We specialize in non-surgical joint treatments, incl. after unsuccessful surgical treatment. We will offer you treatment for degenerative joint diseases, knee meniscus tears, etc., if there are no direct indications for surgery or it was not effective enough. If there are no clear indications for surgery, we will offer you carry out a course of non-surgical treatment, and based on its results judge the need for surgery. The condition of the joint objectively begins to improve, usually after 3-6 weeks.
- Causes and symptoms of knee meniscus damage. Diagnostics at the Echinacea clinic
- Treatment of injuries to the meniscus of the knee joint. Treatment at the Echinacea Clinic
MRI principle for Stoller classification
MRI principle for Stoller classification To diagnose the slightest changes in the integrity of the cartilaginous structures of the knee joint, magnetic resonance imaging is often used.
The essence of this method of visualizing the internal structures of the knee is layer-by-layer scanning of tissue in a magnetic field. This leads to the development of the nuclear resonance effect, which occurs when protons of the nuclei of hydrogen atoms that are part of almost all organic compounds in the body are excited. In a state of magnetic resonance, protons of the nuclei of hydrogen atoms release energy, which is recorded using a special sensor, which makes it possible to construct an image through digital processing.
Is rehabilitation necessary?
Of course, it is necessary, especially after operational activities. What is the purpose of rehabilitation:
- restoration of muscle tone of the injured limb;
- normalization of blood circulation;
- reduction of pain syndrome;
- restoration of full function of the knee joint.
A set of exercises and the frequency of their implementation are developed individually for each patient, guided by the severity of the injury or the complexity of the pathology. Moreover, after surgery, exercise therapy begins 2 months after the operation, and with conservative treatment - 15-20 days after the injury.
The mechanism of pathology development
Mechanism of development of pathology
The medial cartilaginous meniscus is fixed more rigidly with the help of ligaments, therefore, when exposed to excessive mechanical force (rotation of the thigh with a fixed shin, a direct blow to the knee area or a fall on it), a violation of integrity occurs. In the case of the development of a degenerative-dystrophic process associated with the destruction of cartilaginous structures against the background of a violation of their nutrition, or inflammation, a decrease in strength occurs. In this case, a violation of integrity can occur even without the impact of excessive functional loads on the joint.
Pathological changes associated with the development of degenerative-dystrophic processes in the knee mainly develop in older people (gonarthrosis). Pathological damage to the meniscus of the knee joint develops more often. Stoller classification, based on objective visualization of changes, allows the doctor to select adequate 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.
Stoller degree of meniscus damage
Due to the presence of certain anatomical features, damage to the posterior horn of the medial meniscus develops more often. According to Stoller, there are 4 degrees of destruction:
- Grade 0 – no changes were detected in the cartilage tissue during the study, which indicates its normal condition.
- Grade 1 meniscal injury – Stoller classification involves identifying a localized focal signal of increased intensity that does not reach the surface of the cartilage.
- Stoller grade 2 meniscal damage includes the determination of a linear signal of increased intensity, which also does not reach the surface of the cartilaginous structure. Horizontal damage to the meniscus of grade 2 according to Stoller indicates a partial violation of the integrity of the cartilage tissue without disturbing the general anatomical structure (there is no complete separation of part of the cartilage yet).
- Stoller grade 3 meniscus damage - this degree of severity of changes is characterized by the determination of a linear signal of increased intensity that reaches the surface of the cartilage tissue. Such changes indicate a violation of the anatomical structure in the form of avulsion. Separately, there is a grade 3a meniscus injury according to Stoller, in which part of the cartilaginous structure of the knee joint is displaced (complete tear with displacement).
Determining the degree of pathological or traumatic changes in cartilaginous structures according to Stoller is possible only using the visual examination technique of magnetic resonance imaging.
Causes of degeneration
The anatomical features of the location and structure of the menisci determine the high incidence of pathologies both among young people and among mature people. Most often, athletes, ballerinas, dancers suffer from ruptures, damage and cystosis - that is, people who are in constant motion and experience high loads.
Other possible reasons:
- dysplasia – abnormal formation of the knee joint;
- gout, syphilis, tuberculosis, rheumatism and other diseases that can affect joints;
- sprains of ligaments, as well as their incorrect formation;
- flat feet (low shock absorption of the foot is compensated by increased load on the knee);
- high physical activity;
- excess weight.
X-ray examination
X-ray examination
X-ray examination. Includes taking x-rays of the knee in frontal and lateral projections. They make it possible to identify gross changes, therefore this method of visual examination is mainly used in the initial stages of diagnosis (in case of traumatic injuries, radiography is the first research method prescribed by a doctor in a trauma center).
CT scan. An imaging method based on layer-by-layer scanning of tissues performed using X-rays in a special installation. The resulting series of images is processed on a computer, which makes it possible to determine the slightest changes in tissues at different depths. The method has a fairly high resolution, but is not suitable for determining the degree of change according to Stoller.
Ultrasound. Tissue visualization occurs using a sound wave, which is recorded when reflected from media with different densities. This diagnostic research technique allows us to identify inflammatory signs, in particular an increase in the volume of synovial fluid in the joint cavity.
Arthroscopy. A modern invasive research technique in which the internal structures of the joint are examined using an arthroscope inserted into its cavity (a special tube with a video camera and lighting). Arthroscopy is used to perform surgical procedures.
Prevention
To avoid degenerative changes in the medial meniscus, you should follow simple precautions:
- Eat a balanced diet, do exercises and constantly monitor your body weight. Excess weight has an adverse effect on joints.
- To avoid troubles with the knee, it is better to fix it with an elastic bandage or special pads.
- You should not suddenly get involved in physical work or sports: you must first warm up your muscles, stretching them and gradually increasing the load.
- Frequently undergo a general examination to identify pathologies that contribute to the development of degenerative changes in the cartilage lining, and begin their timely treatment.
- We recommend that you wear comfortable shoes when playing sports to reduce the risk of falling to zero.
Clinical signs of damage classification according to Stoller
Pathological or traumatic changes in the medial cartilage of the knee are more often recorded. Symptoms of changes depend to a certain extent on their severity:
- Zero degree determines the absence of any changes in cartilaginous structures without the development of clinical symptoms.
- Damage to the medial meniscus, grade 1 according to Stoller - minimal changes lead to the appearance of unexpressed pain in the knee joint, which usually intensifies in the evening, after prolonged standing or walking. Also, when bending the knee, a characteristic crunch may appear, indicating the development of a degenerative-dystrophic process.
- Damage to the medial meniscus, grade 2 according to Stoller - more severe disorders are manifested by pain, the intensity of which increases during movements of the knee or after prolonged standing. Against the background of clicking and crunching, inflammatory changes may appear, including redness of the skin and swelling of the soft tissues.
- Damage to the medial meniscus grade 3 according to Stoller - a violation of the anatomical structure of the cartilage of the knee is accompanied by severe pain and limitation of movements in it. Damage to the internal meniscus, grade 3a according to Stoller, can be accompanied by severe acute pain and blocking of the ability to move in the joint.
Injury to the internal meniscus of grade 3 according to Stoller often has a traumatic origin, and therefore is characterized by the acute development of clinical manifestations.
What are degenerative changes in the medial and lateral menisci?
These are anatomical injuries that could occur due to:
- atypical joint structure;
- diseases;
- injuries.
Moreover, it is the medial meniscus that is most often injured due to its rigid fixation and the impossibility of displacement in one direction or another without serious consequences for the knee joint. The horns of the internal cartilage are located quite close to the condyles (that is, thickenings, of which there are two on the tibia: medial and lateral), which creates a difficult situation in the event of any displacement of the bone process. And as a result, either a rupture of the meniscus or its damage.
Aching pain in the knee, discomfort and stiffness in movement due to a meniscus tear can be felt for many months or even years.
Degenerative changes in the medial meniscus are disorders observed in the structure of the organ, which inevitably lead to loss of its functionality (partial and sometimes complete).
Treatment
Depending on the symptoms, type and extent of the problem, appropriate treatment without surgery, surgery, knee taping or other types of rehabilitation is prescribed.
The Yekaterinburg clinic records patients with any stage of the disease, meniscal and anterior cruciate ligament rupture.
Untreated meniscus damage can lead to serious consequences and serious complications, including arthritis and arthrosis. The cost of treatment, discomfort during movement and pain in this case will increase significantly. Therefore, it is so important to contact a clinic specialist in a timely manner while the injury is still fresh.