Inflammation of the meniscus: causes, symptoms, treatment methods

05 Sep 2021 at 13:11 MRI of joints in Tushino 13090

The knee is one of the largest elements of the human musculoskeletal system and the largest joint in the body. Despite this, it is the knee that is most often exposed to various types of damage - injuries, diseases and other problems that prevent a person from moving comfortably.

A huge number of components of the joint make its movement quite comfortable - the menisci provide shock absorption and stabilization, cartilage tissue softens bone friction well, etc. Violation of one of the functions can cause problems in movement and cause severe pain, making a person incapacitated.

The menisci perform one of the most important functions in the functioning of the knees. There are two of them in each joint - internal and external, and they consist of dense cartilage tissue. In addition to stabilizing the knee, they ensure even distribution of the load on the joint.

Causes of meniscus damage

With any load on the knee joint, the menisci reduce pressure and protect the internal components from overload. However, any overload, excessive mechanical stress or other trauma can cause damage or even rupture of the meniscus - more often internal than external.

In addition to the load, these elements can be damaged for other reasons:

1. A strong blow to the knee or a fall of a person, in which the main force fell on the joint and cup.
2. Sudden knee extension.
3. Chronic joint diseases, incl. arthrosis, arthritis, etc.

Based on the reasons for the violation of integrity, we can distinguish several groups of people who are most often exposed to this problem.

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At-risk groups:

• pensioners whose bones are weakened with age and whose musculoskeletal system is susceptible to various types of damage;
• professional athletes who load their bodies every day and receive frequent injuries;
• loaders and other persons whose profession involves carrying heavy loads;
• people with impaired blood circulation and metabolism, lack of vitamins and useful elements in the body.

Inflammatory processes can occur as a result of various injuries or with arthritis or arthrosis, which in the later stages of development are accompanied by inflammation due to excessive degenerative changes in cartilage tissue.

Symptoms of inflammation of the meniscus of the knee joint

Due to the fact that pain after an injury can mean damage to any part of the joint, it is quite difficult to identify the inflammatory process in the meniscus.

However, there are several characteristic symptoms that appear specifically with inflammation of the meniscus :

1. The pain is quite sharp and unpleasant at first, but over time the person gets used to it.
2. A feeling of “rolling” of the bones appears in the joint, and a soft click is heard.
3. The patient feels a foreign object in the joint.
4. Soft tissues in the affected area swell.
5. If the meniscus is torn, the joint is blocked.

Types of meniscopathy

There are external (20%), internal (75%) and bilateral (5%) meniscopathies. A larger percentage of cases occur on the internal (medial) meniscus. Pathology manifests itself as:

• cyst formation;
• meniscus tear (marginal, transverse, flap or horizontal);
• detachment of cartilage tissue;
• instability or excessive mobility due to rupture.

Any unusual load can lead to one of the above symptoms.

Diagnosis and treatment

Since this type of joint problem is quite difficult to diagnose without the help of a doctor, you should go to the hospital at the first symptoms. An experienced doctor, in addition to interviewing the patient, will refer him for tests and conduct one of the hardware diagnostic methods: ultrasound, MRI of the joint or x-ray.

The problem with x-ray examination is that it cannot always detect microscopic damage, so tomography is considered the most rational. A tomograph uses magnetic waves to study the smallest violations of the integrity of tissues and muscles, ligaments and other components of the joint, and then provides the doctor with the results of the study in 3D. The doctor can examine the images in detail, zooming in on the required area to the maximum.

If the x-ray does not show any abnormalities, but you are sure that changes are occurring in the joint, go for a tomography.

Get a consultation on MRI diagnostics. Consultation on the service does not oblige you to anything.

First aid

If a joint blockage occurs immediately after an injury, it is necessary to eliminate it, as well as get rid of other unpleasant consequences, numb the knee and give the leg rest for 3-4 weeks. To do this, the patient takes analgesics and wears a special bandage that reduces the load on the joint and saves the person from unnecessary movements that can aggravate the situation.

Diagnostic actions

To obtain a correct diagnosis of meniscitis, the following studies are required:

• Anamnestic data - visual examination by a doctor, clinical monitoring of the patient’s tests.
• Palpation is an examination by feeling the inflammatory tissues of the knee joint.
• Ultrasound - determination of the condition of cartilage in the joint (degree of inflammation), identification of hematomas.
• X-ray - assessing the level of effusion of the knee cavity, identifying the degree of tissue thinning, excluding a disease affecting bone tissue.
• Arthroscopy - the condition of the joint structures is examined.
• Arthrography is the visualization of articulation surfaces by introducing a contrast agent and air into the cavity.

Conservative therapy

To eliminate the inflammatory process and to prevent the disease from becoming chronic, it is necessary to take treatment measures in a timely manner and comply with them for the prescribed period.

In some cases, when the meniscus has been slightly damaged, a course is prescribed that allows you to quickly get back on your feet and restore mobility to the joint. This course includes taking anti-inflammatory medications, which are taken orally or rubbed into the knee in the form of gels and ointments.

In addition, when there is a significant improvement in the condition and tests show that there is no longer inflammation, the treatment does not end there. A long period of rest greatly weakens the muscles, and it is necessary to restore their tone, as well as develop the joint. To do this, the patient must attend physiotherapy procedures that improve blood circulation in the affected area and metabolism. Thus, food products containing useful and strengthening elements bring more benefits, and these same vitamins are absorbed better and faster.

Therapeutic gymnastics is a separate point in the course of human treatment. This is a set of exercises that is prescribed for each case individually and requires responsibility from the patient himself. At first, the exercises do not carry much load, so as not to damage the joint. For example, a patient can simply move a foot or hip, and at the same time improve blood flow and maintain muscle tone. Then the complex becomes more complex, requiring movement in the joint itself. Training is carried out lying or sitting. At the final stage of treatment, full loads are recommended.

Clinical picture

With meniscopathy, an inflammatory process quickly develops, accompanied by the following manifestations:

• pain in the projection of the joint during movement and palpation, if the medial meniscus is damaged - pain on the inside of the knee, and pain on the lateral side - on the outside;
• deformation and enlargement of the joint due to the accumulation of intra-articular fluid;
• limited mobility;
• swelling (mild) with redness of the skin (hyperemia);
• local hyperthermia;
• general weakness and elevated temperature to subfebrile (37.5 °C).

If you do not contact a specialist in a timely manner, the process becomes chronic, which leads to a blockade of the shock-absorbing functions of the meniscus.

Surgical methods of treatment

Since conservative therapy does not make sense in all cases, sometimes (especially with ruptures) surgical intervention is performed. A huge advantage of this method these days is that there is no need to open the joint and heal the wound. This type of surgery, arthroscopy, involves minimal incisions - doctors make several punctures: a special camera with a cold light source is inserted into one to provide the doctor with a good view, and a surgical instrument is inserted through the second to carry out the necessary manipulations. The operation involves suturing the torn edges of the meniscus, or completely removing it. The type of action to be performed is determined in advance by studying x-rays, MRI results of the knee joint or ultrasound.

After the operation there is a period of postoperative rehabilitation. The patient should take care of his knee, not overload it and monitor its condition. The inflammatory process should not become chronic or cause problems with other parts of the musculoskeletal system.

To avoid thrombosis and thromboembolism, it is necessary to engage in therapeutic exercises, accelerating the blood and improving metabolic processes. Modern methods allow you to quickly get rid of this problem and prevent its recurrence.

Get a consultation on MRI diagnostics. Consultation on the service does not oblige you to anything.

Prognosis for recovery

With drug therapy, the chance of complete recovery is very high. If surgery is performed, recovery depends on the individual case. The more severe the case, the more time it will take for rehabilitation and the less likely it is that the knee will fully function. The patient must strictly follow the doctor’s instructions, including rehabilitation, then the chance of recovery increases.

Meniscitis of the knee is a serious and dangerous injury. If it occurs, you must immediately seek help, then you can avoid lengthy diagnostics and begin treatment faster. Naturally, the earlier treatment is started, the faster the recovery will be and the greater the chances of avoiding various complications.

Ischemia of the muscles of the lower limb

To prevent bleeding during arthroscopy, doctors apply a tourniquet to the patient's leg. Unfortunately, long-term exposure can cause temporary paralysis of the lower limb. The pathology is characterized by a short-term impairment of muscle contractility and motor functions of the leg.

The leg is bandaged.

Table 2. The risk of developing paresis depending on the age of the patients and the time of application of the tourniquet.

Short	Occurs in patients under 50 years of age who have had a tourniquet applied for less than 40 minutes. The predicted incidence of complications in such patients is 7.6%.
Average	Typical for persons under 50 years of age with an exposure time of 40-60 minutes and persons over 50 years of age with an exposure time of less than 40 minutes. Among this group of patients, paresis develops in 10-16% of cases.
High	Equal to 28% or more. Characteristic of all patients in whom a tourniquet was applied for more than 60 minutes.

Thus, the likelihood of temporary paresis is much higher among older people. Those patients who have undergone complex long-term operations are also at greater risk. Undesirable complications can be avoided by reducing the time of application of the tourniquet.

Fact! Temporary paresis is usually harmless and responds well to treatment. To combat them, physical therapy, massage and physiotherapeutic procedures are used.

Infection

Infectious complications are rare, occurring in only 0.1-0.42% of patients. The causative agent of septic arthritis is most often Staphylococcus aureus. The disease is acute and usually does not cause difficulties in diagnosis. In rare cases, it may have a subacute, more “insidious” course.

Classic signs of septic arthritis:

• acute pain;
• severe swelling;
• skin redness;
• fever;
• increased ESR and neutrophilic leukocytosis in the blood.

Infectious inflammation.

Note that the absence of typical symptoms of arthritis does not mean the patient is completely healthy. Infection can be excluded only through bacteriological examination of the synovial fluid. The analysis should be done at the slightest suspicion of septic arthritis.

During arthroscopic procedures, doctors may not prescribe prophylactic antibiotics to patients. This, like intra-articular corticosteroids during arthroscopy, increases the risk of infectious complications.

Treatment for septic arthritis can take anywhere from a few days to 6 weeks. In some cases, parenteral administration of antibiotics is sufficient for patients. Sometimes patients require lavage and drainage of the joint cavity. The choice of treatment usually depends on the severity of the arthritis.