There are 2 menisci in each knee joint. They are crescent-shaped cartilages and provide a tight junction of the articular surfaces of the bones that form the knee joint - the femur and tibia. The menisci are also involved in distributing the load and maintaining knee stability. Therefore, they are its most important component, and the ability of the knee joint to function properly depends on their condition.
Like any cartilaginous structures, menisci tend to wear out over the years, which leads to changes in their structure and disruption of functioning. This is called degenerative changes. A number of factors accelerate these undesirable processes, so today degenerative changes in the menisci can be detected even in middle-aged and young people. In any case, the situation requires medical intervention, since in advanced cases, the altered menisci are unable to perform their functions, which provokes not only severe pain in the knee, but can even lead to its complete immobilization.
Structure of the meniscus of the knee joint
The meniscus is a cartilage-like formation inside the knee joint that performs a shock-absorbing and protective function. It has a crescent shape and is located between the articular surfaces. There are two of them in each knee, namely:
- Lateral (also known as external) – is less likely to be injured, but is more mobile.
- Medial (otherwise called internal) - most susceptible to injury, less mobile compared to the external.
The structure of the knee joint. Internal and external meniscus of the knee.
The strength and elasticity of this cartilage layer is provided by collagen fibers located radially. Given the crescent shape, each of them has two horns: anterior and posterior. The inner surface has a worse blood supply than the outer surface, facing the joint capsule. This affects the healing processes at different locations and treatment tactics, respectively.
What are degenerative changes in the menisci?
Degenerative changes are anatomical damage to an organ resulting from injury, atypical joint structure or disease. Degeneration of the meniscus is most often the result of injury, sometimes not even obvious: one unsuccessful rotation of the tibia can cause damage to the cartilage disc, which is accompanied by severe pain.
Most often, due to the anatomical structure, the medial meniscus undergoes degeneration. If the outer cartilage, which cushions the movement of the knee joint, does not have rigid fixation and moves to any side if necessary, then the medial one is rigidly fixed in the joint, and its horns are in close proximity to the condyles. One sharp turn of the shin - and the meniscus does not have time to escape from the displaced process of the bone, the result is its damage or rupture.
Degenerative changes can be different:
- separation from the attachment point;
- rupture of the horns and body of the meniscus;
- excessive mobility as a result of rupture of the intermeniscal ligaments;
- cyst - the formation of cavities filled with fluid inside the cartilage;
- meniscopathies are dystrophic changes that develop under the influence of minor injuries, as well as as a complication of gout, osteoarthritis, rheumatism, tuberculosis and a number of other diseases.
Types of meniscal tears
Types of meniscal tears of the knee joint.
The meniscus is damaged both in isolation and in combination with other anatomical formations. When exposed to an external force, the rupture is called traumatic. It is usually found in athletes. If changes occur due to arthrosis, this is a degenerative damage that is more common in people of the older age group. Moreover, both of these options are often multiple, affecting articular cartilage. They are, one way or another, interconnected and one does not exclude the other or is its consequence.
A distinction is made between complete and partial rupture. In the first case, free fragments become mobile and can cause blocking (“jamming”), namely the occurrence of impingement syndrome. A sharp immobilization occurs, which can only be eliminated by specialists and mainly by surgical means. If the part where there is active blood circulation is damaged, hemarthrosis is most likely - the accumulation of blood inside the joint. It manifests itself externally by a rapid increase in swelling.
First aid for meniscus injury
When a meniscus ruptures, a sharp pain occurs in the first minutes, which intensifies when the leg is extended.
If pain occurs as a result of an injury, care must be taken to ensure that the victim gets to a medical facility as soon as possible. The injured leg must be immobilized. To avoid bending during transportation, it is better to apply a splint or splint. It is strictly not recommended to eliminate the blockade, if it occurs, on your own. In order to alleviate the condition and avoid the increase in swelling, cold is applied to the knee, for example, an ice pack. Aerosol coolers, used more often among athletes, are optimal. As a last resort, you can offer the victim a non-steroidal anti-inflammatory drug. The sooner the patient gets to the clinic in compliance with all transportation rules, the less complications can be expected.
Meniscus tear: causes and course of the disease
A meniscus tear can occur when the ankle is severely dislocated or injured. Simple overload of the knee joint after jerking loads (start/stop) or sudden rotational movements can lead to overstrain and, as a consequence, to a meniscus tear.
Meniscus tear and sports
A meniscus tear is a common pathology in people involved in skiing, namely when the skis tilt to the side. If a skier is moving at full speed, the kinetic energy of his body can provoke a dislocation of the knee joint and a torn meniscus. Football, basketball, as well as other so-called contact sports associated with strong acceleration and often with excessive uncontrolled external force (for example, an opponent) can cause injury of this nature.
Meniscus tear during the working day
Some categories of professions subject the knee joint to particularly heavy loads. Such activities include squatting work (eg tilers). Excessive flexion of the knee joint, as well as the impact of the entire body weight on the leg, negatively affects the knee joint and causes severe pain.
The next difficulty is lifting a heavy load from a squatting position. As a rule, the position of the back recommended by doctors during such work actually puts a lot of stress on it. And if the knee has already been damaged, then you need to choose whether to overstrain the meniscus or the intervertebral discs.
Degenerative meniscus tear in elderly patients
Most often, in older patients, the connective tissues of the cartilaginous structure of the knee lose their elasticity and become less mobile. Since the meniscus is cartilaginous tissue and wears out quickly, its rupture can be caused by minor injuries.
Pre-existing injuries of this nature are taken into account by our specialists when drawing up a treatment plan. Complete restoration of a degeneratively injured meniscus can only be achieved with long-term treatment.
In younger patients, meniscal rupture occurs after severe traumatic exposure. Elderly patients simply need to turn carelessly or trip.
Meniscus tear: Orthopedic aspects of the disease
Any regular strain on the knee joint can lead to a weakening of the meniscus. Therefore, excess weight is one of the main criteria for the occurrence of its rupture or degeneration (wear). Violation of the axis of the lower extremities, due to valgus (X-shaped) or varus (O-shaped) deformation of the legs, negatively affects the forces acting in the knee joint and thus can accelerate the process of wear of its individual parts.
A previous rupture of the cruciate ligament also creates a certain load on the menisci. In addition, it is worth noting that the cruciate ligaments are located in the cavity of the knee joint and are responsible for centering the femur and tibia. They also have signal receptors through which they transmit information to the leg muscles about the expected occurrence of injury. When the cruciate ligaments rupture, all tangential, inertial, and braking forces directly impact the meniscus to such an extent that they lose their role as a seat belt inside the knee joint.
If the meniscus ruptures, contact an orthopedist as soon as possible: after all, such an injury often leads to pinching, irritation and impaired motor functions of the knee joint. A visual signal of a meniscus tear is a painfully swollen Baker's cyst in the popliteal cavity (popliteal cyst), which is caused by inflammatory irritation of the joint capsule. Often, surgical treatment is necessary to avoid pathologies such as joint wear and arthrosis. Only an experienced diagnostician and specialist in the treatment of knee diseases will be able to assess the condition of the patient’s knee joint and tell whether the injury will heal on its own.
Diagnostics
By the time of consultation with a specialist, as a rule, extensive swelling has already formed in the injured area, and the pain syndrome is reduced due to the use of painkillers. Anamnesis data, as well as special functional tests, allow the doctor to conduct a differential diagnosis. They are simple, relatively painful, but help clarify the picture of the disease. Tests help determine the presence and location of pathology. The doctor decides which ones to use.
The most common of them include:
- Baykov's method. The knee is bent at a right angle, after which the joint space is palpated, while simultaneously extending the leg. The occurrence of sharp pain symptoms confirms the presence of damage.
- Shteiman's sign. The knee joint is bent 90 degrees, then the shin is rotated. If the pain increases with inward rotation, it means the medial meniscus is damaged, and with outward rotation, the lateral meniscus is damaged.
- Chaklin test. There are two types of such testing. Firstly, the presence of a rupture is indicated by a crunching sound when flexing and extending, and as if “rolling” the lower leg over an obstacle. In the second test, the patient raises his straight leg, and the doctor in this position palpates it for muscle atrophy in the thigh area.
- Polyakov's symptom. He lifts the healthy leg up, while trying to raise the pelvis and lean his elbow on the heel of the injured one. There is pain at the rupture site.
- Landau test. It consists of sitting in a “Turkish” position. Such an attempt in the presence of deformity will result in pain in the area of the rupture.
- Mac Murray's method. The patient, lying on his back, bends his leg and then rotates his knee. Painful sensations will appear, and a click will also be heard.
- Perelman's symptom. It has two varieties - climbing stairs or putting on shoes without hands. In both cases, pain appears, localized in the area of injury.
In addition, X-ray diagnostics (x-ray or computed tomography) and MRI (magnetic resonance imaging) are performed. They give a clear picture of the location and degree of deformation. Arthroscopy is also used for diagnosis. It also allows you to immediately perform the necessary surgical treatment.
Conservative therapy
Shock wave therapy is an effective method of conservative treatment for minor disorders.
Conservative treatment is aimed at reducing inflammation and accelerating healing when the rupture is incomplete and surgery can be avoided. If there is pathological fluid in the joint - blood due to vascular damage or effusion due to inflammation - it is removed using a puncture. The limb is partially immobilized with an orthosis in order to avoid excessive stress when moving. A course of non-steroidal anti-inflammatory drugs is prescribed. Sometimes intra-articular corticosteroids are required. Injections of hyaluronate, platelet-rich plasma, help cartilage quickly recover. For this purpose, oral chondroprotectors are prescribed. You need to start developing the joint under the supervision of a rehabilitation specialist. Rehabilitation is aimed at restoring all functions and strengthening the thigh muscles. In addition to kinesiotherapy, mechanotherapy and massage are used. Physiotherapeutic methods (UHF, electrophoresis, electromyostimulation) accelerate the healing process.
Prevention
To avoid degenerative changes in the medial meniscus, it is recommended to choose the right shoes, avoiding high-heeled shoes. You should lead an active lifestyle, engage in feasible sports, quit bad habits, and eat right. All injuries and infectious diseases must be treated promptly. Physical activity on the leg should be moderate, especially if there are already problems with the joint. Otherwise, damage to the knee cartilage will progress.
Meniscus arthroscopy
At the SportClinic, meniscal arthroscopy is performed by the best traumatologist-surgeons in Russia.
Surgical treatment of meniscal tears of the knee joint is carried out using arthroscopy. This is a minimally invasive and effective method for diagnosing and treating such pathologies today. It is low-traumatic in relation to surrounding tissues. The high resolution of the arthroscope camera provides a detailed image, which is displayed in an enlarged format on the screen, which ensures the accuracy of the examination during arthroscopy. Immediately after diagnosis, all surgical procedures are performed. In case of a rupture, this means resection or removal of the meniscus, and in case of minor damage, it can be sutured.
Arthroscopic suturing of the meniscus
By connecting the torn edges, mainly from a fresh injury, it is possible to achieve their fusion and restore the integrity of the damaged structure. This occurs most successfully after a rupture in the part that faces the joint capsule and is better supplied with blood. During arthroscopy, special clamps are introduced into the joint, which the doctor places on the torn edges, having previously connected them. This method is especially relevant for athletes and people who regularly expose their knee to fairly heavy loads. The effectiveness of the technique is high, success is achieved in 90%. Arthroscopy is a low-traumatic and easily tolerated operation. If you follow the recommendations of specialists during the rehabilitation period, it is possible to restore your previous shape in the shortest possible time.
Meniscus resection
If reconstruction is not possible after a rupture, then resection is performed through arthroscopy - damaged and torn elements are removed. The remaining healthy tissue is preserved and the surface and edges are sanded for best function. After which, the leg returns to active movements without significant consequences. As a rule, if most of the meniscus was preserved, then the functions of the knee do not suffer in any way in the future; after several weeks of a rehabilitation course, the patient is allowed to participate in sports training.
Complete arthroscopic removal
Complete removal or meniscectomy is a common operation and is also performed using an arthroscopic technique. The meniscus, previously affected by arthrosis, literally falls into pieces under traumatic influence. Sometimes a complex mechanism of injury leads to its loss. The decision to remove is usually made during arthroscopy. The limb after such operations functions stably, provided proper recovery and moderate loads. Further, it is recommended to be constantly monitored by a doctor to prevent the development of arthrosis.
What treatment methods are used at the Quality of Life clinic?
A properly designed rehabilitation treatment program will shorten the recovery period, reduce the risks of serious complications (including post-operative ones), and allow professional athletes to return to their normal rhythm of life and return to training. We have established methods and experience in treating representatives of all sports after injuries: skiers, basketball players, athletes, gymnasts.
The key to effective recovery after injuries to the knee joint is an integrated approach. If a meniscus injury occurs, the patient is treated by a well-coordinated team of specialists - an osteopath, a psychologist, a neurologist, and a rehabilitation specialist. We have the necessary experience and equipment to deliver treatment safely and effectively. Gradually, step by step, we will help restore motor activity after damage to the meniscus of the knee joint and restore lost joint functions.
Osteopathic correction
Osteopathic treatment methods allow in some cases to avoid surgery on the menisci and restore their function naturally. In addition, osteopathic correction allows you to reduce the dosage of potentially unsafe medications, and sometimes completely stop taking them.
Soft manual techniques: • reduce pain in the menisci; • increase mobility in the joint; • eliminate swelling and inflammation.
If permanent injury to the menisci of the knee joint is associated with scoliosis, pelvic or sacral misalignment, planovalgus foot deformity and other skeletal deformities, osteopathic correction eliminates these causes.
In addition, osteopathic treatment methods remove obstacles - congestion in blood vessels, ligaments of the knee joint, muscles surrounding the meniscus, as well as in nervous tissue that is not present in the meniscus.
Possibilities of physical therapy exercises
Osteopathic correction at the Quality of Life Clinic is complemented by physical therapy. Performing general developmental exercises can improve blood circulation in the injured leg and strengthen muscles and ligaments. In the first days after removing the splint, exercises are performed in a gentle manner.
For the rehabilitation of patients, exercises are also prescribed in the Neurac kinesiotherapy unit. Gravity loads in a rehabilitation simulator train stabilizer muscles, improve coordination and restore anatomically correct biomechanics of movements.
Rehabilitation after arthroscopy
After arthroscopy, the rehabilitation period proceeds quite easily and quickly, in contrast to open access surgery, and no large scars are left on the patient’s body. A rehabilitation plan is developed individually by a rehabilitologist, taking into account the characteristics of the pathology, the treatment performed, age characteristics, concomitant pathologies, and his lifestyle. Following all recommendations is the key to a successful and quick recovery.
The main methods include:
- Kinesiotherapy. Otherwise, this method of rehabilitation can be called physical therapy. This is a set of exercises aimed at strengthening the muscles in the desired area and developing the motor activity of the joint.
- Manual therapy. Relieves spasms, stimulates atrophied muscles to activity, and promotes better innervation.
- Mechanotherapy. Exercises on machines that strengthen the muscle frame in the required area.
In addition, kinesiotaping (application of special patches that regulate the load on certain muscles), physiotherapy, including: ultrasound, myostimulation, shock wave therapy, magnetic therapy and others, are used. As a rule, recovery takes about one and a half months, after which patients return to their normal lives, and athletes can begin training.