knee.

If we consider the chronic, in other words, the old form, then it can be characterized:

• pain from excessive exertion;
• crackling noise during motor movements;
• accumulation of fluid in the joint;
• porous structure of meniscal tissue.

Diagnostics

Acute pain is not something to joke about, just like all the symptoms described above. Seeing a doctor with a rupture of the posterior horn of the medial meniscus or other types of ruptures of the cartilage tissue of the knee is mandatory. It must be carried out in a short period of time.

At the medical institution, the victim will be examined and referred to:

1. X-ray, which is used when there are visible signs of rupture. It is considered not particularly effective and is used to exclude concomitant bone fractures.
2. Ultrasound diagnostics, the effect of which directly depends on the qualifications of the traumatologist.
3. MRI and CT, considered the most reliable way to determine a rupture.

Based on the results of the above examination methods, treatment tactics are selected.

Treatment tactics

Treatment of a rupture of the posterior horn of the medial meniscus of the knee joint should be carried out as soon as possible after injury in order to prevent the transition of the acute course of the disease to chronic. Otherwise, the smooth edge of the tear will begin to fray, which will lead to disturbances in the cartilaginous structure, and then to the development of arthrosis and complete loss of motor functions of the knee.

Primary damage to the integrity of the meniscus, if it is not chronic, can be treated using a conservative method, which includes several stages:

• Reposition. This stage is distinguished by the use of hardware traction or manual therapy for repositioning a damaged joint.
• The stage of eliminating edema, during which the victim takes anti-inflammatory drugs.
• The rehabilitation stage, which includes all restorative procedures:
• massage;
• physiotherapy.
• Recovery stage. It lasts up to six months. For complete recovery, the use of chondroprotectors and hyaluronic acid is indicated.

Often, treatment of the knee joint is accompanied by the application of a plaster cast; the need for this is decided by the attending physician, because after all necessary procedures, he needs long-term immobility, which is what the application of plaster helps with.

Operation

The method of treatment using surgical intervention solves the main problem - preserving the functionality of the knee joint. and its functions and is used when other treatments are excluded.

First of all, the damaged meniscus is examined for stitchability, then the specialist chooses one of several forms of surgical treatment:

1. Arthromia. A very complex method. It is used in exceptional cases with extensive damage to the knee joint.
2. Stitching of cartilage tissue. The method is carried out using an arthroscope inserted through a mini-hole into the knee in case of a fresh injury. The most favorable outcome is observed when stitching in the red zone.
3. Partial meniscectomy is an operation to remove the injured part of the cartilage and restore its entire part.
4. Transfer. As a result of this operation, someone else's meniscus is inserted into the victim.
5. Arthroscopy. Traumatization in this most common and modern method treatment, the most minimal. As a result of the arthroscope and saline solution being inserted into two mini-holes in the knee, all necessary restorative manipulations are carried out.

Rehabilitation

The importance of the recovery period, compliance with all doctor’s instructions, and its correct implementation is difficult to overestimate, since the return of all functions, painless movements and complete recovery of the joint without chronic consequences directly depends on its effectiveness.

Small loads that strengthen the structure of the knee are provided by properly prescribed hardware methods of recovery - exercise machines, and to strengthen the internal structures, physiotherapeutic procedures and exercise therapy are indicated. It is possible to remove swelling with lymphatic drainage massage.

Treatment is allowed to be carried out at home, but still a greater effect is observed with inpatient treatment.

Several months of such therapy ends with the victim returning to normal life.

Consequences of injury

Ruptures of the internal and external menisci are considered the most complex injuries, after which it is difficult to return the knee to its usual motor functions.

But there is no need to despair - the success of treatment largely depends on the victim himself.

It is very important not to self-medicate, because the result will largely depend on:

• timely diagnosis;
• correctly prescribed therapy;
• rapid localization of injury;
• how long ago the breakup was;
• with the success of the restoration procedures.

Often, after injury to the structures located in the knee joint, a rupture of the posterior horn of the medial meniscus is diagnosed. To avoid negative consequences and complications after an injury, it is important to begin treating the injury. If the damage is partial, it will be possible to correct the situation with conservative therapy. When a complete rupture and destruction of cartilage is diagnosed, surgical intervention is indispensable.

Causes of damage

If damage to the posterior horns of the meniscus is diagnosed, most likely a complex fracture of the limb has occurred with damage to the integrity of the ligamentous apparatus, bone, and soft tissues.

The medial meniscus is a sedentary, cartilaginous formation located on the inside of the knee joint. Much less commonly diagnosed is a rupture of the outer cartilage, which is located on the outside of the knee, it is called lateral. However, in addition to injuries, rupture of the internal meniscus is provoked by:

• A degenerative disease of the musculoskeletal system that causes bone structures to become fragile and prone to fracture.
• Unsuccessful landing on your feet when jumping from a great height.
• Old, untreated damage to the internal meniscus of the knee joint.
• Congenital diseases that negatively affect the condition of joints.

One of the most complex structures of parts of the human body are joints, both large and small. The structural features of the knee joint make it possible to consider it the most susceptible to various injuries, such as fractures, hematomas, and 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, ensure normal flexion when walking, sitting and running. However, large loads placed on the knee during various manipulations can lead to a rupture of the posterior horn of the meniscus.

A 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

– cartilaginous tissue of the knee, located between two intersecting bones and allowing one bone to slide over the other, allowing unhindered flexion/extension of the knee.

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

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

The outer one is considered the most mobile. Therefore, damage to it is much less common than damage to the internal one.

The internal (medial) meniscus is a cartilage pad 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 lesions 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 connecting the meniscus to the knee joint.

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

• Anterior horn;
• Middle part;
• Posterior horn.

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

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

Meniscus tears

The illustration shows a tear in the anterior horn of the lateral meniscus of the knee joint

Knee injuries are not that uncommon. In this case, injuries can occur not only to people who lead an active lifestyle, but also to those who, for example, sit on squats for a long time, try to rotate on one leg, or perform long jumps. Tissue destruction occurs over time, people over 40 years of age are at risk. Damaged knees at a young age eventually begin to have an inveterate nature of the disease in old age.

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

Forms of discontinuities

Cartilage ruptures can vary in nature and shape of the lesion. Modern traumatology distinguishes the following groups of internal meniscus tears:

• Longitudinal;
• Degenerative;
• Oblique;
• Transverse;
• Rupture of the posterior horn;
• Horizontal;
• Rupture of the anterior horn.

Dorsal horn rupture

A tear of the posterior horn of the medial meniscus is one of the most common types of knee injuries. This is the most dangerous damage.

Lacerations of the posterior horn can be:

1. Horizontal, that is, longitudinal tear, in which layers of tissue separate from one another, 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 the cartilage tissue appear. The edges of the lesion look like rags, which, falling between the bones of the joint, create a cracking sound in the knee joint.
3. Combined, that is, carrying damage to the (medial) internal meniscus of two types - horizontal and radial.

Symptoms of injury to the posterior horn of the medial meniscus

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

1. Acute pain that occurs even at rest.
2. Hemorrhage within the tissue.
3. Knee joint lock.
4. Swelling and redness.

Chronic form ( old breakup) is characterized by the following symptoms:

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

Treatment of cartilage damage

To prevent the acute form from becoming chronic, it is necessary to begin treatment immediately. If treatment is started late, the tissue begins to suffer significant damage, turning into rags. Tissue destruction leads to cartilage degeneration, which in turn leads to knee arthrosis and immobility.

Stages of conservative treatment

The conservative method is used in the acute, unadvanced stage in the early stages of the disease. Therapy using conservative methods consists of several stages.

• Relieving inflammation, pain and swelling with.
• In cases of “jamming” of the knee joint, reposition is used, that is, realignment using manual therapy or traction.
• Massotherapy.
• Physiotherapy.

• Pain relief with analgesics.
• Applying plaster (as recommended by a doctor).

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 procedures:

• Arthrotomy – partial removal of damaged cartilage with extensive tissue damage;
• Meniscotomy – complete removal of cartilage tissue; Transplantation – moving the donor meniscus to the patient;
• – introduction of artificial cartilage into the knee;
• Stitching of damaged cartilage (carried out for minor damage);
• – puncturing the knee in two places in order to carry out further manipulations with the cartilage (for example, suturing or endoprosthetics).

After the treatment is carried out, regardless of how it was carried out (conservative or surgical), the patient will have a long life. The patient must provide himself with complete rest throughout the entire period of treatment and after it. Any physical activity after completion of therapy is contraindicated. The patient should take care that the cold does not penetrate to the extremities and that the knee is not subjected to sudden movements.

Conclusion

Thus, knee injury is an injury that occurs much more often than any other injury. In traumatology, several types of meniscus 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 the anterior or middle part. This is due to the fact that the medial meniscus is less mobile than the lateral one, therefore, the pressure on it during movement 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 old) the damage is, what condition the cartilage tissue of the knee is in, what specific gap is present (horizontal, radial or combined).

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

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

In order to avoid injury to the lower extremities, you should avoid turning, sudden movements, falls, and jumping from heights. After meniscus treatment, 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?