Damage to the posterior horn of the meniscus. Rupture of the posterior horn of the meniscus What is the posterior horn of the medial meniscus

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.

Menisci are layers of cartilage inside the knee joint that mainly perform shock-absorbing and stabilizing functions. There are two menisci of the knee joint: internal (medial) and external (lateral)

Meniscal tears are the most common knee problem. Fundamentally, meniscal tears can be traumatic, which often occur as a result of injury in young people, and degenerative, which occur more often in older people and can occur without injury against the background of degenerative changes in the meniscus, which are a variant of the course of arthrosis of the knee joint. If left untreated, a traumatic tear will eventually become degenerative.

A doctor can diagnose a meniscus tear. Magnetic resonance imaging (MRI) may be needed to confirm the diagnosis of a meniscus tear. Less commonly, ultrasound examination (ultrasound) may be used to confirm the diagnosis.

Meniscus tears occur in the posterior horn, in the body and in the anterior horn of the meniscus.

A rupture of the meniscus can lead to the fact that its torn and dangling part will serve as a mechanical obstacle to movement, cause pain and, possibly, block the joint and limit movement. Moreover, the loose part of the meniscus destroys the adjacent cartilage covering the femur and tibia.

The main method of treating knee meniscus tears is surgery. But this does not mean that you always need to have surgery if an MRI reveals a meniscus tear. Only those ruptures that cause pain and mechanical obstacles to movement in the knee joint are operated on.

Currently, the “gold standard” for the treatment of meniscal tears of the knee joint is arthroscopy - a low-traumatic operation that is performed through two one-centimeter incisions. There are other techniques (meniscal suture, meniscus transplantation), but they give less reliable results.

During arthroscopy, the loose and torn part of the meniscus is removed and the inner edge of the meniscus is straightened with special surgical instruments. Please note that only part of the meniscus is removed, and not the entire meniscus. The torn part of the meniscus no longer performs its function, so there is little point in saving it.

After arthroscopic surgery, you may be able to walk the same day, but full recovery may take several days to several weeks.

Anatomy

In the knee joint between the femur and tibia there are menisci - crescent-shaped cartilage layers that increase the stability of the joint by increasing the contact area of the bones.

Both the external (lateral) and internal (medial) meniscus are conventionally divided into three parts: posterior (posterior horn), middle (body) and anterior (anterior horn).

The shape of the inner (medial) meniscus of the knee joint usually resembles the letter “C”, and the outer (lateral) meniscus is a regular semicircle. Both menisci are formed by fibrocartilage and are attached anteriorly and posteriorly to the tibia. The medial meniscus is also attached along the outer edge to the capsule of the knee joint by the so-called coronary ligament. The thickening of the capsule in the area of the middle part of the meniscal body is formed by the tibial collateral ligament. The attachment of the medial meniscus to both the capsule and the tibia makes it less mobile than the lateral meniscus. This less mobility of the inner meniscus causes it to tear more frequently than outer meniscus tears. The lateral meniscus covers most of the upper lateral articular surface of the tibia and, unlike the medial meniscus, has the shape of an almost regular semicircle. Due to the more rounded shape of the lateral meniscus, the anterior and posterior points of its attachment to the tibia lie closer to each other. Slightly inward from the anterior horn of the lateral meniscus is the attachment site of the anterior cruciate ligament. The anterior and posterior meniscofemoral ligaments, which attach the posterior horn of the lateral meniscus to the medial condyle of the femur, pass anterior and posterior to the posterior cruciate ligament and are also called Humphrey's ligament and Wriesberg's ligament, respectively. Lateral menisci that extend to the articular surface more than normal are called discoid; they are reported to occur in 3.5% to 5% of people. In simple terms, a discoid lateral meniscus means that it is wider than the normal outer meniscus of the knee. Among the discoid menisci, we can distinguish the so-called solid discoid (entirely covering the outer condyle of the tibia), semi-disciform and Wriesberg variants. In the latter, the posterior horn is fixed to the bone only by the Wriesberg ligament.

Along the posterolateral surface of the joint, through the gap between the capsule and the lateral meniscus, the popliteus tendon penetrates into the joint cavity. It is attached to the meniscus by thin bundles that apparently perform a stabilizing function. The lateral meniscus is fixed to the joint capsule much weaker than the medial one and therefore moves more easily. The microstructure of the meniscus is normally represented by fibers of a special protein - collagen. These fibers are oriented predominantly circularly, i.e. along the meniscus. A smaller part of the collagen fibers of the meniscus is oriented radially, i.e. from edge to center. There is another fiber option - perforating. There are the fewest of them, they go “randomly”, connecting circular and radial fibers with each other.

a - radial fibers, b - circular fibers (most of them), c - perforating, or “random” fibers. Radial fibers are oriented mainly at the surface of the meniscus; crossing, they form a network, which is believed to ensure the stability of the meniscus surface against shear forces. Circular fibers make up the bulk of the meniscal core; This arrangement of fibers ensures the distribution of longitudinal load on the knee joint. On a dry matter basis, the meniscus consists of approximately 60–70% collagen, 8–13% extracellular matrix proteins, and 0.6% elastin. Collagen is mainly represented by type I and in small quantities by types II, III, V and VI. In newborns, the entire tissue of the menisci is penetrated by blood vessels, but by the age of 9 months, the vessels completely disappear from the inner third of the menisci. In adults, the vascular network is present only in the outermost part of the meniscus (10-30% of the outer edge) and with age the blood supply to the meniscus only worsens. It is worth noting that with age, the blood supply to the meniscus deteriorates. From the point of view of blood supply, the meniscus is divided into two zones: red and white.

Cross section of the meniscus of the knee joint (in the section it has a triangular shape). Blood vessels enter the thickness of the meniscus from the outside. In children they penetrate the entire meniscus, but with age the blood vessels become less and less and in adults there are blood vessels only in 10-30% of the outer part of the meniscus adjacent to the joint capsule. The first zone is the border between the joint capsule and the meniscus (red-red zone, or R-R). The second zone is the border between the red and white zones of the meniscus (red-white zone or R-W zone). The third zone is white-white (W-W), i.e. where there are no blood vessels. The part of the lateral meniscus near which the popliteus tendon penetrates into the knee joint is also relatively poor in blood vessels. Nutrients reach the cells of the inner two-thirds of the meniscus through diffusion and active transport from the synovial fluid.

Photograph of the blood vessels of the lateral meniscus (a contrast agent has been injected into the bloodstream). Note the lack of blood vessels where the popliteus tendon passes (red arrow). The anterior and posterior horns of the meniscus, as well as its peripheral part, contain nerve fibers and receptors that are presumably involved in proprioceptive afferentation during movements of the knee joint, i.e. signal to our brain about the position of the knee joint.

Why are menisci needed?

At the end of the 19th century, menisci were considered "non-functioning remnants" of muscles. However, as soon as the importance of the function performed by the menisci was discovered, they began to be actively studied. The menisci perform different functions: distribute the load, absorb shocks, reduce contact stress, act as stabilizers, limit the range of movements, participate in proprioceptive afferentation during movements in the knee joint, i.e. signal to our brain about the position of the knee joint. The main ones among these functions are the first four - load distribution, shock absorption, contact stress distribution and stabilization. When the leg is flexed and extended at the knee 90 degrees, the menisci account for approximately 85% and 50-70% of the load, respectively. After removing the entire medial meniscus, the area of contact between the articular surfaces is reduced by 50-70%, and the tension at their junction increases by 100%. Complete removal of the lateral meniscus reduces the area of contact between the articular surfaces by 40-50% and increases the contact stress by 200-300%. These changes, caused by a meniscectomy (i.e., an operation in which the entire meniscus is removed), often lead to a narrowing of the joint space, the formation of osteophytes (bone spurs, growths) and the transformation of the femoral condyles from round to angular, which is clearly visible on radiographs. Meniscectomy also affects the function of articular cartilage. Menisci are 50% more elastic than cartilage and therefore play the role of reliable shock absorbers during shocks. In the absence of a meniscus, the entire load during impacts without shock absorption falls on the cartilage. Finally, the medial meniscus prevents the tibia from moving forward relative to the femur when the anterior cruciate ligament is injured. When the anterior cruciate ligament is intact, the loss of the medial meniscus has little effect on the anteroposterior displacement of the tibia during flexion and extension of the leg at the knee. But with anterior cruciate ligament injury, loss of the medial meniscus increases the anterior displacement of the tibia when the knee is flexed to 90° by more than 50%. In general, the inner two-thirds of the menisci are important for increasing the contact area of the articular surfaces and shock absorption, and the outer third is important for distributing the load and stabilizing the joint. How common is a knee meniscus tear?

How common is a knee meniscus tear?

Meniscus tears occur with a frequency of 60-70 cases per 100,000 population per year. In men, meniscal tears occur 2.5-4 times more often, with traumatic tears predominant at the age of 20 to 30 years, and tears due to chronic degenerative changes in the meniscus at the age of 40 years and older. It happens that meniscus rupture occurs at 80-90 years of age. In general, the inner (medial) meniscus of the knee joint is more often damaged.

Photos taken during arthroscopy of the knee joint: a video camera (arthroscope) is inserted into the joint cavity through a 1-centimeter incision, which allows you to examine the joint from the inside and see all the damage. On the left is a normal meniscus (no fibering, elastic, smooth edge, white), in the center is a traumatic meniscus tear (the edges of the meniscus are smooth, the meniscus is not fibered). On the right is a degenerative tear of the meniscus (the edges of the meniscus are disintegrated)

At a young age, acute, traumatic meniscal tears occur more often. An isolated rupture of the meniscus can occur, but combined injuries to intra-articular structures are also possible when, for example, the ligament and meniscus are damaged at the same time. One of these combined injuries is a rupture of the anterior cruciate ligament, which in approximately every third case is accompanied by a meniscus tear. In this case, the lateral meniscus, which is more mobile, like the entire outer half of the knee joint, is torn approximately four times more often. The medial meniscus, which becomes a limiter of anterior displacement of the tibia when the anterior cruciate ligament is damaged, is more likely to tear when the anterior cruciate ligament is already damaged. Meniscus tears accompany up to 47% of fractures of the tibial condyles and are often observed with fractures of the femoral diaphysis with associated effusion into the joint cavity.

Symptoms

Traumatic ruptures. At a young age, meniscal tears occur more often as a result of injury. As a rule, a rupture occurs when twisting on one leg, i.e. with axial load in combination with rotation of the tibia. For example, such an injury can occur while running, when one leg suddenly lands on an uneven surface, landing on one leg with a twisting of the body, but a meniscus tear can also occur due to another mechanism of injury.

Usually, immediately after a rupture, pain appears in the joint and the knee swells. If the meniscus tear affects the red zone, i.e. the place where there are blood vessels in the meniscus, then a hemarthrosis- accumulation of blood in the joint. It manifests itself as bulging, swelling above the patella (kneecap).

When a meniscus ruptures, the torn and dangling part of the meniscus begins to interfere with movements in the knee joint. Small tears may cause painful clicking or a feeling of difficulty moving. With large tears, blockage of the joint is possible due to the fact that the relatively large size of the torn and dangling fragment of the meniscus moves to the center of the joint and makes some movements impossible, i.e. the joint “jams.” With ruptures of the posterior horn of the meniscus, flexion is often limited; with ruptures of the body of the meniscus and its anterior horn, extension in the knee joint is affected.

The pain from a torn meniscus can be so severe that it is impossible to step on your foot, and sometimes a torn meniscus only manifests itself as pain during certain movements, for example, when going down the stairs. In this case, climbing the stairs can be completely painless.

It is worth noting that blockade of the knee joint can be caused not only by a meniscus tear, but also by other reasons, for example, a rupture of the anterior cruciate ligament, a loose intra-articular body, including a detached fragment of cartilage in Koenig’s disease, “plica” syndrome of the knee joint, osteochondral fractures , fractures of the tibial condyles and many other reasons.

With an acute tear in combination with anterior cruciate ligament injury, swelling may develop faster and be more pronounced. Injuries to the anterior cruciate ligament are often accompanied by a tear of the lateral meniscus. This is because when the ligament ruptures, the outer part of the tibia dislocates forward and the lateral meniscus becomes pinched between the femur and tibia.

Chronic, or degenerative, ruptures most often occur in people over 40 years of age; pain and swelling develop gradually, and it is not always possible to detect their sharp increase. Often there is no indication of trauma in the history, or only a very minor impact is detected, such as bending a leg, squatting, or even a tear can occur simply when getting up from a chair. In this case, a joint block may also occur, but degenerative ruptures often only produce pain. It is worth noting that with a degenerative tear of the meniscus, the adjacent cartilage covering the femur or, more often, the tibia is often damaged.

Like acute tears of the meniscus, degenerative tears can give a varied severity of symptoms: sometimes the pain makes it completely impossible to step on the leg or even move it slightly, and sometimes the pain appears only when going down the stairs or squatting.

Diagnosis

The main symptom of a meniscus tear is pain in the knee joint that occurs or worsens with certain movements. The severity of pain depends on the location where the meniscus tear occurred (body, posterior horn, anterior horn of the meniscus), the size of the tear, and the time that has passed since the injury.

Let us note once again that a meniscus tear can occur suddenly, without any injury. For example, a degenerative rupture can occur at night while a person is sleeping and manifest itself as pain in the morning when getting out of bed. Often degenerative ruptures occur when getting up from a low chair.

The intensity of pain is influenced by individual sensitivity and the presence of concomitant diseases and injuries of the knee joint (arthrosis of the knee joint, ruptures of the anterior cruciate ligament, ruptures of the lateral ligaments of the knee joint, condylar fractures and other conditions that themselves can cause pain in the knee joint) .

So, pain from a meniscus tear can be different: from weak, appearing only occasionally, to severe, making movement in the knee joint impossible. Sometimes the pain makes it impossible to even step on your foot.

If pain occurs when descending stairs, then most likely there is a tear in the posterior horn of the meniscus. If there is a tear in the body of the meniscus, the pain intensifies with extension of the knee joint.

If the knee joint is “jammed”, i.e. If a so-called blockade of the joint occurs, then most likely there is a meniscus tear, and the blockade is due to the fact that the torn part of the meniscus blocked the movements in the joint. However, blockade occurs not only when the meniscus is torn. For example, a joint can “jam” due to ruptures of the anterior cruciate ligament, pinched synovial folds (plica syndrome), or exacerbation of arthrosis of the knee joint.

It is impossible to diagnose a meniscus tear on your own - you need to contact an orthopedic traumatologist. It is advisable that you contact a specialist who is directly involved in the treatment of patients with injuries and diseases of the knee joint.

First, the doctor will ask you about how the pain appeared and the possible causes of its occurrence. Then he begins the inspection. The doctor carefully examines not only the knee joint, but the entire leg. First, the amplitude and pain of movements in the hip and knee joints are assessed, since some of the pain in the hip joint radiates to the knee joint. The doctor then examines the hip to look for muscle wasting. Then the knee joint itself is examined: first of all, it is assessed whether there is effusion in the knee joint, which can be synovitis or hemarthrosis.

Typically, effusion, i.e. accumulation of fluid in the knee joint, manifested by visible swelling above the kneecap (patella). The fluid in the knee joint may be blood, in which case it is said to be hemarthrosis of the knee joint, which literally translated from Latin means “blood in the joint.” Hemarthrosis occurs with fresh meniscus tears.

If the rupture occurred a long time ago, then effusion in the joint is also possible, but this is no longer hemarthrosis, but synovitis, those. excess accumulation of synovial fluid, which lubricates the joint and nourishes the cartilage.

Swelling of the right knee joint. Please note that the swelling is located above the patella (kneecap), i.e. fluid accumulates in the suprapatellar bursa (superior inversion of the knee joint). The left, normal knee is shown for comparison.

A meniscus tear often manifests itself as an inability to fully straighten or bend the leg at the knee joint.

As we have already noted, the main symptom of a meniscal tear is pain in the knee joint that occurs or intensifies with a certain movement. If the doctor suspects a meniscus tear, then he tries to provoke this pain in a certain position and with a certain movement. As a rule, the doctor presses with a finger in the projection of the joint space of the knee joint, i.e. slightly below and to the side (outside and inward) of the patella and flexes and straightens the leg at the knee. If pain occurs, then most likely there is a meniscus tear. There are other special tests that can help diagnose a meniscus tear.

The main tests that a doctor performs to diagnose a knee meniscus tear.

The doctor must perform not only these tests, but also others that allow one to suspect and diagnose problems with the cruciate ligaments, the patella, and a number of other situations.

In general, if a doctor evaluates the knee joint based on a combination of tests, and not on any one of the signs, then a tear of the internal meniscus can be diagnosed in 95% of cases, and an external meniscus tear in 88% of cases. These indicators are very high, and in fact, often a competent traumatologist can quite accurately diagnose a meniscus tear without any additional examination methods (x-ray, magnetic resonance imaging, ultrasound). However, it will be very unpleasant if the patient falls into those 5-12% of cases when a meniscus tear is not diagnosed even though it exists, or is diagnosed erroneously, so in our practice we quite often try to resort to additional research methods that confirm or refute doctor's guess.

Radiography. An X-ray of the knee joint can be considered mandatory for any pain in the knee joint. Sometimes there is a desire to immediately perform magnetic resonance imaging (MRI), which “will show more than an x-ray.” But this is wrong: in some cases, x-rays make it easier, faster and cheaper to establish the correct diagnosis. Therefore, you should not prescribe studies on your own, which may turn out to be a waste of time and money.

X-rays are performed in the following projections: 1) in a direct projection in a standing position, including with the knees bent at 45° (according to Rosenberg), 2) in a lateral projection and 3) in an axial projection. The posterior surfaces of the femoral condyles usually wear out earlier in arthrosis of the knee joint, and when the legs are flexed 45° in a standing position, a corresponding narrowing of the joint space can be seen. In any other position, these changes are likely to be imperceptible, so other radiographic positions are not relevant for the evaluation of knee pain. If a patient complaining of pain in the knee joint has an x-ray revealed significant narrowing of the joint space, extensive damage to the meniscus and cartilage is very likely, in which arthroscopic resection of the meniscus (incomplete or partial meniscectomy), which we will discuss below, is useless. To exclude a cause of pain such as chondromalacia of the patella, radiography in a special axial projection (for the patella) is necessary. Plain radiography, which does not in any way facilitate the diagnosis of a meniscus tear, nevertheless allows us to exclude such concomitant disorders as osteochondritis dissecans (Koenig's disease), fracture, tilt or subluxation of the patella and articular mice (loose intra-articular bodies).

MRI (Magnetic resonance imaging) significantly increased the accuracy of diagnosing meniscal tears. Its advantages are the ability to image the meniscus in several planes and the absence of ionizing radiation. In addition, MRI allows you to evaluate the condition of other articular and periarticular formations, which is especially important when the doctor has serious doubts about the diagnosis, as well as if there are concomitant injuries that make it difficult to perform diagnostic tests. The disadvantages of MRI include high cost and the possibility of incorrect interpretation of changes with subsequent additional studies. A normal meniscus gives a weak, homogeneous signal for all pulse sequences. In children, the signal may be enhanced due to a more abundant blood supply to the meniscus. Increased signal in older people may be a sign of degeneration.

According to MRI, there are four degrees of changes in the meniscus (classification according to Stoller). Grade 0 is a normal meniscus. Degree I is the appearance of a focal signal of increased intensity in the thickness of the meniscus (not reaching the surface of the meniscus). Degree II - the appearance of a linear signal of increased intensity in the thickness of the meniscus (not reaching the surface of the meniscus). Grade III is a signal of increased intensity reaching the surface of the meniscus. Only grade III changes are considered a true meniscus tear.

Grade 0 (normal), meniscus without changes.

I degree - spherical increase in signal intensity, not associated with the surface of the meniscus.

II degree - linear increase in signal intensity not associated with the surface of the meniscus.

III degree (tear) - increased signal intensity in contact with the surface of the meniscus.

Magnetic resonance imaging. On the left is a normal, intact meniscus (blue arrow). Right - tear of the posterior horn of the meniscus (two blue arrows)

The accuracy of MRI in diagnosing a meniscus tear is approximately 90-95%, especially if a signal of increased intensity is recorded twice in a row (i.e., on two adjacent sections), covering the surface of the meniscus. To diagnose a tear, you can also focus on the shape of the meniscus. Typically, on sagittal plane images, the meniscus has a butterfly shape. Any other shape could be a sign of a rupture. A sign of rupture is also the symptom of “double posterior cruciate ligament” (or “third cruciate ligament”), when, as a result of displacement, the meniscus ends up in the intercondylar fossa of the femur and is adjacent to the posterior cruciate ligament.

A meniscus tear can be detected by MRI even in the absence of complaints from the patient, and the frequency of such cases increases with age. This shows how important it is to take into account all clinical and radiological data during the examination. In a recent study, meniscal tears that did not produce complaints or physical signs (i.e., positive test results when examined by a physician) were detected on MRI in 5.6% of patients aged 18 to 39 years. According to another study, 13% of patients under 45 years of age and 36% of patients over 45 years of age had signs of meniscal tears on MRI in the absence of complaints and physical signs.

What are the types of meniscus tears in the knee?

Meniscal tears can be classified depending on the cause and the nature of the changes detected during examination (MRI) or during surgery (knee arthroscopy).

As we have already noted, ruptures can be traumatic (excessive load on an unchanged meniscus) and degenerative (normal load on a meniscus altered by degenerative processes).

According to the place where the rupture occurred, ruptures of the posterior horn, body and anterior horn of the meniscus are distinguished.

Since the meniscus is unevenly supplied with blood, three zones are distinguished in it: peripheral (red) - in the area of the connection of the meniscus with the capsule, intermediate (red-white) and central - white, or avascular zone. The closer to the inner edge of the meniscus the tear is located, the fewer vessels pass near it and the lower the likelihood of its healing.

According to their shape, tears are divided into longitudinal, horizontal, oblique and radial (transverse). There may also be ruptures combined in shape. In addition, there is a special variant of the shape of a meniscus tear: “watering can handle” (“basket handle”).

Classification of meniscal tears according to H. Shahriaree: I - longitudinal tear, II - horizontal tear, III - oblique tear, IV - radial tear

A special variant of the shape of a meniscus tear: “watering can handle” (“basket handle”)

Acute traumatic ruptures that occur at a young age run vertically in a longitudinal or oblique direction; combined and degenerative ruptures occur more often in older people. Vertical longitudinal tears, or watering can handle tears, can be complete or incomplete and usually begin at the posterior horn of the meniscus. With long ruptures, significant mobility of the torn part is possible, allowing it to move into the intercondylar fossa of the femur and block the knee joint. This is especially true for tears of the medial meniscus, possibly due to its reduced mobility, which increases the shear force acting on the meniscus. Oblique tears usually occur at the border between the middle and posterior third of the meniscus. Most often these are small tears, but their free edge can fall between the articular surfaces and cause a rolling sensation or clicking. Combined tears occur in several planes at once, are often localized in or near the posterior horn, and usually occur in older people with degenerative changes in the menisci. Horizontal longitudinal tears are often associated with cystic degeneration of the menisci. These tears usually begin at the inner edge of the meniscus and move towards the junction of the meniscus and capsule. They are thought to be caused by shear forces and, when associated with cystic degeneration of the meniscus, form in the inner medial meniscus and cause local swelling (bulging) along the line of the joint space.

How to treat a torn meniscus of the knee joint?

Treatment of meniscal tears can be conservative (that is, non-surgical) and surgical (meniscectomy, that is, removal of the meniscus, which can be complete or incomplete (partial)).

Special options for surgical treatment of meniscus tears are suture and meniscal transplantation, but these techniques are not always possible and sometimes do not give very reliable results.

Conservative (non-surgical) treatment of knee meniscus tears. Conservative treatment is usually prescribed for small tears of the posterior horn of the meniscus or for small radial tears. These tears may be accompanied by pain, but do not impinge on the meniscus between the articular surfaces and do not cause any clicking or rolling sensations. These tears usually occur in stable joints.

Treatment consists of temporarily reducing the load. Unfortunately, you can often find a situation where in our country a plaster cast is applied for a torn meniscus, completely preventing movement in the knee joint. If there are no other injuries in the knee joint (fractures, torn ligaments), but only a meniscus tear, then such treatment is fundamentally wrong and can even be called crippling. The fact is that large meniscal tears will still not heal, despite a cast and complete immobilization of the knee joint. And small meniscal tears can be treated in more gentle ways. Complete immobilization of the knee joint with a heavy plaster cast is not only painful for a person (after all, it is impossible to wash properly, bedsores can develop under the plaster), but has a detrimental effect on the knee joint itself. The fact is that complete immobilization can lead to joint contracture, i.e. persistent limitation of the amplitude of movements due to the fact that the non-moving cartilaginous surfaces are glued together, and, unfortunately, movements in the knee cannot always be restored after such treatment. It is doubly sad when treatment with a plaster cast is used in cases where the gap is large enough that after several weeks of suffering in a cast, surgery still has to be done. Therefore, it is so important to immediately contact a specialist who is well acquainted with the treatment of meniscus and knee ligament tears in case of a knee joint injury.

If the patient plays sports, then with conservative treatment it is necessary to exclude situations that can further injure the joint. For example, temporarily stop exercising in sports that require quick jerks, especially with turns, and movements in which one leg remains in place - they can worsen the condition.

In addition, you need exercises that strengthen the quadriceps and hamstring muscles. The fact is that strong muscles additionally stabilize the knee joint, which reduces the likelihood of such shifts of the femur and tibia relative to each other that injure the meniscus.

Conservative treatment is often more effective in older people, since in them the cause of the described symptoms is often arthrosis rather than a meniscus tear. Small (less than 10 mm) stable longitudinal tears, tears of the upper or lower surface that do not penetrate the entire thickness of the meniscus, as well as small (less than 3 mm) transverse tears may heal on their own or do not appear at all.

In cases where a torn meniscus is combined with a torn anterior cruciate ligament, conservative treatment is usually used first.

Surgical treatment of meniscal tears of the knee joint. Indications for arthroscopic surgery include significant size of the tear, causing mechanical symptoms (pain, clicking, blockades, limitation of movements), persistent effusion in the joint, as well as cases of unsuccessful conservative treatment. Let us note once again that the very fact that conservative treatment is possible does not mean that all meniscal tears should first be treated conservatively, and then, if that fails, then resort to “surgery as a last resort.” The fact is that quite often meniscus tears are of such a nature that it is more reliable and effective to operate on them immediately, and sequential treatment (“first conservative, and then, if that doesn’t help, then surgery”) can significantly complicate recovery and worsen the results. Therefore, we emphasize once again that in case of a meniscus tear, and indeed in case of any injury to the knee joint, it is important to consult a specialist.

With meniscus tears, friction and blockage, called mechanical or motor symptoms (because they occur with movement and disappear or are significantly reduced by rest), can interfere with both daily life and sports. If symptoms occur in everyday life, then the doctor will easily be able to detect signs of rupture during examination. As a rule, effusion is detected in the joint cavity (synovitis) and pain in the projection of the joint space. Limitation of movements in the joint and pain during provocative tests are also possible. Finally, other causes of knee pain must be ruled out based on the history, physical examination, and x-rays. If these symptoms are present, this means that the meniscus tear is significant and surgery should be considered.

It is important to know that in case of meniscus tears, you do not need to delay surgery for a long time and endure pain. As we have already noted, a dangling meniscus flap destroys the adjacent cartilage covering the femur and tibia. The cartilage changes from smooth and elastic to soft, loose, and in advanced cases, a dangling flap of a torn meniscus wears the cartilage completely down to the bone. Such damage to cartilage is called chondromalacia, which has four degrees: in the first degree, the cartilage is softened, in the second, the cartilage begins to become unfibered, in the third, there is a “dent” in the cartilage, and in the fourth degree, the cartilage is completely absent.

Photograph taken during knee arthroscopy. This patient endured pain for almost a year, after which he finally turned to traumatologists for help. During this time, the dangling flap of the torn meniscus completely erased the cartilage to the bone (chondromalacia fourth degree)

Meniscus removal, or meniscectomy (arthrotomy through a large incision 5-7 centimeters long), was initially considered a harmless intervention and complete removal of the meniscus was performed very often. However, long-term results were disappointing. Recovery or noticeable improvement was observed in 75% of men and less than 50% of women. Complaints disappeared in less than 50% of men and less than 10% of women. Young people had worse surgical results than older people. In addition, 75% of those operated on developed arthritis (versus 6% in the control group of the same age). Arthrosis often appeared 15 years or more after surgery. Degenerative changes developed more quickly after lateral meniscectomy. When the role of the menisci finally became clear, the surgical technique changed and new instruments were created that made it possible to restore the integrity of the menisci or remove only part of them. Since the late 1980s, arthrotomic complete removal of the meniscus has been recognized as an ineffective and harmful operation, which has been replaced by the possibility of arthroscopic surgery, which allows preserving the intact part of the meniscus. Unfortunately, in our country, due to organizational reasons, arthroscopy is not available everywhere, so there are still surgeons who offer their patients to completely remove the torn meniscus.

Nowadays, the meniscus is not completely removed, since its important role in the knee joint has become clear, but a partial (partial) meniscectomy is performed. This means that not the entire meniscus is removed, but only the torn part, which has already ceased to perform its function. What is the principle of partial meniscectomy, i.e. partial removal of the meniscus? The video and illustration below will help you understand the answer to this question.

The principle of partial meniscectomy (i.e. incomplete removal of the meniscus) is not only to remove the loose and loose part of the meniscus, but also to make the inner edge of the meniscus smooth again.

The principle of partial removal of the meniscus. Various types of meniscal tears are shown. A part of the meniscus is removed from its inner side in such a way as not only to remove the dangling flap of the torn meniscus, but also to restore the smooth inner edge of the meniscus.

In the modern world, the operation of partial removal of a torn meniscus is performed arthroscopically, i.e. through two small punctures. An arthroscope is inserted into one of the punctures, which transmits the image to a video camera. Essentially, an arthroscope is an optical system. Using an arthroscope, a saline solution (water) is injected into the joint, which inflates the joint and allows it to be examined from the inside. Through the second puncture, various special instruments are introduced into the cavity of the knee joint, with which damaged parts of the menisci are removed, the cartilage is “restored” and other manipulations are performed.

Arthroscopy of the knee joint. A- The patient lies on the operating table, the leg is in a special holder. At the back is the arthroscopic stand itself, which consists of a xenon light source (the joint is illuminated with xenon through a light guide), a video processor (to which a video camera is attached), a pump (injects water into the joint), a monitor, a wiper (a device for ablation of cartilage, the synovial membrane of the joint), shaver (a device that “shaves”). B- an arthroscope (left) and a working instrument (nippers, right) were inserted into the knee joint through two one-centimeter punctures. IN- Appearance of arthroscopic cutters, clamps.

If arthroscopy reveals cartilage damage (chondromalacia), the doctor may recommend that you inject special medications into the knee joint after the operation (Ostenil, Fermatron, Duralan, etc.). You can find out more about which drugs can be injected into the knee joint and which cannot, on our website in a separate article.

In addition to meniscectomy, there are techniques for repairing the meniscus. These include meniscal suture and meniscal transplantation.Deciding when it is best to remove part of the meniscus and when it is best to restore the meniscus is difficult. It is necessary to take into account many factors that influence the outcome of the operation. In general, it is believed that if the meniscus is damaged so extensively that almost the entire meniscus must be removed during arthroscopic surgery, then it is necessary to consider the possibility of repairing the meniscus.

A meniscus suture can be performed in cases where little time has passed since the rupture. A necessary condition for successful healing of the meniscus after suturing is sufficient blood supply to the meniscus, i.e. The gaps should be located in the red zone or, at a minimum, on the border of the red and white zones. Otherwise, if you stitch a meniscus that has developed in the white zone, the suture will sooner or later become insolvent again, a “re-rupture” will occur and surgery will be required again. The meniscal suture can be performed arthroscopically.

The principle of arthroscopic suture of the meniscus "from the inside to the outside". There are also “outside-in” techniques and meniscus stapling

Photograph taken during arthroscopy. Meniscus suture stage

Meniscus transplantation. Now there is also the possibility of meniscus transplantation. Meniscus transplantation is possible and may be advisable in cases where the meniscus of the knee joint is significantly damaged and completely ceases to perform its functions. Contraindications include severe degenerative changes in the articular cartilage, instability of the knee joint and curvature of the leg.

Both frozen (donor or cadaveric) and irradiated menisci are used for transplantation. The best results are reportedly expected from the use of donor (fresh frozen) menisci. There are also artificial meniscal endoprostheses.

However, meniscus transplantation and endoprosthetics operations are associated with a number of organizational, ethical, practical and scientific difficulties, and this method does not have a convincing evidence base. Moreover, among scientists and surgeons there is still no consensus on the advisability of meniscal transplantation and endoprosthetics.

In general, it is worth noting that transplantation and meniscus replacement are performed extremely rarely.

Questions to discuss with your doctor

1. Do I have a meniscus tear?

2. What kind of meniscus tear do I have? Degenerative or traumatic?

3. What is the size of a meniscal tear and where is the tear located?

4. Are there any other injuries besides the meniscus tear (is the anterior cruciate ligament, collateral ligaments intact, are there any fractures, etc.)?

5. Is there damage to the cartilage covering the femur and tibia?

6. Do I have a significant meniscal tear? Is an MRI necessary?

7. Can my meniscal tear be treated without surgery or should I perform arthroscopy?

8. What is the likelihood of cartilage damage and the development of arthrosis if I delay the operation?

9. What is the likelihood of cartilage damage and the development of arthrosis if I undergo arthroscopic surgery?

10. If arthroscopy gives a greater chance of success than the non-surgical method, and I agree to surgery, how long will the recovery take?

27
Oct
2014

What is a meniscus?

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

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

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

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

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

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

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

Why do meniscal injuries occur?

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

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

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

Types of meniscus injuries.

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

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

Symptoms of a meniscus tear.

- Traumatic ruptures.

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

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

When a meniscus ruptures, one part can come off, after which it will hang loose and interfere with the full functioning of the knee joint. Small tears can cause difficulty moving and painful clicking sounds in the knee joint. A large tear leads to a blockade of the knee joint, due to the fact that the torn and dangling part of the meniscus moves to the very center and begins to interfere with various movements.

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

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

- Acute rupture.

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

- Degenerative ruptures.

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

Increased pain and swelling of the knee cannot always be detected, since their development occurs gradually.

It is important to note that it is not always possible to find indications of the injury that occurred in the patient’s health history. In some cases, a torn meniscus can occur after performing a normal activity, such as getting up from a chair. At this time, blockage of the knee joint may occur. It should be borne in mind that in many cases chronic ruptures lead only to pain.

With this injury, the meniscus may be damaged, and its adjacent cartilage may cover the tibia or femur.

The signs of chronic meniscus tears are different: pain with a certain movement or a pronounced pain syndrome that does not allow you to step on your leg.

Regardless of the type of injury, you should consult a doctor in a timely manner.

How should a torn posterior horn of the meniscus be treated?

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

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

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

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

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

Features of surgical intervention.

If surgery is necessary, the possibility of suturing the meniscus is determined. This method is usually preferred when the “red zone” is damaged.

What types of operations are usually used for injury to the horn of the medial meniscus?

Arthrotomy is a complex operation that involves removing damaged cartilage. They are trying to abandon this method, but arthrotomy is mandatory if the damage to the knee joint is extensive.
Meniscatomy is an operation that involves complete removal of cartilage. The technique used to be common, but now it is considered harmful and ineffective.
Partial meniscectomy is a surgical procedure during which the damaged part of the cartilage is removed and the remaining part is restored. Surgeons must trim the edge of the cartilage, trying to bring it into an even state.
Endoprosthetics and transplantation. Many people have heard about these types of operations. The patient must have a donor or artificial meniscus transplanted, and the affected meniscus is removed.
Arthroscopy is recognized as the most modern type of surgery. This method is characterized by low trauma. The technique involves two small punctures. An arthroscope, which is a video camera, must be inserted through one puncture. Saline solution enters the joint. Another puncture is necessary to perform various manipulations with the joint.
Cartilage suturing. This method can be performed using an arthroscope. The operation can be effective only in the thick zone, where there is a high chance of cartilage fusion. Surgery should be performed almost immediately after the rupture.

The best method of surgery should be selected by an experienced surgeon.

Rehabilitation period.

Treatment of the meniscus necessarily involves restoring the functions of the knee joint. It is important to remember that rehabilitation should be carried out under the strict supervision of a rehabilitation specialist or orthopedist. The doctor must determine a set of measures aimed at improving the condition of the knee joint. Rehabilitation measures should promote rapid recovery. The recovery stage of treatment can be carried out at home, but it is necessary to visit a clinic. Ideally, rehabilitation should be carried out in a hospital. It should be noted that the range of measures includes physical therapy, massage, and modern hardware methods. To stimulate the muscles and develop the joint, the load must differ in dosage.

In most cases, it takes several months to fully restore the function of the knee joint. You can lead a normal lifestyle one month after surgery. Functions will be restored gradually, since a serious problem is caused by the presence of intra-articular edema. To eliminate swelling, lymphatic drainage massage is necessary.

Making an accurate diagnosis and timely treatment allows you to count on a favorable prognosis. Consulting with an experienced physician will ensure that any knee joint problems are addressed, thereby eliminating any mobility issues. Following all the recommendations of an experienced doctor will allow you to restore your ideal state of health.

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.

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.

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.

Front horn

Treatment of a tear in the anterior horn of the medial (internal) meniscus

The medial meniscus differs from the lateral one in its larger circumference and greater distance between the horns (approximately two times). The anterior horn of the medial meniscus is attached in the area of the anterior edge of the articular part of the tibia - in the so-called intercondylar fossa. The outer surface of the meniscus is tightly connected to the articular capsule, and the inner surface is tightly connected to the medial collateral ligament.

Normally, the anterior horn of the meniscus has a smooth surface and its edges are quite thin. The blood supply to the menisci is mainly localized in the anterior and posterior horns, but the blood vessels extend only 5-7 mm from the edge of the meniscus.

Statistics

It is estimated that medial meniscus injuries account for 60 to 80 percent of all knee injuries. Rupture of the anterior horn of the medial meniscus ranks first in frequency of occurrence. Longitudinal and flap tears are more typical for this injury.

Causes

The main reason for rupture or separation of the anterior horn of the meniscus is a significant load on the knee joint, combined with fixation of the foot and rotational movement of the knee. At risk are young people leading an active lifestyle, as well as older men. Statistically, rupture occurs more often in men than in women.

Symptoms

Damage to the anterior horn of the medial meniscus is often combined with displacement of the torn part and its blocking between the internal surfaces of the joint. When the anterior horn is torn off with entrapment, symptoms such as blockade of the knee joint, knee pain and the inability to move independently appear. After treatment, the joint block is eliminated. Also, with an injury to the anterior horn of the meniscus, the patient can often slightly bend the knee, after which a blockade occurs.

With an injury to the anterior horn of the medial meniscus, the following symptoms may also occur:

Feeling of pain inside the joint,
Increased pain when trying to bend the leg at the knee,
Flabbiness of the thigh muscles,
Sensation of “lumbago” when the knee joint is tense,
Pain in the area where the meniscus and ligament attach.

Kinds

It is customary to distinguish three types of rupture:

Rupture of the immediate anterior horn (complete or partial).
A meniscal tear with degenerative changes.
Rupture of the ligament that secures the meniscus.

Conservative treatment

For minor meniscus injuries, conservative treatment is sufficient. In the first stages, the injured limb is fixed using a splint. A puncture of the joint can also be performed to get rid of the blood accumulated in the cavity and remove the blockage of the joint. The patient is advised to rest and the load on the leg should be limited. Subsequently, a course of physiotherapy, physical therapy, massage sessions and electrical myostimulation is recommended.

Surgical treatment

If there is a complete rupture of the anterior horn of the internal meniscus, surgical treatment is recommended. A meniscectomy is performed, that is, an operation to remove the torn fragment. Today, open surgery is almost never performed, as is complete removal of the meniscus. Instead, stitching or fragmentary removal is performed using arthroscopy. Due to the low invasiveness of the arthroscopic method, trauma to the knee joint and the rehabilitation period are significantly reduced. Performing such a procedure allows you to preserve functionally significant elements of the meniscus, which prevents the development of arthrosis and osteoporosis and allows the patient to quickly return to normal life.

In young patients, it is possible to undergo arthroscopic suturing of the meniscus. In this case, a rupture of the anterior horn of the meniscus is an indication for such suturing, since the anterior horn has a good blood supply, and its restoration occurs faster and more fully.

Rehabilitation

Arthroscopy can significantly reduce recovery time after a meniscal injury. After just a few days, it becomes possible to put a load on the limb, develop the knee joint and return to the usual rhythm of life. The essence of rehabilitation is to get rid of pain and restore mobility to the knee joint.