Meniscus injury consequences. Damage to the meniscus of the knee joint

A tear of the meniscus of the knee joint is understood as a violation of the integrity of the special cartilage inside the joint, which plays the role of a lining. From an anatomical point of view, the correct name for the pathology is “meniscus tear”, since the meniscus is present only in the knee joint. But the name has stuck and is used among patients and in the clinic.

The knee joint experiences a lot of stress during active movements, but it is softened thanks to this padding. If it were not for the meniscus, disorders of the articular surfaces of the knee joint would develop at a young age. Damage to the meniscus leads to deterioration of natural shock absorption, increased load on the joint structures and greater wear and tear.

Treatment is conservative, but if the results are not satisfactory, then surgical restoration of the integrity of the meniscus is indicated, and in case of severe injury, meniscectomy (its removal).

Total information

A torn meniscus is the most common of all types of knee injuries. Most often it occurs in those who lead an active, and often extreme, lifestyle. As a rule, these are people who play sports or do heavy physical work. The age group mainly affected is from 18 to 40 years. Men visit the clinic for a torn meniscus of the knee joint more often than women - the ratio of visits is 3:2. The predominance of male patients is associated with more pronounced physical activity than in women.

note

Due to the age-related characteristics of the meniscus (its more pronounced elasticity and firmness), in children under 14 years of age, its rupture is practically not diagnosed; each case has some special prerequisites.

Most children are injured due to a pronounced impact on the knee joint or due to some congenital pathology. Against the background of the latter, the meniscus becomes weaker than in other children, this contributes to its damage.

According to statistics, meniscus tears occur equally often on both knee joints. The outer side of the knee joint is more open to external influences and very often takes the blows on its own. However, internal meniscus tears occur approximately 3 times more often than external meniscal tears.

Simultaneous ruptures of both menisci are diagnosed quite rarely - in 5% of all clinical cases of this injury.

Features of the menisci

Menisci are elastic, elastic cartilage formations that are located inside the knee joint - between the articular surfaces of the tibia and femur.

There are two menisci in each human knee joint:

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

The anterior parts of the menisci are attached to one another using a transverse ligament - a bundle of connective tissue fibers. Also, the internal meniscus is attached to the lateral internal ligament of the joint - during trauma, both of these formations can be damaged simultaneously.

Each meniscus is shaped like a semicircle. It consists of:

• body - that’s what its middle is called;
• anterior and posterior horns (edges).

The anterior horns of the menisci are attached to the anterior part of the intercondylar eminence, the posterior horns to the posterior part. The lateral parts of the menisci have a convex surface - in this place the meniscus is fused with the capsule of the knee joint.

The menisci serve not only as a cushion in the knee joint. Their main functions are as follows:

• shock absorption and shock absorption that falls on the knee joint when it is involved in the process of movement (walking, running);
• stabilization of the knee joint - the meniscus does not allow it to be in a loose state;
• increasing the area of ​​contact between the tibia and femur - this reduces the load on their articular surfaces;
• signals to the brain what position the lower limb is in. Such “hints” are possible thanks to the proprioceptors that are present in the menisci - these are nerve structures.

There are no vessels in the menisci themselves; they are nourished as follows:

• lateral parts - due to the vessels of the joint capsule;
• the internal parts - due to the proximity of the synovial fluid, from which nutrients enter the meniscal tissue.

Taking into account the nutritional characteristics, three zones are distinguished in the menisci:

• red;
• intermediate;
• white.

red zone is located in close proximity to the capsule. If there are any traumatic ruptures in this area, they generally heal on their own due to the developed blood supply in this location.

Intermediate zone is located further from the capsule, so its blood supply is somewhat worse, healing of meniscal tissue is more problematic. For this reason, if the integrity of the meniscus is damaged in this location, surgical treatment is necessary.

White zone called the area of ​​the meniscus that is closer than other areas to the center of the knee joint. This location is less well supplied with blood than both others described above, and the nutrients in the synovial fluid are not enough for full-fledged repair processes that would ensure the fusion of damaged areas of the meniscus. Because of this, the full restoration of the integrity of the meniscus does not occur; surgical treatment is necessary to eliminate the problem.

Causes

The causes of a knee meniscus tear are purely mechanistic. Pathology can occur with the development of such mechanisms as:

• indirect or combined injury, in which the lower leg is sharply rotated (turned) inward or outward. In the first case, the external meniscus is damaged, in the second - the internal one;
• excessive extension of the leg. This mechanism does not lead to a meniscus tear as often as the injury described above;
• too sharp adducting or abducting movement of the leg;
• direct trauma. This could be a blow from an object that is moving, sudden contact of the knee joint with a hard surface (for example, when falling on steps), and so on.

In case of a combined injury (for example, a fall on the knee with rotation of the tibia), other structural elements of the knee joint are very often damaged simultaneously with the meniscus:

• ligaments;
• joint capsule;
• cartilage

If repeated injuries of the knee joint are observed (bruises), against their background, the physical properties of the meniscus deteriorate. A degenerative process often develops - literally degeneration of the meniscal tissue. Against this background, another injury poses a great danger in terms of meniscal rupture. A vicious circle is formed, the links of which contribute to each other’s development. The degenerative process is often accompanied by the formation of meniscal cysts - small cavity formations with fluid inside.

The causes of such degeneration, which subsequently contribute to the development of the described pathology, can also be:

• infectious diseases;
• microtraumas that occur due to regular overload of the knee joint;
• chronic intoxication;
• metabolic disorders;
• endocrine disruptions;
• congenital pathologies.

From infectious pathologies, which lead to a degenerative process in the menisci and thereby contribute to its rupture, most often noted is an infectious and inflammatory pathology of connective tissue with predominant damage to the heart and blood vessels. But any other infectious lesions can cause the same effect.

Microtraumas Against the background of regular overload of the knee joint, this is a real scourge: by overloading the knee joint for a long time, a person does not suspect that he is thereby contributing to a future meniscus tear, which forms during the first significant knee injury. Those involved in heavy physical labor, as well as athletes, are often exposed to such microtraumas. Strength sports, as well as collective sports accompanied by confrontation, have a particularly great negative significance:

• struggle;
• Weightlifting;
• football;
• hockey;
• volleyball;
• basketball

and many others.

Chronic intoxication, which contributes to damage to the meniscus of the knee joint, can occur in the following cases:

• long-term infectious pathologies with the constant release into the blood of toxins of microorganisms, their metabolic products and the decay of dead microbial bodies (,);
• regular contact with toxic substances - often due to the type of activity (when working with vinyl chloride, benzene, toluene, and others).

note

Of the metabolic disorders that cause the menisci to weaken and become more easily damaged, the most commonly observed is a metabolic disorder in which uric acid salts are deposited in the tissues.

Weakness of the cartilage tissue of the menisci, which contributes to their ruptures, occurs against the background of endocrine disorders. We are talking about an imbalance on the part of those hormones that regulate the growth and development of cartilage tissue - these are:

• estrogens;
• corticosteroids;
• somatotropic hormone.

Congenital pathologies that contribute to meniscal weakness may include:

• systemic disorders of the structure of cartilage tissue;
• hypoplasia of the menisci - their underdevelopment;
• disruption of the structure of the vessels of the knee joint, due to which the blood supply to the menisci, which do not have their own vessels, suffers even more.

Against the background of the listed contributing factors, meniscal tears can occur even as a result of minor traumatic effects.

Development of pathology

Menisci are small structures. However, there are a number of their injuries, which are classified for convenience in the clinic.

According to the type of damage, meniscus tears are:

According to the degree of development, meniscal tears are:

• full;
• incomplete.

Based on the characteristics of the damage, the following types of this pathology are distinguished:

• isolated - in this case one meniscus is damaged;
• combined – the integrity of both menisci of the knee joint is compromised.

Of all types of injuries, ruptures of the “watering can handle” type are most often diagnosed; isolated injuries of the posterior and anterior horn are somewhat less common.

There are other types of classification of this injury.

Symptoms of a meniscus tear

The clinical picture of a knee meniscus tear consists of the following periods:

• spicy;
• subacute;
• chronic.

A feature of the acute period in case of damage to the meniscus is that a nonspecific reactive inflammatory process with all the attendant signs of inflammation predominates in its tissues, so it is difficult to make a correct diagnosis. The following main signs are observed:

• restriction of movements.

Characteristics of pain:

Of the entire “set” of movements that are possible in the knee joint, extension is especially difficult.

The course of the acute period depends on the severity of the lesion:

• if the ruptures are incomplete, insignificant, then the clinic is not pronounced and disappears over the next few weeks;
• with moderate ruptures, the pain becomes acute, movements are limited, but the patient can walk (albeit with difficulty). If full treatment is prescribed, the symptoms will stop within a few weeks, and if it is not carried out, the pathological process becomes chronic;
• with severe damage to the menisci of the knee joint, severe swelling and severe pain are observed, and blood accumulates in the joint (this condition is called). Walking is, at best, severely difficult, and at worst, completely impossible. This condition will require surgical treatment.

The subacute period develops after 2-3 weeks. Inflammatory reactive phenomena become less pronounced. Mostly local phenomena are observed:

• compaction of the knee joint capsule;
• pain;
• impaired movement in the joint (blockade) is the most accurate confirmation of a meniscus tear (more often occurs when the internal meniscus is damaged).

If the meniscus tear was small, then when acute and subacute phenomena subside, the process becomes chronic, which manifests itself as constant moderate pain and impaired movement in the knee joint.

Diagnostics

The diagnosis is made based on the patient’s complaints, anamnestic data (fact of injury), and the results of additional examination methods.

A physical examination reveals the following:

• on examination - moderate swelling of the knee joint, impaired movement in it;
• on palpation (palpation) – pain, which intensifies when attempting passive movements in the joint performed by the doctor’s hands.

To confirm the diagnosis, special tests are performed:

• mediolateral test;
• test to detect compression symptoms;
• rotational (Steiman-Bragarda);
• extension (Landy, Rocher)

and others.

Important instrumental diagnostic methods are:

Differential diagnosis

Differential diagnosis of a meniscus tear of the knee joint is carried out with such diseases and pathological conditions as:

• infringement of intra-articular bodies;
• reflex muscle.

Incarceration of intra-articular bodies can occur with such pathologies as:

• Hoffa's disease (another name is lipoarthritis) - degeneration of the fatty tissue that is located around the knee joint (it is also called Hoffa's fatty bodies);
• Koenig's disease is a type of osteochondropathy, which consists of the occurrence of necrosis (death) in a limited area of ​​articular cartilage. In this case, the affected fragment breaks off from the surface of the cartilage and forms an articular mouse;
• chondromatosis is a dysplastic process (disturbance of metabolic processes in tissues), in which cartilaginous bodies are formed in the synovial membrane of the joint;
• Chondromalacia is a disorder of the mineral composition of cartilage, which leads to its softening.

Reflex muscle contracture accompanies pathologies such as:

• bruises;
• damage to ligaments and joint capsule.

Complications

The main complication of a torn meniscus of the knee joint is its blockade - the inability to perform movements.

In some cases, reactive inflammation develops simultaneously, but it is not pronounced, and therefore cannot be regarded as a separate complication.

Knee rupture treatment and surgery

Treatment for a knee meniscus tear mainly depends on:

• severity of injury;
• its localization.

At the initial stage, treatment is as follows:

• puncture of the joint and, if blood is present, suctioning it out;
• rest of the lower limb, if necessary, immobilization (for this purpose, apply a plaster cast);
• on the day of injury - local cold;
• painkillers.

Surgical treatment is performed for the following indications:

• separation of the body and horns of the meniscus;
• meniscal rupture with subsequent displacement;
• crushing it;
• lack of effect from conservative therapy.

The most popular operations are:

• restoration of the integrity of the meniscus using sutures and special structures;
• meniscectomy.

Traumatologists use the slightest chance to preserve the meniscus, since in its absence the following develops:

• the anatomical relationships in the joint are disrupted;

Such disorders provoke the development of post-traumatic deforming - non-inflammatory destruction of its elements.

It is possible to suture the meniscus if:

• separation from the joint capsule;
• peripheral and longitudinal vertical tears.

The chances of favorable results after surgery are higher in circumstances such as::

• fresh injury;
• patient age under 40 years;
• presence of damage in the intermediate or red zone.

Often, instead of stitching, meniscus fragments are fastened using absorbable dart-shaped or arrow-shaped fasteners.

Absolute indications for removal of the entire meniscus or its fragment are:

• separation of a large fragment;
• ensuing degeneration of cartilage tissue.

It should be remembered that meniscectomy eliminates pain only in 50-70% of cases and in itself is a factor that can cause complications in the postoperative period such as:

• effusion formation;
• – inflammation of the joint;
• arthrosis

The larger the removed fragment of the damaged meniscus, the higher the risk of postoperative complications.

The operation is carried out:

• open method;
• using an arthroscope.

Treatment in the postoperative period consists of the following:

• limiting the load on the joint for 6-12 months after surgical treatment;
• physiotherapy;
• massage;
• chondroprotectors;
• NSAIDs.

Prevention

Preventative measures for knee meniscal tears are:

• avoiding any situations in which there is a high chance of injury to the lower limb in general and the knee joint in particular;
• if necessary, activities associated with the risk of injury - use of knee pads;
• prevention of pathologies that contribute to the weakness of the cartilaginous tissues of the meniscus, and when they appear, timely diagnosis and treatment.

Forecast

The prognosis for a torn meniscus of the knee joint varies. If adequate treatment has been carried out, the prognosis is usually favorable, without surprises. Sometimes there may be unsteady gait and pain when putting pressure on the knee joint.

Content

If you make an unsuccessful jump, hit, sit for a long time, or make a sharp turn, you can get injured. A torn meniscus of the knee joint is a common type of injury during high physical activity. Acting as shock absorbers, these cartilage plates smooth out the friction of the leg bones. If the damage is not diagnosed in time, the knee joint will be constantly disturbed, and complications such as its destruction are possible. Without a doctor, it is impossible to determine the type of injury.

What is a meniscus tear

This problem is faced by athletes and people leading an active lifestyle. The meniscus of the knee joint is a shock absorber consisting of cartilage tissue. It contracts as it moves. There are two layers of cartilage in the knee - the outer (lateral) and the inner (medial). If the second one is damaged, fusion is more difficult. Without diagnosis, it is difficult to distinguish a rupture from a bruise. Damage can be traumatic (due to sudden movement) or degenerative (due to age). The torn part of the cartilage tissue interferes with walking, causing pain.

Causes

A meniscus tear occurs when carelessly turning on one leg or squatting for a long time. In this case, the load becomes high, the cartilage layer cannot cope with it. A torn meniscus is unable to perform its functions. At risk are obese people who perform heavy physical work, and athletes in contact games (for example, football players, skiers, runners, jumpers, speed skaters). It also includes those who suffer from chronic diseases associated with circulatory and metabolic disorders. Causes of damage:

• heavy loads on the knees;
• unsuccessful jump, squat, uncoordinated movements;
• blow to the leg, fall on the rib of the kneecap;
• natural aging processes;
• repeated injuries, old bruises - cause meniscopathy (chronic form);
• gout, microtraumas, intoxication of the body, rheumatism lead to degenerative changes in cartilage.

Symptoms

Meniscus damage can easily be confused with other knee diseases. Movements are constrained and acute pain occurs. Sometimes there is an imaginary recovery with periodic relapses. The affected knee swells greatly. If you do not tear, but slightly damage the layer in the joint, a click is felt. Trauma can lead to compression of the cartilage plate, its separation from the capsule, and the presence of transverse or longitudinal damage. To confirm the diagnosis, it is necessary to undergo ultrasound, radiography, MRI, CT. Symptoms of a torn meniscus are:

• joint blockade with restriction of movement;
• sensation of a foreign object under the kneecap;
• you can feel the bone heads rolling;
• at first there is a sharp pain, which can later become habitual;
• swelling due to the development of inflammation;
• increasing pain due to circulatory problems;
• increased temperature of the damaged joint;
• pain when going up/down stairs.

Consequences

Proper treatment of a knee meniscus tear without surgery does not have any negative side effects. It is recommended to limit physical activity to prevent the injury from recurring. It will take 2-3 months to restore working capacity. To speed up this process, physiotherapy, physiotherapy and massage are prescribed on an individual basis. Cartilage tissue wears out faster after injuries, osteoporosis and arthrosis develop.

Medial meniscus tear

This injury is more common due to inactivity. A tear of the medial meniscus of the knee joint means damage to the inner plate of cartilage, which is shaped like the letter “C”. Inactivity and impaired blood supply mean that such an injury is rarely eliminated. The internal cartilaginous plate cannot be cured with medication; surgery must be used. According to the shape of the injury, there are: patchwork oblique, horizontal, longitudinal vertical, radial-transverse.

Lateral meniscus tear

The outer cartilage layer is more mobile and is more difficult to damage than the medial layer, because it is not tightly fixed to the joint capsule. The resistance to non-physiological loads is higher. The damage must be treated comprehensively. If a rupture of the internal meniscus of the knee joint can occur on its own, then the lateral one appears in the presence of other problems, for example, an injury to the cruciate ligament.

Treatment of a torn meniscus

The type of therapy is determined by the extent of the damage. There are conservative treatment (non-surgical) and surgical. The second option is necessary if it is not possible to neutralize the blockade of the knee joint, in a chronic form. The outcome of treatment depends on many factors: the patient’s age, the presence of meniscopathy, degenerative processes, and the area of ​​injury. It is important to provide correct first aid:

• immobilization of the knee joint - fixation of the leg to a hard surface;
• to relieve swelling, apply a knee pad with cold - this will help narrow the blood vessels and prevent fluid from accumulating;
• if the meniscus is torn, the pain will be unbearable at first, it is better to give drugs that reduce these sensations (Diclofenac, Promedol, Indomethacin).

Without surgery

Blockage of the knee joint is eliminated by puncture and removal of accumulated blood or effusion (fluid). The doctor you contacted for injuries performs manipulations on the foot and lower leg. If the blockage persists, a posterior splint is placed on the leg to provide immobility. Conservative therapy for a meniscal tear consists of physical therapy, massage, and taking chondroprotectors (restore the structure of cartilage tissue). It is supplemented by a UHF course, which relieves inflammation, relieves pain, and accelerates cell regeneration.

Surgical

Surgical intervention is relevant if there is repeated blockade of the knee joint, hemarthrosis, crushing of cartilage tissue, if the meniscus of the anterior and posterior horn is damaged, without displacement or with displacement. After diagnosing and studying the extent of damage, the traumatologist determines the scale of the operation. It is performed on people under 45 years of age who do not have degenerative processes in their cartilage. Main approaches in surgical treatment:

• meniscectomy - removal (partial or complete) - a painful operation that leads to arthritis;
• restoration of the cartilage plate is a more gentle option for preserving the biomechanics of the knee joint, performed by:
  • fastenings inside the joint using arrow-shaped fasteners (no incisions required);
  • transplantation with complete crushing of the cartilaginous layer;
  • arthroscopy - a camera (arthroscope) is inserted through the incision, the gap is sutured with non-absorbable threads.

Video

Attention! The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

The most commonly used symptoms of a knee meniscus injury are:

Constant pain at the level of the knee joint gap.

Atrophy of the muscles of the thigh, and sometimes the lower leg.

Baykov's symptom

Baikov's symptom: the knee joint is bent to an angle of 90°, a finger is pressed on the corresponding part of the joint space and the lower leg is passively extended, while the pain sharply increases.

Chaklin's symptoms

Chaklin's tailor's sign: with active raising of the straight leg, atrophy of the internal portion of the quadriceps femoris muscle is visible and against this background the tension of the sartorius muscle is sharply contoured;

Chaklin's "click" symptom during movements in the knee joint.

• Turner's symptom: increased local pain and temperature sensitivity in the innervation zone of the n.saphenus, along the inner surface of the knee joint (if the internal meniscus is damaged);
• Perelman’s “staircase” symptom: pain when going down the stairs;
• flexion contracture of the knee joint;
• Landau's symptom: pain in the area of ​​injury when trying to sit cross-legged;
• painful cushion at the level of the joint space in the damaged area;
• arrhythmic gait (the result of muscle atrophy);
• Shteiman's symptom: when the leg is bent at the knee joint at an angle of 90°, rotational movements are accompanied by pain, when the internal meniscus is damaged
• with internal rotation, with damage to the external meniscus
• with external rotation;
• galosh symptom: pain when putting on galoshes;
• Rauber's symptom (develops in the first 2-3 months after the onset of the disease): on radiography, spine-like growths on one or two condyles;
• symptom of lateral meniscus dysplasia: bevel of the contour of the lateral condyle, widening of the external gap of the knee joint;
• Polyakov's symptom: the patient, in a supine position, raises his healthy straight leg up and raises his torso, leaning on the shoulder blades and heel of the injured leg
• pain occurs in the area of ​​the damaged meniscus (menisci);
• Steimann's symptom Ⅰ the appearance of pain on the inside of the knee joint with external rotation of the leg;
• Steimann's symptom Ⅱ when bending the knee, the pain shifts posteriorly, since when bending the meniscus is pulled posteriorly;
• Bragard's symptom Ⅰ pain during internal rotation;
• Bragard's symptom Ⅱ pain moves posteriorly with continued flexion of the knee;
• Mc symptom. Murray's, with the knee bent and the patient lying on his stomach, turning and abducting the leg with a fixed foot causes a sensation of pain and cracking. Symptoms of damage to the internal meniscus of the knee joint:

• pain on the inside of the knee joint;
• point sensitivity over the place of attachment of the ligament to the meniscus;
• painful shooting when tense;
• "block" of the knee;
• pain along the tibial collateral ligament when hyperextending and turning the tibia outward with the leg bent at the knee;
• pain when bending the leg too much;
• synovitis;
• weakness of the muscles of the anterior thigh. Symptoms of damage to the lateral meniscus of the knee joint:
• pain with tension, pain along the fibular collateral ligament, radiating to the outer part of the knee joint;
• "block" of the knee;
• pain along the fibular collateral ligament with hyperextension and excessive flexion and internal rotation of the leg;
• synovitis;
• weakness of the muscles of the front of the thigh.

Anatomy of the meniscus

The menisci of the knee joint are cartilage pads that act as shock absorbers in the joint, as well as stabilize the knee joint and increase the congruence of the articular surfaces in the knee joint.

When moving in the knee joint, the menisci are compressed and their shape changes. There are two menisci in the knee joint - external (lateral) and internal (medial). In front of the joint they are connected by a transverse ligament.

The external meniscus is more mobile than the internal one, so traumatic injuries occur less frequently.

The internal meniscus is less mobile and is connected to the internal collateral ligament of the knee joint, so the injury is often combined with damage to this ligament.

Lateral to the joint, the menisci are fused to the joint capsule and have a blood supply from the arteries of the capsule. The internal parts are located deep in the joint and do not have their own blood supply, and their tissues are nourished by the circulation of intra-articular fluid.

Therefore, damage to the meniscus near the joint capsule heals well, but tears in the inner part, deep in the knee joint, do not heal at all. Prevalence of meniscus injuries

Among internal injuries of the knee joint, meniscal injuries occupy the first place. According to the CITO sports and ballet injury clinic, where mainly athletes are treated, in whom this injury occurs most often, meniscal injuries account for 60.4% of 3019 people, of which 75% are patients with injuries to the internal meniscus, 21% with injuries and diseases of the external meniscus and 4% - with damage to both menisci.

The proportion of meniscus damage is correspondingly 4:1. This is due to the patient population and improved diagnostics (arthroscopy and other methods). Thus, the menisci are most often damaged in athletes and physical workers aged 18 to 40 years.

In children under 14 years of age, meniscus rupture occurs relatively rarely due to anatomical and physiological characteristics. Damage to the menisci is more common in men than in women - in a ratio of 3:2, the right and left are affected equally.

Causes of meniscus injuries

Knee joint in extended (right) and bent (left) positions. The contact surfaces of the femoral condyles (red line) with the menisci in the extended position of the leg are significantly larger than in the bent position.

As a result, the body weight on the tibia in the first case is distributed over a larger area than in the second, and the articular cartilage does not experience a one-sided, clearly limited area load. When the knee is bent, the menisci are moved slightly back, the collateral ligaments are relaxed, and the lower leg can rotate relative to the thigh.

In a bent position, the condyles are held together by the cruciate ligaments. If the knee joint is forced to rotate while the leg is straightened, such as when playing football or skiing, the result can be damage to the meniscus or even rupture of the ligaments.

The cause of a meniscus tear is an indirect or combined injury, accompanied by rotation of the tibia outward (for the medial meniscus), inward (for the external meniscus). In addition, damage to the meniscus is possible with sudden excessive extension of the joint from a bent position, abduction and adduction of the lower leg, and less often when exposed to direct trauma (hitting the joint on the edge of a step or being hit by some moving object). Repeated direct trauma (bruises) can lead to chronic trauma to the menisci (meniscopathy) and subsequently to its rupture (after squatting or a sharp turn).

Degenerative changes in the meniscus can develop as a result of chronic microtrauma, after rheumatism, gout, chronic intoxication, especially if the latter are present in people who have to walk a lot or work while standing. With a combined mechanism of injury, in addition to the menisci, the capsule, ligamentous apparatus, fat body, cartilage and other internal components of the joint are usually damaged.

Types of meniscus damage

The following types of meniscus injury are distinguished: separation of the meniscus from its attachment sites in the area of ​​the posterior and anterior horns and the body of the meniscus in the paracapsular zone;

Tears of the posterior and anterior horns and the body of the meniscus in the transchondral zone;

Various combinations of the listed damages;

excessive mobility of the menisci (rupture of the intermeniscal ligaments, meniscus degeneration);

Chronic trauma and degeneration of the menisci (meniscopathy of a post-traumatic and static nature - varus or valgus knee (see varus and valgus);

Cystic degeneration of the menisci (mainly external). Types of meniscal tears

Nature of meniscus damage

Meniscal tears can be complete, incomplete, longitudinal (“watering can handle”), transverse, flap-like, or fragmented.

More often the body of the meniscus is damaged with the transition of the damage to the posterior or anterior horn (“handle of a watering can”), isolated damage to the posterior horn is less common (25-30%), and even less often the anterior horn is injured (9%). Tears can be with or without displacement of the torn part. Tears of the medial meniscus are often combined with damage to the lateral capsuloligamentous apparatus. With repeated blockades with displacement of the torn part of the meniscus, the anterior cruciate ligament and the cartilage of the internal femoral condyle are injured (chondromalacia). Symptoms of meniscus damage

In the clinical picture of meniscus damage, acute and chronic periods are distinguished. Diagnosis of meniscus injuries in the acute period is difficult due to the presence of symptoms of reactive nonspecific inflammation, which also occur with other internal injuries of the joint. Characterized by local pain along the joint space corresponding to the area of ​​damage (body, anterior, posterior horn), severe limitation of movements, especially extension, the presence of hemarthrosis or effusion.

With a single injury, bruises, tears, pinching, and even crushing of the meniscus often occur without tearing it off or separating it from the capsule. Predisposing factors for complete rupture of a previously undamaged meniscus are degenerative phenomena and inflammatory processes in it. With proper conservative treatment of such damage, complete recovery can be achieved.

After the reactive phenomena subside (after 2-3 weeks - the subacute period), the true picture of the damage is revealed, which is characterized by a number of typical clinical symptoms in the presence of an appropriate history and mechanism of injury: local pain and infiltration of the capsule at the level of the joint space, often effusion and joint blockade.

Various characteristic pain tests confirm the damage. The number of these tests is large. The most informative of them are the following: symptoms of extension (Roche, Baikov, Landa, etc.); rotational (Shteiman - Bragarda); compression symptoms and mediolateral test.

Diagnosis of meniscus injuries

The so-called voiced tests, i.e., symptoms of sliding and movement of the menisci and clicking during passive movements, are also of great importance in the diagnosis of meniscal injuries. The most typical and easiest to recognize a medial meniscus tear is a true joint block (a “watering can handle” meniscal tear). In this case, the joint is fixed at an angle of 150-170°, depending on the size of the displaced part of the meniscus.

True blockade of the meniscus must be differentiated from reflex muscle contracture, which often occurs with bruises, damage to the capsular-ligamentous apparatus and entrapment of intra-articular bodies (chondromalacia, chondromatosis, Koenig's disease, Hoffa's disease, etc.). We must not forget about the possibility of pinching the hypertrophied pterygoid fold. Unlike blockade of the joint by the meniscus, these infringements are short-term, easily eliminated, harmless, but are often accompanied by effusions.

In case of damage to the outer meniscus, joint blockades occur much less frequently, since the meniscus, due to its mobility, is more often subject to compression than to tearing. In this case, the meniscus is crushed by the articular condyles, which with repeated injuries leads to degeneration and often cystic degeneration. Discoid menisci are especially often cystic.

The most characteristic symptoms of damage to the external meniscus are local pain in the outer part of the joint space, aggravated by internal rotation of the leg, swelling and infiltration in this area; a symptom of a click or roll and, less often, a symptom of blockade.

Many of the listed symptoms of meniscal damage also occur with other injuries and diseases of the knee joint, so timely recognition of a meniscal tear in some cases presents significant difficulties. A carefully collected anamnesis is the main diagnostic criterion. Pain tests, as a rule, are not detected, there is no irritation of the synovium. There is only a positive Chaklin's symptom (tailor's test), sometimes a sound phenomenon (clicking, rolling, friction).

A plain radiograph reveals a narrowing of the corresponding parts of the joint space with signs of deforming arthrosis. In such cases, paraclinical methods help. Great difficulties are encountered with atypical forms of the meniscus (discoid or continuous meniscus), with chronic trauma (meniscopathy), rupture of the ligamentous apparatus of the meniscus (hypermobile meniscus), and damage to both menisci.

A discoid, predominantly external, meniscus is characterized by a rolling symptom (clicking knee). Due to its massiveness, it is more often subject to crushing by articular surfaces, which leads to degeneration or cystic degeneration.

There are three degrees of cystic degeneration of the external meniscus (according to I. R. Voronovich). Grade I is characterized by cystic degeneration of meniscus tissue (cysts are detected only histologically). Clinically, moderate pain and infiltration of the capsule are determined. In grade II, cystic changes spread to the meniscus tissue and the pericapsular zone. Clinically, in addition to the indicated symptoms, a small painless protrusion is detected in the anteromedial part of the external joint space, which decreases or disappears when the knee joint is extended (due to movement of the meniscus deep into the joint). In grade III, the cyst involves parameniscal tissue; mucous degeneration occurs with the formation of cystic cavities not only in the meniscus tissue, but also in the surrounding capsule and ligaments. The tumor-like formation reaches a significant size and does not disappear when the joint is extended. Diagnosis of degrees II and III is not difficult.

Chronic microtrauma of the menisci is characterized by poor anamnestic and clinical data. With meniscopathy, there is usually no history of significant trauma; pain along the joint space, synovitis, and atrophy of the inner head of the quadriceps femoris muscle periodically appear. Meniscopathy also develops when there is a static disorder (valgus, varus knee, flat feet, etc.).

Arthroscopy makes it possible to detect degenerative changes: the meniscus, as a rule, is thinned, lacks shine, has a yellow tint with the presence of cracks and tissue disintegration in the area of ​​the free edge; easily torn, excessively mobile. Histological examination using electron microscopy with a scanning device reveals significant cracks and erosions of the surface layer, and in some places, areas of destruction in deep layers.

Symptomatology for damage to both menisci consists of the sum of the symptoms inherent in each of them. Simultaneous damage to both menisci is rare. A predisposing factor is rupture of the intermeniscal ligament, which leads to pathological mobility of the menisci and contributes to their damage. Diagnosis of a rupture of both menisci is difficult, since the clinical picture of damage to the internal meniscus usually predominates. Errors in recognizing meniscal injuries are 10-21%.

References

Traumatology and orthopedics / Guide for doctors. In 3 volumes / ed. Shaposhnik Yu.G. - M.: “Medicine”, 1997.

Clinical Sports Medicine / Peter Brukner and Kharim Khan - Third edition, "McGraw

You can purchase vitamins and medicines on the Pharmacy-med website

At the opposite extreme, a large, painful watering can-handle tear causes blockage of the knee joint and requires immediate arthroscopic surgery.

Most actual meniscus injuries fall somewhere between these two extremes and the resulting treatment decisions. Therefore, the decision for immediate surgery should be made based on the severity of symptoms and signs, while taking into account the athletic level and workload of the athlete.

Surgery

Arthroscopic knee surgery

Patients whose condition does not improve with conservative treatment require surgery. The purpose of the operation is to preserve the body of the meniscus as much as possible. Some meniscal lesions are suitable for fusion by surgical suture, which can be performed arthroscopy.

The decision as to whether to attempt repair of a tear is based on several factors, including the recency of the injury, the age of the patient, the stability of the knee, the location of the tear, and its orientation. The outer third of the meniscus rim has a blood supply, and a tear in this area can heal.

A tear with an increased chance of successful healing is a fresh longitudinal tear in the peripheral third of the meniscus in a young patient with simultaneous anterior cruciate ligament reconstruction. Degenerative processes, displaced tears, horizontal dissections, and complex lesions are poor candidates for healing. Young patients have a greater likelihood of success. Displaced tears may require removal of the torn portion of the meniscus (meniscectomy).

Meniscus surgery in modern clinics is done by arthroscopy, which is performed through several small surgical holes and takes approximately 1-2 hours. Through these holes, the surgeon inserts surgical instruments into the joint cavity, including a small video camera that allows you to see the joint from the inside.

Rehabilitation after meniscus injuries

Rehabilitation after surgery varies for different people and depends on a number of conditions, so the rehabilitation period is determined by the doctor individually. Patients whose meniscus has been partially or completely removed should prepare to walk on crutches for 4 to 7 days.

Small swelling may persist for 3 to 6 weeks. After 4-6 weeks, and maybe even earlier, the patient will be able to return to normal physical activity. If a torn meniscus has been repaired, crutches must be used for much longer (4-6 weeks) and no stress must be placed on the injured knee to allow the meniscus to heal completely.

Compared to outdated open knee surgery and large surgical incisions, arthroscopic surgery minimizes the necessary tissue disruption, which, of course, greatly reduces recovery time after surgery and allows you to quickly return to work and sports.

A frequent companion to meniscus surgery is arthritis, as in the photo below.

For comparison, a model of a joint without arthritis:

Video

Injury to the internal meniscus is one of the most common types of knee injuries. In young people, pathologies are mainly traumatic in nature, while in more mature people, damage to the meniscus is of a degenerative type and is accompanied by the general process of aging and changes in the tissue structures of the joint.

The meniscus itself is cartilage tissue that is located on the condyles of the tibia. This tissue is part of the knee joint and is designed to perform a specific set of functions, including distributing loads, providing shock absorption at certain points in the joint, reducing stress when joint structures come into contact, and transmitting nerve impulses to the brain that notify the position of the knee.

Internal meniscus injury

The knee joint includes two types of meniscus: medial (internal) and lateral (external). Given their different locations, these tissues are injured in different ways. The main disorders of the internal meniscus include:

• injuries;
• tissue ruptures;
• degeneration of cartilage tissue.

Features of the course of pathologies of cartilage tissue

Causes of pathology

The main causes of pathologies of the internal meniscus of the knee are external influences and internal changes.

Among the external factors we can highlight:

• injuries that led to dislocation;
• blows to the knee;
• falls that cause damage to the knee joint;
• full extension of the joint;
• repeated injuries.

Internal causes include weakening of cartilage tissue and some diseases that result in a disturbance in the structure or development of the meniscus - rheumatism, gout, arthrosis, etc.

The risk group includes:

1. athletes;
2. people whose activities involve frequent unsystematic physical activity;
3. persons with dysfunction of the musculoskeletal system;
4. people who have a tendency to injury or a hereditary predisposition;
5. persons suffering from obesity.

Diagnostics

As mentioned earlier, to diagnose damage to cartilage tissue, you need to consult with a specialist and undergo an examination. At the first appointment, the doctor conducts a thorough examination of the patient and a survey in order to study the symptoms of the disease in detail. Next, the meniscus, which is presumably damaged, is palpated.

Additional examination methods are prescribed:

• X-ray;
• atheroscopic examination.

Meniscus treatment

To treat pathological conditions of the internal meniscus, two methods are used:

1. Drug treatment. It is prescribed for minor injuries, since minor damage to the meniscal horn heals quite successfully on its own. In this case, the prescribed medications should relieve pain and swelling. For these purposes, anti-inflammatory drugs are used in the form of ointments and oral medications. Along with this, the knee is fixed to limit its movement.

For people with degenerative disorders, treatment is prescribed in parallel, aimed at eliminating the underlying cause of the disease. If there is tissue pinching or fluid accumulation in the joint, conservative therapy is contraindicated.

1. Surgical intervention. If a tear is 10-12 mm in size, it requires suturing - sutures are applied with specific needles to speed up the healing process. Typically, this method is used to suturing the posterior horn in the absence of concomitant diseases.

A method of connecting the meniscus that does not involve sutures is also proposed, but it is not highly effective. In case of extensive lesions of cartilage tissue, its complete removal is performed, followed by installation of an implant.