Meniscoscopy of the knee joint symptoms and treatment

Meniscopathy of the knee joint is a common pathology, the treatment of which is performed by traumatologists and orthopedists. The disease is common among athletes and people with increased physical labor. The predominant age category is from 18 to 40 years. The problem state of the meniscus of the knee often affects not women, but men (3: 2 ratio), since they work more with heavy weight. If on the eve of the development of the inflammatory process inside the meniscus there was no obvious damage to the knee joint, the first 2 stages of the disorder proceed in a form that is hidden to the patient. Meniscopathy is difficult to diagnose – this feature becomes the cause of complex treatment, since the violation is detected late.

Pathogenesis

Menisci are a particularly vulnerable part of the knee joint. These anatomical structures play an important mechanical role, and their damage affects the general functional state of the limb and the motor activity of the patient. Being part of the capsular-ligamentous apparatus, menisci provide stabilization of the knee joint in flexion / extensia; help to transfer and correctly (safely) distribute the load from the femur to the tibial plateau.

As part of the musculoskeletal system, the meniscus performs 5 main functions:

  • softens, absorbs shock between articular surfaces;
  • stabilizes articular mobility;
  • evenly distributes axial load on the surface of the thigh and lower leg;
  • performs a suction function.

85% of clinical cases of knee meniscopathy are the consequences of traumatic effects that occur acutely (once) or chronically (permanently). In only 15% of cases, the disease is the result of a progressive pathology within the joint. Often such phenomena are degenerative-dystrophic in nature.

Symptoms of meniscopathy

The clinical picture of meniscopathy of the acute and chronic phases is different. The individual sensitivity of the patient’s organism also matters. It is important to consult a doctor immediately after damage to minimize the likelihood of complications, to prevent the transition of the pathology into a chronic form.

Table 1. Signs of pathology in the acute stage

A sign accompanying the course of the diseaseIts manifestationSymptom Features
Pain syndromePalpation performed by a doctor during the examination causes severe pain. Pain during flexion and extension of the knee joint.To stop the pain, it is necessary to supplement the introduction of non-steroid drugs with analgesics
Knee swellingA swelling is visualized upon examination without the use of additional diagnostic methods, especially if the stage of meniscopy is 2 or moreThe extent of edema depends on the presence of blood clots around the knee joint. A similar phenomenon is observed after injury (fall, shock)
Mobility restrictionIn 15% of cases, due to drug exposure, an early restoration of the range of motion of the damaged joint occurs.If surgery was performed for meniscopathy, in the postoperative period, drugs help to eliminate blockade of motor activity (flexion, extension and rotation of the leg) in 18 patients out of 20 observed

The clinical manifestations of meniscopathy disorders in 50% of cases do not correspond to the stage of damage – they are masked by other pathological changes inside the knee joint, complicating the diagnosis.

Diagnostics

The following types of research allow you to get a complete picture of the condition:

  • laboratory research. The analysis made it possible to determine that synovial fluid with meniscopathy caused by injuries and the same pathology, but already caused by a degenerative-inflammatory process, is significantly different. During the process of osteoarthrosis, the number of glycosaminoglycans decreases, the activity of lysosomal enzymes increases, in contrast to the meniscus disturbance caused by damage. An increase in ESR and leukocytosis are detected in the blood;
  • MRI, CT as the best methods of radiation imaging. Provide almost 100% diagnosis of intraarticular injuries of menisci, cartilage of the knee joint;
  • arthroscopy. Minimally invasive method of endoscopic diagnosis. Thanks to the procedure under consideration, it is possible to detect hidden knee injuries that were not detected on radiographs or when performing an MRI. If a trauma preceded meniscopathy, after 4-6 weeks there is an almost complete loss of uniformity of the meniscus tissue around the defect, which in a healthy person is even and grainy.

The results of a comprehensive study make it possible to predetermine the spectrum of the upcoming intervention, to understand how to conduct therapy, is there any sense in surgical intervention.

Treatment

The goal of treatment is to preserve the meniscus, since the loss of this structure puts the patient at risk of subsequent degenerative changes within the knee. Basic therapy aims to reduce the progression of degenerative changes in the joints and cartilage. It is important to reduce the use of non-steroidal anti-inflammatory drugs that adversely affect the gastric mucosa. By correctly planning the therapeutic approach, it will be possible to improve the quality of life of the patient. The patient needs to prepare for the fact that the duration of the average therapeutic course is 1-1,5 months.

Shishkevich Vladimir, orthopedic and traumatologistShishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.

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Medication

In 8 cases out of 10, meniscopathy after an injury becomes the main cause of arthrosis. The task of the doctor is to try to normalize the patient’s condition with medication.

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Such groups of drugs are prescribed:

  • painkillers and non-steroidal anti-inflammatory drugs. The pathology under consideration is characterized by intense pain. To facilitate the well-being of the patient, Diclofenac, Ibuprofen, Voltaren are administered, supplement any of the listed drugs with Ketanov or Ketorol (only in the absence of an analgesic effect from NSAIDs);
  • vitamin therapy. The vitamins of group B are recognized as the most effective – thanks to them it is possible to improve blood circulation inside the tissues surrounding the knee joint;
  • hormone therapy. Dexamethasone or Prednisolone is administered to reduce the degree of inflammation, normalize the patient’s motor activity;
  • chondroprotectors. The introduction of drugs of this group is justified in cases where the etiology of meniscopathy is osteoarthrosis;
  • the introduction of hyaluronic acid. Suitable for low viscosity or a small amount of synovial fluid.

The need for repeated administration of hormones in the same joint for 1 year indicates the ineffectiveness of the therapy – you need to review the entire patient management plan.

It is recommended to limit motor activity, to immobilize the affected joint with an orthosis. Depending on the root cause of the deterioration of the limb, it is permissible to apply Lioton or Fastum.

If conservative treatment of knee joint meniscopathy fails, surgical intervention is indicated.

Surgical

Arthroscopy is an effective method with a high diagnostic and therapeutic value. It suggests certain indications and contraindications, is associated with general and specific complications, but allows you to prevent the development of degenerative-dystrophic changes inside the knee joints.

The healing advantages of arthroscopy are great, since the manipulation is less traumatic, surgical intervention does not imply a large dissection. Due to the individual characteristics of the procedure, direct access to the meniscus is provided. This opens up the possibility of carrying out fine precision surgical intervention on it.

Patients after partial or complete meniscectomy do not need to immobilize the limb. Returning to full load is acceptable for 4-8 days, the seams are removed for 8-10 days. Arthrotomy involves immobilization lasting at least 5 days (on average up to 10 days), then walking on crutches without support – lasting up to 13-17 days.

Physical therapy and physiotherapy

Isometric contractions of the quadriceps muscle are prescribed in the period of postoperative recovery (at least 2 days). The goal is the prevention of muscle hypotrophy and the prevention of contracture. Active movements in the joint, which are recommended to be combined with physiotherapeutic types of exposure, are prescribed from 6-7 days of postoperative rehabilitation. UHF and magnetotherapy are recognized as the most effective in terms of achieving recovery. Methods normalize blood circulation, promote healing, improve flexibility.

Treatment by folk methods

Only an experienced specialist can be entrusted with the appointment of a suitable therapeutic approach, since delay in treatment is dangerous for the development of disability.

Meniscopathy is not eliminated by traditional medicine methods – attempts to realize them are equated with a deliberate loss of valuable time. The beneficial substances present in decoctions, infusions, compresses, are not able to affect the existing problem of joint tissue, even if they are in excess. The restoration of the knee joint occurs only with the right combination of drug treatment, exercise therapy and massage.

Conclusion

Only a doctor can determine that the cause of the patient’s well-being is knee meniscopathy. Symptoms of this pathology resemble many other disorders. The normalization of the condition of the damaged meniscus is one of 4 therapeutic approaches – this is a conservative treatment, meniscectomy, meniscus suture or its plastic. Conservative therapy is effective only with minor damage to the meniscus of the knee joint. Meniscectomy is the operation of choice. Fresh damage – indication for the seam. Plastic surgery – the need to restore the knee section under consideration with significant damage. The listed methods are united by a common aspect – the goal of preserving the meniscus (even part of it), which will restore the full functional ability of the knee.

Shishkevich Vladimir

Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews. It specializes in the treatment of diseases in orthopedic, traumatological, vertebrological profiles

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