Removal of the posterior horn of the medial meniscus. Damage to the posterior horn of the meniscus

Dorsal horn rupture medial meniscus- this is a consequence of an injury that occurs both in athletes or those who lead an active lifestyle, and in people in old age who suffer from other concomitant diseases(for example, arthrosis).

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

Both cartilaginous layers - external and internal - are C-shaped and differ significantly from each other. Yes, y lateral meniscus increased density, it is quite mobile, due to which it is not injured so often. As for the inner inlay, it is rigid, therefore, rupture (or other injuries) of the medial meniscus are much more common.

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

Note! Doctors once believed that removing a torn meniscus could save a person from all troubles. But now it has been proven that both menisci play 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

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

It is also worth noting that there are the following factors risks predisposing to rupture:

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

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

Symptoms of damage

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

Conservative treatment

Primary meniscus damage is treated with therapeutic methods. Of course, in some cases after injury, patients require emergency surgery, but often conservative therapy is 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.

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

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

Rehabilitation course

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

Note! 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!

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.

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

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

Video – Arthroscopy of the medial meniscus

Rehabilitation

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

Note! The rehabilitation course can take place at home, but it is advisable to do it in a hospital setting, where there is equipment for physical therapy.

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

The main difficulty of the rehabilitation period is considered to be intra-articular swelling, due to which 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.

What is the danger of a rupture of the posterior horn of the medial meniscus of the knee joint, treatment of damage to the horns of the meniscus - these questions are of interest to patients. Movement is one of the most beautiful gifts that human nature has endowed. Walking, running - all types of movement in space are carried out thanks to a complex system, and largely depend on such a small cartilage pad, which is otherwise called the meniscus. It is located between the knee joints and serves as a kind of shock absorber when any human movement occurs.

Meniscus injury

The medial meniscus changes shape when moving, which is why people’s gait is so smooth and flexible. The knee joints have 2 menisci:

Doctors divide the meniscus itself into 3 parts:

• the body of the meniscus itself;
• the posterior horn of the meniscus, that is, its inner part;
• anterior horn of the meniscus.

The internal part differs in that it does not have its own blood supply system, however, because nutrition should still be there, it is carried out thanks to the constant circulation of articular synovial fluid.

Such unusual properties lead to the fact that if an injury to the posterior horn of the meniscus occurs, then, unfortunately, it is most often incurable, because the tissue cannot recover. Moreover, a tear in the posterior horn of the medial meniscus is difficult to determine. And if such a diagnosis is suspected, urgent research is needed.

Most often, the correct diagnosis can be determined using magnetic resonance imaging. But with the help of developed tests, which are based on joint extension, scrolling movements, as well as the sensation of pain, the disease can be determined. There are a lot of them: Roche, Landa, Baikov, Shteiman, Bragard.

If damage to the posterior horn of the medial meniscus occurs, sharp pain, and severe swelling begins in the knee area.

When a horizontal tear of the posterior horn of the medial meniscus occurs, it is impossible to go down the stairs due to severe pain. If a partial tear of the meniscus occurs, it is almost impossible to move: the torn part dangles freely inside the joint, giving off pain at the slightest movement.

If you feel less painful clicking sounds, it means that tears have occurred, but they are small in size. When the tears occupy a large area, the torn part of the meniscus begins to move towards the center of the damaged joint, as a result the movement of the knee is blocked. The joint becomes wedged. When the posterior horn of the internal meniscus is torn, it is almost impossible to bend the knee, and the affected leg will not be able to withstand the load from the body.

Symptoms of a knee meniscus injury

If a meniscus tear occurs in the knee joint, the following symptoms will appear:

• pain that will eventually concentrate in the joint space;
• weakness of the muscles in the front of the thigh is felt;
• fluid begins to accumulate in the joint cavity.

As a rule, degenerative rupture of the posterior horn of the meniscus in the knee occurs in people of pre-retirement age due to age-related changes in cartilage tissue or in athletes whose load falls mainly on the legs. Even a sudden awkward movement can lead to a rupture. Very often, ruptures of the degenerative form become protracted and chronic. A symptom of a degenerative tear is the presence of a dull, aching pain in the knee area.

Treatment of medial meniscus injury

For treatment to be beneficial, it is necessary to correctly determine the severity of the disease and the type of injury.

But first of all, when damage has occurred, it is necessary to relieve the pain. In this case, a pain-relieving injection and pills that will reduce inflammation will help, and cold compresses will also help.

You need to be prepared for doctors to puncture the joint. Then it is necessary to clean the joint cavity from the blood and fluid accumulated there. Sometimes it is even necessary to use a joint blockade.

These procedures are stressful for the body, and after them the joints need rest. To avoid disturbing the joints and fix the position, the surgeon applies a plaster cast or splint. During the rehabilitation period, physical therapy and knee pads will help you recover; you will need to do physical therapy and walking with by various means support.

Minor damage to the posterior horn of the lateral meniscus or an incomplete tear of the anterior horn can be treated conservatively. That is, you will need anti-inflammatory medications, as well as painkillers, manual and physical therapy procedures.

How is damage treated? As a rule, surgical intervention is usually unavoidable. Especially if it is an old medial meniscus of the knee joint. The surgeon is faced with the task of suturing the damaged meniscus, but if the damage is too serious, it will have to be removed. A popular treatment is arthroscopic surgery, which preserves intact tissue, only resection of damaged parts and correction of defects. As a result, complications very rarely occur after surgery.

The whole procedure goes like this: an arthroscope with instruments is inserted into the joint through 2 holes to first determine the damage and its extent. When the posterior horn of the meniscus ruptures affecting the body, it happens that the torn fragment moves, rotating along its axis. He is immediately returned to his place.

Then the meniscus is partially bitten out. This needs to be done at the base of the posterior horn, leaving a thin “bridge” to prevent displacement. The next stage is cutting off the torn fragment from the body or anterior horn. Part of the meniscus then needs to be given its original anatomical shape.

It will be necessary to spend time in a hospital under the supervision of a doctor and undergo rehabilitation.

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

There are two menisci in the knee joint: medial (inner) and lateral (outer). Their ends are attached to the tibia. The medial one is located in the inner part of the knee and is connected to the internal collateral ligament. In addition, along the outer edge it is connected to the capsule of the knee joint, through which partial blood circulation is ensured.

The cartilaginous portion of the meniscus adjacent to the capsule contains a significant number of capillaries and is supplied with blood. This part of the medial meniscus is called the red zone.

The middle region (intermediate zone) contains a small number of vessels and is very poorly supplied with blood. Finally, the inner region (white zone) has no circulatory system at all.

The lateral meniscus is located on the outer area of ​​the knee. It is more mobile than the medial one, and its damage occurs much less frequently.

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

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

The meniscus is a cartilage pad that sits between joints and acts as a shock absorber.

During motor activity The menisci can change their shape, making the gait smooth and not dangerous.

The knee joint contains the outer (lateral) and inner (medial) menisci.

The medial meniscus is less mobile, so it is susceptible to various injuries, among which ruptures should be noted.

Each meniscus can be divided into three parts: anterior horn, posterior horn, and body.

The posterior horn of the meniscus, which is the internal part, is characterized by the absence of a circulatory system. The circulation of synovial fluid is responsible for nutrition.

In this regard, damage to the posterior horn of the medial meniscus is irreversible, because the tissue is not designed for regeneration. The injury is difficult to diagnose, and therefore magnetic resonance imaging is a mandatory procedure.

Meniscus injuries can be caused by various diseases and other reasons. Knowing all the reasons that increase risks, you can guarantee the maintenance of ideal health.

• Mechanical injuries can be obtained due to third-party mechanical influence. The danger is caused by the combined nature of the damage. In most cases, several elements of the knee joint are affected at once. The injury can be global and include damage to the ligaments of the knee joint, rupture of the posterior horn of the medial meniscus, rupture of the body of the lateral meniscus, and fracture of the joint capsule. In this situation, treatment must be started in a timely manner and must be thoughtful, since only in this case can it be avoided unwanted complications and restore all functions.
• Genetic causes suggest a predisposition to various diseases joints. Diseases may be hereditary or a congenital disorder. In many cases, chronic diseases of the knee joint develop due to the fact that the menisci quickly wear out, lack nutrition, and blood circulation in the knee joint is impaired. Degenerative damage may appear early. Damage to cartilaginous ligaments and menisci can occur at a young age.
• Pathologies of the joints caused by previous or chronic diseases, is usually classified as a biological type of damage. As a result, the risk of injury increases due to exposure to pathogens. Ruptures of the horn or body of the meniscus, abrasion, and separation of fragments may be accompanied by inflammatory processes.

It should be noted that the above list represents only the main reasons.

A common injury to the cartilage plate is a tear, complete or incomplete. Professional athletes and dancers, whose specialty involves high loads, are often injured. Injuries occur in older people and as a result of accidental, unexpected stress on the knee area.

Damage to the body of the posterior horn of the medial meniscus occurs for the following main reasons:

• increased sports loads (jogging over rough terrain, jumping);
• active walking, prolonged squatting position;
• chronic articular pathologies in which inflammation of the knee area develops;
• congenital articular pathology.

The listed reasons lead to meniscus injuries of varying severity.

Classification

Symptoms of injury to cartilaginous elements depend on the severity of the damage to the cartilage tissue. There are the following stages of internal meniscal injury:

• Stage 1 (mild). Movement of the injured limb is normal. The pain is mild and becomes more intense during squats or jumps. There may be slight swelling above the kneecap;
• Grade 2 injury is accompanied by severe pain. The limb is difficult to straighten even with outside help. You can move while limping, but the joint can become blocked at any moment. The swelling gradually becomes more and more skin covering changes shade;
• Damage to the posterior horn of the medial meniscus of the 3rd degree is accompanied by pain syndromes of such intensity that it is impossible to tolerate. It hurts most at the location of the kneecap. Any physical activity is impossible. The knee becomes larger in size, and the skin changes its healthy color to purple or bluish.

If the medial meniscus is damaged, there are following symptoms:

1. the pain intensifies if you press on the kneecap with inside and simultaneous extension of the limb (Bazhov’s maneuver);
2. the skin of the knee area becomes overly sensitive (Turner's symptom);
3. when the patient lies down, the palm passes under the injured knee without any problems (Land's sign).

After making a diagnosis, the doctor decides which treatment method to use.

The meniscus is cartilage tissue that consists of fibers and serves as a shock absorber for the knee joint. It looks like two crescents, their ends are called horns.

The lesser crescent is the outer (lateral) part of the meniscus, and the greater crescent is the inner (medial).

There are different types of breaks:

• vertical and horizontal;
• oblique and transverse;
• degenerative;
• ruptures of the posterior and anterior horns meniscus

But most often, a rupture of the posterior horn of the internal meniscus occurs, since it is less mobile.

Causes

Degenerative-dystrophic processes do not develop in a healthy body. This must be preceded by violations at various levels: local and general.

They have a clear relationship, which distinguishes the development of pathology from traumatic injuries, when only mechanical impact on the knee joint is sufficient. Undoubtedly, injuries and prolonged excessive stress on joints are key factors in the formation of degenerative changes, but there are other conditions that contribute to such processes:

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

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

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

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.

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.

Damage to the posterior horn of the medial meniscus is a polyetiological pathological condition that develops under the influence of various factors:

• The impact of kinetic force on the knee area in the form of a blow or fall on it.
• Excessive flexion of the knee, leading to tension in the ligaments that secure the menisci.
• Rotation (rotation) femur with a fixed shin.
• Frequent and long walking.
• Congenital changes that cause a decrease in the strength of the knee ligaments, as well as its cartilage.
• Degenerative-dystrophic processes in the cartilaginous structures of the knee, leading to their thinning and damage. This cause most often occurs in older people.

Finding out the causes allows the doctor not only to select the optimal treatment, but also to give recommendations regarding the prevention of recurrence.

Injury to the posterior horn of the lateral meniscus varies from patient to patient. The causes of injury largely depend on the age of the person. Thus, in young people under 35 years of age, the cause of injury is most often mechanical impact. In elderly patients, the cause of rupture of the posterior horn is most often a degenerative change in the meniscal tissue.

In women, rupture of the posterior horn of the external meniscus occurs less frequently than in men, and the rupture itself is usually organic in nature. In children and adolescents, rupture of the posterior horn also occurs, usually due to awkward movement.

Injury resulting from mechanical impact can have two possible reasons: direct blow or rotation. The direct impact in this case is associated with a strong blow to the knee.

The victim's foot is usually fixed at the moment of impact. Damage to the posterior horn is also possible with awkward, sharp bending of the leg at the knee joint.

Age-related changes meniscus significantly increase the risk of injury.

The rotational mechanism of injury implies that a meniscus rupture occurs in the event of a sharp twisting (rotation) of the ankle with the foot fixed. The condyles of the tibia and femur with such rotation shift in opposite directions. The meniscus also becomes displaced while attached to the tibia. If there is excessive displacement, there is a high risk of rupture.

Types of breaks

Most injuries to the extremities occur on the internal part (more than 70%). The outer part suffers less often (about 20%). And only 5% are cases of damage to both types of meniscus.

The following types of breaks are distinguished:

• vertical gap (longitudinal);
• oblique;
• degenerative;
• transverse (radial);
• horizontally;
• injury to the horns (anterior or posterior).

Let us tell you more about the types of meniscal tears and types of treatment.

Tear of the posterior horn of the medial meniscus

As noted, many people experience combined meniscal injuries that include a tear or avulsion of the posterior or anterior horn.

• Tears or the appearance of a part of the meniscus in the capsule of the knee joint, torn off due to abrasion or damage, are one of the most common cases in traumatology. These types of damage usually include the formation of a fragment by tearing off part of the meniscus.
• Tears are injuries in which part of the meniscus is torn. In most cases, ruptures occur in the thinnest parts, which should take an active part in motor activity. The thinnest and most functional parts are the horns and the edges of the menisci.

Depending on the main causative factor that led to the development of the pathological condition of the cartilaginous structures of the knee, traumatic and pathological degenerative damage to the posterior horn of the medial meniscus is distinguished.

According to the criterion of the duration of the injury or pathological violation of the integrity of this cartilaginous structure, fresh and old damage to the posterior horn of the medial meniscus is distinguished. Combined damage to the body and posterior horn of the medial meniscus was also identified separately.

Signs of ruptures

Damage to the medial meniscus most often occurs when physical exercise: running on rough terrain, spinning on one leg, sudden lunges and other situations.

Depending on the clinical manifestations, acute and chronic tears of the medial meniscus are distinguished. A distinctive feature of the first form is intense pain of a sudden nature, localized along the line of the joint fissure, where damage to the cartilaginous layer presumably occurred.

Other typical symptoms of a medial meniscus tear in the knee include:

• severe limitation of motor ability (if the torn area blocks the movement of the joint);
• hemarthrosis (bleeding into the joint cavity);
• edema.

Note: When the knee is bent, a person does not always feel intense pain. It appears more often when trying to straighten the leg. This hallmark injuries to the inner part of the intercartilaginous lining.

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 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 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.

The main sign of a meniscus tear is severe pain in the knee joint. When the posterior horn ruptures, the pain is localized mainly in the popliteal region. If you touch the knee with noticeable pressure, the pain increases sharply. It is practically impossible to move due to pain.

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Symptoms

When the meniscus of the knee joint is damaged, there are two characteristic periods - acute and chronic. The acute period lasts 4-5 weeks and is characterized by a number of painful symptoms.

The moment of meniscus damage is usually determined by a cracking sound and sharp pain in the knee area. In the first period after the injury, a cracking sound and pain accompanies a person during exertion (for example, moving up the stairs).

Swelling develops in the knee area. Often a meniscus tear is accompanied by hemorrhage into the joint.

A tear of the medial meniscus of the knee joint has a number of characteristic symptoms. Injury to the internal posterior horn of the meniscus causes intense pain on the inside of the knee. When you press with your finger in the area where the horn of the meniscus attaches to the knee ligament, a sharp pain appears. A rupture of the posterior horn causes blockage of movement in the knee joint.

The gap can be determined by performing flexion movements. It manifests itself in the form of sharp pain when straightening the leg and turning the lower leg outward.

Pain also occurs when the leg is strongly bent at the knee. According to the severity of damage to the meniscus of the knee joint, they are divided into minor, moderate and severe.

Small tears (partial), including the horns of the meniscus, are characterized by pain and slight swelling in the knee area. Such signs of injury cease to appear after 3-4 weeks.

With moderate severity of injury, all the considered symptoms of the acute period appear, but they are limited in nature and appear when physical activity such as jumping, moving up inclined planes, squat. Without treatment, this form of injury becomes chronic. This degree is typical for some tears of the anterior and posterior horn of the medial meniscus.

With severe injury, pain and swelling of the knee become obvious; hemorrhage occurs into the joint cavity. The horn is completely torn off from the meniscus, and its parts end up inside the joints, which causes a blockage of movement. Independent movement of a person becomes difficult. Severe injury requires surgery.

Traumatic ruptures.

After this injury, a person may feel pain and notice swelling of the knee.

If you experience pain when going down stairs, you may suspect a tear in the back of the meniscus.

When a meniscus ruptures, one part can come off, after which it will hang loose and interfere with the full functioning of the knee joint. Small tears can cause difficulty moving and painful clicking sounds in the knee joint.

A large tear leads to a blockade of the knee joint, due to the fact that the torn and dangling part of the meniscus moves to the very center and begins to interfere with various movements.

Damage to the posterior horn of the meniscus of the medial meniscus in most cases is limited to a violation motor activity knee joint and knee flexion.

In case of injury, sometimes the pain is particularly intense, as a result of which a person cannot step on his leg. In other cases, the tear may cause pain only when performing certain movements, such as going up or down stairs.

Acute rupture.

In this case, a person may suffer from swelling of the knee, which develops in a minimum time and is particularly pronounced.

Degenerative ruptures.

Many people after forty years suffer from degenerative meniscal tears that are chronic.

Gain pain syndrome and knee swelling cannot always be detected, since their development occurs gradually.

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.

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 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-absorbing cartilage layer is damaged.

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.

Diagnostics

To make a definitive conclusion about meniscopathy, it is necessary to conduct an imaging examination. This includes radiography or magnetic resonance imaging.

The latter method has significant advantages, since it allows you to accurately assess the condition of intra- and periarticular soft tissues and does not have radiation exposure. Based on the tomography results, the degree of damage to the meniscus is determined (according to Stoller):

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

We can talk about a true break only in the latter case. In addition, the image clearly shows the dislocation of cartilaginous structures, changes in shape, and separation of one of the horns.

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.

Arthroscopy also makes it possible to carry out therapeutic manipulations under visual control after additional introduction of special microinstruments into the joint cavity.

Treatment

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

The conservative (therapeutic) method is applicable for small and moderate ruptures. This treatment is based on a number of therapeutic measures and is often effective.

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

Typically, the conservative method involves long-term treatment for 6-12 months. First, the knee joint is reduced (repositioned) if there is a blockade. Manual methods can be used to remove the blockade. For the first 3 weeks, rest should be ensured, and the knee joint should be immobilized using a plaster splint.

When cartilage is damaged, it is necessary to restore and fuse it. For this purpose, a course of taking chondroprotectors and hyaluronic acid is prescribed.

The use of drugs containing chondroitin and glucosamine is recommended as protectors. Painful symptoms and inflammatory processes must be eliminated by taking non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, indomethacin) and others.

To eliminate swelling and accelerate healing, external agents in the form of ointments (amzan, voltaren, dollit and others) are used. The treatment process includes a course of physiotherapy and special therapeutic exercises. Therapeutic massage gives a good effect.

Treatment of meniscopathy of the knee joint is necessary in a comprehensive manner. Conservative and surgical methods are used.

Depending on the severity of the disease, the effect of the drugs used may be different. To achieve maximum results, you should follow all doctor's recommendations.

And first of all, it is necessary to reduce the load on the sore leg. You can wear an elastic bandage or a knee orthosis, but completely immobilizing the joint with a cast is fundamentally wrong - this will not improve its function, but will lead to contractures.

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

Drug therapy

Pathology of the knee joint, including damage to the menisci, requires the use of medications. Drugs are especially necessary for acute ruptures, but chronic processes cannot be effectively corrected without drugs.

With dystrophic changes, it is important to normalize biochemical processes in the body. To improve the condition of the meniscus and reduce symptoms, the following medications are used:

• Nonsteroidal anti-inflammatory drugs.
• Chondroprotectors.
• Metabolic.
• Vascular.
• Vitamins.

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

Physiotherapy

Physiotherapy is also used to restore the integrity of the meniscus. For this purpose, several procedures are used: electro- and phonophoresis, laser and wave treatment, magneto-, paraffin- and balneotherapy.

Which of them are indicated in each case will be determined by the doctor. But one should not expect a pronounced effect from the isolated use of physiotherapy - it is used only in combination with other methods.

Physiotherapy

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

Conservative measures are good for small tears, as well as for older people, who often show signs of osteoarthritis.

Operation

If the lesion of the internal or external meniscus reaches grade 3 according to Stoller, is of significant size and is accompanied by severe symptoms, as well as if previous therapy is ineffective, then there are all indications for surgical intervention. Only a doctor can determine when surgery should begin, but there is no point in delaying it.

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

Knee pain can occur due to the development of degenerative processes and meniscal rupture. It is important to carry out timely treatment to restore damaged tissue. What is better to use - conservative therapy or surgery - is determined by the clinical situation.

Once an accurate diagnosis has been made, it is necessary to begin treatment in a hospital setting.

For minor ruptures, conservative treatment is necessary. The patient takes anti-inflammatory and painkillers, undergoes manual therapy and physical therapy.

Serious damage requires surgery. In this case, the torn meniscus must be sutured. If restoration is not possible, the meniscus should be removed and a menisectomy performed.

Recently, arthroscopy, which is an invasive technique, has become increasingly popular. It is important to note that arthroscopy is a low-traumatic method characterized by the absence of complications in the postoperative period.

After surgery, the patient must spend some time in the hospital under the supervision of a physician. IN mandatory Rehabilitation treatment should be prescribed to promote full recovery. Rehabilitation includes therapeutic exercises, antibiotics and preventative medications. inflammatory processes.

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

When emergency technicians arrive, they will give you an injection of painkillers. After this, it will be possible, without torturing the victim, to apply a temporary splint.

This is necessary to immobilize the knee joint and prevent the damage from getting worse. It may be necessary to drain fluid and blood from the joint cavity. The procedure is quite painful, but necessary.

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

Options

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

The surgeon can perform the following interventions:

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

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 non-steroidal anti-inflammatory drugs (NSAIDs).
• In cases of “jamming” of the knee joint, reposition is used, that is, realignment using manual therapy or traction.
• Physiotherapy.
• Massotherapy.
• Physiotherapy.

• Treatment with chondroprotectors.
• Joint treatment with hyaluronic acid.
• Treatment folk remedies.
• 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;
• Endoprosthetics – implantation of artificial cartilage into the knee;
• Stitching of damaged cartilage (carried out for minor damage);
• Arthroscopy – puncture of the knee in two places in order to carry out further manipulations with the cartilage (for example, suturing or endoprosthetics).

This type of injury, like any other, must be treated immediately after the injury.

Important! If left untreated for a long time, the rupture can become chronic.

If treatment is not undertaken in a timely manner, it can lead to the destruction of the cartilage of the knee joint, inflammation, changes in its structure and arthrosis. To avoid these troubles, you should immediately visit a doctor as soon as an injury occurs.

Conservative treatment method

A tear of the posterior horn of the medial meniscus of the knee is generally treated without surgery. With the exception of severe trauma, requiring operational assistance. Treatment takes place in several stages:

1. If there is a blockage of the joint, it must be removed. This is done using manual methods or with hardware traction of the joint.
2. Swelling is relieved with anti-inflammatory drugs (Diclofenac, Indomethacin).
3. Relieving pain with painkillers (Ibuprofen, Paracetamol).
4. After relieving pain and inflammation, it is necessary to begin physical therapy, physical therapy and massage.
5. The longest stage is the restoration of the cartilage that makes up the menisci. For this purpose, drugs containing chondroitin sulfate and hyaluronic acid.

Take these medicines it takes a long time; one course can take up to six months. They must be repeated annually to prevent deterioration of the cartilage.

In some cases, after traction of the joint, a cast is applied. This is done in order to provide the joint with rest and immobility for a certain time. But such a measure is not taken in all cases.

Surgical treatment methods

In the case where the above treatment method does not have the desired effect on the damaged part, resort to surgical method treatment. If the body of the meniscus itself is damaged, then most often it can be stitched.

There are several types of operations to treat damage to the horn of the meniscus, but some of them are currently performed extremely rarely, as they are considered ineffective or even harmful. These include, for example, arthrotomy. This is the removal of damaged cartilage tissue, which is performed by completely opening the knee.

Surgical methods for treating a torn meniscus of the knee joint are currently aimed at preserving or restoring it. They come in several types:

1. Partial meniscectomy. In this case, the edges of the meniscus at the site of the lesion are cut off and the remaining part is restored.
2. Arthroscopy. An operation that is performed through three punctures in the knee joint. The tools necessary for manipulation are introduced into one of them. The other receives saline solution and washes out unnecessary particles of cartilage, accumulated blood, etc. A camera is inserted into the third puncture, through which the surgeon can see everything that happens inside the knee, and thereby controls the entire process.
3. Transplantation. The patient receives a donor meniscus transplant.
4. Endoprosthetics. An artificial organ is inserted into the knee joint.

Whatever method the operation is performed, after it complete rest of the knee joint and protection from the effects of cold are necessary.

After an objective diagnosis has been carried out, determining the location and severity of the violation of the integrity of the cartilaginous structures of the joint, the doctor prescribes a comprehensive treatment. It includes several areas of activities, which include conservative therapy, surgical surgery, as well as subsequent rehabilitation.

Mostly all activities complement each other and are assigned sequentially.
.

Treatment without surgery

If partial damage to the posterior horn of the medial meniscus (grade 1 or 2) has been diagnosed, conservative treatment is possible. It includes the use of various drugs pharmacological groups(non-steroidal anti-inflammatory drugs, vitamin preparations, chondroprotectors), performing physiotherapeutic procedures (electrophoresis, mud baths, ozokerite).

During therapeutic measures, functional rest for the knee joint must be ensured.
.

Surgical intervention

The main goal of the operation is to restore the anatomical integrity of the medial meniscus, which allows for normal functional state knee joint in the future.

Surgery can be performed using an open approach or arthroscopy. Modern arthroscopic intervention is considered the technique of choice, since it is less traumatic and can significantly reduce the duration of the postoperative and rehabilitation period.

For small tears, non-surgical treatment is preferred. Puncture gives good results when blocking a joint - removing blood helps to “free” the joint and eliminate the blockage. Further treatment consists of undergoing a series of physiotherapeutic procedures: therapeutic exercises, electromyostimulation and massage.

Often, during conservative treatment, medications from the group of chondroprotectors are also prescribed. However, if there is serious damage to the posterior horn, then this measure will not be able to completely restore the meniscal tissue. In addition, the course of chondroprotectors often lasts more than one year, which extends the treatment over time.

For significant ruptures, surgical treatment may be prescribed. The most commonly used method is arthroscopic removal of part of the meniscus. Complete removal is not practiced, since in the absence of the meniscus the entire load falls on the knee cartilage, which leads to their rapid wear.

Surgical treatment

In case of injury to the meniscus, the following points are indications for surgical manipulation:

• severe injuries;
• when the cartilage is crushed and the tissue cannot be restored;
• severe injuries to the meniscal horns;
• tear of the posterior horn;
• articular cyst.

The following types of surgical procedures are performed in case of damage to the posterior horn of the shock-absorbing cartilaginous plate:

1. resection of torn elements or meniscus. This type of manipulation is performed with incomplete or complete tear;
2. restoration of destroyed tissues;
3. replacement of destroyed tissue with implants;
4. meniscus suturing. Such surgical intervention is carried out in case of fresh injury and immediate medical attention is sought.

Let's take a closer look at the types of surgical treatment for knee injuries.

Arthrotomy

The essence of arthrotomy comes down to complete resection of the damaged meniscus. This operation is performed in rare cases when the articular tissues, including blood vessels, are completely damaged and cannot be restored.

Modern surgeons and orthopedists have recognized this technique as ineffective and is practically not used anywhere.

Partial meniscectomy

When restoring the meniscus, the damaged edges are trimmed so that there is a smooth surface.

Endoprosthetics

A donor organ is transplanted to the site of the damaged meniscus. This type of surgical intervention is not performed often, because rejection of the donor material is possible.

Stitching damaged tissues

Surgical treatment of this type aims to restore destroyed cartilage tissue. This type of surgical intervention gives positive results if the injury has affected the thickest part of the meniscus, and there is a possibility of healing of the damaged surface.

Stitching is performed only for fresh damage.

Arthroscopy

Surgical intervention using arthroscopic technique is considered the most modern and effective method treatment. With all the advantages, trauma during the operation is practically eliminated.

To perform the operation, several small incisions are made in the articular cavity, through which the instruments are inserted along with the camera. During the intervention, saline solution is supplied through the incisions.

The arthroscopy technique is remarkable not only for its low traumatism during its implementation, but also because it is possible to simultaneously see the true condition of the injured limb. Arthroscopy is also used as one of the diagnostic methods when making a diagnosis after damage to the meniscus of the knee joint.

When thinking about surgery, people often worry about the wrong things and overlook important things. Reviews will help you figure out whether the operation is useful or not.

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Then, it's OK! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...

Very often, athletes and people who constantly engage in physical labor complain about 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 wide range actions: from surgical interventions to traditional methods 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.

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.

Orthopedic doctors differentiate injuries knee meniscus into several types:

• pinching,
• rupture of the posterior horn of the medial meniscus and rupture in the area 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 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

When cartilage is injured, the disease becomes 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. How younger man, 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

With micro-fractures, chronic injuries and pinched 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 an 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 containing hyaluronic acid are necessary. If there is swelling and the patient suffers from pain, intra-articular injections are necessary:

• nimulida,
• Voltaren,
• corticosteroids.

After the above measures, long-term drug therapy 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 performed every day as long as the meniscus hurts. If you don't have fresh burdock, you can use dried leaves by first 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.

Treatment of knee meniscus without surgery

Injuries and treatment of the medial meniscus of the knee joint

If we feel pain in the knee, then, as a rule, this means that the meniscus hurts. Since the meniscus is a layer of cartilage, it is most at risk of rupture or damage. Knee pain can indicate several types of 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
• Meniscus tear
  • Tear of the posterior horn of the meniscus
  • Tear of the posterior horn of the lateral (outer) 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 damage appears one month after injury. With these injuries, a person begins to feel local pain in the gap of the knee joint, weakness of the muscles of the outer surface of the thigh, “blockage” of the knee, and accumulation of fluid in the joint cavity appear.

The exact signs of damage to the medial meniscus are revealed through various examinations. Eat special tests for extension of the knee joints (Roche, Baykov, Landa, etc.), when at a certain extension of the knee you feel pain symptoms. 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.

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 pain, therefore, first of all, the patient is given an anesthetic injection, then a joint puncture is taken, 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 gypsum bandage. 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.

Surgery 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 surgery has become widespread due to careful attitude to 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 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:

At the same time, meniscus 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 elderly 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 break there is big 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 adduction 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 damage.

A pronounced symptom of a rupture is pain when 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 by severe pain, but do not lead to pinching of the 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; in this case, the needle is passed through the gap on the outside of the knee joint and then into its cavity.

With the development of technology, seamless fastening inside the joint is gradually gaining popularity. The process itself takes a little time and 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 that cannot be eliminated with 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 meniscal 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.

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Damage or rupture of the medial meniscus of the knee joint usually occurs in athletes and overly active people; this condition requires urgent treatment. In addition to them, people of retirement age are susceptible to this disease, especially those who suffer from arthrosis or arthritis.

What is the meniscus and where are its horns?

The meniscus is cartilage tissue that consists of fibers and serves as a shock absorber for the knee joint. It looks like two crescents, their ends are called horns.

The lesser crescent is the outer (lateral) part of the meniscus, and the greater crescent is the inner (medial).

There are different types of breaks:

• vertical and horizontal;
• oblique and transverse;
• degenerative;
• ruptures of the posterior and anterior horns of the meniscus.

But most often, a rupture of the posterior horn of the internal meniscus occurs, since it is less mobile.

What can cause damage to the posterior horn?

This disease always occurs as a result of injury. The meniscus is not so fragile that it can be damaged by any force. The most common causes of rupture:

1. Excessive body rotation while standing on one leg without lifting the foot off the floor.
2. Jumping and running with obstacles is too energetic.
3. Walking very quickly or, conversely, staying in a squatting position for a long time.
4. An injury caused by an existing degenerative knee joint.
5. Not enough good development joints and ligaments caused by congenital pathology.

In people of retirement and pre-retirement age, rupture of the posterior horn occurs due to the fact that the cartilage tissue is often already destroyed by arthrosis. Therefore, it is much easier to damage it.

How to recognize a gap?

Without qualified diagnostics, it is impossible to say for sure whether there is damage to fibrocartilage tissue. But there are signs that suggest its presence:

1. When an injury occurs, a click is clearly heard and pain shoots through the knee. Lasts about 5 minutes, then subsides a little. During this period, a person is able to move, overcoming pain. After a significant amount of time, about half a day, pain occurs in the knee again. This time the acute pain is also accompanied by a burning sensation. Bending and straightening the knee occurs with increased pain. Rest gives some relief.
2. If a rupture of the medial meniscus does occur, then a blockade of the knee joint occurs. Outside of medicine, this is called “jammed.” This happens because part of the torn meniscus cartilage is fixed by two bones, thereby limiting the movement of the knee. But this symptom does not always indicate a meniscus tear. It can also occur due to ligament damage.
3. If in the body of the meniscus itself, where there are capillaries, then blood accumulates in the knee. This is called hemarthrosis.
4. A few hours after the rupture, swelling of the adjacent tissues occurs.

With the help of hardware research, it is possible to determine whether the gap is chronic or recently acquired. An acute rupture has smooth edges and an accumulation of blood. A chronic tear has fibrous, uneven edges, and the tissue is swollen. It is not blood that accumulates near it, but synovial fluid.

A degenerative tear of the posterior horn of the meniscus can be diagnosed using MRI or arthroscopy. Without these methods, this diagnosis is quite difficult to establish, since there are no: acute pain, blockade.

Treatment of a tear in the posterior horn of the medial meniscus of the knee joint

This type of injury, like any other, must be treated immediately after the injury.

Important! If left untreated for a long time, the rupture can become chronic.

If treatment is not undertaken in a timely manner, it can lead to the destruction of the cartilage of the knee joint, inflammation, changes in its structure and arthrosis. To avoid these troubles, you should immediately visit a doctor as soon as an injury occurs.

A rupture of the posterior horn of the knee joint is generally treated without surgery. With the exception of severe trauma requiring surgical assistance. Treatment takes place in several stages:

1. If there is a blockage of the joint, it must be removed. This is done using manual methods or with hardware traction of the joint.
2. Swelling is relieved with anti-inflammatory drugs (Diclofenac, Indomethacin).
3. Relieving pain with painkillers (Ibuprofen, Paracetamol).
4. After relieving pain and inflammation, it is necessary to begin physical therapy, physical therapy and massage.
5. The longest stage is the restoration of the cartilage that makes up the menisci. For this purpose, medications containing chondroitin sulfate and hyaluronic acid are prescribed.

These medications need to be taken for a long time; one course can last up to six months. They must be repeated annually to prevent deterioration of the cartilage.

In some cases, after traction of the joint, a cast is applied. This is done in order to provide the joint with rest and immobility for a certain time. But such a measure is not taken in all cases.

Surgical treatment methods

In the case when the above treatment method does not have the desired effect on the damaged part, they resort to surgical treatment. If the body of the meniscus itself is damaged, then most often it can be stitched.

There are several types of operations to treat damage to the horn of the meniscus, but some of them are currently performed extremely rarely, as they are considered ineffective or even harmful. These include, for example, arthrotomy. This is the removal of damaged cartilage tissue, which is performed by completely opening the knee.

Surgical methods for treating a torn meniscus of the knee joint are currently aimed at preserving or restoring it. They come in several types:

1. Partial meniscectomy. In this case, the edges of the meniscus at the site of the lesion are cut off and the remaining part is restored.
2. . An operation that is performed through three punctures in the knee joint. The tools necessary for manipulation are introduced into one of them. The other receives saline solution and washes out unnecessary particles of cartilage, accumulated blood, etc. A camera is inserted into the third puncture, through which the surgeon can see everything that happens inside the knee, and thereby controls the entire process.
3. Transplantation. The patient receives a donor meniscus transplant.
4. Endoprosthetics. An artificial organ is inserted into the knee joint.

Whatever method the operation is performed, after it complete rest of the knee joint and protection from the effects of cold are necessary.