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

Content:

The structure of the knee with a description

It leads to frequent injuries in area knee joint. Tears of the lateral and cruciate ligaments, fractures of the femoral and femoral condyles may occur. tibia, a fracture of the kneecap, and the most common type of injury is a meniscus tear.

What is the meniscus and what is the reason for its increased incidence of injuries?

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

The meniscus is a semicircular 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 rupture medial meniscus.

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.

Incidence of meniscal tears

This injury ranks first among internal injuries of the knee joint. It is more common among athletes, people involved in heavy physical labor, professional dancers, and the like. More than 70% are tears of the medial meniscus, about 20% are tears of the lateral meniscus, and about 5% are tears of both menisci.

Damaged knee joint

Depending on the type of damage, they are distinguished:

• vertical longitudinal tear - like a “watering can handle”;
• oblique, patchwork tear of the meniscus;
• degenerative rupture - massive proliferation of meniscus tissue;
• radial – transverse gap;
• horizontal break;
• damage to the anterior or posterior horns of the meniscus;
• other types of ruptures.

Also distinguished are isolated injuries of the internal or external menisci or combined damage.

Causes of meniscal tears

The cause of a rupture of the menisci of the knee joint is most often an indirect traumatic impact, which leads to the fact that the lower leg turns sharply inward or outward, which causes rupture of the knee ligaments and menisci. Also, a meniscus rupture is possible with a sharp abduction or adduction of the lower leg, excessive extension of the knee, or direct injury - a sharp blow to the knee.

Meniscus tear clinic

A torn meniscus of the knee has characteristic symptoms. There are acute and chronic periods of the disease.

Acute period - lasts up to 4 - 5 weeks, a meniscus rupture is accompanied by a characteristic cracking sound, immediately after the injury there appears acute pain, an increase in size, swelling, inability to move, and hemorrhage into the joint cavity. A characteristic symptom is the “floating patella” - from the accumulation of fluid in the cavity of the knee joint.

Meniscus tear - options

These symptoms are common to all injuries of the knee joint; in order to accurately determine the type of injury, it is necessary to carry out X-ray examination.

During the transition acute period In chronic cases, characteristic symptoms appear that confirm the diagnosis of meniscal rupture.

Symptoms of a torn meniscus are:

• Baikov's symptom is the appearance of pain upon palpation in the front of the knee and simultaneous extension of the lower leg.
• Landa's sign - or the "palm" symptom - in a lying patient, the leg is bent at the knee and you can place your palm under it.
• Turner's symptom – hyper-il gapesthesia ( increased sensitivity skin) under the knee and in the upper third of the leg.
• Perelman's symptom is the occurrence of pain and instability of gait when going down the stairs.
• Chaklin's symptom, or “sartorius” symptom - when raising the straight leg, atrophy of the quadriceps femoris muscle and severe tension of the sartorius muscle are visible.
• The blockade symptom is one of the most important symptoms in the diagnosis of medial meniscal tears. When putting stress on the sore leg - climbing stairs, squatting - the knee joint becomes “jammed”, the patient cannot fully straighten the leg, pain and effusion appear in the knee area.

Symptoms of medial meniscus damage:

• the pain is more intense during inside knee joint;
• when pressing on the place of attachment of the ligament to the meniscus, point pain occurs;
• "block" of the knee;
• pain when hyperextending and turning the leg outward;
• pain when bending the leg too much.

Symptoms of damage lateral meniscus:

• when the knee joint is strained, pain occurs, radiating to the outer part;
• pain when hyperextending and internally rotating the lower leg;
• weakness of the muscles of the front of the thigh.

Severity of meniscus injury

Damage to the knee joint

Depending on the severity, the doctor prescribes treatment. The following degrees are distinguished:

1. A small tear of the meniscus is accompanied by minor pain and swelling in the knee. Symptoms subside within a few weeks.
2. Moderate rupture - acute pain occurs in the knee joint, severe swelling appears, movements are limited, but the ability to walk is preserved. During physical activity, squats, climbing stairs, acute pain appears in the knee. These symptoms are present for several weeks; if treatment is not carried out, the disease becomes chronic.
3. Severe rupture – severe pain and swelling of the knee joint, possible hemorrhage into its cavity. It is characterized by complete crushing of the meniscus or separation of parts; fragments of the meniscus fall between the articular surfaces, which causes stiffness of movement and the inability to move independently. Symptoms worsen over several days and surgery is required.

With frequent microtraumas in older people, a chronic or degenerative stage of the disease occurs. Cartilage tissue, under the influence of numerous damages, loses its properties and undergoes degeneration. With or without physical activity visible reasons knee pain, swelling, gait disturbance and other symptoms of meniscus damage appear.

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 symptom 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. On X-ray images The menisci are not visible, 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.

Medical and surgical treatment

Choice medicinal products 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.

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

Indications for surgical treatment Meniscus tear:

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

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

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

   During this operation, it is necessary to take into account the duration and location of the rupture. A fresh injury and localization in the red or intermediate zone, the patient’s age under 40 years increase the chances of a successful operation.

3. Arthroscopic is the most modern and atraumatic method of performing surgical intervention. An arthroscope is used to visualize the injury site and perform surgical intervention. The advantages of this method are minimal disruption of the integrity of surrounding tissues, as well as the possibility of performing interventions inside the knee. To suture the meniscus from the inside, special needles with non-absorbable suture material, which connect the gap in the cavity of the knee joint through arthroscope cannulas. With this method, the seams can be placed tightly, perpendicular to the tear line, which makes the seam stronger. This method is suitable for ruptures anterior horn or the body of the meniscus. In 70-85% of cases, complete fusion of cartilage tissue and restoration of the functions of the knee joint occurs.
4. Fastening the meniscus using special arrow-shaped or dart-shaped clamps. This allows the meniscus to be fixed without additional incisions or the use of special devices such as an artoscope. Absorbable fixatives of the first and second generation are used. The first generation of fixators were made of a material that took longer to dissolve, they weighed more, and therefore more often complications occurred in the form of inflammation, granuloma formation, effusion, damage to articular cartilage, and the like. Second-generation fixators dissolve faster, have a more rounded shape and the risk of complications is much lower.
5. Meniscus transplantation - today, thanks to the development of transplantology, it is becoming possible to completely replace the damaged meniscus and restore its functions. Indications for surgery are complete crushing of the meniscus, the impossibility of restoration by other means, a significant deterioration in the patient’s standard of living, and the absence of contraindications.

Contraindications for transplantation:

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

Rehabilitation

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

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

Consequences of a rupture of the meniscus of the knee joint with proper and timely treatment practically absent. Pain during physical activity, unsteady gait, and the possibility of recurrence of injury may persist.

It is necessary to perform a set of special exercises, which should be prescribed by the doctor, taking into account the location, severity of the injury, the presence or absence of complications, the patient’s age and other related circumstances.

Stages of rehabilitation after a knee meniscus tear

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

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

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

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Often, after injury to the structures located in the knee joint, a rupture is diagnosed posterior horn medial meniscus. To avoid negative consequences and complications after 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, without surgical intervention not enough.

Causes of damage

If damage is diagnosed posterior horns meniscus, most likely there was a complex fracture of the limb 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.

Forms of tear of the posterior horn of the medial meniscus

Damage to the posterior horn of the medial meniscus can be of the following types:

Violations of the integrity of cartilage can be different types.

• Radial or transverse. Often such a tear is partial, but if the cartilage is damaged obliquely, this provokes mobility of the meniscal body. Once in the interarticular space, the structure blocks the knee, causing the victim to be unable to move.
• A linear or horizontal tear of the posterior horn of the medial meniscus is characterized by peeling of the cartilage, but the body retains its shape and is not deformed. The main sign of such damage is the formation of edema.
• A vertical or longitudinal tear means the destruction of the internal structure of the cartilage in a straight line, while the marginal part of the body remains intact.
• A flap rupture of the meniscus indicates that the cartilaginous formation is completely destroyed and deformed. The consequence of such damage is the formation of fragments similar to shreds.

Degree of damage

There are 3 degrees of destruction of the integrity of cartilage:

• Easy stage. It has no clearly defined symptoms, the pain is often moderate, and the functioning of the knee joint is not impaired. The symptomatic picture worsens if the patient increases the load on the leg, and slight swelling also appears.
• Average. At this stage, the degenerative process becomes more pronounced, the person is bothered by acute pain in the knee, and the limb cannot be flexed or straightened. At first the block of the joint is incomplete, but after a couple of hours the mobility of the joint is completely impaired.
• Heavy. A rupture of the posterior horn of the internal meniscus in a severe stage is manifested by an acute unbearable pain symptom that does not go away even after complete immobilization of the limb and taking painkillers. Swelling forms, due to which the knee becomes 2 times larger. The temperature of the damaged area increases, and the skin becomes brownish-bluish in color.

Signs of violation

The symptom of injury is pain in the back of the knee.

If the horn of the medial meniscus is damaged, the first sign characterizing the violation will be severe pain in the popliteal part of the joint. But a rupture of the posterior horn of the lateral meniscus is manifested by the localization of pain from the outer part. On palpation, the signs intensify, the joint becomes immobile, swells and increases in size. To avoid complications, you need A complex approach in treatment, otherwise the victim faces complete or partial removal of the cartilage.

Diagnostics

In order for the treatment of a rupture to be adequate, it is important for the doctor to diagnose accurate diagnosis and find out the reasons for the violation. It is also important to determine where exactly the violation is localized, because with severe trauma, a rupture of the anterior horn of the medial meniscus can occur. To exclude bone tissue destruction, the patient is first sent for an X-ray examination. If the bones are intact, MRI diagnostics is additionally performed. Thanks to him, it will be possible to study the degree of damage to cartilage and other soft tissues, which will help determine treatment methods.

What treatment is used?

Conservative

If the posterior horn of the medial meniscus is not severely damaged, and the body of the cartilage is only partially destroyed, the doctor prescribes a course drug therapy which takes place in several stages:

To normalize the nutrition of the tissues of the knee joint, massage is prescribed.

• Relieving swelling, inflammation and pain using NSAIDs and analgesics.
• Restoration of cartilage structures using chondroprotectors.
• Normalization of joint functioning using reposition, manual therapy or traction.
• Training muscle corset with the help of exercise therapy and therapeutic gymnastics.
• Activation of blood supply and nutrition to the damaged area using physiotherapy, therapeutic massage, folk remedies.

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

Origin various injuries it is in this place of the leg that it is due to 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 considered important precise definition places of meniscal rupture - 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 meniscus led to serious illnesses, 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 when moving.
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 breaks:

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.
• A horizontal rupture of 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, and it occurs inside the meniscus.

The most common and unpleasant knee injury, based on medical statistics, it 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 damaged tissue When examined, they look like rags.
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

Usually 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. Intensive 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 is preceded by 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 to be the main cause of 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 meniscus 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 transition in time acute course illness into 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 to realign the 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 the necessary procedures, it needs long-term immobility, which is what the application of a 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. Most favorable outcome observed during cross-linking 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

Importance recovery period, compliance with all doctor’s instructions, its correct implementation is difficult to overestimate, since the return of all functions, painlessness of movements and full recovery joint without chronic consequences.

Small loads that strengthen the structure of the knee are provided by correctly prescribed hardware methods of recovery - exercise machines, and for strengthening 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

Tears 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.

An intact knee joint has 2 cartilaginous inlays: lateral and medial. These tabs are shaped like a crescent. The external meniscus has a fairly dense base, it is more mobile, and accordingly it is injured much less often. The inner meniscus is not flexible enough, so damage to the medial meniscus occurs most often.

Rupture of the posterior horn of the medial meniscus.

Nowadays, qualified specialists call one main reason origin of the rupture of the posterior horn of the medial meniscus. This reason is acute injury. There are also a couple of additional factors that contribute to the occurrence of the above injury.
- A strong jump, such as is done on a very flat surface.
- Rotation on one leg, without lifting the foot.
- Excessively active walking or prolonged squatting.
- Injury resulting from joint disease.
- Pathology in the form of weak joints or ligaments.
When the posterior horn of the medial meniscus ruptures, the patient immediately feels severe pain that lasts for a long time. Before feeling pain, a person hears a sound similar to a click. The patient may experience a blockade of the internal meniscus; this symptomatology occurs as a result of a torn part of the meniscus being pinched between the bones. The patient develops hemarthrosis. After a short amount of time, the patient experiences swelling of this joint.

Damage to the posterior horn of the medial meniscus.

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

Posterior horn of the medial meniscus, treatment methods.

If the rupture of the above type of meniscus is mild or moderately severe, then treatment is prescribed in a conservative way. The patient is strongly advised not to forcefully physical exercise on the sore knee. To do this, the patient is prescribed crutches, it is necessary to minimize long walks as much as possible. fresh air. Bed rest is not necessary; a person can do all the housework quite calmly. In order to relieve pain and swelling, the patient is advised to apply ice packs to the injured area for 15-20 minutes at least 3 times a day. Prohibited to hold long time ice, due to the fact that damage to the skin may occur.
A person with this injury must wear elastic bandages. The bandage will not only help the swelling go away faster, but will also significantly limit the mobility of the knee. Specialists must show the patient how to adjust the bandage. When watching TV or reading, your leg should be slightly higher than your heart. If they bother you severe pain, it is allowed to use paracetamol or non-steroidal medications.
If conservative treatment didn't show desired result, the patient is scheduled for surgery. There are several types of surgical intervention.
1. Meniscus restoration. This type The intervention is quite gentle and is performed on patients under forty years of age, due to the fact that their cartilage tissue is healthy.
2. Removal of the meniscus is prescribed if there is severe damage to the cartilage tissue. This operation is prescribed extremely rarely, since complete removal of the meniscus can cause complications.
3. Meniscus transplant is prescribed if it is not possible to restore the damaged meniscus. The transplant is made from artificial material or there is a donor.
A couple of days before the operation, the doctor conducts a conversation with the patient, telling in detail about the progress of the operation. A few weeks before the scheduled date of surgery, the patient is strongly advised to completely eliminate the use of tobacco and alcohol, as this will significantly reduce the risk of blood clots. The likelihood of success increases if the operation is performed within 2 months of the injury.
After the operation, the patient is prescribed a course of physiotherapy. The time a person returns to everyday life is directly related to how well the surgery went and how long the postoperative period lasts.

Posterior horn

Treatment of a rupture of the posterior horn of the medial (internal) meniscus.

According to its structure, the medial (internal) meniscus is less mobile than the lateral (external) one. This accounts for the higher incidence of medial meniscus injury. Conventionally, the internal meniscus can be divided into three parts: the body of the meniscus (middle part), the anterior and posterior horn. The posterior horn of the medial meniscus does not have its own blood supply - there is no meniscus in this part blood vessels. Therefore, the dorsal horn is nourished through the continuous circulation of intra-articular fluid. In this regard, ruptures of the posterior horn are considered irreversible, since the meniscal tissue cannot recover and heal. Diagnosing a tear of the posterior horn of the medial meniscus is also quite difficult, so most often, in addition to palpation techniques, magnetic resonance imaging is used for diagnosis.

Statistics

A torn meniscus is an injury that confidently leads the list of the most common injuries to the knee joint. At risk are athletes and people whose professional activity associated with heavy physical labor. Of all meniscus injuries, up to 75% are caused by a tear or rupture of the medial meniscus and, in particular, its posterior horn.

Causes

Among the most common reasons Damage to the posterior horn can be distinguished as follows:

1. Mechanical damage. Most often, injuries of this kind are the result of a sharp rotation of the hip around its axis with simultaneous fixation of the ankle. In some cases, damage may result from a blow from a heavy object. Danger mechanical injuries lies, first of all, in the fact that the damage most often has a combined nature, and not one element of the joint suffers, but several at once, and the injury becomes more extensive. Thus, damage to the posterior horn of the medial meniscus is combined with damage to the knee ligaments or even a fracture of the joint capsule.
2. Genetic background. In this case, the patient has a congenital predisposition to develop chronic pathologies joints. The menisci in such patients wear out much faster, which is due to impaired nutrition or blood circulation in the knee joint.
3. Biological reasons. We are talking about joint pathologies caused by chronic diseases microbial or viral nature. In this case, the rupture of the posterior horn is accompanied by an inflammatory process.

Symptoms

Immediately after the injury, the person feels strong, sharp pain in the knee joint. Swelling begins to appear. If the posterior horn is damaged, the pain intensifies when going down the stairs. If the meniscus is torn, then its fragment can move inside the joint and interfere with the normal movement of the knee - a blockade of the joint develops. If the gap is minor, clicking sounds may be heard in the knee when moving. A rupture of the posterior horn also manifests itself as a limited ability to bend the knee.

In elderly patients, due to age-related degenerative changes in the body, rupture of the posterior horn can be triggered by even minor physical effort (for example, a sudden rise from a chair). It is quite difficult to diagnose such a gap, since it manifests itself only aching pain in the knee. Due to the difficulty of diagnosing this type of rupture, it often becomes chronic.

Kinds

It is customary to distinguish the following types of rupture:

• vertical gap,
• Oblique or patchy tear,
• Degenerative damage
• Transverse gap
• Horizontal gap.

Damage to the posterior horn of the internal meniscus can also be combined with injury to the knee ligaments. In this case, they talk about combined injury.

Conservative treatment

For minor injuries (the rupture is small), conservative treatment is prescribed. Its essence lies in the use of painkillers, anti-inflammatory drugs, limiting the load on the injured leg, as well as the patient undergoing physiotherapy and manual therapy (massage).

Surgical treatment

In case of serious damage (the gap has a large area), it is prescribed surgery. The torn part of the meniscus is sutured or, if this is not possible, the torn fragment is removed and the remaining part of the meniscus is aligned along the edge. IN last years This type of operation has become more often performed using the low-traumatic method of arthroscopy.

Rehabilitation

Rehabilitation treatment after a rupture of the posterior horn of the meniscus consists of sessions of therapeutic exercises, a course of antibiotics and a gradual restoration of range of motion in the knee joint.