Causes and treatment of rupture of the posterior horn of the medial meniscus of the knee joint. A characteristic feature of a tear in the posterior horn of the medial meniscus. Oblique horizontal tear in the posterior horn of the medial meniscus.

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

What is the meniscus and where are its horns?

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

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

There are different types of breaks:

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

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

What can cause damage to the posterior horn?

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

Excessive body rotation while standing on one leg without lifting the foot off the floor.
Jumping and running with obstacles is too energetic.
Walking very quickly or, conversely, staying in a squatting position for a long time.
An injury caused by an existing degenerative knee joint.
Insufficient development of joints and ligaments caused by congenital pathology.

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

How to recognize a gap?

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

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

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

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

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

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

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

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

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

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

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

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

Surgical treatment methods

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

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

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

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

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

Pathology of the musculoskeletal system includes a rupture of the posterior horn of the medial meniscus. This injury is a consequence of indirect trauma to the lower limb. The human knee joint is very complex. Each of them contains 2 menisci. They are formed by cartilage tissue. They consist of a body, posterior and anterior horns. Menisci are essential for shock absorption, limiting range of motion, and matching bone surfaces.

Types of breaks

A tear of the posterior horn of the medial meniscus is a type of closed joint injury. This pathology is most often found in adults. This type of injury is rare in children. Women suffer from this disease 2 times more often than men. The gap is often combined with.

This is the most common joint injury. Complex rupture is diagnosed mainly in people from 18 to 40 years old. This is due to an active lifestyle. Sometimes combined damage to both menisci is observed.

The relevance of this problem is due to the fact that such an injury often requires surgical intervention and a long recovery period.

After surgical treatment, patients move on crutches. A distinction is made between complete and incomplete tissue rupture. The following options are known:

longitudinal;
vertical;
patchwork bias;
radial-transverse;
horizontal;
degenerative with tissue crushing;
isolated;
combined.

An isolated posterior rupture is diagnosed in 30% of all cases of this injury.

Causes of damage

The development of this pathology is based on strong extension of the lower leg or its sharp outward rotation. The longitudinal gap is due to several reasons. The main etiological factors are:

falling onto a hard surface;
bruises;
traffic accidents;
blows;
degenerative processes against the background of gout and rheumatism;
sprains;
microtraumas.

A rupture of the posterior horn of the meniscus is most often caused by indirect and combined trauma. This usually happens in winter when there is ice. Failure to take precautions, haste, intoxication and fighting all contribute to injury. Often, rupture occurs when the joint is in fixed extension. Athletes face a similar problem. The risk group includes football players, figure skaters, gymnasts and hockey players.

Permanent damage causes meniscopathy. Subsequently, when making sharp turns, a rupture occurs. Degenerative damage is highlighted separately. It occurs mainly in elderly people with repeated microtraumas. The cause may be intense loads during training or careless work activities. Degenerative horizontal rupture of the posterior horn of the medial meniscus often occurs against the background of rheumatism.

It is facilitated by previously suffered tonsillitis and scarlet fever. Damage to the meniscus due to rheumatism is caused by impaired blood supply to tissues due to edema and other pathological changes. The fibers become less elastic and durable. They are not able to withstand heavy loads.

Less commonly, the cause of rupture is gout. Tissue injury occurs due to uric acid crystals. Collagen fibers become thinner and less durable.

How does a gap manifest itself?

If there is damage to the posterior horn of the medial meniscus, the following symptoms are possible:

pain in the knee area;
restriction of movements;
cracking sound when walking.

In the acute period, reactive inflammation develops. The intensity of the pain syndrome is determined. If it is incomplete, then the symptoms are mild. Clinical signs persist for 2–4 weeks. A moderate flap rupture is characterized by acute pain and limited extension of the limb at the knee.

The sick person can walk. If proper treatment is not carried out, this pathology becomes chronic. Severe pain combined with tissue swelling is characteristic of a severe rupture. In such people, small blood vessels in the knee area may become damaged. Developing. Blood accumulates in the cavity of the knee joint.

It is difficult to support your leg. In severe cases, the local temperature rises. The skin takes on a bluish tint. The knee joint becomes spherical. After 2–3 weeks from the moment of injury, a subacute period develops. It is characterized by localized pain, effusion and blockages. Specific symptoms of Roche, Baykov and Shteiman-Bragard are typical. In the degenerative form of this meniscus pathology, complaints may appear only during work.

Patient examination plan

It is necessary to treat a linear break after clarifying the diagnosis. The following studies will be needed:

general clinical tests;
CT or MRI;
radiography;
arthroscopy.

Differential diagnosis is carried out in the following cases:

arthritis of various etiologies;
gonarthrosis;
softening of cartilage tissue;

If the posterior horn of the meniscus is damaged, treatment begins after assessing the condition of the joint tissues. Magnetic resonance imaging is very informative. Its advantage is the absence of radiation exposure. Arthroscopy is performed according to indications. This is an endoscopic research method. A knee examination can be performed for both therapeutic and diagnostic purposes. Arthroscopy can be used to visually assess the condition of the knee joint. Before the procedure, you must undergo a series of tests. The study can be carried out on an outpatient basis.

Treatment tactics

Partial damage to the meniscus requires conservative therapy. The main aspects of treatment are:

plaster application;
use of painkillers;
puncture of the knee joint;
maintaining peace;
applying cold compresses;
massage;
physiotherapy.

If the cause is degenerative-dystrophic processes, then chondroprotectors are prescribed. These are medications that strengthen the cartilage tissue of the joints. They contain chondroitin sulfate and glucosamine. Chondroprotectors include Arthra, Teraflex, Dona and. To eliminate pain, NSAIDs are prescribed (Ibuprofen, Movalis, Diclofenac Retard). These medications are taken orally and applied to the skin in the joint area.

External agents are used after the plaster is removed. Patients must maintain motor rest. To accelerate the healing of the medial meniscus, physiotherapy (electrophoresis, UHF therapy, exposure to magnetic fields) is performed. A puncture is often required. A needle is inserted into the joint. If there is a small amount of blood, the puncture is not performed.

Analgesics and anti-inflammatory drugs may be administered during the procedure. In severe cases, radical treatment is required. Indications for the operation are:

separation of the horns and body of the medial meniscus;
lack of effect from conservative therapy;
displacement rupture;
tissue crushing.

Reconstructive surgical interventions are most often performed. A complete meniscectomy is performed less frequently. This is due to the fact that removal of the medial meniscus in the future can lead to the development of deforming gonarthrosis. Special designs are used for tissue restoration. In the case of peripheral and vertical tears, the meniscus may be sutured.

Such an intervention is justified only if there are no degenerative changes in cartilage tissue. A complete meniscectomy can only be performed if there is a large tear and severe damage to the meniscus. Currently, arthroscopic operations are widely used. Their advantage is less trauma. After the operation, painkillers, physiotherapy and exercises are prescribed. Patients need to rest for up to a year.

Forecast and preventive measures

The prognosis for a rupture of the posterior horn of the internal meniscus of the knee is most often favorable. It worsens with severe hemarthrosis, combined lesions and untimely treatment. After therapy, pain disappears and range of motion is restored. In some cases, gait instability and discomfort while walking are observed.

The accumulation of large amounts of blood in the knee joint, without proper care, can cause arthrosis.

In old age, treatment can be difficult due to the impossibility of surgery. Rupture of the horns of the medial meniscus can be prevented. To do this, you need to adhere to the following recommendations:

avoid sudden movements of the legs;
observe safety precautions while working at work and at home;
stop drinking alcohol;
do not get into fights;
wear knee pads when playing sports;
give up traumatic activities;
be careful during icy conditions;
in winter weather, wear shoes with threads;
give up extreme sports;
promptly treat arthritis and arthrosis;
diversify your diet;
move more;
take vitamins and mineral supplements;
treat rheumatism in a timely manner and.

A meniscus tear is a very common pathology in adults and adolescents. In case of a fall or injury and pain, you should go to the emergency room.

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

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

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

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

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

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

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

The structure of the meniscus

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

In their shape, the menisci look like plates, crescent-shaped, and sometimes disc-shaped, in which the posterior and anterior horn of meniscus, as well as his body.

Lateral meniscus, also called external (external), is more mobile due to the lack of rigid fixation; this circumstance is the reason that during mechanical injuries it moves, which prevents injury.

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

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Purpose of the meniscus

The limb joint belongs to a complex structure, where each element solves a specific task. Each knee is equipped with menisci that bisect the articular cavity and perform the following tasks:

stabilizing. During any physical activity, the articular surfaces shift in the desired direction;
act as shock absorbers, softening shocks and shocks during running, jumping, and walking.

Injury to shock-absorbing elements occurs with various joint injuries, precisely because of the load that these joint parts take on. In each knee there are two menisci, consisting of cartilage tissue:

lateral (outer);
medial (internal).

Each type of shock-absorbing plate is formed by a body and horns (back and front). Shock-absorbing elements move freely during physical activity.

The main damage occurs to the posterior horn of the internal meniscus.

Why does injury occur?

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

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

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

The listed reasons lead to meniscus injuries of varying severity.

Classification

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

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

If the medial meniscus is damaged, the following symptoms exist:

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

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

Horizontal gap

Depending on the location of the injured area and the general characteristics of the injury, types of injury to the medial meniscus are distinguished:

walking along;
oblique;
passing across;
horizontal;
chronic form of pathology.

Features of horizontal damage to the posterior horn of the medial meniscus are the following:

with this type of tear of the internal shock-absorbing plate, injury occurs directed to the joint capsule;
Swelling occurs in the area of the joint gap. This development of pathology has common symptoms with damage to the anterior meniscal horn of the outer cartilage, so special attention is required when diagnosing.

With horizontal, partial damage, the cavity begins to accumulate excess synovial fluid. Pathology can be diagnosed by ultrasound.

After the first symptoms are relieved, a set of special gymnastic exercises is developed for each patient. Physiotherapy and massage sessions are prescribed.

If traditional treatment methods do not give a positive result, then surgical intervention is indicated.

Synovitis due to injury to the medial meniscus

Due to damage to the posterior horn of the medial meniscus, synovitis may begin. This pathology develops due to structural cartilaginous changes that occur in tissues when injured. When a rupture occurs, synovial fluid begins to be produced in large volumes and fills the joint cavity.

As synovitis (fluid accumulation) develops, it becomes increasingly difficult to perform movements. If there is a transition to the degenerative course of the pathology, then the knee is constantly in a bent position. As a result, muscle spasm develops.

Advanced forms of synovitis lead to the development of arthritis. Therefore, during diagnosis, the symptoms of a torn meniscus are similar to chronic arthritis.

If synovitis is not treated in time, the cartilaginous surface will be completely destroyed. The joint will no longer receive nutrition, which will lead to further disability.

Treatment methods

For any joint injury, treatment must be started promptly, without delay. If you delay going to the clinic, the trauma becomes chronic. The chronic course of the pathology leads to changes in the tissue structure of the joints and further deformation of the damaged limb.

Treatment for damage to the posterior horn of the medial meniscus can be conservative or surgical. When treating such injuries, traditional methods are often used.

Complex, traditional therapy for injury to the internal meniscus includes the following measures:

A joint block is performed using special medications, after which the motor ability of the joint is partially restored;
anti-inflammatory medications are prescribed to remove swelling;
recovery period, including a set of special gymnastic exercises, physiotherapy and massage sessions;
Next comes the use of chondoprotectors (drugs that help restore the structure of cartilage). Among the active components of chondoprotectors is Hyaluronic acid. The course of treatment can last up to six months.

Throughout the entire course of treatment, painkillers are used, because ligament damage is accompanied by constant pain. To eliminate pain, medications such as Ibuprofen, Diclofenac, and Paracetamol are prescribed.

Surgical intervention

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

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

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

resection torn elements or meniscus. This type of manipulation is performed with incomplete or complete tear;
recovery destroyed tissues;
replacement destroyed tissue by implants;
stitching menisci. Such surgical intervention is carried out in case of fresh injury and immediate medical attention is sought.

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

Arthrotomy

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

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

Partial meniscectomy

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

Endoprosthetics

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

Stitching damaged tissues

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

Stitching is performed only for fresh damage.

Arthroscopy

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

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

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

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Meniscus injuries

The structure of the meniscus includes the body of the meniscus and two horns - anterior and posterior. The cartilage itself is fibrous, the blood supply comes from the joint capsule, so the blood circulation is quite intense.

A meniscus injury is the most common injury to the knee joint. The knees themselves are a weak point in the human skeleton, because the daily load on them begins from the very moment the child begins to walk. Very often, damage to the meniscus occurs during outdoor games, when playing contact sports, during too sudden movements or during falls. Another cause of meniscal tears is knee injuries sustained in road accidents.

Treatment of a tear of the posterior horn of the medial meniscus can be surgical or conservative.

Conservative treatment

Conservative treatment consists of adequate pain relief. If blood accumulates in the joint cavity, it is punctured and the blood is pumped out. If a joint blockade occurs after an injury, it is eliminated. If a meniscus tear occurs, combined with other knee injuries, a plaster splint is applied to provide complete rest to the leg. In this case, rehabilitation takes more than one month. To restore knee function, gentle physical therapy is prescribed.

With an isolated rupture of the posterior horn of the medial meniscus, the recovery period is shorter. In these cases, plaster is not applied, because it is not necessary to completely immobilize the joint - this can lead to stiffness of the joint.

Surgery

If conservative treatment does not help, if the effusion in the joint persists, then the question of surgical treatment arises. Also, indications for surgical treatment are the occurrence of mechanical symptoms: clicks in the knee, pain, the occurrence of joint blockades with limited range of motion.

Currently, the following types of operations are performed:

Arthroscopic surgery.

The operation is performed through two very small incisions through which the arthroscope is inserted. During the operation, the separated small part of the meniscus is removed. The meniscus is not completely removed because its functions in the body are very important;

Arthroscopic suture of the meniscus.

If the gap is significant, then an arthroscopic suture technique is used. This technique allows you to restore damaged cartilage. Using one stitch, the incompletely separated part of the posterior horn of the meniscus is sutured to the body of the meniscus. The disadvantage of this method is that it can only be carried out in the first few hours after the injury.

Meniscus transplantation.

Replacement of the meniscus with a donor one is carried out when the cartilage of one’s meniscus is completely destroyed. But such operations are carried out quite rarely, because the scientific community does not yet have a consensus on the feasibility of this operation.

Rehabilitation

After both conservative and surgical treatment, it is necessary to undergo a full course of rehabilitation: develop the knee, increase leg strength, train the quadriceps femoris muscle to stabilize the damaged knee.

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As a rule, a torn meniscus affects football players, dancers and other people whose lives are connected with sports. But you should be prepared for the fact that a disease of this kind can overtake you, so it is important to know the symptoms and treatment methods.

A rupture of the posterior horn of the medial meniscus is the result of an injury that can be sustained not only by athletes or overly active individuals, but also by older people who simultaneously suffer from other diseases, such as arthrosis.

So what is a torn meniscus? To understand this, you need to know, in general, what a meniscus is. This term refers to a special fibrous cartilage tissue that is responsible for shock absorption in the joint. In addition to the knee joint, such cartilage is also found in the joints of the human body. However, it is the injury to the posterior horn of the meniscus that is considered the most common and dangerous injury, which threatens complications and serious consequences.

A little about menisci

A healthy knee joint has two cartilaginous inserts, external and internal, respectively, lateral and medial. Both of these tabs are crescent shaped. The lateral meniscus is dense and quite mobile, which ensures its safety, that is, the external meniscus is less likely to be injured. As for the internal meniscus, it is rigid. Thus, medial meniscus injury is the most common injury.

The meniscus itself is not simple and consists of three elements: the body, the posterior and anterior horn. Part of this cartilage is penetrated by a capillary network, which forms the red zone. This area is the densest and is located on the edge. In the middle is the thinnest part of the meniscus, the so-called white zone, which is completely devoid of blood vessels. After an injury, it is important to correctly determine which part of the meniscus was torn. The living zone of cartilage is subject to better restoration.

There was a time when experts believed that as a result of complete removal of the damaged meniscus, the patient would be relieved of all problems associated with the injury. However, today it has been proven that both the external and internal menisci have very important functions for joint cartilage and bones. The meniscus cushions and protects the joint and its complete removal will lead to arthrosis.

Today, experts talk about only one obvious cause of such an injury: a rupture of the posterior horn of the medial meniscus. This cause is considered to be an acute injury, since not any aggressive impact on the knee joint can lead to damage to the cartilage responsible for shock absorption of the joints.

In medicine, there are several factors that predispose to cartilage damage:

vigorous jumping or running performed on an uneven surface;

twisting on one leg without lifting the limb from the surface;

fairly active walking or long squatting;

injury sustained in the presence of degenerative joint diseases;

congenital pathology in the form of weakness of joints and ligaments.

Symptoms

Typically, damage to the medial meniscus of the knee joint occurs as a result of the unnatural position of parts of the joint at a certain moment when the injury occurs. Or the rupture occurs due to pinching of the meniscus between the tibia and femur. The tear is often accompanied by other knee injuries, so the differential diagnosis can be difficult at times.

Doctors advise people who are at risk to know and pay attention to symptoms indicating a meniscus tear. Signs of injury to the internal meniscus include:

pain that is very sharp at the time of injury and lasts for several minutes. You may hear a clicking sound before the pain sets in. After some time, the acute pain may subside and you will be able to walk, although it will be difficult to do so through the pain. The next morning you will feel pain in your knee, as if a nail has been stuck there, and when you try to bend or straighten your knee, the pain will intensify. After rest, the pain will gradually subside;

jamming of the knee joint or in other words blockage. This symptom is very characteristic of a rupture of the internal meniscus. A meniscal block occurs when the torn part of the meniscus becomes pinched between the bones, as a result of which the motor function of the joint is impaired. This symptom is also characteristic of ligament damage, so you can find out the true cause of the pain only after diagnosing the knee;

hemarthrosis. This term refers to the presence of blood in the joint. This happens when the rupture occurs in the red zone, that is, in the zone penetrated by capillaries;

swelling of the knee joint. As a rule, swelling does not appear immediately after a knee injury.

Nowadays, medicine has learned to distinguish between an acute tear of the medial meniscus and a chronic one. This may have been due to hardware diagnostics. Arthroscopy examines the condition of cartilage and fluid. A recent tear of the internal meniscus has smooth edges and an accumulation of blood in the joint. While in case of chronic injury, the cartilage tissue is multi-fiber, there is swelling from the accumulation of synovial fluid, and often the nearby cartilage is also damaged.

A tear of the posterior horn of the medial meniscus must be treated immediately after the injury, since over time, untreated damage will become chronic.

If treatment is not timely, meniscopathy develops, which often, in almost half of the cases, leads to changes in the structure of the joint and, consequently, to degradation of the cartilaginous surface of the bone. This, in turn, will inevitably lead to arthrosis of the knee joint (gonarthrosis).

Conservative treatment

Primary tear of the posterior horn of the meniscus must be treated with therapeutic methods. Naturally, injuries occur when the patient needs emergency surgery, but in most cases conservative treatment is sufficient. Therapeutic measures for this damage, as a rule, include several very effective stages (of course, if the disease is not advanced!):

reposition, that is, realignment of the knee joint during blockade. Manual therapy helps a lot, as well as hardware traction;

elimination of joint swelling. To do this, specialists prescribe anti-inflammatory drugs to the patient;

rehabilitation activities such as exercise therapy, massage, physiotherapy;

The longest, but at the same time the most important process is the restoration of the menisci. Typically, the patient is prescribed courses of chondroprotectors and hyaluronic acid, which are carried out for 3-6 months annually;

Do not forget about painkillers, since damage to the posterior horn of the meniscus is usually accompanied by severe pain. There are many analgesics used for these purposes. Among them, for example, ibuprofen, paracetamol, diclofenac, indomethacin and many other drugs, dosage

Be healthy!

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Types of breaks

The meniscus is a part of the knee joint that protects the bone tissue from friction and strengthens the joint from the inside. The menisci are located between the bony epiphyses of the knee and stabilize its position.

The horns of the meniscus are the extensions of connective tissue that secure the shape of the knee joint. They do not allow the position of the bones to change relative to each other. Between the horns, the outermost parts of the meniscus, there are denser areas - this is the body of cartilage.

The medial meniscus is fixed by horns on the bone, it is located on the inside of the lower limb. The lateral one is located in the outer part. The lateral meniscus is largely responsible for mobility. Therefore, its damage occurs less frequently. But the medial one stabilizes the joint and does not always withstand tension.
Meniscal tears account for 4 out of 5 cases of all knee injuries. In most cases, they occur due to too much stress or sudden movements.

Sometimes degenerative processes in the cartilage tissue of the joint become a concomitant risk factor. Osteoarthritis of the knee increases the likelihood of traumatic injury. This also includes excess weight, lack of habit of ligaments to loads.

The rupture does not always occur instantly due to too much stress, shocks and falls. Sometimes it develops over a long period of time. Symptoms may or may not be present in this situation. However, if the cartilage junction is not treated, sooner or later its edges will rupture.

Damage to the posterior horn

Types of injuries:

Anterior horn injuries

Damage to the anterior horn develops generally according to the same pattern as the posterior one:

The patient often loses the ability to move.
The pain is piercing, preventing you from bending and straightening your leg.
The muscles weaken and become flabby.

The anterior horn breaks more often than the posterior one, since it is somewhat less thick. In most cases, the damage is longitudinal. In addition, the tears are stronger and more often form flaps of cartilage tissue.

Signs

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

The easiest way to understand that a rupture has occurred is when trying to move. The most severe pain occurs if the victim tries to straighten the lower limb or make other movements with the lower leg.

After injury, symptoms vary depending on how much time has passed. The first month and a half the pain is quite severe. If the patient has not lost the ability to walk, the pain will intensify with the slightest exertion. In addition, even normal walking will be accompanied by unpleasant sounds, the meniscus will crack.

The knee joint will swell and become unstable. Because of this, doctors may advise not to stand up, even if the victim is physically able to do so.

If the rupture is not traumatic, but degenerative in nature, the symptoms become chronic. The pain here is less pronounced and appears mainly during tension. Sometimes the pain does not develop immediately, and the patient does not visit the doctor for a long time. This can lead to acute traumatic disruption of the integrity of the joint.

To diagnose an injury, your doctor may use the following specific symptoms:

a sharp pain pierces if you press on the front of the knee while straightening the lower leg;
the injured lower limb may straighten more than usual;
the skin in the knee and upper leg becomes more sensitive;
when trying to climb stairs, the knee joint “jams” and stops working.

Degrees

Classification of the condition of the knee cartilage according to Stoller:

Treatment

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

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

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

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

Options

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

The surgeon can perform the following interventions:

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

During the operation, a skin incision is made. A drainage tube, a light source and an endoscopic lens are inserted through it. These devices help make surgery less traumatic.

All manipulations of the meniscus, including removal, are carried out with thin instruments inserted through the incision. This ensures not only that the operation is less bloody, but also makes it possible in principle. The area of the posterior horn is difficult to reach, and this is the only way to influence it.

Conservative therapy and rehabilitation after surgery may include:

Damage to the external meniscus of the knee joint

Meniscus injury is the most common injury. The knees themselves are a weak point in the human skeleton, because the daily load on them begins from the very moment the child begins to walk. Very often they occur during outdoor games, when playing contact sports, with too sudden movements or with falls. Another cause of meniscal tears is injuries sustained in an accident.

Treatment of a posterior horn rupture can be surgical or conservative.

Conservative treatment

Conservative treatment consists of adequate pain relief. If blood accumulates in the joint cavity, it is punctured and the blood is pumped out. If a joint blockade occurs after an injury, it is eliminated. If it occurs combined with other knee injuries, then a plaster splint is applied to provide complete rest to the leg. In this case, rehabilitation takes more than one month. To restore knee function, gentle physical therapy is prescribed.

Surgery

Currently, the following types of operations are performed:

Arthroscopic surgery.

Arthroscopic suture of the meniscus.

Meniscus transplantation.

Rehabilitation

The knee joint has a rather complex structure. It consists of the femur and tibia, the patella (kneecap), and a system of ligaments that provides stability to the bones of the joint. Another part of the knee joint is the meniscus - cartilage layers between the femur and tibia. When moving, a large load is placed on the knee, which leads to frequent injury to its elements. A tear of the posterior horn of the medial meniscus is one such injury.

Injuries to the knee joint are dangerous, painful and fraught with consequences. A rupture of the posterior horn of the meniscus, which can occur in almost any active person, is the most common and dangerous injury. It is dangerous primarily due to complications, and therefore requires timely detection and treatment.

What is meniscus

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

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

The cartilaginous portion of the meniscus adjacent to the capsule contains a significant number of capillaries and is supplied with blood. This part of the medial meniscus is called the red zone. The middle region (intermediate zone) contains a small number of vessels and is very poorly supplied with blood. Finally, the inner region (white zone) has no circulatory system at all. The lateral meniscus is located on the outer area of the knee. It is more mobile than the medial one, and its damage occurs much less frequently.

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

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

One of the characteristic injuries to the menisci is their rupture. Research shows that such injuries can occur not only in people involved in sports, dancing or heavy work, but also in accidental activities, as well as in older people. It has been found that meniscus tears occur in an average of 70 out of every 100,000 people. At a young age (up to 30 years), the damage is acute; With increasing age (over 40 years), the chronic form begins to predominate.

A torn meniscus can be caused by excessive lateral load combined with twisting of the tibia. Such loads are typical when performing certain movements (running over rough terrain, jumping on uneven surfaces, spinning on one leg, squatting for long periods of time). In addition, ruptures can be caused by joint diseases, tissue aging, or pathological abnormalities. The cause of injury can be a sharp, strong blow to the knee area or rapid extension of the leg. Based on the nature and location of the damage, several types of ruptures can be distinguished:
longitudinal (vertical);

oblique (patchwork);

transverse (radial);

horizontal;

rupture of the anterior horn of the lateral or medial meniscus;

rupture of the posterior horn of the meniscus;

degenerative rupture.

Degenerative rupture is associated with changes in tissue due to disease or aging.

Symptoms of meniscus damage

When the meniscus of the knee joint is damaged, there are two characteristic periods - acute and chronic. The acute period lasts 4-5 weeks and is characterized by a number of painful symptoms. The moment of meniscus damage is usually determined by a cracking sound and sharp pain in the knee area. In the first period after the injury, a cracking sound and pain accompanies a person during exertion (for example, moving up the stairs). Swelling develops in the knee area. Often a meniscus tear is accompanied by hemorrhage into the joint.

During the acute period, movement of the leg in the knee joint in a person is limited or completely impossible. Due to the accumulation of fluid in the knee area, a “floating patella” effect can occur.

The chronic period of a meniscus tear is less painful. Attacks of pain occur only with sudden movements of the leg or increased stress. During this period, it is quite difficult to determine the fact of a meniscus tear. To diagnose injury, methods have been developed that rely on characteristic symptoms.

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Baikov's symptom is based on identifying pain when pressing with fingers on the outer side of the knee while simultaneously straightening the lower leg. Landa's symptom determines the injury by the degree of straightening of the leg at the knee joint when the leg lies freely on the surface (in case of injury, the palm of the hand is placed between the surface and the knee). Turner's symptom takes into account increased sensitivity of the skin on the inner surface of the knee joint and the upper part of the lower leg on the inside. The symptom of blockade is a gap in the jamming of the knee joint when a person moves up the stairs. This symptom is characteristic of a rupture of the posterior horn of the internal meniscus.

Characteristic symptoms of a medial meniscus tear

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

The gap can be determined by performing flexion movements. It manifests itself in the form of sharp pain when straightening the leg and turning the lower leg outward. Pain also occurs when the leg is strongly bent at the knee. According to the severity of damage to the meniscus of the knee joint, they are divided into minor, moderate and severe. Small tears (partial), including the horns of the meniscus, are characterized by pain and slight swelling in the knee area. Such signs of injury cease to appear after 3-4 weeks.

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

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

Read also: Proper rehabilitation for a fractured patella
Mechanism of posterior horn rupture

A very dangerous longitudinal tear (complete or partial), as a rule, begins to develop from the posterior horn of the medial meniscus. With a complete rupture, the separated part of the meniscal horn can migrate into the cavity between the joints and block their movement.

Oblique tears often develop at the border between the middle of the meniscus body and the beginning of the posterior horn of the internal meniscus. This is usually a partial tear, but the edge may be embedded between the joints. This produces a sound similar to a cracking sound and painful sensations (rolling pain).

Often, a rupture of the posterior horn of the internal meniscus is of a combined nature, combining different types of damage. Such ruptures develop simultaneously in several directions and planes. They are characteristic of a degenerative mechanism of injury.

A horizontal tear of the posterior horn of the medial meniscus originates from its inner surface and develops in the direction of the capsule. Such damage causes swelling in the area of the joint space (the pathology is also characteristic of the anterior horn of the lateral meniscus).

Conservative treatment methods

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

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

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

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

When cartilage is damaged, it is necessary to restore and fuse it. For this purpose, a course of taking chondroprotectors and hyaluronic acid is prescribed. The use of drugs containing chondroitin and glucosamine is recommended as protectors. Painful symptoms and inflammatory processes must be eliminated by taking non-steroidal anti-inflammatory drugs (diclofenac, ibuprofen, indomethacin) and others.

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

Surgical treatment

In severe cases of damage, surgical intervention becomes necessary. In case of crushing of the cartilage, severe rupture and displacement of the meniscus, or complete rupture of the anterior or posterior horns of the meniscus, surgery is necessary. Surgical treatment is divided into several types: removal of the meniscus or torn horn; recovery; suturing the tear site; fastening detached horns using clamps; meniscus transplantation.