Knee meniscus tear

Definition and functions of the meniscus Classification of injuries Possible causes of pathology Symptoms of a meniscus tear Degrees of severity of a meniscus tear Diagnosis of a meniscal tear Treatment of a meniscal tear of the knee joint Prevention of a meniscal tear of the knee joint

The knee joint is the most vulnerable part of the human body

, which is exposed to constant trauma and damage in everyday life. One such injury is a torn meniscus of the knee joint.

This closed injury is rarely accompanied by persistent pain.

, and therefore can remain unnoticed for a long time not only by the patient himself, but also by doctors. There are often cases when the victim is simply sent on sick leave with a recommendation not to put any weight on the sore leg.

But a meniscus tear is an insidious disease

, which leads to the development of intra-articular pathologies. It often provokes the appearance of erosions of the joint capsule, arthrosis and other degenerative and inflammatory diseases associated with deterioration of depreciation in the joint.

Young, physically active people between 20 and 40 years old are most susceptible to meniscus injuries, but a tear can occur at any age

. Elderly patients with problem joints are also susceptible to it. Let's figure out how to treat a meniscus tear in young and old people and what complications this condition is fraught with.

A torn meniscus is a common knee injury.

Definition and functions of the meniscus

The meniscus is a cartilage pad measuring about 6 cm and about 3-4 mm thick that is present in the knee, shoulder, ankle and some other joints.

This spacer is located inside the joint (between the articular surfaces) and has a C-shape. Each knee has 2 menisci - one on the inside (medial menisci, firmly secured by ligaments) and on the outside (lateral menisci, more mobile). They perform the following functions:

depreciation
- absorbing shock loads on the joint when running, walking, jumping;
protection of subchondral bones
- the meniscus protects the bones that form the knee joint from the loads associated with upright posture (distributes them evenly over the entire surface of the joint, preventing rapid wear of the protruding parts);
ensuring congruence (coincidence and optimal interaction) of the articular surfaces
- plays the role of a seal in the joint.

Diagnostic measures

Symptoms indicating inflammation of the knee meniscus also accompany other diseases, for example, a tumor or cyst of the knee, the onset of arthrosis of the joint. The correct diagnosis is made faster if you seek medical help in a timely manner. Consultation with an orthopedist-traumatologist will help clarify the situation. After the initial survey, the doctor will select the necessary diagnostic methods that will give reliable results.

Initially, you should undergo tests and take an x-ray. If the need arises, the attending physician may choose other modern, effective methods to clarify the diagnosis: MRI of the knee joint, ultrasound.

The difficulty of X-ray examination lies in the insufficient degree of information content in the presence of minor pathological changes, so tomography is the method of choice today. Using magnetic waves, the smallest damage to the cartilage tissue of the meniscus, ligaments, muscles, and other structures of the knee joint is determined. The doctor receives the results of the study in the form of a three-dimensional 3D image, which allows a detailed study of the nature of the disorders with the possibility of increasing the size of the image.

When the x-ray shows nothing, but clinical manifestations are present, the patient is necessarily referred for a tomographic examination.

Damage classification

Damage due to a rupture of the meniscus of the knee joint can have different etiologies. So, they can arise due to:

injuries due to external force or incorrectly redistributed load;
degenerative changes in the joint (age-related or associated with wear of the meniscus).

As a rule, in both cases, damage also affects other components of the musculoskeletal system - ligaments, tendons, muscles, synovial cartilage.

A meniscus tear can be:

complete
- in this case, the knee is sharply immobilized due to a sharp narrowing of the gap between the tendons and the joint capsule, any attempt to move causes damage to the tendons and pain;
partial
- can be practically asymptomatic or accompanied by pain, swelling, and stiffness.

There are other bases for classifying meniscal injuries:

which meniscus is affected: lateral or medial;
localization of damage: body of the meniscus, anterior or posterior horn, complex;
according to biomechanical disorders: stable, unstable;
ability to recover: complete, with the help of surgery, unrecoverable;
according to the shape of the gap: patchwork, “watering can handle”, “parrot’s beak”.

What is a meniscus injury?

Meniscal injury is a relatively new diagnosis. It came into use among doctors with the widespread use of MRI diagnostics. It is on the tomogram after a characteristic injury that a change in the structure of the meniscus may be observed, “not reaching” the rupture. That is, the meniscus remains seemingly intact, but already pathologically altered.

A meniscal injury may subsequently result in a so-called degenerative tear. This violation of the anatomy of the knee does not occur at the time of injury, but some time after it. Proper and timely treatment of a meniscal injury can protect against complications.

Possible causes of pathology

The cause of a meniscus tear can be careless movement, prolonged stay in an uncomfortable position, or other high load on the cartilage pad.

At a young age, a meniscus tear is usually provoked by professional and amateur sports - team sports (volleyball, basketball), badminton, running, gymnastics, wrestling - because the cartilage plate of the knee is not designed for such loads. Professional athletes can withstand them only by strengthening the muscular-ligamentous apparatus. But when the load is decompensated (for example, an unsuccessful eversion), it injures the meniscus of both a trained and an ordinary person with equal effect.

The following factors contribute to a tear of the knee meniscus:

chronic or repeated traumatization of the meniscus or other parts of the joint architecture - for example, when performing heavy household and professional duties (loaders, masons, dancers, farmers);
sports and sports injuries;
habit of squatting for a long time;
age-related changes in joints;
chronic diseases - systemic and joints (rheumatism, arthritis, gout, intoxication of the body, autoimmune diseases);
excess weight.

Traumatic meniscus tears usually occur during so-called “twist” movements—rotational movements of the legs with a load on the knee. It can be caused by a sharp movement of the knee inward or outward (twisting the leg), a deep squat (especially with a barbell or other load), a blow to the knee, or displacement when lifting weights. In old age, it is enough to just get up from a chair or squat and rotate your leg in the joint.

The victim of such unfortunate accidents is usually the medial (inner) meniscus of the joint.

Among the traumatic causes of meniscal tears, the leading ones are:

jumping from heights;
an unsuccessful fall to your knees;
spinning on one leg;
joint hypermobility;
failure to comply with safety precautions when exercising in the gym or performing eversion exercises;
running on rough terrain (or on a path with natural uneven ground);
dislocations and subluxations of the knee joint.

Sports injuries are the most common cause of knee meniscus tears.

Symptoms of a meniscus tear

Immediately after injury, victims experience acute symptoms of a meniscus tear, which, however, can be masked by concomitant injuries - bruises, sprains, dislocations, and ligament tears. Therefore, the patient can learn about a rupture of the meniscus of the knee joint only 3-4 weeks after the incident, after the remaining causes of inflammation and pain have subsided.

Characteristic symptoms of a meniscus tear

and traumatic pathological process are:

acute pain in the knee joint;
blocking movement in the joint (due to pain or swelling - may be complete or incomplete);
stiffness, stiffness of the joint;
extensive swelling that occurs due to inflammation or hemorrhage in the joint capsule.

In people over 40 years of age, symptoms of a meniscal tear not related to injury may be virtually absent. In their case, the damage appears as a result of a chronic degenerative process. The pain is usually long-lasting (the patient “gets used” to it) and slowly progresses.

Regardless of the cause of the tear, patients may experience a feeling of uncertainty in the joint when stepping on the affected leg. This symptom of a meniscus tear becomes especially noticeable when going down the stairs, which is harder for most patients than going up. They feel like the joint is “wobbly”, as if something is missing. Over time, the discomfort increases.

Does physiotherapy help with meniscus injuries?

If the clinical picture allows the injury to be treated conservatively, drug therapy is supplemented with physiotherapeutic procedures. Laser, shock wave, ultrasound and magnetic therapy help speed up recovery.

If the patient is not allergic to bee products, he may be offered bee stinging under the supervision of a specialist. The principle is this: on the first day, one bee is planted on the sore spot, on the second - three, on the third - 5. The maximum number of bees is 9. Many patients say that after just one or two stings the healing effect is impressive.

For meniscus injuries, compresses of honey and alcohol are often made

Severity of meniscus tear

When a meniscus is damaged, there are 3 degrees of severity, which are determined using MRI:

The 1st degree is characterized by a small point disturbance in the structure of the cartilaginous lining (in its inner part);
In grade 2, a crack is diagnosed that does not touch the edge of the meniscus. There is no fragmentation of the meniscus.
A grade 3 meniscal tear is characterized by complete separation of the cartilage, with a linear lesion extending to the edge of the meniscus.

Symptoms of a torn meniscus also vary depending on the severity:

1st degree

— there are no pronounced pain sensations, as well as limitation of mobility in the joint. There may be a crunching sound when bending the joint, discomfort or mild pain during certain specific loads (squats, turns, long walks, climbing stairs). A small amount of fluid may accumulate under the knee - swelling is usually only visible when comparing two knees side by side.

2nd degree

- Patients feel severe pain. There is usually a noticeable limp during gait, caused by spontaneous or permanent blocking of movement in the joint. With a moderate meniscus tear, patients cannot fully straighten their leg even with outside help. Swelling in the knee area is very pronounced; bluishness of the skin is possible due to impaired tissue trophism.

3rd degree

Meniscus tear - the pain is sharp and excruciating; any movement of the leg causes pain in the patient. The limb is constantly in a half-bent state without the ability to straighten it. The skin in the area of edema with a 3rd degree meniscus tear has the appearance of a blurred hematoma and acquires a purple tint.

Diagnosis of meniscus tear

As mentioned above, diagnosing meniscus injuries is complicated by injuries to nearby soft tissues. Therefore, even contacting a traumatologist does not guarantee an accurate diagnosis.

without additional hardware research. Palpation and motor tests can be made more difficult by swelling or pain in the knee or long-term use of painkillers.

Functional tests for diagnosing a meniscus tear include: Chaklin's test, Shteiman's symptom, Baikov's method, Polyakov's symptom, Landau's test, McMurray's method, Perelman's symptom.

The most common diagnostic methods include:

computed tomography or magnetic resonance imaging (also helps to determine the condition of ligaments, tendons, cartilage, muscles, and to determine the presence of microfractures that are invisible on an x-ray);
arthroscopy.

These techniques are necessary to accurately determine the location of the rupture and the extent of damage. X-ray and ultrasonography are not informative methods of research, since they do not provide a complete picture and can give false results.

Diagnostic studies help determine the presence of microtrauma that is undetectable by simple examination. Although microtrauma to the meniscus is not a tear, it can have unpredictable consequences for the knee joint as a whole and therefore also requires treatment.

Patella dislocation.

During flexion and extension of the knee joint, the patella moves along the femoral block, like a train on rails. However, there are reasons for incorrect movement and the train derails - the patella dislocates.

Causes: improper development of the trochlea and condyles of the femur, anatomical disorders, rupture of the medial retinaculum of the patella, patella alta (high position of the patella due to an excessively long patellar ligament), weakness of the quadriceps muscle, incorrect position of the tibial tuberosity.

A large complex of conservative treatment is used to correct anatomical disorders with good treatment results. But if there is no effect or with a large number of dislocations, surgical treatment is indicated.

There are open and arthroscopic techniques for stabilizing the patella, which are determined based on examination and the causes of instability. For diagnosis, radiographs of the knee joints in 2 standard projections and axial (skyline view), MRI are important, and computed tomography (CT) may also be needed.

After the operation, you are prescribed to wear a special orthosis that limits movement in the knee joint, walking with crutches, classes with a rehabilitation therapist, exercise therapy and ERT.

Restoration of joint function can be expected within 2 months from the date of surgery, return to sports is closer to 4 months.

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Treatment of a torn meniscus of the knee joint

First aid for a knee injury that is accompanied by severe pain is immobilization (using a splint or splint) and cooling (using an ice pack or sports cooler). Then the victim must be taken to a traumatologist as soon as possible to receive adequate treatment. This approach significantly reduces the risk of complications from a knee meniscus tear.

Meniscus tears are divided into:

separation at the point of attachment to the joint (the damage can heal with bed rest and immobilization of the limb with a splint);
rupture in the central part (requires surgical treatment);
flap rupture (the most severe damage).

The choice of treatment strategy for a tear in the meniscus of the knee joint is also influenced by which meniscus is damaged. The medial (internal) meniscus is much less well supplied with blood vessels, so its rupture requires longer treatment and the use of auxiliary drugs (for example, intra-articular administration of glucocorticoids).

After an accurate diagnosis, the doctor chooses the direction of treatment - conservative or surgical

. The first is to fight inflammation, accelerate the regeneration of cartilage tissue, and relieve pain. The limb is immobilized or protected with a compression orthosis; if necessary, a puncture is performed (removal of fluid accumulated in the joint, be it blood or effusion), and ice compresses are applied (about 20 minutes a day).

Surgical treatment for a knee meniscus tear involves arthroscopy.

Immobilization of the knee - first aid for a torn meniscus

Physiotherapy for a torn meniscus

Physiotherapy is especially advisable during the rehabilitation period after a torn meniscus of the knee joint. It is designed to strengthen the muscles of the thigh and lower leg, naturally reducing the load on the knee joint, and also fully restore mobility in the joint. This is facilitated by:

mechanotherapy;
kinesiotherapy;
ultra-high frequency therapy (UHF);
electromyostimulation;
massage;
taping.

These types of physiotherapy are used to relieve spasm, restore atrophied muscles, and improve innervation.

When treating a knee meniscus tear, only anti-inflammatory techniques are usually used, for example:

physiotherapy;
medicinal electrophoresis;
cryotherapy and thermotherapy;
ultrasound.

They are also used to relieve swelling before meniscus surgery.

Drug treatment of a torn meniscus of the knee joint

In the conservative treatment of a rupture of the meniscus of the knee joint, as well as after surgery, patients are prescribed non-steroidal anti-inflammatory drugs to relieve swelling and pain, and improve soft tissue trophism. eliminating “inflammatory” enzymes that destroy articular cartilage.

If NSAIDs do not provide sufficient effect and do not reach the meniscus well, the doctor may decide on intra-articular injections of corticosteroid hormones and hyaluronates. This procedure allows you to relieve pain and inflammation within 15-20 minutes after administering the medicine.

In case of poor blood circulation and injuries of the medial meniscus, blood microcirculation correctors are additionally connected.

Chondroprotectors play almost the central role in the treatment of meniscal tears of the knee joint. These are preparations enriched with natural polymers - components of cartilage tissue and synovial fluid. Chondroprotectors

accelerate the regeneration of cartilage tissue, serve as a prevention of complications (from joints and ligaments), and ensure fusion of the meniscus with minimal scarring of the tear. They help relieve inflammation, improve nutrition of the joint and improve the shock-absorbing function of cartilage.

It is especially important to take chondroprotectors for degenerative meniscus tears - when the cartilage tissue is already severely worn out, has a low potential for recovery and needs to be recharged. In this case, chondroprotectors should be taken for life, in annual courses of 3-6 months.

One of the most effective chondroprotectors is the drug Artracam.

Surgery

Modern surgical treatment for knee meniscus tears is usually performed in the form of arthroscopy. Since arthroscopy is a diagnostic procedure, minimally invasive surgery during its process can be performed immediately after clarifying the location and extent of the meniscus tear. The surgery begins with the insertion of a microscopic camera into a tiny incision (1.5-3 cm) and takes only 30 minutes.

After the examination, the doctor makes a decision on stitching, resection or removal of the meniscus. Stitching the edges with bioabsorbable suture material is usually indicated for 1st and 2nd degree tears of the meniscus of the knee joint - after this operation, rest for the affected limb is required for 3-4 weeks. Stitching is especially effective for lateral tears of the meniscus of the knee joint, as well as for fresh injuries.

Resection involves partial removal of a fragment of the meniscus that blocks movement in the joint, or severely damaged tissue, followed by grinding of the edges. If most of the meniscus is preserved, the patient does not feel any discomfort or changes in sensations after surgery. After 3 weeks of rehabilitation, athletes can return to training.

Complete removal (meniscectomy) is performed in exceptional cases and only for grade 3 meniscal tears. Removal is recommended for old ruptures or complex injuries, when reconstruction is impossible, as well as for severe damage to the meniscus, excessive looseness of cartilage tissue (arthrosis and other chronic diseases). Rehabilitation after such an operation is more complex, and the shock-absorbing characteristics of the joint worsen (patients are recommended to take lifelong chondroprotectors and be monitored by a rheumatologist). However, with arthroscopic removal of the meniscus, the patient can step on the affected leg on the day of surgery - using a walking stick or crutch. If medical recommendations are followed, motor activity does not suffer after meniscectomy.

Recovery time

after arthroscopy of the meniscus of the knee joint are individual. Typically patients require:

3 days before discharge from hospital;
2-4 weeks for recovery at home.

In this case, disability (depending on the profession) lasts from 2 to 6 weeks. Driving is allowed 6 weeks after surgery.

Gymnastics and exercises for meniscus tears

Performing gymnastic exercises for a torn meniscus of the knee joint is allowed only during the recovery period

, after complete removal of inflammation and with the permission of the attending physician. The physical therapy instructor (PT) selects the following groups of exercises for the patient;

training the muscular-ligamentous apparatus to strengthen the knees (sit down/stand up from a chair, shift your body weight first to one side, then to the other, step-up exercises);
strength training (mainly for the thigh muscles) and flexibility training;
training for coordination of movements and maintaining balance, which prevent re-injury of the knees and help to work the deep muscles;
workouts to maintain general tone.

The exact list of exercises is selected by a specialist taking into account the general health, constitution, physical fitness, age of the patient and other factors. Rehabilitation after surgery involves a gradual increase in loads.

Anterior cruciate ligament rupture.

Ligaments give stability to the knee joint and keep it in the correct position during movement. The most commonly injured ligament requiring surgery is the anterior cruciate ligament (ACL). This ligament is a strong cord of connective tissue that is directed from the anterior surface of the tibia to the posterior surface of the intercondylar notch of the lateral femoral condyle. The ACL provides anterior-posterior rotational stability and is an important element of proprioception in the sensory chain (proprioception is the ability to perceive the position and movement in space of one’s own body or its individual segments).

Clinical manifestations of an ACL rupture are: pain, limited movement in the knee joint, swelling, hemarthrosis (blood in the joint), redness of the joint area. With minor injuries, these manifestations are minimal, edema and hemarthrosis may not develop. During the examination, the doctor checks the strength of the ligamentous apparatus by performing some tests to determine the stability of the joint.

There are several degrees of ACL rupture, based on the number of damaged fibers and the amount of displacement of the tibia:

Grade I is a partial rupture in which a small part of the fibers is damaged, but the general anatomy of the ACL is preserved. This degree of damage is also called sprain, but this term is not entirely correct, since the ligament does not stretch, but an incomplete rupture of its fibers occurs.
II degree - damage to about 50% of the fibers, but the anatomical integrity is still preserved, while the length of the ligament increases. Instability 1+.
III degree – complete rupture, disruption of the integrity of all fibers, which leads to disruption of the anatomy of the ACL and disruption of joint functions. Instability from 2+ to 3+.

For instrumental diagnostics, radiography is used to exclude possible bone pathology, and MRI is used for direct visualization of ligamentous damage. By comparing clinical manifestations with research results, a decision is made on the need for surgery.

The operation is performed using arthroscopy. Repairing your own torn ligament is currently of little use. However, work to preserve one's ACL is gaining momentum. The most common is plastic surgery of the anterior cruciate ligament from the patient’s tendons of various locations of the lower limb (pes anserine tendon, peroneus longus tendon, patellar ligament, tendon of the quadriceps femoris muscle).

In the postoperative period, it is recommended to walk with crutches without supporting the leg for 2-3 weeks, fixation of the knee joint in a splint (an orthosis that prevents the knee from bending), compression stockings, classes with a rehabilitation specialist, a course of antibiotics, painkillers and anti-inflammatory drugs.

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Prevention of knee meniscus tear

To ensure you never wonder how to treat a knee meniscus tear, you should take the following precautions:

Be sure to warm up before any physical activity.
Avoid deep squats, sudden and twisting movements.
Monitor your weight and consume a balanced menu high in vitamins and minerals.
Do not neglect moderate sports loads to maintain the muscular-ligamentous apparatus and stabilize the knee joint.
After 40 years, start taking prophylactic chondroprotectors, even if there are no symptoms of a meniscus tear.

Damage to cartilage of traumatic origin.

During a knee joint injury, the ligamentous apparatus and menisci, due to their extensibility, may not be damaged. On the contrary, hard structures such as cartilage can collapse. Cartilage tissue is very difficult to restore, and therefore, when defects occur, plastic surgery is resorted to. Cartilage defects with an area of up to 1-1.5 cm2 in non-load-bearing joint surfaces and with good cartilaginous sides around are most often subject to tunnelization or microfracture. Loose fragments are removed, the defect is cleaned down to the bone (refreshed) and channels are formed throughout its entire area for the possible flow of blood from the bone marrow. This technique provides a regenerative vascular response, promoting filling of the defect with a fibrocartilaginous scar.

Defects in load-bearing areas may be considered an indication for mosaic chondroplasty. Using special instruments, cylindrical columns with a height of about 2 cm and a diameter of 6-8 mm, consisting of healthy cartilage and underlying bone, are taken from the donor sites. These columns are placed at the site of the defect after appropriate preparation and, like a mosaic, fill the required space. The capabilities of the technique are limited by the size of the defect itself and the amount of donor material. The best results are observed with a defect size of no more than 3 cm2.

An alternative technique that can close large defects is implantation of a collagen matrix. The defect is also refreshed and channels are made in it to allow blood and bone marrow elements to come to the surface. To hold them on the surface of the defect, this matrix is needed, which can be glued with special medical glue or sewn around the perimeter to healthy cartilage. The matrix impregnated with bone marrow elements will be the basis for filling the space with a fibrocartilaginous scar.

Chondroplasty techniques mainly involve open surgical treatment, i.e. with making the cut. Whereas tunnelization of small defects is performed arthroscopically.

After completion of such complex operations, a competent rehabilitation period of recovery is required. The duration of restriction of axial load on the limb and walking with crutches is up to 12 weeks. During this period, passive development of movements under the supervision of a rehabilitation therapist, a set of physiotherapeutic programs, and drug therapy to stimulate tissue regeneration are prescribed. Additionally, intra-articular injections of PRP, SVF, BMAC are recommended to maintain graft viability. To protect the cartilage, injections of hyaluronic acid are subsequently used.

Prepared channels for donor columns

Posts installed in the defect.

Cosmetic suture after mosaic chondroplasty.

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