Degenerative damage to the internal meniscus (medial) of the knee joint treatment

Menisci are important cartilaginous structures of the knee joints, providing them with stability, strength and a high range of motion. Therefore, any damage to them, and especially complete ruptures, are fraught not only with serious pain in the knees, but also with severe restrictions on movement, even blocking the knee joint. In this case, treatment tactics largely depend on the nature of the injury and can consist of both the use of conservative methods and surgery.

Features of the internal meniscus

There are 2 menisci in each knee joint: the inner (medial) and the outer (lateral). They are located between the condyles of the femur and the recesses of the tibia. These cartilaginous structures are crescent-shaped, but the inner meniscus is slightly larger than the outer one. At the same time, they both perform the function of a kind of shock absorbers of the lower extremities, as they are designed to soften the shocks that occur during movement. In addition, they help to correctly distribute the load on the structural components of the joint and limit its mobility within physiological limits.

The wide part of each meniscus is called the body, and the two narrow ends are called the horns. The horn of each meniscus, facing anteriorly, is called anterior, and the opposite, respectively, posterior. The outer part of the meniscus is firmly fused with the articular capsule, while the inner part has a sharper shape and is directed towards the articular cavity.

¾ of the meniscus consists of collagen fibers directed in different directions: radially and circularly. The first ones intersect with each other, thanks to which they form a strong network. This gives the meniscus important resistance to mechanical stress of various kinds, which is the main protection against damage. Circular fibers serve a different function. They are responsible for uniformly distributing the load throughout the meniscus, so the largest number of them is concentrated in its body. Also in the structure of the cartilaginous tissue of the meniscus, there is another 3rd, but very few, type of collagen fibers - perforating cords. They are necessary to combine radial and circular fibers into a single whole, which increases the strength of the meniscus.

The inner meniscus is shaped like the letter “C”. At one end it is attached to the tibia, and at the other to the outer edge of the articular capsule. Attached to its body is the tibial collateral ligament, which is also called the internal collateral ligament. It is responsible for holding the tibia and limiting its excessive outward displacement. The anterior meniscofemoral ligament is attached to its anterior surface, which connects the meniscus to the lateral condyle of the femur. The transverse ligament of the knee also runs along the anterior part, connecting the medial and lateral meniscus.

In this case, the internal meniscus is much more tightly connected to the joint capsule than the external one. Therefore, it is characterized by a more rigid fixation provided by the ligaments. This is the main reason for his more frequent traumatization. Moreover, in most cases, it is the posterior horn, which is characterized by the least strength, that is affected.

In adults, the menisci are practically devoid of blood vessels: they are present only in their outer part, called the red zone. This explains the low tendency of the menisci to regenerate, since the main part of the cartilage does not receive direct nutrition, and the necessary substances are delivered to it through diffusion from the synovial fluid.

Severity of rupture

When determining therapeutic tactics, the traumatologist must take into account the type of injury and its severity. Minor injury to the meniscus often does not require surgical intervention, but when it is fragmented or displaced fragments, surgery is necessary. There are 3 degrees of severity of rupture of the cartilage lining of the knee:

degree of severity. Clinically, the injury is manifested by moderate pain, mild swelling in the knee area;
degree of severity. The leading symptoms of damage are severe pain, the severity of which gradually decreases, swelling, hematoma;
degree of severity. A rupture is characterized by acute pain, extensive swelling, hematoma, and inability to put weight on the foot.

A rupture of any severity requires seeking medical help. Due to improper fusion of cartilage tissue, the knee joint will not be able to fully function.

Types of damage

Any part of the internal meniscus, both the horns and the body, can be injured. And although the posterior horn is damaged more often than others, this does not exclude the possibility of injury to other parts of the cartilage. Determining the type of injury is of great importance for selecting effective treatment tactics.

Today it is customary to classify all injuries to the internal meniscus of the knee joint according to several parameters. One of the most important criteria is the degree of cartilage tear: complete and incomplete or partial. In the first case, a fragment of the meniscus is completely torn off from the main part, and in the second, partial damage is observed, which does not affect the entire cartilage and does not lead to a change in its structure. The meniscus may also be detached from the attachment site of the posterior and anterior horns or the body of the meniscus itself. However, combined injuries, as well as cystic degeneration, are not excluded, although the medial meniscus is rarely subject to this.

Based on the nature of damage to the internal meniscus, the following types of tears are distinguished:

transverse or radial;
longitudinal like a “watering can handle”;
patchy;
fragmented;
oblique like a “parrot’s beak”.

Often there is damage to the internal meniscus along the longitudinal axis with a rupture of its middle part, i.e., the body, but maintaining the integrity of the anterior and posterior horns, which is called a “watering can handle” rupture. Transverse tears of the body of the internal meniscus in the area under the tibial collateral ligament are most rarely diagnosed.

Interpretation of MRI of the knee joint with a meniscus tear

The study is carried out in T1 and T2 modes, if necessary, contrast enhancement is used. The doctor assesses the condition of the joint elements and surrounding tissues. In the process of deciphering the MRI results, a scanning protocol is filled out. The specialist describes:

shape, location of joint elements, including menisci;
the presence of bone destructive changes;
violation of the integrity of articular elements;
signs of inflammatory processes;
density and thickness of ligaments;
fluid level in the joint capsule;
the thickness of the cartilage of the articular surfaces;
condition of the anterior, posterior horns and bodies of the menisci;
configuration of the cartilage plate;
signs of a meniscal tear with location indication.

The radiologist makes a preliminary diagnosis based on the images obtained. The choice of treatment method remains with the attending physician.

The results of an MRI for a meniscus tear are given to the patient on the day of treatment. The doctor fills out a research protocol and draws up a conclusion; the resulting photographs are recorded on a CD or other electronic media.

Rupture of the posterior horn of the medial cartilage on images taken in different modes, the arrow indicates a violation of the integrity of the plate

At the Magnit clinic, MRI of the knee meniscus is performed using a 1.5 Tesla tomograph from the German company Siemens. The device allows you to obtain high-resolution images, which has a positive effect on the reliability of the research results. You can sign up for a scan by phone or on the clinic’s website.

Causes

The main cause of injury to the medial meniscus is indirect knee injury. Moreover, other intra-articular structures may be affected at the same time. But in general, there are 3 mechanisms of injury:

severe knee bruise;
falling onto a hard surface with a protruding angle, such as a step or curb;
unsuccessful rotation of the tibia outward with a fixed hip against the background of a high load or vice versa.

In some cases, an injury to the internal meniscus is combined with a rupture of the anterior cruciate ligament or a fracture of the tibial condyle.

However, the likelihood of injury increases against the background of:

The progression of degenerative-dystrophic processes in cartilage tissue, which is due to the inevitable decrease in the strength of cartilage that occurs against the background of deterioration in its nutrition.
Genetically determined changes in the properties of the menisci, which are usually detected in childhood when injured as a result of low loads, in particular when walking, running, squats and other types of activity typical for children.
A long-term inflammatory process involving the menisci. This usually occurs with chronic arthritis of the knee joints and some autoimmune diseases.
Previously suffered a rupture of the anterior cruciate ligament.

Most often, injuries to the internal meniscus of the knee joint are diagnosed in athletes and people engaged in heavy physical labor. Moreover, the vast majority of patients with such injuries are men under 45 years of age. In women, injuries to the internal meniscus are 2 times less common.

Situations where damage to the internal meniscus is chronic and caused by the progression of degenerative-dystrophic changes are called degenerative tears. They are most typical for people over 45-50 years old. Most often, ruptures in such cases are the result of frequent microtraumas of the knee that occur when the knee joint is exposed to too high a load when playing sports or performing professional and household duties.

When repeated injuries lead to chronic damage to the internal meniscus, a disease called meniscopathy develops. In such situations, any sudden movement in the knee can cause a meniscus tear, including squatting or quickly rotating the shin.

Determining the exact cause of damage to the internal meniscus of the knee joint plays a large role in the development of effective treatment, which will not only be aimed at eliminating the consequences of an existing injury, but also at preventing recurrent injuries.

What should you pay attention to after surgery for a torn meniscus?

Immediately after surgery, the knee should be kept elevated and a cooling compress applied. After about 5 days, the stitches will be removed and you will be able to shower again.

To avoid complications, monitor your movements for several weeks. The duration of sick leave depends on the type of your professional activity and can last up to six weeks. Prevention of thrombosis is also mandatory. Comprehensive physiotherapeutic treatment at this stage is very important, as these procedures prevent muscle destruction and help restore the functions of the knee joint.

A return ticket should be booked no earlier than 7 weeks after the operation. However, we recommend staying in the Gelenk Clinic for at least 10 weeks.

Inpatient treatment: 3-4 days
Recommended length of stay in the clinic: 10-14 days
When can you go home: 7 days after surgery
When recommends leaving the clinic: 10 days after surgery
When is it permissible to shower: after 5 days
How long is it recommended to stay on sick leave: 2-6 weeks (depending on professional activity)
When the stitches are removed: after 5 days
Outpatient physical therapy: 2 weeks
When can you drive again: after 6 6 weeks
Light sports activity: no earlier than after 8 weeks
Habitual sports activities: after 6 months

Symptoms

Both complete and incomplete tears of the internal meniscus manifest themselves acutely, and the severity of symptoms directly depends on the degree of damage. Therefore, victims notice different intensities:

Pain in the area of the inner surface of the knee, which gains strength or shooting occurs when trying to make any movements in the joint, especially when bending the leg.
Restrictions on the mobility of the knee, up to its complete blocking, if a fragment of the internal meniscus is torn off and gets into the joint space between the contacting surfaces of the bones. In this case, when trying to make any kind of movement, a sharp pain occurs in the knee.
Signs of the development of an inflammatory process, which may include redness and swelling of soft tissues. As a result, the size of the knee increases to a greater or lesser extent. An increase in tissue temperature directly in the projection of injury may also be observed. Therefore, the inside of the knee may become hot to the touch.
Hemarthrosis (hemorrhage and swelling of soft tissues slightly above the knee joint), which is the result of damage to the internal meniscus affecting its red zone.

After the end of the acute period, which lasts on average 15-20 days, if left untreated, damage to the internal meniscus becomes chronic. This is accompanied by the same symptoms, but less pronounced.

In some cases, patients who did not receive timely qualified medical care and did not undergo treatment may experience periods of apparent recovery. This is accompanied by a decrease in pain and limited movement. But after some time, with awkward movement, the symptoms and knee blockage return, which is called a relapse. This can occur either once a week or every day, but it always requires an examination by an orthopedic traumatologist as soon as possible and treatment appropriate to the situation.

Also, if left untreated, tears of the internal meniscus can lead to the development of atrophy of the thigh muscles, and sometimes the lower leg.

Treatment

Treatment can be surgical or conservative. The choice of technique depends on the degree of damage, which was determined during ultrasound or MRI. Conservative therapy involves puncture of the joints (pumping out fluid to reduce swelling and pain), taking medications (NSAIDs and painkillers) and limiting exercise.

Indications for surgical intervention are separation of the body and horns of the cartilaginous plate, displaced ruptures, crushing of the plate and insufficient effectiveness of conservative treatment.

Types of operations: • Stitching of the plate. A suture can be applied in case of separation from the capsule, peripheral and longitudinal vertical damage. A prerequisite is the absence of degenerative changes. • Meniscectomy (complete or partial removal of the cartilage pad). This radical intervention is indicated for large avulsions or degeneration of cartilage tissue. These measures are not always safe and effective. Thus, most methods of conservative treatment (pumping out fluid, painkillers) are only temporary measures that relieve pain for a short time.

Surgery, especially meniscectomy after meniscus tears, is dangerous due to complications such as effusions, arthritis and arthrosis. Therefore, without an integrated approach, good results in knee joint restoration cannot be achieved.

Diagnostics

After receiving a knee injury, especially if symptoms of damage to the internal meniscus occur, you should consult an orthopedic traumatologist. The doctor will determine the conditions of the injury, the nature of the existing symptoms and conduct a visual examination of the injured knee for the presence of hemarthrosis, shape deformation, soft tissue swelling, etc. He can also conduct several diagnostic tests to determine the presence of damage to the internal meniscus and differentiate it from injuries other intra-articular structures.

To definitively confirm a tear of the medial meniscus of the knee joint and to accurately establish its type and extent, visualization of the knee structures is required. For this purpose, instrumental diagnostic methods are prescribed:

X-rays are practically not used today for diagnosing meniscal injuries due to their low information content. But it is indispensable for detecting fractures and cracks in the bone structures of the knee, in particular fractures of the femoral condyles. Therefore, it is prescribed to confirm or exclude their presence.
Ultrasound is a safe, accessible, easy-to-use diagnostic method that allows you to detect meniscal tears, the formation of post-traumatic cysts, and separation of part of the meniscus from the place of its fixation. Ultrasound can also detect meniscus degeneration.
MRI - This study has a high diagnostic value in terms of detecting damage to soft tissue structures, including cartilage. With its help, you can classify a tear of the internal meniscus according to the Stoller system, which involves dividing cartilage damage into 4 degrees, and select the optimal treatment tactics.
CT is a modern, but more informative analogue of X-ray, which is mainly used when there is a suspicion of complex injuries to the femur or tibia.

In rare, particularly complex cases, patients require arthroscopy. Unlike all other diagnostic methods, this procedure is invasive. It involves inserting a special instrument directly into the cavity of the knee joint. But at the same time, it provides the opportunity to thoroughly examine all the changes that have occurred, as well as immediately remove the torn fragments of the meniscus.

Methods for diagnosing meniscal tears

To confirm the diagnosis of a meniscus tear, instrumental diagnostic methods are used. The simplest and most accessible method is ultrasound examination (ultrasound of the knee joint).

Techniques such as radiography, computed tomography, MRI and arthroscopy may also be used.

Magnetic resonance imaging (MRI)

Currently, MRI is considered the “gold standard” for diagnosing meniscal tears. The study allows for a detailed study of the soft tissues of the joint, including the condition of the cartilage.

More information about the diagnostic method

Arthroscopy

Arthroscopy is a method in which endoscopic equipment is introduced into the joint cavity through a small incision, including a light source and a video camera, which allows the doctor to directly see the condition of the joint structures. Used in difficult cases.

Sign up for diagnostics To accurately diagnose the disease, make an appointment with specialists from the Family Doctor network.

First aid for injuries resulting in meniscus damage

If you fall on your knee or use another mechanism of injury, you must first provide rest to the injured limb. If a joint blockage occurs, under no circumstances should you try to remove it yourself, straighten the leg, etc. Immobilization is carried out in the position in which the joint is blocked. For this purpose, a splint bandage or a special removable splint is used.

After this, cold is applied to the affected knee. As a source of this, you can use either an ice pack or a cold compress made from a cloth soaked in cold water. It is applied to the most painful point. This will reduce the likelihood of swelling and hemarthrosis, and further reduce pain. The cold is held on the knee for 15-30 minutes.

In this position, the victim must be taken for examination to an orthopedist-traumatologist. Otherwise, the pain will gradually decrease, but the injury to the internal meniscus will regularly make itself felt and ultimately lead to the development of meniscopathy and other complications. Therefore, it is important to immediately consult a doctor if you receive damage to this cartilage structure and begin treatment.

If a knee block occurs, the importance of contacting an orthopedist is difficult to overestimate. Independent attempts to restore limb mobility can lead to even greater damage to the meniscus and other intra-articular structures. Therefore, in such cases, you must immediately obtain qualified medical assistance.

Elimination of blockade of the knee joint

When diagnosing a blockade, the orthopedist performs several sequential actions to restore normal knee function:

Puncture of the knee joint to remove effusion and blood accumulated in its cavity. This is done using a special puncture needle. After this, an anesthetic solution is injected into the joint cavity, which reduces pain and facilitates further manipulations.
15-20 minutes after the administration of the anesthetic drug, the orthopedist-traumatologist pulls the foot of the affected limb down with his hands or using a loop rolled from a bandage.
Without releasing the tension, the doctor moves the lower leg outward. This ensures expansion of the joint space and creates conditions for the damaged meniscus to return to its normal position.
The tibia is rotated inward, which allows the normal position of the cartilage to be fixed.
The quality of knee extension is checked. The manipulation is considered successful if the function of the joint is fully restored and movements do not require effort.
The leg is fixed from the toes to the upper third of the thigh with a plaster cast. The immobilization period is 5-6 weeks.

If the first attempt to remove the blockade was unsuccessful, the steps are repeated. No more than 3 attempts are allowed. If they are unsuccessful, surgical intervention is indicated.

Further treatment can be carried out conservatively or surgically, depending on the degree and type of tear of the internal meniscus. But it is always aimed at eliminating the problems that have arisen and restoring the normal functioning of the knee joint.

Post-operative care, rehabilitation and aids after meniscus tear surgery?

During the first week after surgery for a meniscus tear, the knee is immobilized using a special splint. In order to relieve tension from the knee joint, you will need to use elbow crutches. Then the load on the knee will be gradually increased. As long as the patient only partially strains the knee, thrombosis prophylaxis (eg Hepoarin/Enoxaparin) is mandatory. You should also wear compression stockings until your doctor allows you to put full weight on your leg. After the operation, we will provide you with everything you need.

Conservative treatment

For minor injuries or incomplete rupture of the internal meniscus, treatment can be carried out non-surgically. But even in such cases it is always complex and consists of:

Providing rest for the injured limb, which is achieved by applying tight bandages made of an elastic bandage or a plaster splint.
Carrying out complex drug therapy aimed at improving the patient’s well-being, preventing further destruction of the internal meniscus and improving the course of metabolic processes, which helps speed up recovery.
Performing physiotherapeutic procedures, the importance of which increases when signs of chronicity of the process are detected.
Regular exercise therapy (PT) to prevent the development of complications and loss of muscle tone.
Carrying out a course of therapeutic massage after removing the plaster cast, which helps to activate blood circulation, eliminate swelling and preserve muscle mass.

Recovery after removal of the cast, with proper conservative treatment and the absence of complications, lasts 1.5-2 months.

Drug therapy

All patients with injuries of the internal meniscus are prescribed a complex of medications:

Painkillers from the NSAID group, which also have anti-inflammatory properties. They help reduce pain and inflammation in the joint.
Corticosteroids. Used for severe inflammation in the joint resulting from injury.
Chondroprotectors. Prescribed to increase the rate of regeneration of damaged cartilage and reduce the risk of its destruction.
Vitamin complexes. Indicated to improve metabolic processes and provide cartilage tissue with the substances it needs.

Exercise therapy

From the first days of conservative treatment, patients are required to engage in exercise therapy daily. For each patient, a set of exercises is selected individually.

During the period of immobilization of the affected limb, it is necessary to perform general developmental exercises for all muscle groups using the healthy leg. As for the injured limb, at first you need to perform special exercises that will use its thigh muscles.

Also, before removing the cast, it is necessary to lower the affected leg down for a short time, and then return it to a higher ground. This will reduce the risk of obstruction of blood flow from the leg.

After removing the plaster cast, patients are prescribed exercises to restore the functions of the lower limb. They consist of performing rotational movements with the foot, engaging large joints, and tensing all the muscles of the affected leg. But the load, as well as the nature of the exercises, is selected separately for each patient in accordance with the characteristics of his recovery.

Physiotherapy

Physiotherapeutic methods are usually used after the end of the acute period. Most often, patients are advised to take the following courses:

UHF;
magnetic therapy;
electrophoresis with corticosteroids or anesthetics;
ozokerite.

These types of effects ensure increased blood circulation in the affected area, which helps eliminate inflammation, accelerate regeneration processes and reduce swelling.

Why is a meniscus needed?

The meniscus plays a vital role in the functioning of the musculoskeletal system. It is a kind of connecting link between the bones of the femur and the shin, while it separates them so that when moving they do not touch, which means they are not injured or destroyed. On the other hand, the meniscus limits bone movement, which prevents dislocation and reduces the rate of wear and tear on the joint.

First of all, the meniscus performs a stabilizing function. It promotes displacement of all components of the joint only in a certain direction. In addition, the meniscus protects the cartilage and bone at the junction from destruction. Thanks to him, the entire knee mechanism slides against each other without being subject to friction. At the same time, the meniscus provides a shock-absorbing function. Its fibrous structure can both stretch and compress, relieving stress on tendons and ligaments.

Surgery for internal meniscus tears

For complete tears of the internal meniscus, the only effective way to solve the problem and restore knee function is to perform an operation appropriate to the situation. Also, indications for surgical intervention are:

inability to remove the knee block manually;
repeated knee blocks during conservative treatment;
meniscopathy;
crushing of the meniscus;
hemarthrosis.

As a rule, surgery for tears of the internal meniscus involves performing plastic surgery on the affected structures or removing a fragment of cartilage if it is not possible to achieve its restoration. The last type of surgery is called meniscectomy and involves removing part or all of the medial meniscus. It is shown when:

pronounced destruction of cartilage due to the progression of degenerative processes;
separation of the meniscus or a significant part of it from the attachment sites;
development of complications of injury.

Meniscectomy is a traumatic operation that carries a significant risk of developing chronic knee arthritis. However, it is effective only in 60-65% of cases. Therefore, today they are trying to abandon it in favor of more gentle methods of restoring the internal meniscus. Their use is possible in patients under 40-45 years of age with:

peripheral rupture of the internal meniscus, including with a shift to the center;
absence of degenerative changes;
vertical longitudinal tear like a “watering can handle”.

The operations themselves can be performed using open access, which involves making large soft tissue incisions, and using arthroscopy. The latter technique involves the use of special equipment. This allows you to gain excellent access to intra-articular structures in a minimally invasive way and carry out all the necessary manipulations on them in full.

Open operations are performed extremely rarely. They are mainly performed for severe combined injuries that require removal of a large amount of tissue or implantation. Therefore, today, for injuries of the internal meniscus, arthroscopy is most often performed. This technique allows for minor injuries to carry out the required amount of restoration measures and obtain a good effect with a minimal risk of complications. Therefore, the recovery time after such an operation, as well as the period of hospital stay in a medical institution, are significantly reduced.

Arthroscopy involves inserting an endoscope with a video camera and a manipulator into the knee joint through 2 punctures. As a result, the surgeon visually assesses the condition of all structures through the monitor and, using a manipulator, can remove irreparable fragments, apply sutures to the tear and perform other manipulations. This operation gives a positive result in 75-90% of cases.

In case of complete fragmentation of the internal meniscus and chronic degenerative changes in it, implantation may be recommended.

Rehabilitation

After any operation, patients need competent organization of the recovery period. Its nature, duration and complexity largely depend on the type of operation performed.

Rehabilitation is easier and faster after arthroscopy.

All activities during the rehabilitation period are aimed at accelerating the regeneration of tissues and components of the knee joint. Therefore, all patients are advised to:

restriction of mobility for different periods;
treatment of postoperative wounds with antiseptic solutions;
carrying out drug therapy including antibiotics, NSAIDs, chondroprotectors and other drugs;
Exercise therapy with a gradual increase in load;
physiotherapy;
therapeutic massage performed after removing the fixing bandages.

Thus, no one is immune from damage to the internal meniscus of the knee joint. But with proper and timely provision of qualified medical care and treatment appropriate to the situation, it is possible to completely restore the function of the knee and maintain a high quality of life.

How is the operation performed at the Gelenk Clinic?

A knee specialist performs an arthroscopy ©Viewmedica
If a torn meniscus causes severe knee pain and limited mobility, immediate surgery is necessary. Surgical interventions on the meniscus are always performed arthroscopically, that is, using a minimally invasive technique. During this operation, the surgeon makes small incisions on both sides of the knee joint in the area of the kneecap, through which a camera is inserted using narrow tubes. Laparoscopic surgery speeds up the wound healing process and also reduces the likelihood of postoperative complications.

Basically, patients are offered two options for treating a meniscus tear: suture or partial removal.

Arthroscopic suture

With fresh ruptures - primarily in the area of the joint capsule, where the blood vessels supplying it (base) enter the thickness of the meniscus - healthy tissue can be preserved using minimally invasive intervention. Ideal arthroscopic sutures, especially in the anterior and lateral areas, are achieved using modern surgical techniques and special sutures. When choosing a suture technique, the surgeon takes into account the size and position of the tear.

Even with more serious types of rupture, so-called “hand-and-water” injuries, our surgeons will try to preserve the meniscus using an arthroscopic suture and thus reduce the risk of arthrosis of the knee joint.

How long does rehabilitation last after arthroscopic suture?

Movement in the first days after meniscus tear surgery should be limited for approx. six weeks. The patient is allowed to put full loads on the knee joint only if the leg is in a fully extended position. As soon as the knee joint bends, any load is contraindicated, otherwise the seam may tear under the influence of shear forces.

This position is ensured by a special splint (orthosis), which can be fixed to prevent the impact of gravity on the knee joint. If the patient wants to bend the knee or sit up, the block can be released and the leg can be flexed without straining. It is recommended to stop playing sports for 6-8 weeks. Sports that involve stress on the knee joint can be resumed no earlier than after 6 months only in agreement with the surgeon.

Meniscus resection: Partial removal

If the shape and position of a meniscus tear indicate failure of conservative treatment and arthroscopic surgery, it is necessary to resect the torn part. This intervention smoothes the articular surface and increases the effectiveness of articular cartilage. Even with such intervention, it is very important to preserve as much healthy tissue as possible. After all, the larger the preserved component, the longer the meniscus will retain its original function.

How long does rehabilitation last after meniscus resection?

After partial removal of the meniscus, the patient can put weight on the knee on the day of surgery. Elbow crutches will help balance the stress on the knee joint. As a rule, you will be on sick leave for one to two weeks. A longer stay at home may be required only if the patient’s profession involves special stress.

After a week, you can ride a bike and do light sports again. It will be possible to swim only when the wound has healed completely and when the stitches have been removed.

After 3-4 weeks you will be able to play football, tennis or go jogging again.

Meniscus tear: transplantation and synthetic implant

Donor material can be used for transplantation. In younger patients with more serious injuries, this method is often the only option to prevent wear and tear on the knee joint. Transplantation of an artificial implant is also possible.

Both transplantation and the use of artificial material are emergency interventions that are performed after previously unsuccessful operations during which it was not possible to preserve the function of the meniscus.

Very often the operation is performed earlier than necessary and more tissue is removed than the situation actually requires. The results of surgery with the introduction of synthetic implants are encouraging, but the long-term effect of the operation is not yet available.

Therefore, these interventions should not be considered as the main methods of treating meniscal tears. Therefore, after an injury, patients should contact a knee joint specialist as soon as possible, who will conduct the necessary diagnostics and make the right decision regarding further therapy. No matter what, the goal of any treatment for a torn meniscus should be to preserve the actual tissue, preserve the natural function of the meniscus, and thus avoid graft surgery.

Meniscus transplant: surgery for a torn meniscus with the help of a donor

Sometimes arthroscopic surgery is not considered by surgeons as a treatment option for a torn meniscus. This may be due to the size, unfavorable location of the tear, or extensive tissue loss. In this case, doctors often use donor material, which helps prevent the initial stages of arthrosis, as well as ruptures of articular cartilage in young patients.

During this surgery, both the inner and outer menisci can be replaced. As part of the diagnosis, it is very important to determine the exact size and position of the injured meniscus. The necessary donor material is supplied to the Gelenk-Klinik in Gundelfingen from the international transplant center. Although sometimes patients have to wait quite a long time for a suitable donor. Due to various bureaucratic obstacles, there is no uniform donor system for meniscal tissue in Germany. Mostly material for transplantation is imported from the Benelux countries. Fortunately, when transplanting donor menisci, there is no rejection reaction, as sometimes happens with transplantation of other organs.

Since the implant is removed and tested for germs under sterile conditions, the risk of infection is minimal.

The minimally invasive procedure, during which the surgeon inserts the prepared implant through a microscopic approach and then sews it in the desired location, lasts approximately two hours.

Synthetic meniscus transplantation

Synthetic fabrics are used primarily to compensate for partial tears of the inner and outer meniscus. Due to its porous structure, the recently developed sponge material is particularly suitable for this type of operation. Blood vessels grow into its dense structure, which in turn contributes to the formation of endogenous tissue. As soon as the new tissue begins to perform its function, the implant dissolves in the body. And in this case, surgeons resort to arthroscopy through a small incision and subject to maximum preservation of healthy tissue.

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HOW TO SUSPECT A MENISCUS DAMAGE IN YOURSELF?

There are certain symptoms and signs of a knee meniscus tear. The first thing you should pay attention to is the periodic “blockade” of the joint, for no apparent reason and repeated traumatization, in the form of difficulty in straightening or bending the leg, which may be accompanied by a “clicking” when trying to eliminate it.

Other, less specific symptoms of meniscus damage include:

joint pain that intensifies when going down the stairs more than when going up them - “staircase symptom”
periodically the joint increases in volume due to the accumulation of fluid, which indicates chronic synovitis
“galosh symptom” with swaying movements of the leg, which seems to be putting on a galosh
“Turkish sitting symptom”: when you sit “Turkish”, a painful local swelling appears in the area of the joint space, corresponding to inflammation of the capsule
“Turner's symptom” is a lack of sensitivity of the skin along the inner surface of the knee.

All of the above symptoms, alas, are not specific enough, that is, they do not indicate meniscus damage with 100% certainty. The true state of affairs and the condition of the menisci can be determined by a method such as MRI.

WHAT IS MENISCUS?

What are menisci and why are they needed in the knee joint?
The knee joint consists of the articulating surfaces of the femur and tibia, has an articular capsule, a cavity and synovial fluid in it, which ensures the sliding of the articular surfaces relative to each other, and also nourishes the articular cartilage. Since the articular surfaces are not entirely congruent, that is, they do not completely correspond to each other in shape, menisci come to their aid, which fill the “extra” spaces between the bones, protecting them from wear during movement. Essentially, these are cartilaginous plates with a fibrous structure that provide buffering function and shock absorption. By contracting and unclenching, they stabilize the joint during movement.

Get an MRI of the knee joint in St. Petersburg

The knee joint has two menisci at its disposal - medial (located on the inside of the joint) and lateral (located on the outside). To understand these terms, you need to mentally divide the human body in half, drawing a midline along the spinal column. In medicine, what is closer to this line is called medially located, and what is more distant from it is called lateral, in other words, lateral or external.

WHAT DOES THE MENISC LOOK LIKE ON MRI?

Normally, on MRI, the shape of the meniscus resembles two triangles, with their vertices facing each other. One triangle is the anterior horn of the meniscus, and the second is, respectively, the posterior horn.

As can be seen in the presented image of the medial meniscus, the posterior horn is always larger than the anterior one, and if this discrepancy is violated, then this indicates an abnormality in its shape, and may be a sign of a violation of the integrity of the meniscus. In the lateral meniscus on a sagittal section, the posterior horn is located higher than the anterior one, but their size should normally be the same.

SYMPTOMATICS

Damage to the menisci is the most common pathology of the knee joint.

A typical mechanism of damage to the meniscus is an injury caused by rotation of a bent or half-bent leg, at the time of its functional load, with a fixed foot (playing football, hockey, other types of team sports, collisions, falling while skiing).

Less commonly, meniscus tears occur when squatting, jumping, or uncoordinated movement. Against the background of degenerative changes, the injury that leads to damage to the meniscus may be minor.

In the clinical picture of meniscus damage, it is customary to distinguish between acute and chronic periods. The acute period begins immediately after the initial injury. The patient experiences severe pain in the knee joint, limitation of movements due to pain, sometimes the lower leg becomes fixed in a flexed position ( joint block ). In acute cases, meniscus rupture is often accompanied by bleeding into the cavity of the knee joint ( hemarthrosis ). Swelling of the joint area appears.

Often, meniscus damage in fresh cases is not diagnosed; a diagnosis of joint bruise or sprain is often made. As a result of conservative treatment, primarily due to fixation of the leg and creation of rest, the condition gradually improves. However, if the meniscus is seriously damaged, the problem remains.

After some time, when loads are resumed, or with repeated minor injury, and often with awkward movement, pain occurs again, dysfunction of the joint occurs, synovial fluid re-accumulates in the joint ( post-traumatic synovitis ), or joint blockades are repeated. This is the so-called chronic period of the disease. In this case, we can talk about stale or old meniscus damage .

Typical symptoms: The patient complains of pain in the projection of the meniscus during movements, and can usually clearly show the pain point. Limitation of range of motion (impossibility of fully extending the leg or fully squatting). violation of movements in the knee joint. A symptom of joint blockade, when the torn part of the meniscus moves into the joint cavity and is periodically pinched between the articular surfaces of the femur and tibia. In some cases, the patient himself knows how to eliminate the resulting joint block or resorts to the help of outsiders. After removing the blockade of the joint, movement in it becomes possible again in full. Periodically, reactive inflammation of the inner lining of the joint occurs, synovial fluid accumulates in the joint - post-traumatic synovitis. Weakening and impaired coordination of muscles gradually develops - muscle wasting, gait disturbance.

An additional danger of chronic damage to the meniscus is gradual damage to the articular cartilage and the development of post-traumatic arthrosis.

Which specialist treats a meniscus injury?

A traumatologist treats problems of the musculoskeletal system. But due to the fact that unpleasant symptoms can develop several days after the fall that led to the rupture, not everyone thinks to visit the emergency room. As a last resort, it would not be a mistake to contact a therapist - after an examination, he will determine the problem and give the necessary direction. If there is no clinic with specialized specialists in the city, you will need to visit a surgeon. He will conduct an examination and, if necessary, provide treatment.

Causes of meniscus injury

First of all, chronic diseases affect the destruction of the meniscus. They make its tissues fragile, thin and inelastic. It is enough to slip and make an awkward sudden movement, and a rupture will occur. This can happen even without the fact of a fall. Diseases that reduce the quality of meniscus tissue:

rheumatoid arthritis;
gout;
gonarthrosis;
chronic intoxication.

The most traumatic movement for the meniscus is rotation of the leg with the knee joint bent. This is why meniscal tears are common in hockey players and skiers - both sports involve a characteristic movement of the leg in a bent position.