Lateral knee joint meniscus

Causes and symptoms of lateral meniscus of knee joint

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Definition of disease

Menisci in kneejoints play the role of shock absorbers, serve to fully interact the shape of the contiguous surfaces of bones and maintain the stability of the knee joint. The lateral meniscus is located outside the knee joint and is more mobile than the medial meniscus( internal), due to which it is less susceptible to traumatic injuries.


Causes of trauma to the lateral meniscus of the knee joint

The most common cause of trauma in the lateral meniscus is an indirect or combined injury in which the shin is turned inside. If the leg is too steeply bent out of the bent state, excessive tibial lead, the meniscus can also be damaged.

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Direct injury, for example, when a joint strikes directly on the hard edge of a surface or when it is hit by a heavy moving object, is diagnosed rarely. But, if it happens repeatedly, the most common chronic trauma is the meniscus, which eventually leads to its rupture.

Diseases of a rheumatic nature can cause a degenerative change in the lateral meniscus.


Signs and symptoms of the lateral meniscus

Clinical manifestations of damage to the lateral meniscus are divided into two periods: acute and chronic. Often at the beginning of the disease, it is very difficult to correctly diagnose, since there are symptoms of nonspecific inflammation, which are also characteristic of other internal injuries of the joints. As a rule, the patient is concerned about pain in the area of ​​damage, along the joint space. At movement, especially at an extension, there is a sharp pain that leads to restriction of impellent ability.

In most cases, the injury is one-stage and leads to bruises, tearing, and in severe cases to rupture or even crushing of the meniscus. A complete rupture of the first time the injured meniscus occurs most often in the presence of degenerative changes or an inflammatory process. As a result of conservative therapy, the majority of patients experience complete recovery.

After the end of the subacute period, which lasts 2-3 weeks, the reactive phenomena disappear, and the true clinical picture of the lesion becomes visible. It is characterized by the presence of certain symptoms, such as pain, constantly present and inflammation of the capsule. The presence of effusion is determined and joint blockade often occurs. Anamnesis of the patient with a detailed description of the details of the received trauma and positive pain tests for extension, displacement and compression play an important role in the formulation of the correct diagnosis.


Diagnosis of damage to the lateral meniscus

A detailed description of the moment of injury is very important for diagnosis. Damage to the lateral meniscus is very rarely accompanied by blockade of the joint, due to its mobility, it is more prone to contraction than the rupture. As a rule, there are symptoms of movement and slipping of the meniscus and a specific click with minimal movement.

In the case of traumatic damage to the lateral meniscus, patients complain of pain in the area of ​​the outer joint slit, the intensity of which increases when the shin is moved inwards. Exterior examination can reveal the swelling of the knee joint and the development of infiltration.

These symptoms are quite common and are present in other pathologies of the knee joint, which greatly complicates the diagnosis. Pain tests are most often with lesions of the lateral meniscus, there are negative, except for the clicking knee, joint blockade also does not develop in all cases.

The most objective method is radiography, with the help of which the narrowing of the damaged part of the joint gap with signs of deforming arthrosis is determined.

A certain complexity arises in the diagnosis if the meniscus is of an atypical form or if both menisci are damaged in chronic trauma.


Treatment of damage to the lateral meniscus

The choice of method of treatment depends on the nature of the trauma and the condition of the patient. Contusions, small ruptures, changes of degenerative type, are subject to primary conservative treatment. If the injury is serious, with large gaps and is accompanied by severe pain or blockade, categorically indicated surgical treatment, which is most often performed with the help of endoscopic equipment. Surgical intervention is also required for patients who have not received any improvement as a result of conservative treatment.


Rehabilitation after damage to the lateral meniscus

Terms and measures for the rehabilitation of the treatment of such diseases are chosen individually for each patient. It is recommended at the initial stage to use crutches and the maximum reduction in the load on the aching leg.


ayzdorov.ru

How to treat a meniscus - conservatively or operatively?

The knee meniscus is a cartilaginous layer with a collagen microstructure located between the tibia and the femur, acting as a shock absorber and stabilizer. In total, the knee has two such plates, resembling transparent lenses in the form of a crescent:

  • Internal( medial), more reminiscent of elongated mirror letter C
  • Outer( lateral), similar in shape to the semicircle

Frequent damages of the knee joint meniscus - rupture or separation. Their treatment is carried out, mainly, with the help of surgery.

Menisci in knee plays an important cushioning and stabilizing role

Surgical treatment of the knee joint meniscus

How the meniscus is fastened in the joints

The lateral outer meniscus is loosened more than the medial internal

The lateral meniscus is more free and fastens :

  • to the tibia,her at two close points located in the middle of the bone
  • to the femoral condyle( projection) with the anterior and posterior meniscus-femoral ligaments, linkingx rear horn of the meniscus with the hip( they pass behind and in front of the posterior cruciate ligament)
  • to the synovial capsule by thin beams extending from the hamstring muscle tendon( thus the mobility of the lateral meniscus relative to the capsule is preserved)

Medial fixed more rigidly :

  • At the two extreme pointson the anterior and posterior parts of the tibia
  • Outer edge to thicken on the capsule with the help of the coronary ligament( capsular thickening is formed by the collateral tibial ligament)

  • The role of the meniscus in the knee joint
    • The cartilaginous pads increase the bearing surface of the joint, thereby evenly distributing the load on it
    • They have half the elastic properties compared to the usual cartilage
    • Thanks to the free fastening of the lateral pads,they play the role of shock absorbers for jumping, jerking and bumping
    • The medial internal meniscus performs a stabilizing function:
      • Even with damageennoy anterior cruciate ligament they prevent the displacement of the tibia relative to the femur forward
      • This stability is largely determined by feature fibrillation - the intersection of circular and radial fibers

    Damage to the meniscus of the knee

    Due to its stability, in the normal daily life of the lens are damaged cartilage rare. The exception is damage to the meniscus due to arthrosis of the knee joint, which can occur in the elderly.

    In the late stage of deforming arthrosis, spontaneous destruction of the cartilaginous liner may occur, and any sudden movement or fall may contribute to this.

    At a young age, a meniscus injury with knee injuries occurs in physically active people, for example, in athletes after :

    • Over-bending of the knee due to high jump
    • Simultaneous landing with knee bending
    • Knee bump and other causes

    Menisci candamage themselves or in combination with other injuries :

    • Gaps of the ligaments
    • Fractures of the condyles and diaphysis of the femur and tibia

    Already existing ruptures of cruciformmatings increase the risk of injury meniscus .

    In the event of a trauma, either a tear of the meniscus from the attachment point or its rupture of the occurs.

    Types and symptoms of a meniscus rupture

    Types of ruptures are radial, oblique, horizontal, transverse

    Gaps have different shape and direction:

    • radial, slanting, horizontal, transverse
    • in medial plates often there are tears that resemble the handle of the

    watering can. There are moreand less favorable trauma, depending on the location of the rupture :

    • The most favorable is the rupture of the outer edge, since it is through the peripheral red zone connectedwith a capsule, the blood supply of the meniscus occurs. And if there is a blood supply, then it is possible to recover from an
    • injury. The closer the gap is to the white zone, the fewer blood vessels and less the chances of healing.

    Symptoms of :

    1. A sudden sharp pain( with a degenerative rupture, it can be periodic and not very strong)
    2. Joint blockade( severe limitation of movements):
      This occurs after the detached piece of cartilaginous napkin falls between the joints
    3. Pain on descent( not always)
    4. Sharp edema(
      ) This can happen after hemarthrosis( meniscus hemorrhage)
    5. Pain symptoms when pressed on the interarticular gap
    6. Positive extension tests( Baikova, Landa, Roche) and rotation( Steinman, Bragard)
    7. When old trauma occurs,for the synovitis( joint fluid in the joint)

    Diagnosis

    Breaking the knee joint meniscus on the x-ray

    For diagnostic purposes, perform:

    • Functional radiography in the direct, lateral and axial projection :
      • X-rays are made in the standing position and when the legs are bent
      • because of the transparency of the cartilaginous lens X-ray is used with contrasting
    • MRI of the knee joint :
      MRI intensity measures the degree of rupture from zero( normal meniscus) to the third)
    • Arthroscopy of the knee joint

    Consequences of the rupture of the

    If the rupture is not treated, then this can lead to chondromalacia - the gradual destruction of the cartilaginous surface of the knee joint by a rupturedth meniscus, which during the movement creates friction about the joint

    Chondromalacia is a gradual process that also goes through four stages, like osteoarthritis.

    To prevent chondromolation, it is necessary to conduct timely treatment of the rupture.

    Chondromalacia - is the erasure of the cartilage of the joint by the meniscus flap

    Why is conservative treatment of the meniscus rarely performed?

    Conservative treatment without surgery is justified only in such cases :

    • For small ruptures of cartilaginous pads without broken joint stability
    • In complex combined injuries, when the cruciate ligaments

    are damaged. Treatment of an unstable isolated meniscus injury by immobilizing the joint( gypsum application) is a gross medical error:

    • Large median ruptures still can not grow
    • Small can be eliminated with a minimally invasive operation - arthroscopy
    • Complete immobilization due to gypsum itself is painfully plus leads to persistent contractures

    It often turns out that, following such conservative treatment, one immediately needs to undergo a surgical operation.

    Types of surgical treatment of the meniscus

    The most preferred and low-traumatic method of treatment is arthroscopy.

    is rarely used to completely remove( meniskectomy):

    It is recognized as a harmful and inefficient operation conducted at a time when the remarkable role of these plates has been little studied.

    Today it is clear that the removal of the meniscus leads subsequently to the development of arthrosis and arthritis, so after this radical operation the joint surface decreases and the joint load increases

    The following types of operations are recognized as effective:

    • Partial meniscectomy
    • Restoring the cartilaginous lining by stitching
    • Recovery by transplantation

    Partial meniscectomy

    The procedure is as follows:

    • The detached or dangling piece of cartilage is removed
    • After this edge is trimmed
    • If signs of chondromalacia are found, drugs with hyaluronic acid( osthenil, duralan, etc.) are injected into the joint cavity.

    In the figure below, a more complicated case of surgery when the rupture is large, occurs as a "handle of the watering can" andstitching is not possible.

    Stages of a meniscectomy operation with a "handle-handle" rupture

    It can be seen how the torn flap clings to the tool, it is cut at the base and then twisted

    The meniscus stitch

    The seam can be applied if the rupture is in the red or red-white zone of the meniscus close to its outeredges, that is, where there are blood vessels

    Stitching in the white zone does not lead to healing and threatens to re-break.

    Meniscus transplantation

    This operation is suggested for significant damage to the meniscus and the impossibility of restoring it in another way.

    There are three types of grafts:

    • Own tissues( use large, healthy tendons of the patient)
    • Donor's meniscus
    • Allogenic materials:
      • bone matrix transplants
      • artificial substitutes

    How is the operation itself performed arthroscopy, read here.

    Rehabilitation after meniscus

    The length of rehabilitation depends on the complexity and type of operation. Restoration and physical therapy are required throughout the recovery; the choice is made by a surgeon or rehabilitologist.

    . For different types of operation, the

    rehabilitation scheme is chosen. Recovery for simple operations

    • . Gentle load on the operated knee is possible on the second day
    • Crutches are used periodically to unload the knee within a week
    • After one or two weeks, you can carefully proceed to work
    • After a week, you can try to increase the load when nstrength of the exercise bike
    • More dynamic sports( football, jogging, volleyball, tennis) are possible after 3-4 weeks

    Rehabilitation after stitching the meniscus

    • Crutches and partial load - four weeks
    • Normal knee loading mode is introduced in the fifth week.
    • .doctor's permission) - after two months of rehabilitation
    • Sports exercises with exercise - only after six months

    Rehabilitation for transplantation

    • Partial load period - 5 - 6 weeks
    • Acceptable sports activities - hAfter eight weeks

    With a rehabilitator or surgeon, it is necessary to coordinate each rehabilitation period after the operation on the meniscus, so each patient has his own recovery resources.

    Video: Rehabilitation after knee surgery( arthroscopy)

    ZaSpiny.ru

    What methods are used to treat the horn of the medial meniscus?

    A rupture of the posterior horn of the lateral meniscus or its anterior analog occurs as a result of an injury. This happens in people belonging to the following risk groups:
    • professional athletes( especially football players);
    • people who lead a very active lifestyle and engage in various kinds of extreme sports;
    • men and women of advanced age, suffering from different types of arthrosis and similar diseases.

    What is the damage to the anterior or posterior horn of the inner meniscus? For this it is necessary, at least in general terms, to know what the meniscus itself is. In general terms, this is a special, cartilaginous structure. It is needed for depreciation in knee joints. Similar cartilaginous structures exist in other parts of the human body - they are equipped with all of its parts, which are responsible for flexion and extension of the upper and lower extremities. But the damage to the posterior or anterior horn of the lateral meniscus is considered the most dangerous and the most common injury, which, if untimely, can lead to various complications and make a person disabled.


    A brief anatomical description of the meniscus

    The knee joint of a healthy organism has such cartilaginous inserts as:

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

    Both these structures resemble a crescent in shape. The density of the first meniscus is higher than the corresponding index in the posterior cartilaginous structure. Therefore, the lateral part is less exposed to injury. The internal( medial) meniscus is rigid and most often the injury occurs when it is damaged.

    The very structure of this organ consists of several elements:

    The structure of the tendon-shock absorber of the knee

    • is the cartilaginous body of the meniscus;
    • front horn;
    • its back analog.

    The main part of the cartilaginous tissue is girdled and permeated with a network of capillary vessels, which form the so-called red zone. The entire area has an increased density and is located at the edge of the knee joint. In the middle part is the thinnest part of the meniscus. There are no vessels in it and it is called the white zone. In the initial diagnosis of trauma, it is important to determine precisely which area of ​​the meniscus has suffered and undergone rupture. Previously, it was decided to completely remove the meniscus if the damage to the horn of the inner layer was diagnosed, which supposedly helped the patient get rid of complications and problems.

    But with today's level of medicine development, when it is clearly established that the inner and outer meniscus perform very important functions for the bones and cartilage tissue of the knee joint, doctors try to treat the injury without resorting to surgical intervention. Since the meniscus plays the role of a shock absorber and protects the joint, its removal can lead to the development of arthrosis and other complications, the treatment of which will require additional time and resources. Damage to the anterior horn of the meniscus occurs rarely, since its structure has an increased density and better resists different loads.

    In such traumas, conservative treatment or surgery is usually prescribed if damage to the anterior horn of the lateral meniscus results in a build-up of blood in the knee joint.


    Causes of rupture of cartilaginous tissues

    Damage to the posterior horn of the medial meniscus is most often caused by acute trauma, as when applied to the knee joint, it does not always lead to rupture of the cartilaginous tissue, which is responsible for amortization of this site. Physicians identify a number of factors that contribute to the rupture of cartilage:

    • excessively active jumps or cross-country running;
    • twisting a person's body on one leg when her foot does not come off the surface;
    • frequent and prolonged squatting or active walking;
    • development of knee joint degeneration with certain diseases and injury to the limb in this condition;
    • presence of congenital pathology, in which there is a weak development of ligaments and joints.

    There are different degrees of damage to the meniscus. Their classification is different in different clinics, but the main thing is that they are all determined by the generally recognized characteristics, which will be discussed below.


    Symptoms of hamstring injury of the inner meniscus

    Symptoms of such a trauma of the medial meniscus are as follows:
    • there is a sharp, sharp pain in getting an injury. It can be felt for 3-5 minutes. Before that, a clicking sound is heard. After the pain disappears, a person can move. But it will cause new bouts of pain. After 10-12 hours the patient will feel a sharp burning sensation in the knee, as if a sharp object had penetrated there. When the knee is bent and unbent, the pain intensifies, and after a short rest subsides;
    • knee blockade( "jamming") occurs when ruptured cartilage tissue of the inner meniscus. It can appear at the moment when a severed piece of a meniscus is clamped between the tibia and the femur. This leads to the impossibility of moving around. These symptoms bother the person and if the ligaments of the knee joint are damaged, therefore the exact cause of the pain syndrome can be recognized only when diagnosed in the clinic;
    • with the penetration of blood into the joint can occur traumatic hemarthrosis. This occurs when a meniscus rupture occurs in the red zone, when blood vessels are damaged;
    • after a few hours from the time of injury, swelling of the knee joint may develop.

    It should be clearly distinguished chronic injury of the horn of the medial meniscus 2 degrees from acute trauma. This is now possible with the use of hardware diagnostics, which allows you to carefully examine the condition of cartilage tissue and fluid in the knee joint. A rupture of the meniscus of the third degree leads to the accumulation of blood in the internal parts of the knee. At the same time, the edges of the cliff are even, and in case of chronic disease the fibers are scattered, there is edema that occurs from damage to the nearby cartilage, and penetration into this place and the accumulation of synovial fluid there.


    Treatment of trauma of horn of an inner meniscus

    Characteristic signs of a knee tendon injury

    A rupture of the tissues of the knee joint should be treated immediately after an injury, because after a time, the disease from an acute stage can pass into a chronic illness. If treatment does not start on time, meniscopathy can develop. This will lead to changes in the structure of the knee joint and the degradation of the cartilaginous tissues on the surfaces of the bones. This situation is observed in half of cases of rupture of the posterior horn of the internal meniscus in patients who, for various reasons, started the disease and later applied for medical help.

    Treatment of rupture can be carried out by the following methods:

    • conservative method;
    • surgical intervention.

    After the precise diagnosis of the primary rupture of the meniscus horn, doctors are eliminated using a therapeutic course. In most cases, conservative treatment produces good results, although about a third of cases of such injuries require surgery.

    Treatment with conservative methods consists of several, rather effective stages( if the injury is not started):

    • manual therapy and traction with the help of various equipment, which are aimed at repositioning, that is, the knee joint is being repositioned with the development of the blockade;
    • use of anti-inflammatory drugs that doctors prescribe to the patient to eliminate knee edema;
    • rehabilitation course, in which the treatment is carried out using therapeutic, restorative gymnastics, physiotherapy and massage;
    • appointment to the patient course, in which the treatment is performed with chondroprotectors and hyaluronic acid. This prolonged process can last from 3 to 6 months for several years, but it is important for restoring the structure of the meniscus;
    • as the trauma of the horn of the meniscus is accompanied by a severe pain syndrome, then the doctors continue treatment, using pain medications. For this purpose, analgesics are commonly used, for example, Ibuprofen, Paracetamol, Indomethacin, Diclofenac and other drugs. They can be used only for the purpose of the doctor in the dosage, which is determined by the course of therapy.

    Meniscus treatment is occasionally carried out using gypsum. To impose it on the patient or not, only the specialist decides.

    This is usually done after restoring the joint by manual method, since after that the meniscus should be in a certain position for 2-3 weeks. This can only be done with a plaster lining.


    Surgical intervention with a meniscus injury

    When performing an operation, doctors follow the main principle - to preserve the organ and its functions as much as possible in order to facilitate the patient's rehabilitation period. If conservative methods of eliminating the meniscus rupture are ineffective, then the treatment continues with the help of surgical methods. First, a test is performed on the possibility of sewing a ruptured cartilaginous tissue. This is usually done with damage in the so-called red zone.

    In other types of injuries of the horn of the medial meniscus, this type of surgery is possible:

    • removal of ruptured cartilage - arthrotomy. This is a rather complicated operation, which does not always lead to a cure of the patient. Many surgeons have completely abandoned the use of such an intervention. But with extensive lesions of the meniscus and the entire knee joint, it must be carried out;
    • complete removal of cartilaginous tissue or meniskectomy is practically not used today as it is absolutely ineffective and harmful;
    • removal of a part of the cartilaginous tissue with subsequent restoration of the remaining is called a partial meniscactomy. With her, the surgeon cuts and aligns the edges of the cartilage;
    • transplantation and endoprosthetics are performed by transplantation to a patient with a donor meniscus or an artificial analogue. Such treatment allows to completely restore the functions of the knee joint;
    • to date, medicine is developing towards the production of few traumatizing human operations. In the operation on the meniscus, arthroscopy is considered to be this. It is carried out using 3 small punctures on the knee. In one of them, a miniature video camera and physiological saline are injected, and others perform surgical manipulations inside the knee at the joint. This method allows you to quickly prescribe a patient after rehabilitation;
    • for the elimination of damage in the dense part of the meniscus( white zone) is very effective stitching of damaged cartilage tissue.

    Rehabilitation of patients after the course of treatment

    It is needed to restore the functional capabilities of the joint. It is only under the control of the treating orthopedic physician. He chooses the optimal rehabilitation treatment based on the individual characteristics of the patient's body. All measures in the end should lead to the complete restoration of the damaged joint and the return of the person's ability to work.

    The main thing is to start treatment on time, preferably immediately after getting an injury on the meniscus, and then the patient's recovery is guaranteed.

    MoiSustav.ru

    Knee joint meniscus injury: treatment and consequences

    If the meniscus is torn, then the inflammatory processes and the presence of degenerative phenomena serve as a pushing point to the complete rupture.

    Various pain tests are used to confirm the damage.

    Diagnostics

    Diagnosis of knee joint meniscus damage is performed by visual examination of the patient, instrumental examination methods, but the most informative and correct will be to do arthroscopy or, in contrast, arthrodentgenography. Virtually all the symptoms of meniscus damage are also characteristic of other diseases in the knee joints. It is for this reason that there are sometimes problems in determining the opening of the meniscus in time.

    To diagnose damage to the external meniscus of the knee joint, a method of checking for a click in the knee is used when flexing and unbending. Such damage can lead to cystic degeneration. Three degrees of degeneration of external meniscus lesions are determined:

    1. The first degree is determined by the presence of a moderately painful condition and the infiltration of the capsule.
    2. The second degree is clinically determined by painless protrusion, which becomes smaller, or completely disappears after extension.
    3. The third degree is defined by a tumor-like protrusion or build-up, which, after extension, does not completely disappear.

    Treatment of

    How to treat the knee joint meniscus is determined by the doctor depending on the degree of damage to the knee joint meniscus. As it was said earlier, it is possible to use conservative treatment, and there is a likelihood of surgical intervention. Most of the injuries are somewhere in between a small rupture and a big painful one. That is why, to the decision about surgical treatment, a physician should approach thoroughly what is the severity of the trauma, what is it. The athlete is engaged in the load.

    Treatment without surgery

    The conservative method of treatment is used for minor tears in the medial meniscus of the knee joint. It is also used for small radial ruptures, which, although accompanied by aching pain, but the infringement of the meniscus is absent. There is no rolling, no clicks. All treatment is aimed at limiting the physical load on the aching leg for some time. In our country, there is a practice of applying gypsum to the place of damage to the internal meniscus of the knee joint, but this method is not correct, in the absence of additional injuries or fractures in the knee.

    Operative intervention

    If the patient's condition does not improve with the use of conservative treatment, then the decision is made about the operation of the knee joint meniscus. The purpose of the operation is to leave as much as possible the body of the meniscus. Some parts are spliced ​​using seams. Previously, total meniscectomy was common, today it is often the use of suturing, minimally invasive or open method. Arthroscopic surgery is the newest method in the treatment of the internal knee joint meniscus. This operation lasts up to 2 hours.

    Consequences of damage to the knee joint meniscus

    If the treatment of the internal meniscus of the knee joint or external injuries is carried out at the time and is assigned correctly, then the prognosis is favorable. All the inconvenience is that there will be a restriction of physical exertion for several months. The consequences of damage to the knee joint meniscus depend on their degree and speed of diagnosis. When assistance is provided correctly and by a qualified specialist, the result will be the restoration of full physical activity. The prognosis in persons over 40 years is less favorable, since the ligamentous apparatus at this age is weak.

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    7sustavov.ru

    Meniscus: what's wrong, knee surgery

    • Surgical treatment

    A dense, mobile C-shaped cartilaginous tissue attached to the joint surface at the upper end of the tibia is called a meniscus. This pad - just an indispensable assistant for any movements of the legs. In total, there are two types of cartilage in the knee. The organ located on the inside of the joint is called the medial meniscus, and the lateral meniscus, which is on the outside, is called the medial meniscus.

    IMPORTANT TO KNOW!Doctors are dumbfounded! The pain in the joints is FOREVER!Just before bedtime. .. Read on - & gt;

    Meniscus: anatomy and organ functions

    Menisci made of soft and rather elastic fibrous cartilaginous tissue. Each meniscus is attached to the knee joint capsule. Between them, the sickle-shaped cartilaginous tissue is connected by a transverse ligament. At each individual site, the density of the meniscus is different . With age, the cartilage decreases and becomes thinner. In the meniscus, it is common to distinguish such parts:

    • body organ;
    • front horn;
    • rear horn.

    In view of the fact that the menisci are connected on the side of the joint with its capsule, the blood supply also has from the arteries of the capsule. The inner parts of the cartilage are in the depth of the joint. The tissues are fed by intra-articular fluid circulation.

    For this reason, the meniscus lesions that occur near the joint capsule coalesce quickly, and the ruptures of the internal parts do not grow together at all.

    The medial meniscus has the form of a young moon, and the lateral one is almost an annular surface. The first meniscus is already narrower than the second. The anterior horn of the lateral cartilage is attached outside the medial intercondylar ridge and PKC( anterior cruciate ligament).Directly to the lateral intercondylar elevation, the horn of the organ is attached. For a simpler understanding of the place in the knee where the meniscus is located - the photo helps in the best way.

    Purpose of the meniscus

    The main function of the meniscus is the stabilization and damping of the joint. Cartilage is also needed to mix the synovial fluid during movement, which results in lubrication of the cartilage, and its protection against shocks and shocks is guaranteed. These organs are also needed to maintain and control the consistency of the work of all the elements of the joint at the time of the movements.

    Due to its fibrous structure, menisci increase the concavity of the tibia. They protect articular cartilage from premature or increased wear, and also soften the load on them. The main functions of the meniscus include:

    • participation in the lubrication and nutrition of hyaline cartilage;
    • buffer function( softening of shocks and shocks);
    • increasing the contact area and forming the integrity of the knee structure;
    • control of movements in the joint;
    • stabilizing function.

    Mechanism and frequency of meniscus damage

    Breaking or tearing of the knee joint meniscus is a common injury. According to some data, it exceeds the number of injuries of the anterior cruciate ligament. Frequent in medicine and cases of combined injuries. Every third diagnosis of rupture of PKS is accompanied by a complication in the form of a meniscus injury. In half of cases of fractures of the tibia in the condyle zone, there is also a rupture of the cartilage.

    In all age groups, the meniscus injury is of a different nature. In men between the ages of 40 and 60, the rupture of cartilage occurs due to changes in the tissue of the organ, and young men up to the age of 30 are more likely to receive a meniscus injury. For women, these rates are much lower, and the rupture of the cartilage is of an organic nature. Children and adolescents usually get damage to the cologne because of their high physical activity and careless movements.

    The greatest number of injuries is caused by the meniscus damage by the type of "handle of the watering can", rarely there is isolated damage to the horn( 25-30% of cases).The injury to the anterior horn is only 9%.

    Mechanisms for meniscus injury

    There are two types of mechanisms for knee cartilage injury: direct and indirect( rotational).The direct action mechanism is associated with a direct knee strike with a fixed foot in the normal position. Damage to the lateral meniscus or internal cartilage of the joint can also be caused by sharp bending of the legs in the knees. Increase the risk of injury and degenerative changes of the meniscus.

    Indirect mechanism of cartilage traumatization occurs with a fixed foot with internal or external scrolling of the shin. At the same time, the condyles of the hip and shin are mutually opposite. Moves with them and the meniscus, as they are attached to the articular surface of the tibia. Also at times increases the likelihood of knee injury, the presence of a cyst in the cartilage body.

    Symptoms of a meniscus injury

    When a knee joint meniscus is damaged, signs of injury can be quite ambiguous. Some doctors, not to mention patients, are very confusing.

    The complexity of diagnosis is that often damage to the cartilage is accompanied by symptoms that are characteristic of damage to ligaments, fat bodies or patella. To determine the diagnosis of orthopedists use a number of special tests.

    Meniscus tear: symptoms of

    Small cartilage ruptures are characterized by painful clicks or a sense of difficulty in movement. With complete detachment of the meniscus, joint blockage is possible, part of the torn and dangling fragment of the cartilage that has moved to the center. Problems with leg folding occur with trauma to his body and anterior horn, and the restriction of the knee bend indicates the rupture of the posterior horn of the cartilage.

    In case of acute rupture, which occurred in parallel with damage to the anterior cruciate ligament, the inflammation of the meniscus, expressed in the swelling of the knee surface, will have a pronounced character. External cartilage is often ruptured when anterior cruciate ligament is injured. This is due to the fact that as a result of damage, the meniscus is caught between the femoral and tibia.

    Providing a blockade of the knee joint can not only break the meniscus. The cause is the breaking of the anterior cruciate ligament, the fracture of the tibial condyles, the knee joint plaque syndrome and other troubles.

    Symptoms of chronic and degenerative meniscus tears

    Meniscopathy - chronic cartilage damage can develop in athletes and people older than 40 years. Tumescence and pain in the affected area will develop gradually and will not always flow with a sharp increase. Often, trauma can be detected with very little impact: flexion or extension of the leg. Degenerative ruptures usually give only pain, rarely blockade of the joint.

    In case of degenerative rupture, neighboring cartilage is often damaged. The degenerative signs of a meniscus can have a variety of symptoms: from pain under heavy loads to pain with slightest movement of the legs. In chronic cartilage damage, the medial part suffers. Pain in the knees at the same time appears in the morning, but gradually when walking, decreases or disappears altogether.

    Treatment of meniscus lesions

    There are many tips and real medical tactics for treating knee cartilage injuries. The main thing is to find an effective way. Taking into account many factors concerning the patient, the doctor will choose one of the appropriate methods of treatment: operative or conservative. Regardless of the subsequent therapy, it is important during the first aid to the victim - apply a cold compress.

    Conservative treatment

    A knee joint puncture is performed with conservative treatment. Removing a certain amount of blood helps to remove blockade of the joint. Then the patient must undergo a set of physiotherapy procedures. This approach is most effective for people suffering from cartilage ruptures that are localized in the blood supply zone.

    Physiotherapeutic impact will consist of the following activities:

    • curative gymnastics course;
    • various physical procedures( eg, myostimulation);
    • massage.

    The recovery of the meniscus will also be aimed at taking special preparations - chondroprotectors. They are particularly effective in the early stages of the disease. If the horn of the medial meniscus is damaged or the entire cartilage is damaged, the chondroprotector will not be able to restore the tissue to its full extent. Do not forget that the course of therapy is not fast. Sometimes the intake of drugs lasts up to 3 years.

    Treatment of the meniscus in a conservative way involves two routes of exposure: medicamentous and physiotherapeutic. Preparations, injections, ointments, a set of physical procedures and massage the doctor prescribes strictly in an individual order.

    Surgical treatment

    Arthroscopic meniskectomy - removal of a damaged meniscus by means of special arthroscopic equipment, is the most common operation on cartilage. It is carried out exclusively if there is no possibility to restore the organ.

    Before the resection of the meniscus is scheduled, the doctor will not only conduct a full examination of the patient, but also take into account the following parameters:

    mirsustava.ru

    Knee joint meniscus rupture: symptoms and treatment

    Among all the joints of the human body, the knee has a special location: constant loads during movement and a high risk of injuries are combined with an unusually complex structure. First, the joint is formed on the surface of four bones and has numerous ligaments, and secondly, it has special structures necessary for the damping of motion - medial and lateral meniscus .

    In most cases, knee pain is caused by meniscal pathologies, among which the leading place in people aged 15 to 40 years are injuries, and after 50 years - degenerative changes. The extreme degree of damage is the break.

    What is a meniscus and why is it prone to rupture?

    Meniscus is a cartilaginous layer between the condyles of the femoral and tibia, which is necessary for damping the joint during movement. The shape of the cartilage resembles the letter "C".The lateral meniscus is firmly attached to the articular surface, the medial one, on the other hand, has considerable mobility, which determines the frequency of its damage. Active games and sports that require quick reaction and sudden movements are one of the most common causes of meniscus damage in young people. Unsuccessful sharp turn of the leg - and the medial meniscus does not have time to "escape" from the traumatic squeezing of the condyles. The causes of rupture of the meniscus in people of mature age are almost unrelated to trauma. The soil for them is degenerative changes that occur with age in the cartilaginous tissue. Violation of blood circulation leads to dystrophy and exhaustion, fragility of the meniscus, the formation of cysts.

    Symptoms of rupture

    By the nature of the causes and predisposing factors, the meniscus fractures are divided into two types:

    1. traumatic - proceeds acutely and has very characteristic symptoms;
    2. degenerative - arising in connection with destruction of cartilage without characteristic cases in the anamnesis, proceeds mainly in the chronic and erased forms, without the expressed clinical displays.

    Acute meniscus damage is characterized by intolerable pain, swelling and impaired mobility of the joint. But such symptoms can indicate a number of injuries - from dislocation to ligament rupture, more characteristic symptoms appear later - in 2-3 weeks. During this time, the inflammatory fluid accumulates in the joint cavity, the knee is completely blocked in a half-bent position, the muscles of the front surface of the thigh lose tonus. Often, in the joint cracks, you can also feel the meniscus: when the exudate accumulates, it shifts and jams between the condyles.

    More reliable data on the nature of the knee joint meniscus injury are obtained by the method of pain tests - an attempt to rotate causes intolerable, cutting sensations in the patient. Nevertheless, precise data on the type of rupture and its location can be obtained with the help of special methods, the most informative of which is MRI.With degenerative damage, the symptoms are erased: clicks and joints are felt, soreness sometimes appears, and in periods of exacerbations there is swelling and mobility is impaired, but complete blockade does not occur.

    The rupture of the medial meniscus is more often traumatic, which is due to its anatomical features - high mobility within the joint, because of which a sharp rotation movement causes the cartilage to be squashed between the condyles.

    The rarest form of damage is the rupture of the posterior horn of the lateral meniscus. A rigidly fixed cartilage can be seriously injured only in cases when there is meniscopathy and degeneration, the structure and properties of the "cushioning" knee are lost.

    Meniscus tear is a frequent phenomenon for athletes and dancers, due to the speed of movement and the sharp extension of the knee. In this case, the cartilaginous disc leaves from the articular surface, causing pain and partial blockade of the knee. The consequences of an anguish can affect in a few years - the paramenex cyst becomes the cause of thinning and degeneration of the meniscus.

    How to treat a meniscus rupture?

    Violation of mobility and swelling of the knee are symptoms that are hardly worth fighting with home remedies, and consequences in the form of destruction of the meniscus and arthrosis can lead to complete ankylosis - the immobility of the joint. In modern medical practice the most frequently used conservative methods of treatment of rupture, only ripped and combined forms require immediate surgical intervention.

    Conservative therapy

    Treatment of the meniscus of the knee joint begins with the elimination of the most disturbing symptoms of the patient - pain, swelling and squashing of the cartilage. A puncture is performed in which the inflammatory fluid is removed through the needle with the trocar, after which the disc can be easily adjusted. Intervention under local anesthesia is performed. In some cases, the attending physician decides on the need for immobilization of the knee - for a period of up to three weeks, a plaster cast is applied.

    The second important step is the elimination of inflammatory processes. The most suitable for the treatment of meniscus injuries are drugs combining anti-inflammatory effect with analgesic effect( diclofenac, nimesulide, ibuprofen and others).Along with them, steroid drugs( hydrocortisone, prednisalone) are also used. The third stage is rehabilitation. For several months, complexes of physiotherapeutic procedures have been used - electrophoresis, massage, warming. Particular importance is attached to physiotherapy exercises, developed with different loads for the right and left knee, depending on the nature of the lesion.

    Conservative therapy does not guarantee a complete restoration of the meniscus, so patients are also assigned several courses of treatment with chondroprotectors at intervals of six months. Good results are obtained using conservative treatment of innovative physiotherapy techniques - shock wave therapy, which helps accelerate the movement of blood in the capillaries, the supply of nutrients to the rupture zone and the early recovery process.

    Surgical treatment

    The long-term and long-term damage of the internal meniscus is always the reason for the appointment of surgical treatment, which in most clinics is performed by the method of arthroscopy, without an open incision of the joint.

    In the course of the operation, two miniature incisions are made in the knee tissues, through which the camera and instruments are inserted - all manipulations with the meniscus are performed under the visual control of a specialist. Depending on the type of lesion, several tactics may be selected:

    • resection of the damaged part of the meniscus;
    • complete removal of the cartilaginous disc;
    • stitching.

    Therapeutic arthroscopy can be performed only when the inflammation no longer disturbs the patient - at least two weeks after the injury and after a conservative treatment. As a rule, the operation is performed only in those cases when symptomatic therapy did not give the desired results. It is unavoidable for athletes, too, because it allows you to quickly return to training and competition.

    With the development of medical technologies, the technique of meniscus transplantation, which allows replacing the damaged cartilage with a fully functioning artificial or obtained from donors, has gained wide popularity. Such a solution allows avoiding relapses and long-term consequences in the form of arthrosis and contracture, but the cost of surgery when replacing the disc increases many times.

    Prognosis and consequences

    Cartilage tissue has a fibrous structure and lacks its own blood supply system - it receives food and oxygen through nearby tissues. Accordingly, healing and recovery processes go slowly in it - it may take years to fully recover after a meniscus rupture.

    Forecast of the outcome of the disease specialists formulate, based on a number of factors:

    • Age of the patient. In a young organism, the processes of cell regeneration and multiplication go much faster, so at twenty years there is much more chance of a complete recovery than in the forty
    • Ligament condition. With weak ligaments, the meniscus can be repeatedly shifted and found between the condyles of the bones, which will cause repeated trauma.
    • Localization of the gap. Damages located in the same plane can be sewn together and grow together much more quickly than the torn ones.
    • Damage permanence. The earlier you turn to a specialist, the more likely the cure is by conservative methods.

    Lack of adequate treatment and even just a total removal of the meniscus have very unpleasant consequences - because the depreciation of the movement is violated, cartilage joints undergo destructive changes, gradually thinning. Arthrosis gradually progresses and after years of cartilage completely disappears from the articular surfaces of bones. To avoid this phenomenon, patients after knee injuries are recommended to take chondroprotectors.

    The most severe consequences of the meniscus rupture are contracture and ankylosis, in which the limb loses mobility. Therefore, treatment for a meniscus rupture should be started as early as possible, without fail following all the doctor's recommendations.

    infmedserv.ru

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