The stoller method for diagnosing and classifying meniscal injuries is a modern method based on MRI of the knee joint. New and still expensive, it allows you to obtain maximum information about changes in cartilage tissue and select treatment that will be most effective in a particular case.
Damage to the meniscus can be traumatic or degenerative in nature. Both damages are determined accurately by stoller. Depending on the degree of injury, the patient will be prescribed conservative or surgical treatment. Other methods of detecting pathology cannot accurately reflect the level of cartilage damage.
Knee
Knee
The knee has a complex structure. The joint includes the surfaces of the femoral condyles, the tibia, and the patella. For better stabilization, shock absorption and load reduction, paired cartilaginous formations called medial (internal) and lateral (external) menisci are localized in the joint space. They have the shape of a crescent, the narrowed edges of which are directed forward and backward - the front and rear horns.
The external meniscus is a more mobile formation, therefore, with excessive mechanical stress, it moves slightly, which prevents its traumatic damage. The medial meniscus is secured by ligaments more rigidly; when exposed to mechanical force, it does not shift, as a result of which damage more often occurs in various parts, in particular in the area of the posterior horn.
Causes
Damage to the posterior horn of the medial meniscus is a polyetiological pathological condition that develops under the influence of various factors:
- The impact of kinetic force on the knee area in the form of a blow or fall on it.
- Excessive flexion of the knee, leading to tension in the ligaments that secure the menisci.
- Rotation of the femur with the tibia fixed.
- Frequent and long walking.
- Congenital changes that cause a decrease in the strength of the knee ligaments, as well as its cartilage.
- Degenerative-dystrophic processes in the cartilaginous structures of the knee, leading to their thinning and damage. This cause most often occurs in older people.
Finding out the causes allows the doctor not only to select the optimal treatment, but also to give recommendations regarding the prevention of recurrence.
degree of meniscus damage
degree of meniscus damage
Depending on the main causative factor that led to the development of the pathological condition of the cartilaginous structures of the knee, traumatic and pathological degenerative damage to the posterior horn of the medial meniscus is distinguished.
According to the criterion of the duration of the injury or pathological violation of the integrity of this cartilaginous structure, fresh and old damage to the posterior horn of the medial meniscus is distinguished. Combined damage to the body and posterior horn of the medial meniscus was also identified separately.
A high-quality image is the key to an effective consultation.
Transplantation of artificial meniscus.
There are two types of artificial menisci that have recently been used as transplants - collagen and polyurethane. Collagen is made from bovine Achilles tendon. None of them have yet been registered in Russia and are not approved for transplantation. According to scientific literature, the number of complications during artificial meniscus transplantation can reach
up to 31.8% is a very high percentage of complications. On average 10%, but even this figure makes you wonder, is it necessary? Indeed, according to scientific articles, in the long term there are NO advantages to meniscus transplantation over meniscal resection. In order to install an artificial meniscus in a patient’s knee joint, about 10 special clamps will be required. The threads of this device are very hard and strongly scratch the cartilaginous surfaces of the joint.
This is bad and very bad. In children and adolescents, the absence of a meniscus leads to a disturbance in the growth process - dysplasia of the femoral and tibia condyles, they become flatter, so you can try to implant a collagen meniscus.
There are many methods for suturing the meniscus.
The most common is the meniscus suture using the Fast-Fix system. The Fast-Fix system consists of two plastic micro-buttons, 5 mm long and 0.5 mm wide, connected by a self-tightening knot. The advantage of this method for the surgeon is its speed and ease of use.
The disadvantage of this method is that non-absorbable buttons can cause the formation of cysts, and in some cases, when they move, they destroy the cartilage of the knee joint and cause pain.
We use other meniscus suture techniques such as the arthroscopic "outside-in" and "all-in" meniscus suture techniques.
For the suture of the anterior horn of the meniscus and the body of the meniscus,
We prefer the “outside-in” method, in which the thread is passed through a puncture into the joint using a special needle, grabbed with a special tool or a loop and tied outside the joint.
Posterior horn of the meniscus and body of the meniscus,
In our practice, we prefer to sew using the “all inside” method.
For fixation, PDS-2 threads are used, which dissolve within 180 to 260 days. This method of meniscus suture is borrowed from the surgical technique of the shoulder joint. The essence of the operation is that the suture and knot are formed internally, the likelihood of damaging the anatomical structures of the posterior part of the knee joint is minimal, the suture remains under the meniscus, without the likelihood of damage to the cartilage tissue.
The advantage of the technique is:
1. wrapping suture, which is the strongest and has proven effective in open operations and meniscal transplantation.
2. The thread used is completely absorbable.
3. You can apply as many stitches as necessary to securely fix the meniscus.
To perform operations of this level, it is necessary not only to have specific instruments, but also to have sufficient technical training of the surgeon in performing this surgical technique.
Meniscus root injury
is an independent pathology in which the ligament holding the attachment point of the meniscal horn is torn off. In this case, the meniscus ceases to perform all its shock-absorbing functions.
The damaged root of the meniscus must be fixed, otherwise the rapid development of arthrosis is inevitable. In order to fix the meniscus root, we use the following technique.
We install a guide in the damaged area, draw a special channel in the bone, through this channel we pass a Suture Tape microtape, to which we sew the torn meniscus root, pull the tape and fix it with a bioabsorbable anchor.
RAMP injury is a tear of the capsule from the posterior horn of the meniscus.
Often occurs with massive and chronic injuries. Often associated with a rupture of the anterior cruciate ligament (ACL).
On MRI, RAMP damage is difficult to notice; it is necessary to examine the meniscus through a posterior approach, arthroscopically. If this damage is detected, it must be refixed.
We use in our practice the suture shuttle technique, borrowed from shoulder surgery. The meniscus is sutured to the capsule using absorbable PDS-2 sutures.
After suturing the meniscus, a very important point is competent, careful, individually thought-out rehabilitation. It is necessary to use crutches for 3 to 6 weeks after surgery and avoid full weight bearing on the limb. After a meniscus suture, a patient is not recommended to perform deep squats until 3 months after the operation.
Implantation of collagen meniscus.
In the case of complete destruction of the meniscus, as well as after its removal, especially the outer one, arthritic changes may develop in the knee joint. In this regard, a number of techniques have been proposed that make it possible to replace the missing part of the meniscus and even, to some extent, replace it completely.
The collagen meniscus implant (SMI) from Stryker allows you to replace the missing part of the meniscus and form a meniscus-like structure (meniscoid) in the resection area.
Unfortunately, this product is not registered and cannot be used in the Russian Federation.
Autoplasty or replacement of the meniscus using a tendon.
In some cases, we use a technique to replace the damaged part of the meniscus using the peroneus longus tendon or semitendinosus muscle.
This technique allows the base of the meniscus to be replaced with collagen tissue.
This helps distribute the load in the knee joint and reduce the likelihood of developing arthrosis.
Manifestations
Clinical signs of damage to the posterior horn of the medial meniscus are relatively characteristic and include:
- Pain that is localized on the inner surface of the knee joint. The severity of pain depends on the cause of the violation of the integrity of this structure. They are more intense with traumatic injury and sharply intensify while walking or descending stairs.
- Violation of the condition and functions of the knee, accompanied by a limitation in the full range of motion (active and passive movements). When the posterior horn of the medial meniscus is completely torn off, a complete block in the knee may occur against the background of severe pain.
- Signs of inflammation, including hyperemia (redness) of the skin of the knee area, swelling of soft tissues, as well as a local increase in temperature, which is felt after touching the knee.
With the development of the degenerative process, the gradual destruction of cartilaginous structures is accompanied by the appearance of characteristic clicks and crunches in the knee during movements.
How to prepare for the procedure
Special preparation is not required before MRI with further classification of the condition of the Stoller meniscus. The study is subject to the same contraindications as MRI, and primarily the presence in the body of metal elements and various electrical stimulators and insulin pumps, the operation of which can be affected by the magnetic field of the device.
There will be no pain or discomfort during the examination. The only thing that the patient needs to take into account is that the procedure is lengthy. If the patient is very nervous before the examination, it is recommended that he take valerian or another herbal sedative.
Diagnostics
Diagnostics
Arthroscopy also makes it possible to carry out therapeutic manipulations under visual control after additional introduction of special microinstruments into the joint cavity.
Non-surgical therapy
After a small change affecting the lateral meniscus of the knee joint has been diagnosed using instrumental research methods, treatment without surgery is selected by the traumatologist individually for each patient. It involves several directions:
- General recommendations - an important component of treatment, include a diet with a sufficient supply of organic compounds (especially proteins) and vitamins, limiting knee mobility, and giving up bad habits.
- Drug therapy involves the use of drugs, the most popular of which are anti-inflammatory drugs (glucocorticoids or non-steroidal drugs), chondroprotectors (necessary to improve the characteristics of cartilage tissue and prevent its further destruction), vitamins that improve metabolic processes and the patient’s condition as a whole.
- Physiotherapeutic procedures are an important area of therapy, which is advisable for pathological degenerative disorders. It makes it possible to reduce the severity of inflammation and the level of mediators that provoke its development, as well as accelerate tissue regeneration. The procedures usually include magnetic therapy, electrophoresis, and mud therapy.
An alternative modern method of therapy without surgery is the use of platelet mass (a significant number of platelets in saline solution). It is entered directly into the area of modified components. This biological preparation contains bioactive organic compounds (“growth factors”) that accelerate regenerative processes in the altered components of the musculoskeletal system.
Damage to the posterior horn of the medial meniscus - treatment
After an objective diagnosis has been carried out, determining the location and severity of the violation of the integrity of the cartilaginous structures of the joint, the doctor prescribes a comprehensive treatment. It includes several areas of action, which include conservative therapy, surgical intervention, and subsequent rehabilitation. Mostly all activities complement each other and are assigned sequentially.
Treatment without surgery
If partial damage to the posterior horn of the medial meniscus (grade 1 or 2) has been diagnosed, conservative treatment is possible. It includes the use of drugs of various pharmacological groups (non-steroidal anti-inflammatory drugs, vitamin preparations, chondroprotectors), the performance of physiotherapeutic procedures (electrophoresis, mud baths, ozokerite). During therapeutic measures, functional rest for the knee joint must be ensured.
Cost of arthroscopic knee surgery in Germany
In addition to the cost of surgical treatment of a torn meniscus, it is worth considering the additional costs of diagnostics, doctor's appointments and aids (eg elbow crutches), amounting to approximately 1,500 to 2,000 euros. If you are planning to undergo outpatient physical therapy treatment after meniscal tear surgery, we will be happy to provide you with an estimate of the costs.
Information regarding the cost of hotel accommodation and possible additional treatment at a rehabilitation center can be found on the corresponding website.
Surgical intervention
Surgical intervention
Surgical intervention
The main purpose of the operation is to restore the anatomical integrity of the medial meniscus, which allows for the normal functional state of the knee joint in the future.
Surgery can be performed using an open approach or arthroscopy. Modern arthroscopic intervention is considered the technique of choice, since it is less traumatic and can significantly reduce the duration of the postoperative and rehabilitation period.
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.