A degenerative change is a violation of the normal structure of the meniscus, leading to a partial or complete loss of its functions. The cause of the pathology can be injuries, active sports, hard physical work or excessive load on the knee joint. Degenerative processes in menisci can be a consequence of the natural aging of the body.
Degenerative changes in the knee joints are a common occurrence among older people, athletes and overweight people. Cartilage, ligaments, menisci, synovial membrane are usually involved in the process. In severe cases, the articular surfaces of the bones that form the knee joint are damaged.
Causes of Meniscus Degeneration
The development of degenerative processes in menisci can be triggered by their frequent trauma, displacement, impaired blood supply and / or nutrition. Most often, the pathology develops against the background of chronic inflammatory and degenerative-destructive diseases of the joints. Also the cause may be traumatic injuries of the knee.
Deforming osteoarthritis is the most common disease of the musculoskeletal system. Pathology develops mainly in people older than 50 years. Among people over the age of 60, it is detected in 97% of cases. Knee joints are affected in 70-80% of patients with osteoarthrosis.
Gonarthrosis is characterized by degenerative-dystrophic changes in almost all structures of the knee joint. Menisci are damaged due to poor blood supply, lack of nutrients in the synovial fluid and constant trauma to dilapidated cartilage.
Factors contributing to the development of gonarthrosis:
- hard physical work;
- hormonal and metabolic disorders;
- postmenopausal period;
- past knee surgery
- inflammatory joint diseases;
Deforming gonarthrosis can lead to permanent disability and disability in just a few years. According to statistics, this happens in 25% of patients within 5 years from the onset of the first symptoms of pathology. Early diagnosis and timely treatment help to avoid undesirable consequences.
Meniscus degeneration is detected in 27% of patients with grade I deforming gonarthrosis. At later stages 2, 3, pathology develops in almost all patients.
Frequent trauma or any damage to the meniscus can lead to the development of degenerative processes in it. A provoking factor can be a sharp movement or an unsuccessful turn with a shin. With injuries, the medial meniscus located on the inside of the joint is most often affected. This is due to the peculiarities of its structure and localization, which do not allow it to avoid pinching of the femur by the condyles.
Post-traumatic meniscus degeneration is more common for athletes, hard workers and overly active people. Pathology can be detected at any age.
Do not confuse degeneration with traumatic ruptures, tears, tears, etc. The former are characterized by a long, slowly progressing course with the further development of complications. The latter occur acutely due to injury.
Degeneratively altered menisci break with particular ease. But traumatic injuries themselves often cause degenerative changes. These two pathologies are interconnected and often develop in parallel.
The cause of meniscus dystrophy can be rheumatoid or gouty arthritis, brucellosis, tuberculosis, yersiniosis. The development of pathology can also provoke hypothyroidism, systemic vasculitis and some diseases of the connective tissue (scleroderma, systemic lupus erythematosus, etc.).
Degenerative-dystrophic changes in the meniscus that occur against the background of other diseases are commonly called meniscopathies.
Classification of degenerative changes
Pathology is differentiated by the localization of foci of degeneration. They can be found both in the body and in the front or rear horns. Most often, degenerative changes are detected in the horn of the medial meniscus. This is due to the peculiarities of its structure and location.
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Depending on the severity of pathological changes, 4 stages of degeneration are distinguished. They can only be detected and identified using magnetic resonance imaging (MRI).
- 0 degree – characterized by the absence of pathological changes;
- I degree – focal changes noticeable in the thickness of the meniscus, not reaching its edges;
- II degree – the presence of a linear focus of destruction, not reaching the edges of the meniscus;
- III degree – the pathology reaches one of the edges, which leads to a tear.
A true meniscus rupture can be said if the III degree of degeneration according to Stoller is revealed.
Table 1. The most common consequences of degenerative changes
|Gap||It is characterized by a violation of the meniscus integrity in the area of the body, front or rear horn.||Severe knee pain, preventing the patient from walking normally. If the horn is damaged, it becomes difficult for a person to bend the leg, the front – to straighten|
|Avulsion||A pathologically altered meniscus or its fragment is completely detached from its attachment point||The articular mouse resulting from detachment migrates along the synovial cavity, often causing blockade of the knee joint. The person has severe pain and limited mobility of the knee|
|Hypermobility||Manifested by the abnormal mobility of both menisci due to rupture of the transverse ligament of the knee connecting them||Aching pain in the knee, aggravated by walking, running, squats, descending stairs and other physical activity|
|Cyst||Pathology is characterized by the formation in the meniscus cartilage of a fluid-filled cavity||It may be asymptomatic for a long time. When the cyst ruptures in the knee, sharp pain usually appears|
Meniscus tears are traumatic and degenerative. The appearance of the latter is usually preceded by aching pain, stiffness and discomfort in the knee for several months or even years.
What causes meniscus degeneration
Menisci are important structures of the knee joint. They play a huge role in balancing the load and ensuring proper knee stability. It is thanks to them that the knee joint can work and function normally. Their degeneration leads to pain, instability and impaired mobility of the lower limb. The knee joint becomes loose, and its functioning is gradually disrupted.
When complications (tears, tears, etc.) occur, a person has pain, discomfort and a feeling of instability in the joint. Unpleasant sensations intensify when descending the stairs and squats. Some patients complain of the appearance of characteristic clicks, a crunch and a feeling of movement of a foreign body in the knee during movements.
Damage and deformation of the menisci contribute to the appearance of degenerative-dystrophic processes in other structures of the joint. As a result, a person develops deforming osteoarthrosis.
Methods of diagnosis
The simplest method for diagnosing pathology is radiography of the knee joints in 2 projections. But it is informative only in the last stages of deforming osteoarthrosis. It is impossible to see degeneration itself in radiographs, but you can only suspect it by the presence of indirect signs.
Modern methods for the diagnosis of degenerative changes in the meniscus of the knee joint:
- Ultrasound It is a non-invasive and highly informative research method that allows you to see almost all the structures of the knee joint (ligaments, tendons, meniscus cartilage, hyaline cartilage). The advantage of ultrasound diagnostics is the absence of radiation exposure to the body;
- MRI A modern method to detect meniscus degeneration and other pathological changes in the knee joint at the earliest stages. Magnetic resonance imaging is widely used to diagnose deforming arthrosis;
- arthroscopy. An invasive research method that allows you to examine the cavity of the knee joint from the inside. It is mainly used for severe knee injuries. In 70% of cases, diagnostic arthroscopy turns into a medical one. During such an operation, doctors under visual control eliminate gaps and other dangerous consequences of injury.
To slow down the development of degenerative processes, patients are prescribed corticosteroids, chondroprotectors, hyaluronic acid preparations and agents that restore the normal composition of synovial fluid. Most effective is their intra-articular administration. For local injection therapy (LIT), Diprospan, Kenalog, Alflutop, Noltrex, Zell-T and some other drugs are most often used.
With degenerative changes in the medial or lateral meniscus, accompanied by a rupture, the patient requires surgical intervention. The operation is performed by arthroscopy.
Manifestations in children and adolescents
In childhood, the pathology is most often the result of dysplasia – abnormal formation of the knee joint during fetal development. The baby is born with defects in the structure of bones, cartilage, muscles and ligaments. All this subsequently causes the development of degenerative changes in the menisci.
Unlike adults, in children with injuries, the lateral meniscus is more often damaged. Blockade of the knee joint in childhood and adolescence is rare.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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