- Rupture of the medial and internal knee meniscus, causes and symptoms
- Treatment of the meniscus of the knee with folk remedies
- Knee meniscus cyst
- Removal of the meniscus of the knee
- More articles
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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- Definition of the disease
- Causes of injuries of the lateral meniscus of the knee
- Signs and symptoms of lateral meniscus damage
- Diagnosis of lateral meniscus damage
- Treatment of lateral meniscus damage
- Rehabilitation after damage to the lateral meniscus
- Symptoms and treatment of lateral meniscus rupture
- Causes and signs of injury
- Damage diagnosis
- Therapeutic activities
- Recovery phase
- Lateral knee meniscus
- Symptoms of ailment
- Lesion treatment
- Meniscus injuries
- The most commonly used symptoms of trauma to the meniscus of the knee:
- Symptom Baykova
- Symptoms of Chaklin
- Meniscus anatomy
- Rupture of the lateral meniscus of the knee
- Symptoms of a meniscus rupture
- Medical diagnostics
- Damage Features
- Rupture of the horn of the lateral meniscus
- Rupture of the anterior horn of the lateral meniscus
- Lateral meniscus rupture by type of watering can handle
- Lateral meniscus radial rupture
- Treatment of pathological processes
- What will happen if the injury is not treated
- Types of meniscus injuries: the clinical picture and complications
- Anatomical features of the knee
- Meniscus Functions
- Causes and types of damage
- Clinical manifestations
- Traumatic lacerations
- Degenerative breaks
- What complications are noted
- Diagnosing a condition
- Medical tactic
Definition of the disease
Menisci in the knee joint play the role of shock absorbers, serve to fully interact with the shape of the contacting surfaces of the bones and maintain the stability of the knee joint. The lateral meniscus is located outside the knee joint and is more mobile than the medial meniscus (internal), due to which it is less susceptible to traumatic injuries.
Causes of injuries of the lateral meniscus of the knee
The most common cause of lateral meniscus injury is indirect or combined injury, in which the lower leg turns inside out. If the leg is bent too abruptly from a bent state, the leg is abducted excessively, meniscus damage can also occur.
Direct trauma, for example, when a joint directly hits a hard edge of a surface or when struck by a heavy moving object, is rarely diagnosed. But, if it happens repeatedly, then most often chronic meniscus trauma develops, which leads to its rupture over time.
Diseases of a rheumatic nature can cause the development of degenerative changes in the lateral meniscus.
Signs and symptoms of lateral meniscus damage
The clinical manifestations of lateral meniscus damage are usually divided into two periods: acute and chronic. Often at the beginning of the disease it is very difficult to make a correct diagnosis, since there are symptoms of nonspecific inflammation, characteristic of other internal injuries of the joints. As a rule, the patient is disturbed by pain in the area of damage along the joint gap. When moving, especially during extension, sharp pain occurs, which leads to a limitation of motor ability.
In most cases, the injury is instantaneous and leads to bruises, tears, and in severe cases to rupture or even crush the meniscus. A complete rupture of the first injured meniscus most often occurs in the presence of degenerative changes or the inflammatory process. As a result of conservative therapy in most patients, a complete recovery is observed.
After the subacute period, which lasts 2-3 weeks, the reactive phenomena disappear, and the true clinical picture of the damage becomes visible. It is characterized by the presence of certain symptoms, such as pain present constantly and inflammation of the capsule. The presence of effusion is determined and often there is a blockage of the joint. An anamnesis of the patient with a detailed description of the details of the injury and positive pain tests for extension, displacement and compression play an important role in making the correct diagnosis.
Diagnosis of lateral meniscus damage
For diagnosis, a detailed description of the moment of injury is very important. Damage to the lateral meniscus is very rarely accompanied by blockade of the joint, due to its mobility it is more susceptible to compression than to rupture. As a rule, there are symptoms of displacement and sliding of the meniscus and a specific click with minimal movement.
With traumatic damage to the lateral meniscus, patients complain of pain in the area of the external crack of the joint, the intensity of which increases with the movement of the lower leg inward. An external examination reveals swelling of the knee joint and the development of infiltration.
These symptoms are quite common and are present in other pathologies of the knee joint, which greatly complicates the diagnosis. Pain tests most often with injuries of the lateral meniscus are negative, except for the snapping knee, blockade of the joint also does not develop in all cases.
The most objective method is radiography, which is used to determine the narrowing of the damaged section of the joint space with signs of deforming arthrosis.
A certain difficulty arises in the diagnosis, if the meniscus is atypical in shape or in case of chronic trauma, both menisci are damaged.
Treatment of lateral meniscus damage
The choice of treatment depends on the nature of the injury and the condition of the patient. Bruises, small tears, changes of a degenerative type, are subject to primary conservative treatment. If the injury is serious, with large gaps and is accompanied by severe pain or blockade, surgical treatment is categorically shown, which is most often carried out using endoscopic equipment. Subject to surgical intervention are patients who have not improved as a result of conservative treatment.
Rehabilitation after damage to the lateral meniscus
Dates and measures for the rehabilitation of the treatment of such diseases are selected individually for each patient. The use of crutches and the maximum reduction in the load on the sore leg are recommended at the initial stage.
Expert Editor: Pavel A. Mochalov | D.M.N. general practitioner
Education: Moscow Medical Institute I. M. Sechenov, specialty – “Medical business” in 1991, in 1993 “Occupational diseases”, in 1996 “Therapy”.
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Symptoms and treatment of lateral meniscus rupture
The lateral meniscus acts as a shock absorber, prevents friction of bone surfaces, and maintains joint stability. It is located outside the patella and has greater mobility than the internal cartilage. This helps reduce the risk of injury. The most common cause of damage to the external meniscus is rotation, in which the lower leg rotates inward. With a sharp extension of the knee, excessive abduction of the tibia can also be injured.
Direct damage that occurs when hitting a hard surface or falling from a height is rarely detected. However, when they reoccur, a chronic pathological process develops, leading to a rupture of the body of the lateral meniscus. Rheumatism and arthrosis lead to the destruction of cartilage, which negatively affects the function of the joint.
Causes and signs of injury
Damage to the front horn of the external meniscus develops in 2 stages:
At the early stages, it is quite difficult to make a correct diagnosis, which is associated with the presence of signs of non-specific inflammation characteristic of other joint diseases. After receiving an injury, severe pain in the knee appears, which helps reduce mobility. They increase when walking and squats, a similar phenomenon called blockade of the joint.
Injury in most cases is considered to be simultaneous. The most common damages are:
A complete rupture of the lateral meniscus of the knee joint is observed in the presence of inflammatory or degenerative changes. Conservative therapy with minor damage contributes to a quick recovery. The acute phase ends in 14-21 days, the symptoms subside, a true clinical picture of the injury develops.
The main symptoms of the gap:
The presence of fluid and partial blockage of the knee are detected. Confirm the diagnosis by collecting anamnesis and conducting pain tests.
An important role is played by the description of the process of injury. Horizontal rupture of the posterior horn of the lateral cartilage extremely rarely contributes to a decrease in joint mobility. There are symptoms of displacement and compression of the cartilage, a specific sound when bending the knee.
With injuries of the external meniscus, the patient experiences pain in the joint space, which increases when the lower leg rotates inward. An initial examination allows you to detect swelling and infiltration, in which the knee increases sharply in size.
These signs can also appear with other diseases of the joints, which greatly complicates the diagnosis. Pain tests for injuries of the outer cartilage often give negative results. The blockade also does not always develop. The most informative diagnostic procedure is considered an X-ray examination, which allows to identify the narrowing of the joint space and the symptoms of arthrosis.
Some difficulties in determining the nature of the injury may occur if the external meniscus is irregular in shape or signs of chronic inflammation are observed. In such cases, a diagnostic arthrotomy is prescribed.
Treatment of rupture of the external meniscus begins with antiseptic treatment of the affected area and the application of a tight bandage. You will have to give up labor activity for a while. With minor injuries, conservative treatment can be prescribed, with chronic pathological processes, surgical intervention is indicated.
With the accumulation of blood in the synovial cavity, a puncture is performed, before which an intra-articular injection of novocaine is given. After this, the knee is fixed with a plaster cast with a gauze ring. Have to wear it for at least a week.
The recovery period begins in a few days. At this time, perform exercises aimed at strengthening the muscles of the thigh and maintaining the mobility of the ankle. After removal of the gypsum, physiotherapeutic procedures are prescribed:
In the absence of pain, weight-bearing exercises are allowed. Training is carried out in knee pads or elastic bandages.
Conservative therapy may include hydrocortisone injections, especially for chronic injuries.
If these procedures do not give results, the rupture of the anterior horn of the lateral cartilage will have to be treated surgically.
Damaged cartilage is removed completely, because the presence of tissue residues can lead to repeated injury with increased physical exertion. Currently, arthroscopic operations are becoming more common. After surgery, the joint cavity is treated with an antiseptic solution, the synovial membrane is sutured.
In the early days, a limb is placed on a hill; rehabilitation does not imply a tight bandage. Gypsum is used in the presence of blood in the synovial cavity, the long course of the inflammatory process and degenerative changes in the tissues. Longuet needs to be worn for 3 days, for 2 days, simple exercises are allowed.
After removing the stitches, you can walk using crutches or a cane. The average duration of inpatient treatment is 21 days. After this period, the patient is discharged under the supervision of a traumatologist who continues maintenance therapy.
The timing of rehabilitation largely depends on the nature of the injury, the general condition of the body, the presence of concomitant pathologies. In the first year after getting injured while walking, it is recommended to use assistive devices.
Lateral knee meniscus
The cartilaginous tissue that covers most of the tibial head and has a semicircular shape is called the lateral meniscus. It serves for the complete interaction of bone surfaces and acts as a shock absorber supporting the knee fixation. Damages of various kinds always go painfully, significantly worsening the quality of human life. In certain cases, such damage completely immobilizes the leg and provokes a number of complications.
Meniscus damage is often achieved by indirect mechanical, combined injury or contusion, which is the main cause of this condition. With aggressive exposure, the lower leg bends inward, the meniscus of the knee joint stretches into an unnatural shape, and an tear or complete rupture of the structure occurs. This phenomenon is achieved with strong twisting of the legs with the use of load on it. The abnormal position of the bone provokes strong tension, which as a result leads to severe pain and microtrauma. In addition, a sharp extension of the leg and excessive abduction of the lower leg can affect the lateral meniscus. Less common is pathology due to a direct hit by a heavy object or about an angle, but if the case recurs, the meniscus will be completely damaged. Diseases of a rheumatic nature also adversely affect the condition of cartilage fibers.
Damage to the lateral meniscus of the knee joint is often observed in elderly patients. Age-related changes accelerate the process of degenerative-dystrophic changes, therefore, tissues relatively lose their elasticity and are more prone to trauma. Damage in most cases is defined as simultaneous, in which the anterior cruciate ligament and rupture of the external meniscus occur simultaneously. Main reasons:
Symptoms of ailment
The rupture of the medial meniscus occurs due to the low mobility of a person. Low joint activity and poor blood supply leads to damage to the internal cartilage plate, which cannot be treated with drugs. Damage to the anterior horn of the lateral meniscus is accompanied by unpleasant symptoms that negatively affect the patient’s condition and his ability to move freely. Clinical manifestations are characterized by two types:
In all cases, the patient suffers from prolonged severe pain, which intensifies with the load. The chronic type is characterized by constant pain with the slightest manipulation of the limb and at rest. Often there is an effusion in the knee joint, the formation of a cyst. In the acute type of the disease, the symptoms decrease over time and the pain disappears on its own, but with chronic damage, infiltration appears in the knee, and the limb is completely immobilized. Key features:
A frequent manifestation of the pathology can be pain in the joint area.
A detailed description of the injury becomes a priority in the diagnosis process. The front horn with damage more clearly limits the mobility of the leg, in contrast to the back, so it is necessary to accurately indicate the place of pain and shock. At the initial examination, puffiness and infiltration, which visually increase the knee, can be determined. Similar signs of damage are characteristic of other types of diseases, which greatly complicates the diagnosis. Pain tests also often do not give a result, therefore, an effective way to determine the state of the meniscus and narrow the joint gap is:
The method of therapy determines the degree of damage and the condition of the meniscus. The result of therapy depends on many factors, such as the age of the patient, the presence of meniscopathy, inflammatory processes, degenerative processes, and the trauma zone. There are two main types of treatment: conservative and surgical. First aid for damage consists of arranging rest for a sore leg, you can apply a cold compress. If there is a complete rupture, the pain will be unbearable, so the use of pain medications is an effective way to eliminate the symptom.
The conservative technique is effective for minor injuries and ruptures of a radial nature or for injuring the horn, which does not cause severe pain and immobilization. Fulfilling all the requirements allows you to effectively deal with the problem, and the healing process will be painless. For pain relief, NSAIDs and antibacterial agents are prescribed that resist infections and the development of inflammation. Traditional therapy is based on an integrated approach to the treatment of damage and consists of the following rules:
Surgical interventions are performed in cases of complete rupture with the formation of a cyst and accumulation of fluid. The appearance of a crunch or clicking during manipulations with the leg, complete blockage of the joint, inability to move the limb and severe pain are the main indications for the operation. In addition, the surgical method is carried out if traditional therapy did not give the expected results and the condition of the knee worsened. In cases of a complete rupture, it is important to intervene in time, since the torn fragment erases the cartilage over time, it softens and can be erased to the bone. The modern operation does not provide for the complete removal of the meniscus, only the torn part is withdrawn. The external meniscus is often operated on by the arthroscopic method, with minimal trauma to the skin.
Precautions should be taken seriously by people whose activities are associated with physical activity, athletes and those who are forced to sit for long periods. The main rule to prevent meniscus rupture is the absence of traumatic situations. Avoid dangerous cases of bruises or sprains. It is important to correctly distribute the load on the legs to prevent overwork. Periodically recommended gymnastics for the development of articular joints. Before hard physical work it is worth warming up the muscles and warming up for the legs. It is recommended to avoid hypothermia, it is necessary to completely and correctly treat lesions of cartilage tissues or joints. At the first sign of an unusual sensation in the knee, it is advisable to consult a doctor.
|Symptoms:||Symptom Baykova||Symptoms of Chaklin|
|Causes of Injury|
|Types of damage|
|Nature of damage|
For the prevention of injuries, especially the back, see → here ←
The most commonly used symptoms of trauma to the meniscus of the knee:
Constant pain at the level of the gap of the knee joint.
Atrophy of the thigh muscles, and sometimes the lower leg.
Baikov’s symptom: the knee joint is bent to an angle of 90 ° with a finger, they press the corresponding part of the joint space and passively unbend the lower leg, while the pain intensifies sharply.
Symptoms of Chaklin
Chaklin’s tailoring symptom: with active raising of the straight leg, atrophy of the inner portion of the quadriceps femoris muscle is visible and, against this background, the tension of the tailor muscle sharply contours;
Symptom of “click” Chaklin during movements in the knee joint.
- Turner’s symptom: an increase in local pain and temperature sensitivity in the n.saphenus innervation zone, along the inner surface of the knee joint (if the inner meniscus is damaged);
- Perelman’s “staircase” symptom: pain when descending the stairs;
- knee flexion contracture;
- Landau symptom: pain in the area of damage when trying to sit “in Turkish”;
- painful roller at the level of the joint space in the area of damage;
- arrhythmic gait (result of muscle atrophy);
- Steiman’s symptom: with a leg bent at the knee joint at an angle of 90 °, rotational movements are accompanied by pain, with damage to the inner meniscus
- with internal rotation, with damage to the external meniscus
- with external rotation;
- symptom “galoshes”: pain when putting on galoshes;
- Rauber symptom (develops in the first 2-3 months after the onset of the disease): during radiography, spike-like growths on one or two condyles;
- symptom of lateral meniscus dysplasia: oblique contour of the external condyle, expansion of the external fissure of the knee joint;
- Polyakov symptom: a patient in a supine position raises a healthy straight leg and raises his body, leaning on the shoulder blades and heel of an injured leg
- there is pain in the area of the damaged meniscus (menisci);
- Steimann’a symptom Ⅰ the appearance of soreness on the inner side of the knee joint with external rotation of the lower leg;
- Steimann’s symptom Ⅱ when bending the knee, the pain moves posteriorly, since when bending the meniscus stretches posteriorly;
- symptom of Bragard’a pain during internal rotation;
- symptom of Bragard’a Ⅱ pain is shifted posteriorly with continued bending of the knee;
- symptom of Mc. Murray’a with a bent knee in the position of the patient on the abdomen, turns and abduction of the legs with a fixed foot cause a feeling of pain and crackling. Symptoms of damage to the internal meniscus of the knee joint:
- pain on the inside of the knee;
- point sensitivity over the place of attachment of the ligament to the meniscus;
- painful lumbago with tension;
- “Block” of the knee;
- pain along the tibial collateral ligament with overextension and rotation of the tibia outward with a leg bent at the knee;
- pain with excessive bending of the leg;
- muscle weakness of the anterior thigh. Symptoms of damage to the external meniscus of the knee joint:
- pain with tension, pain along the peroneal collateral ligament, extending to the external section of the knee joint;
- “Block” of the knee;
- pain along the peroneal collateral ligament with overextension and excessive flexion and rotation of the lower leg inward;
- muscle weakness of the anterior thigh.
Menisci of the knee joint are cartilage pads that act as shock absorbers in the joint, as well as stabilize the knee joint and increase the congruence of the articular surfaces in the knee joint.
During movements in the knee joint, menisci contract, their shape changes. There are two menisci in the knee joint – external (lateral) and internal (medial). In front of the joint, they are connected by a transverse ligament.
The external meniscus is more mobile than the internal one, therefore its traumatic injuries occur less frequently.
The internal meniscus is less mobile and is associated with the internal lateral ligament of the knee joint, so injury is often combined with damage to this ligament.
On the side of the joint, menisci are fused to the capsule of the joint and have blood supply from the capsule arteries. The internal parts are deep in the joint and do not have their own blood supply, and their tissues are nourished through the circulation of intraarticular fluid.
Therefore, damage to the menisci near the joint capsule fuses well, and tears of the inner part, deep in the knee joint, do not fuse at all. The prevalence of meniscus injuries
Among the internal injuries of the knee joint, meniscus injuries take first place. According to the Sports and Ballet Injury Clinic of the CITO, where most athletes with the most frequent injuries are treated, meniscus injuries account for 60,4% per 3019 people, 75% of them are patients with internal meniscus injuries, 21% with injuries and diseases of the external meniscus and 4% – with injuries of both menisci.
The proportion of meniscus damage is 4: 1, respectively. This is due to the contingent of patients and improved diagnosis (arthroscopy and other methods). Thus, most often menisci are damaged in athletes and physical workers aged 18 to 40 years.
In children under 14 years of age, meniscus rupture due to anatomical and physiological characteristics occurs relatively rarely. Meniscus damage in men is more common than in women – in a ratio of 3: 2, the right and left are affected equally.
Rupture of the lateral meniscus of the knee
The lateral meniscus of the knee joint is an external movable cartilaginous structure that acts as a stabilizer and shock absorber in the joint. As practice shows, he is less likely to be injured than the internal counterpart, but self-harm is often combined, with various secondary complications.
Symptoms of a meniscus rupture
The lateral meniscus of the knee joint is less susceptible to various injuries compared to internal cartilage structures due to its great mobility, despite this, diagnosticians regularly identify similar pathologies in patients.
In this case, the most common causes are indirect or combined injury, in which the lower leg turns inside. In addition, damage to the external meniscus can form against the background of frequent sharp leg extensions when bent, as well as due to excessive abduction of the lower leg.
In the general case, the victim is concerned about pain in the specified location, which is aggravated during the extension of the joint with a large amplitude. In this case, the edema may be insignificant or absent altogether if the knee injury has a first or second degree of severity.
With the end of the acute period of the pathology, its symptoms change. In particular, aching regular pain and inflammation of the capsule, joint blockage are formed and sometimes an effusion is formed.
In the context of the potential search for a knee joint injury related to the lateral meniscus, the specialist in the field makes a comprehensive diagnosis of a possible pathology.
Diagnostic measures include:
- The primary reception of the victim. The patient’s complaints and medical history are recorded, the circumstances of the injury are clarified, palpation of the problem localization is performed and, if necessary, a manual test for joint stability as a whole;
- Roentgenography. It is prescribed for suspected gross pathological changes in the joint in the form of bone injuries. X-ray examination is carried out in two projections, however, it does not allow to detect damage directly, but only by indirect signs;
- Ultrasound procedure. The ultrasound procedure allows you to monitor the cavity of the knee joint for the presence of synovial fluid or blood in it, as well as to visualize the state of adjacent soft tissues;
- CT scan. An advanced method of using X-rays for layer-by-layer scanning of tissues of the knee joint, followed by processing the results using modern software. A sufficiently high resolution of the equipment allows to qualitatively and quantitatively assess the condition of bones, tendons and cruciate ligaments, as well as detect gross meniscus pathologies;
- Magnetic resonance imaging. The most qualitatively informative non-invasive technique for monitoring the state of the meniscus of the knee joint. The procedure consists in layer-by-layer scanning of localization using a magnetic field and the effect of nuclear resonance in the framework of the excitation of protons and nuclei of hydrogen atoms. A group of sensors captures the results and using digital processing gives a high-precision picture of the state of all components of the knee joint;
- Arthroscopy In rather difficult situations with the ineffectiveness of all previous diagnostic techniques, a specialist may decide to perform arthroscopy. It is a minimally invasive technique for a direct visual review of the intraarticular cavity and available knee structures by performing a puncture and maintaining an arthroscope into it.
Modern clinical practice allows us to diagnose not only the severity of damage, but also the nature of the injury. In general, it may be acute or chronic.
The first is associated with shock physical activity against a background of a number of adverse circumstances. The second mainly acts as a consequence of chronic injuries cured insufficiently qualitatively, as well as degenerative-dystrophic processes.
Rupture of the horn of the lateral meniscus
Rupture of the posterior horn of the lateral meniscus of the knee (right, left) joint is the most characteristic type of damage to the cartilage structure. But at the same time, the pathology itself can be longitudinal, radial, or combined, which corresponds to horizontal, transverse and oblique, as well as complex rupture.
It is impossible to detect a clear localization of the traumatic lesion during the initial examination by a specialist. For these purposes, the doctor prescribes additional instrumental methods of research, in particular radiography, ultrasound, MRI, computed tomography and, if necessary, arthroscopy.
Rupture of the anterior horn of the lateral meniscus
This type of pathology is less common than damage to the horn in view of the specifics of receiving the trauma of the external meniscus itself. By analogy with the previous variations in localization, the gap can be radial, longitudinal, or combined.
The symptoms of the problem are identical in the form of pain, the formation of edema and internal hemorrhages. Moreover, the blocking of the composition almost never occurs with mild to moderate injuries.
Rupture of the external meniscus of the knee joint is treated both surgically and conservatively. The specific choice of a therapeutic regimen is determined by a specialist and depends on external and internal factors, as well as the presence of concomitant problems.
Lateral meniscus rupture by type of watering can handle
One of the most severe types of specific lesions is a “watering can handle” tear. This rather complex structural pathological modification of the cartilage tissue affects most of the central part of the external meniscus.
In addition to the main cartilaginous body, a wide, sometimes winding, long line can cross vascular, avascular and transitional zones.
Moreover, in the form of open surgery, since arthroscopy, despite its small invasiveness, does not always allow stitching of the damaged meniscus of such a large volume, its endoprosthesis replacement and removal, as well as plastic and implant placement.
Lateral meniscus radial rupture
A fairly rare, but characteristic type of pathological process, which can be associated with both acute injuries and degenerative-dystrophic processes in the chronic stage. The integrity violation occurs in the central part of the external meniscus perpendicular to the basal plane of the cartilaginous structure with trauma to the radial fibers going to the lateral rim.
That is why surgery remains the predominant method of treatment, with the parallel conduct of conservative therapy in the acute period of the problem. Rehabilitation measures include wearing immobilization devices in the form of a collar, orthosis, brace or teips, various physiotherapy, massage procedures, and exercise therapy exercises.
Treatment of pathological processes
Regardless of the circumstances, a specific therapeutic scheme for future treatment is prescribed exclusively by a specialist after a complete diagnosis of the severity and nature of the pathology, with the obligatory taking into account the individual characteristics of the victim’s body, the presence of possible complications and other factors.
Treatment of rupture of the lateral meniscus of the knee joint includes the following actions:
- Easy degree. Conservative therapy with the use of non-steroidal anti-inflammatory drugs and chondroprotectors that improve the metabolic processes of cartilaginous structures and facilitate their recovery is mainly used. In addition, the knee joint is partially immobilized with the help of orthoses, teips and other devices;
- Medium degree. Conservative treatment is also the basis, but the list of possible drugs can be expanded taking into account typical complications, for example, secondary bacterial infections, the need to replenish the body with certain useful substances, using vitamin-mineral complexes, improve peripheral circulation, and so on. The mandatory practice is physiotherapy, massage and exercise therapy in the framework of the main rehabilitation measures after the end of the acute period;
- Severe degree. With traumatic injuries of the 3rd degree, often the pathology is also accompanied by a violation of the cruciate ligaments, tendons, and sometimes bones.
What will happen if the injury is not treated
Some “folk experts” without a medical education claim that meniscus injuries should not be treated by doctors, since this type of lesion easily disappears on its own after some time.
There is a small amount of truth in this statement, but in the end, the victim may receive much more problems in the medium term than with timely treatment for medical help.
As clinical practice shows, after two to three weeks, the main negative external manifestations of the pathology in the form of pain, swelling and other symptoms fade out or disappear altogether.
The meniscus becomes denser and thicker, often repeatedly injured after minor physical exertion on the knee joint. Moreover, the presence of complications along with a long-standing trauma provokes degenerative-dystrophic processes in the knee, requiring mandatory surgical intervention with a certain probability of patient disability if appropriate measures fail.
Victor Sistemov – expert at 1Travmpunkt
Types of meniscus injuries: the clinical picture and complications
Menisci of the knee joint are cartilaginous disks located between the femur and tibia. Their shape resembles a crescent. Menisci are responsible for the stability of the joint, and also increase the contact area of the articular surfaces. In addition, cartilage formations play the role of shock absorbers when walking and performing other motor activities. Injury of the meniscus of the knee joint for specialists is most often associated with its rupture.
Menisci are naturally strong enough, however, its rupture is one of the most frequent injuries of the knee joint. Most often observed in people who lead an active life in terms of physical activity. As noted in statistics, per 100 thousand people, damage to the cartilaginous formations is observed in 60-70. Until the age of 30 they have a traumatic origin, and after 40 they are a consequence of chronic changes in the degenerative plan.
Anatomical features of the knee
Knowledge of the structure of the knee is important for the correct assessment of the causes and consequences of damage to the menisci of the knee joint.
There are two menisci in each knee:
- external or lateral, the form of which is similar to the Latin letter C;
- internal or medial, its shape is the correct semicircle.
Each of these menisci, in turn, is divided into three anatomically dependent parts:
The meniscus forms fibrous cartilage. Front and rear, they are attached to the surface of the tibia. The medial meniscus along its outer edge is attached to the joint capsule with the coronary ligament. The triple mount makes the inner meniscus extremely motionless. Such a natural property of him is the main explanation why this particular formation is most often injured.
The meniscus, in which the inflammatory process is not observed, consists of 60-70% collagen, 8-13% are extracellular matrix proteins, the remaining percent belongs to elastin. It also has an area filled with blood vessels – the red zone, as experts call it.
To understand the mechanism of development of meniscus damage, it is important to know not only the anatomy of the joint, but also the functions performed by these structures from the cartilage. Namely:
- uniform distribution of load on articular surfaces;
- joint stabilization;
- depreciation during running, walking, jumping;
- stress reduction at direct contact of the knee;
- the transmission to the brain of information about the occupation of an unnatural position by the joint;
- limitation of the amplitude of movements, which reduces the likelihood of developing dislocations.
A variety of functions makes the knee joint one of the most important parts of the human bone system. And also – it causes an increase in the risk of injury.
Interesting: it was previously believed that menisci are muscle residues devoid of any functionality.
Causes and types of damage
Symptoms of a trauma to the meniscus of the knee directly depend on what caused the development of the condition. They also determine the classification of damage. Namely:
- ruptures of a traumatic nature – a consequence of a traumatic effect. For example, it could be a jump, a turn, committed too abruptly; excessive squats; rotational movements;
- degenerative ruptures are a consequence of chronic diseases of the knee joint.
Depending on the location of the damage, a meniscus rupture can occur in one of the parts of the meniscus – the front or rear horn, the body.
Another classification basically has the shape of a meniscus tear. Accordingly, damage can be:
- horizontal – the result of cystic degeneration;
- oblique, radial and longitudinal – located on the border of the posterior and middle third of the formation;
- combined – takes place in the horn.
To prescribe the right therapeutic program, it is important to know the degree of damage. It can only be installed using an MRI machine. There are four degrees of meniscus injury:
- 0 – no pathological changes were found in the meniscus;
- I – a focal signal is noted in the thickness of the formation;
- II – a linear type signal is recorded in the thickness of the meniscus;
- III – an intense signal reaches the highest point of the meniscus.
Symptoms of a trauma to the meniscus of the knee joint directly depend on the type of damage.
At the time of injury, the victim notes a sharp pain. Soft tissues swell after a short period of time. In cases where the injury occurred in the red zone, blood is poured into the joint cavity. This results in hemarthrosis, i.e. above the patella, swelling and swelling are observed.
The degree of pain intensity can be different. Some victims experience such acute pain that they cannot lean on the affected limb. Others have pain only during certain movements – descending stairs, crouching.
When injuring the inner meniscus, any attempt to strain the leg ends with a sharp shooting pain. Flexion of the limb leads to the fact that along the tibial ligament pain begins to spread. The patella is immobilized. Muscle atrophy is observed in the area of the anterior thigh.
If the damage is concentrated in the area of the external meniscus, discomfort occurs when the injured person turns the lower leg inward. Atrophy of the muscular system is observed in the front of the femoral portion of the affected limb.
The rupture of the meniscus results in the movement of the torn part and the difficulty in mobility of the knee joint. Minor damage causes a slight limitation and the appearance of quite painful clicks. If the separated fragment is significant, a complete blockage of the knee joint is not excluded. In cases where the victim has a violation of leg flexion, experts suspect a rupture of the horn. If the limb does not extend, this is a signal of damage to the front horn and meniscus body.
In traumatology, there are cases when a rupture of the external (less often internal) meniscus is combined with a violation of the integrity of the anterior cruciate ligament. Outwardly, this manifests itself in the rapid formation of a swelling, the size of which is much larger than in the case of an isolated, independent injury.
Such disorders are most often observed in people over 40 years old. The traumatic factor does not dominate the development of the clinical picture. As a rule, a gap occurs when performing the usual activity. For example, the transition from a sitting position to a standing position.
Clinically, the condition manifests itself in swelling and pain, which does not have an acute component. It is extremely rare to develop partial or complete blockade of the motor function of the knee joint. A degenerative meniscus can lead to a violation of the integrity of the cartilage covering the femur or tibia.
With degenerative ruptures, the severity of pain can be different, as in the case of traumatic injury. In some patients, pain is observed when trying to lean on the affected limb, in others – during the commission of a certain movement.
What complications are noted
The consequences of a trauma to the meniscus of the knee joint can be very different. Much depends on the correctness and timeliness of the diagnosis. In some cases, the absence of acute pain syndrome causes the patient to be diagnosed not with meniscus damage, but with an elementary bruise of the knee joint. Moreover, the patient due to lack of pain may not seek medical help for a long period of time.
The consequence of an incorrect diagnosis and / or prolonged failure to see a doctor is the destruction of the surface of the joint and, as a result, gonarthrosis or deforming arthrosis. The developed pathology subsequently becomes an indication for endoprosthetics.
With any knee injury, regardless of the cause of development, the following clinical phenomena are mandatory reasons for seeking medical help:
- pain of any intensity that occurs when moving (up and / or down) up the stairs;
- the appearance during bending of a limb click, crunch;
- single or multiple cases of knee blockage;
- sensation of a foreign object when moving;
- deep squats become impossible.
Important: the reason for going to the doctor is not only a complex of the listed clinical phenomena, but also the appearance of one or more.
Diagnosing a condition
To make a diagnosis and prescribe the appropriate therapeutic program, a diagnosis is required. It begins with the collection and analysis of the complaints of the victim, the results of an external examination. Further, special tests are carried out, the accuracy of which is about 95%. Namely:
- Steiman rotational tests;
- Rocher and Baykov tests to determine the degree of extension of the joint;
- mediolateral test.
Additionally, to confirm the diagnosis, MRI, ultrasound, and radiography are performed. The first method is often used due to the high information content.
Therapeutic tactics are determined by the severity of the injury. For small gaps, as well as in the case of degenerative changes, they are limited to conservative methods.
Surgical intervention is recommended if the gaps are significant, and blocking of the knee joint also occurs.