Injuries of the meniscus of the knee joint: treatment without surgery at home, risk groups and types of injuries. Meniscus cyst of the knee joint: how to treat? Patella meniscus

Damage to the meniscus of the knee joint, symptoms and treatment is a problem for people who are not used to sitting in one place and those who are actively involved in sports. The meniscus plays a very important role in the knee joint system, and its injury can seriously affect a person's motor abilities. Any damage to the internal meniscus of the knee joint requires emergency measures and effective treatment. Poorly healed injuries can cause the development of various articular pathologies and early disability of a person.

Anatomical and physiological features

The meniscus of the knee joint is a trihedral cartilaginous lining that separates the femur and tibia. The main tasks of such pads are to absorb sharp shocks, redistribute emerging loads, reduce contact stress in the area of ​​bone articulation and stabilize the joint. With flexion movement in the joint, more than 80% of the load is perceived by the menisci, and with leg extension - up to 70% of the load.

In any knee joint there are 2 types of elements: internal (medial) and external (lateral) meniscus. The C-shaped inner meniscus connects the tibia to the outer capsular border of the joint. The tibial ligament is fixed in its middle. Such fastening of the medial meniscus reduces its mobility, which is the reason for its more frequent damage (destruction). The outer meniscus covers almost the entire top of the lateral region of the joint of the tibia. Due to the fact that the lateral meniscus is not limited to the joint capsule in mobility, its injuries are recorded 8-9 times less often than injuries of the internal element.

Both types of menisci have the following main components in their structure: the body, as well as the anterior and posterior horns. The composition of the meniscus is almost 75% formed by collagen fibers with multidirectional orientation. The interlacing and orientation of the fibers provides a very high strength of the structure. The outer end of the meniscus is composed of a thickened layer of collagen and is firmly attached to the joint capsule, while the inner end is slightly pointed and oriented into the joint cavity. The increased elasticity of the meniscus is provided by a small amount of a specific protein (elastin). This structure makes the menisci almost 1.5 times more elastic than cartilage, which determines the functions of reliable shock-absorbing elements.

If we consider the blood flow system, then the menisci have a specific character. The following zones are distinguished in them: a red area in contact with the capsule and having its own circulatory network; the intermediate zone, which is fed by the red zone, and the white zone, in which there are no blood vessels, and nutrition occurs as a result of the diffusion of nutrients from the synovial fluid. In the meniscus attachment system, the following main ligaments are distinguished that strengthen the structure: the transverse ligament connecting the menisci to each other, the frontal and dorsal femoral ligaments.

The essence of the problem

Despite the significant loads on the menisci, in a normal state they are able to perform their functions. Another thing is the appearance of excessive loads that exceed the strength of the fibers. Such efforts occur, as a rule, with abnormal rotation of the lower leg at the knee, when landing after a jump from a great height or squatting with a large load. In general, damage to the meniscus of the knee, especially damage to the medial meniscus, is a fairly common phenomenon, most often affecting men. The most common type is sports injury.

Damage to the meniscus has the form of a rupture along its body or a complete separation at the point of attachment to the capsule or bone ending. One of the most common is damage to the posterior horn of the medial meniscus, however, ruptures of the anterior horn and body can be observed, both in the medial and lateral elements. Damage to the meniscus can be completely isolated, but is often combined with damage to other articular elements. As a rule, the lateral and cruciate ligaments, the articular capsule suffer. Almost half of the pathologies are combined with a fracture of the condyles of the tibia. The rupture of the body can occur with complete separation and movement of the detached part, or in the form of a partial rupture, when the connection between the elements is not completely broken.

Etiological features of pathology

In the etiology of meniscal injuries, 2 main mechanisms are distinguished: traumatic and degenerative type. The traumatic mechanism causes damage to an absolutely healthy joint at any age of a person when an excessive load occurs. The most common injuries are: damage to the internal meniscus - a sharp turn of the lower leg with a significant amplitude in the outward direction, and the lateral meniscus - when it rotates inward.

Traumatic destruction of the medial meniscus often occurs in the longitudinal direction with destruction in its central area. A watering can handle is considered typical when the middle of the body is destroyed, but both horns are not destroyed. At the same time, lesions of the anterior and posterior horns are often observed. Transverse ruptures occur much less frequently. Rupture of the lateral fibers in an adult is not a typical lesion due to the high mobility of this meniscus. Such an injury is more common in adolescence, when the tissues are not yet strong enough.

The degenerative mechanism of joint destruction is associated with chronic processes that reduce the strength of colloidal fibers. It develops in people older than 48-55 years. When the structure of the menisci is weakened, their destruction can occur under loads that are not normally critical. The provoking causes that trigger the degenerative mechanism are the following factors:

• rheumatism;
• polyarthritis;
• gout;
• age factor;
• hypothermia;
• metabolic disease.

Symptomatic manifestation of pathology

If an injury such as a meniscus lesion is received, the symptoms depend on the extent of the lesion and the involvement of other articular elements. The most characteristic symptom is pain. It can be localized at the point of rupture, more often felt throughout the joint space. If the damage is not too great and the parts have not dispersed, then pains are felt in the form of clicks and discomfort appears.

In case of complete destruction, the detached fragment migrates into the joint and blocks its mobility. There is an intense painful symptom.

In the case when destruction occurs in the red zone, a hematoma develops as a result of internal bleeding. The process is accompanied by swelling slightly above the kneecap. If a piece of the anterior horn is torn off, then the function of the joint to extend the leg is disrupted, and if the posterior horn is destroyed, it is to flex the joint. Gradually, effusion can accumulate in the joint - exudate as a result of the inflammation process.

The presence of a torn meniscus is determined by performing certain tests to establish the following symptoms:

1. Baikova: when the leg is bent at a right angle, with the help of a doctor, intense pain should appear;
2. Shteiman: rotation of the lower leg by a doctor while bending the leg at a right angle. To determine the localization of the injury, the rotation is carried out in different directions. If the pain occurs during the rotational movement of the lower leg inward, the medial element is affected, when it appears in the opposite direction of rotation, the external meniscus is affected.
3. Chaklin: detection of a click in the articular zone during flexion and extensor movements (click symptom) and a tailor's symptom - thinning of the wide femoral muscle.
4. Polyakova: pain occurs when lifting a healthy limb from a lying position, while lifting the body based on the shoulder blades and heel of the affected limb.
5. Landau: pain syndrome occurs when taking the “Turkish sitting” position.
6. Perelman - 2 types are identified: "ladder" - increased pain when walking up the stairs or any hill down; "galosh" - the pain manifests itself when turning the lower leg.
7. McMurray: pain and crunching are detected during the rotational movement of the knee in a supine state with bent limbs.

Symptoms of damage to the meniscus of the knee joint, most often, appear quite clearly (pain, swelling, impaired mobility), but for the final clarification of the type of pathology, it is necessary to differentiate these signs from articular diseases.

Diagnostics

The primary diagnosis is based on the results of the examination and testing. The next step in clarifying the pathology is radiography and ultrasound of the knee joint. However, it should be borne in mind that X-ray does not give a clear picture of the meniscus lesion, but helps to establish the involvement of bone tissues in the process. An accurate diagnosis is based on the results of computed tomography and MRI.

• 0 degree - the meniscus is in a normal state;
• 1 degree - the origin inside the meniscus of the lesion without reaching its surface;
• 2 degree - a linear type signal is detected inside the meniscus without reaching the surface;
• Grade 3 - the exit of the lesion to the surface of the meniscus or a complete rupture of the body.

Principles of therapeutic measures

The treatment regimen for a damaged meniscus is determined by the type and extent of the lesion. For small lesions, conservative therapy can be used, but the most common method is surgery. Which method to apply, only the doctor can decide after receiving the results of ultrasound and MRI.

Conservative therapy aims to eliminate the blockade of the joint. For this purpose, fluid is removed from the joint cavity by puncture and Procaine is injected. An important stage of treatment is the reduction of the meniscus in its place. If the procedure is carried out correctly, then the blockade of the joint is removed. Further treatment includes the following procedures: UHF exposure, exercise therapy according to an individual program, therapeutic massage, the appointment of chondroprotectors to restore cartilage (Glucosamine, Chondroitin, Rumalon). If necessary, drugs are used to relieve pain and relieve inflammation.

Surgery is performed in the following circumstances:

• flattening of the body of the meniscus;
• damage to blood vessels with bleeding;
• rupture (separation) of the horn;
• complete break;
• destruction of the meniscus with displacement;
• recurrence of joint immobilization after conservative therapy.

The meniscus of the knee is a cartilaginous formation that resembles a crescent moon in its shape. It is medial and lateral. The medial meniscus of the knee joint is also called the internal meniscus, and the second type is the external one. They act as shock absorbers, keep the joints from moving too much, and also keep them from wearing out. Very often, the cartilage of the knee suffers from injuries sustained during sports activities. Let's take a closer look at what are the main symptoms of meniscal damage, and in what ways they can be treated.

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Why Meniscus Problems Occur

The meniscus can tear or tear due to a sharp sliding blow to the knee with a heavy object, as well as due to falling on the step with the kneecap. Injury can be obtained with a sharp turn of the lower leg outward or inward. If the meniscus of the knee joint is injured very often, it may soon burst completely. Diseases such as gout, rheumatism, and general intoxication of the body lead to degenerative changes in cartilage. When ruptured, it begins to slowly destroy the surface of the joints, and after a while leads to deforming arthrosis and disability. If a person has a knee injury, it is important to immediately apply an ice pack wrapped in a cloth to it.

Symptoms of the disease

With cartilage rupture, such a pathology can be noticed only 14 days after the injury. The following symptoms indicate a rupture:

1. Strong pain that is felt on the surface of the knee outside or inside;
2. Muscles at the cellular level begin to eat poorly;
3. During the performance of sports exercises, the victim feels constant pain in the knee;
4. The knee joint becomes very hot;
5. The joint increases in size;
6. A click is heard during bending.

Since the described symptoms indicate a large number of problems in the knee, it is important to urgently consult a doctor after an injury, who will prescribe a complete examination in order to make an accurate diagnosis.

When the medial meniscus is injured, the following symptoms are observed:

• The victim feels pain inside the joint, it is especially pronounced over the area of ​​\u200b\u200bthe junction of the meniscus and ligament;
• During strong bending of the legs, pain is also felt;
• The muscles of the front of the thigh weaken;
• During tension, sudden shootings are felt.

The lateral meniscus after injury has the following symptoms:

1. Painful sensations appear in the peroneal ligament;
2. During strong flexion of the legs, pain occurs in the collateral ligament;
3. The front of the thigh becomes weaker;
4. Synovitis develops.

Diagnosis of a damaged meniscus

Before performing the treatment of the meniscus of the knee joint, it is necessary to undergo a diagnostic examination. The doctor may order an x-ray to rule out possible other damage. Thanks to MRI, the specialist carefully examines the intra-articular structure and damage in it. Based on the information received, he can make the correct diagnosis and prescribe the correct and effective treatment for the meniscus of the knee.

Additionally, the patient can do an ultrasound diagnosis of the knee or computed tomography.

We treat meniscus injuries correctly

When you get a knee injury, it is important to immediately provide peace to the victim, apply a cold object to the joint and apply an elastic bandage on top. To prevent or relieve swelling, the leg should be placed just above chest level.

When the meniscus is displaced, thanks to the deft movements of an experienced traumatologist, it is put in place. In this case, the injury should be treated by the subsequent wearing of a cast for three weeks, as well as rehabilitation therapy.

Treatment of the meniscus of the knee joint with traditional medicine:

1. The traditional method of treatment uses drugs such as Meloxicam, Ibuprofen or Diclofenac;
2. To restore cartilage tissue, Glucosamine or Chondroitin sulfate are used;
3. Rubbing the knee is carried out with the help of such ointments: Ketoral, Dolgit, Voltaren;
4. To restore knee mobility and relieve pain, Ostenil is injected into the joint bag. The course of treatment with such injections is 5 to 7 days.

Cartilage damage in the knee can be treated with physical therapy. To fully restore the work of the knee, the patient must regularly perform gymnastics and massage.

With the help of myostimulation, the thigh muscles are relaxed and strengthened. Laser therapy and magnetotherapy improve microcirculation and metabolic processes in muscle tissue cells.

At home, you can perform the following exercises:

• Place a small rubber ball under your knee. Bending the knee, you need to squeeze the ball, while straightening the knee, try to hold it;
• Through the pain you need to walk on the carpet on all fours.

Treatment of the meniscus with surgery

The doctor is forced to resort to the operation in the following situations:

1. With a crushed meniscus;
2. With a torn or displaced meniscus;
3. With hemorrhage in the joint cavity;
4. With an absolute separation of the meniscus.

Knee injuries can be treated surgically with arthroscopy.

Benefits of knee surgery using arthroscopy:

1. Small incisions are made in the knee, which do not leave a single trace behind;
2. The duration of the operation is no more than two hours;
3. There is no need to wear a plaster cast after arthroscopy;
4. Rehabilitation after surgery is very fast, so the patient gets home faster;
5. Arthroscopy can be done on an outpatient basis.

In young patients, menisci can be restored even with very serious injuries. After 30 days of strict bed rest, a person can start simple sports activities - cycling or swimming. If properly treated, you can completely cope with the resulting knee injury.

Rehabilitation after surgery:

• After meniscectomy on the second day after surgery, you can walk around the ward in doses, leaning on a cane or crutches;
• After fusion of the meniscus, you need to move on crutches for a month. At the same time, you need to take care of the injured leg and do not stand on it;
• It is important to additionally fix the knee joint with an elastic bandage or soft knee pad;
• During rehabilitation, you need to undergo a course of physiotherapy, massage, special exercises.

Traditional medicine and meniscus injuries

Folk remedies are forbidden to treat meniscus shift and blocking movements in the joint. Alternative methods can be used only after consulting a doctor and in combination with the main treatment.

Treatment of meniscus injuries with folk remedies is as follows:

1. Mix equal proportions of honey and medical alcohol. Heat the resulting product in a water bath. Apply warm to the affected knee. Fix the honey compress and insulate. Such procedures should be done twice a day for two hours for 30 days;
2. The knee can be wrapped with burdock leaves. Such a compress must be kept for at least eight hours;
3. Folk remedies can quench the pain. Chop a couple of onions and add sugar. Put the resulting mass on a wide bandage, and wrap it around your knee. Cover the compress with cellophane all night;
4. Mix birch leaves with violet grass and nettle. Pour half a liter of boiling water. Let it brew for half an hour and use one hundred grams four times a day;
5. Folk remedies can improve blood circulation and relieve pain. To do this, it is useful to take coniferous baths an hour before bedtime every other day.

Now you know why knee meniscus injuries occur, what are their main symptoms, and how traditional treatment and treatment with folk remedies are carried out. Be careful and take care of your knees!

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• Causes of meniscus problems
• Damage symptoms
• Treatment

Today, the medical terms “torn knee meniscus” or “torn Achilles tendon” are as common in the sports section of football news as penalties and goals. Of course, football is a contact game, and injuries to the lower extremities are indispensable, and during matches the risk of damage is much higher than in training.

And the cause of the injuries is obvious: high speeds, rapid changes in direction and sharp blows. To reduce the risk of injury, to play without pain, fatigue, just comfortable to play, helps to choose the right shoes, bandaging the knee and an accurate calculation of one's strength.

The human knee joint is the most complex in its structure, and for us the most important. The knees experience enormous stress throughout life. But a person, and an athlete in particular, sometimes requires the impossible from his knee joint. Here is the desire to be the first, and big money, and exorbitant loads.

So let's take a closer look at the problem.

In the photo on the left - a healthy knee joint. Right - meniscus injury

Causes of meniscus problems

In the cavity of the knee joint there are two cartilaginous formations - the menisci of the knee. Their main purpose is cushioning during movement and protection of articular cartilage. They limit excess mobility and reduce friction in the knee joint.

Causes of rupture or tear of the meniscus: a sharp sliding blow to the knee with a heavy object, a fall on the edge of the step with the kneecap, or an injury accompanied by a sharp turn of the lower leg outward or inward.

Repeated injuries or bruises lead to a chronic meniscopathy disease, and subsequently to a rupture of the meniscus. As a result of chronic microtrauma, gout, rheumatism, general intoxication of the body, degenerative changes in the meniscus develop. During an injury, the meniscus is torn and ceases to fulfill its main purpose, becoming practically a foreign body for the body. And this body will slowly destroy the articular surface. An unhealed injury turns into deforming arthrosis, and a person often becomes disabled.

This disease is more susceptible to football players and team sports athletes, people who spend most of their working time on their feet.

It happens that the meniscus can also be damaged as a result of a combined injury, when a strong blow falls on the knee and the lower leg sharply turns inward or outward.

Injuries immediately apply ice (or something cold)

Damage symptoms

Often at the initial stage, a disease such as the meniscus of the knee joint - the symptoms are similar in manifestation to other diseases of the knee joint. Only after 2-3 weeks, when the reactive phenomena subside, can we speak specifically about the rupture of the meniscus.

• A pronounced pain of a diffuse nature, after a while it is located on the inner or outer surface of the knee.
• Difficulty getting up and down stairs.
• The trophism of muscle tissue is sharply reduced.
• When the joint is flexed, a characteristic click occurs.
• The joint is enlarged. With this symptom, treatment begins immediately.
• Pain during sports.
• Rise in temperature in the joint area.

Damage symptoms are often non-specific, the same symptoms can occur with severe bruises, sprains, arthrosis, so the doctor requires a thorough examination of the patient.

Depending on the injury, the meniscus may be torn from the capsule, torn transversely or longitudinally, or may be compressed. The outer meniscus is quite mobile, so it is more often compressed, and ruptures occur in the meniscus fixed in the cavity of the knee joint.

Naturally, with damage to the knee joint, your movements are severely constrained.

meniscus treatment

As a result of injury, the meniscus can tear or tear completely. Depending on the severity of the condition, the age of the patient and his vital activity, the doctor chooses a method for treating the knee meniscus: conservative or surgical.

But first aid, regardless of the severity of the injury, the victim is immediately given complete rest, a cold compress and an elastic bandage on the knee joint area. To prevent or relieve swelling, the patient's leg is placed slightly above chest level.

The doctor in the clinic recommends that the patient take an x-ray to make sure the bones are intact. And to exclude the presence of internal damage, an ultrasound is performed. Computed tomography and magnetic resonance imaging play a special role in the diagnosis of meniscal injuries. But the full picture of the damage allows you to see arthroscopy of the knee joint.

If there was only a displacement of the meniscus, then an experienced traumatologist will be able to quickly deal with the problem. Then, plaster is applied for about three weeks, after which rehabilitation therapy is prescribed.

Traditional treatment of the disease includes non-steroidal painkillers: Meloxicam, Ibuprofen, Diclofenac.

To restore cartilage tissue, the joint needs chondroprotectors that improve metabolism in the restorative tissue and intra-articular fluid - these are Glucosamine, Chondroitin sulfate. Dietary supplement Collagen ultra prevents inflammation and participates in the restoration of cartilage, increases its water-retaining properties.

Medical treatment

For rubbing the joint, ointments Alezan, Ketoral, Dolgit, Voltaren, Toad stone balm are used.

With limited mobility and pain, Ostenil is injected into the joint capsule. Improvement occurs after the first injection. The course of treatment requires at least five ampoules.

If possible, you can use bee stings or Tentorium cream, which contains bee venom.

Physiotherapy

To fully restore the knee joint, the patient is prescribed therapeutic exercises with an exercise therapy instructor, a course of physiotherapy and massage.

Myostimulation relaxes, strengthens the thigh muscles. Laser therapy and magnetotherapy improve microcirculation and metabolic processes in muscle tissue cells.

Physiotherapy is one of the components of complex treatment

And at home you can do the exercises:

- Place a small rubber ball under the knee, bend the knee, squeezing the ball and straighten the knee without dropping the ball.
– Walking on all fours, overcoming a little pain.

Folk methods

• A compress of honey and alcohol in a 1:1 ratio is applied to the joint for two hours, fixed with an elastic bandage and covered with a warm scarf.
• A compress from a grated onion and a spoonful of sugar can be applied all night, after wrapping it with cling film and a warm scarf.
• For ten days, apply a compress of medical bile.
• Malakhov recommends making compresses from children's urine, which relieves swelling well.
• A compress of burdock leaves is kept on the knee for up to 8 hours.

All folk methods, as well as physical exercises - you can apply at home.

If all conservative methods of treatment have been tried, but there has been no improvement, then we have to talk about surgical intervention.

Operation?

If your knee meniscus hurts, is surgery really necessary?

Indications for surgical intervention are:

• Crushing of the meniscus.
• Rupture and displacement of the meniscus.
• Hemorrhage in the joint cavity.
• Complete detachment of the horns and body of the meniscus.

In the region of the body of the meniscus, there is insufficient blood circulation, therefore, a rupture of the body of the meniscus very rarely heals, therefore, in this case, the patient will have to undergo a complete or partial resection of the meniscus.

Arthroscopy is performed not only to diagnose the condition of the joint, but also to treat the meniscus of the knee joint.

The most common operations are stitching and removal of the meniscus, in exceptional cases, meniscus transplantation is performed, i.e. remove the damaged part and replace it with a graft. Artificial or donor menisci take root well, only it takes 3-4 months to restore working capacity.

Arthroscopy has a number of advantages:

• Small incisions in the patient's skin that do not leave scars.
• Short duration of intervention, no more than two hours.
• No plaster cast.
• Rapid postoperative recovery.
• Reduced hospital stay
• The operation can be performed on an outpatient basis.

In young patients, it is possible to save even a meniscus torn into lobes. And after a month of sitting and bed rest, you can start sports activities. For this, exercise bikes and swimming are best suited. With proper treatment, a full recovery occurs.

Professional athletes often choose a cardinal decision - surgery. In order for the recovery process to go faster, you must strictly follow the doctor's prescriptions and eat right.

In medical practice, such phenomena as inflammation or rupture of the meniscus are quite common.

Treatment of meniscus injuries is a common procedure for climbers, football players, and ballerinas. But problems with the knee joint can take ordinary people by surprise.

What is inflammation of the meniscus of the knee joint: symptoms, causes ^

The knee meniscus is a cartilaginous lining in the knee joint that performs the function of cushioning. It is crescent shaped and is located between the thigh and lower leg. This fibrous cartilaginous structure gives softness to movement, protects the bone from friction and damage.

There are two types of meniscus: internal (medial) and external (lateral). They have an identical structure, but a different shape and way of connecting to the joint.

Since the meniscus is a very fragile part of the knee joint, it is prone to various types of damage. Inflammation of the meniscus develops against the background of a sharp and frequent flexion of the joint. Other causes of damage to the cartilage lining include:

• falling on straightened legs during high jumps, long jumps, etc.;
• direct blow to the knee (fall from stairs, hit with a heavy object);
• chronic intoxication;
• arthritis, gout or rheumatism;
• injury to ligaments or cartilage;
• activities associated with long walking;
• getting injured while playing football, hockey, skiing, etc.

A meniscus injury is accompanied by the following symptoms:

• severe pain in the knee joint;
• a sharp restriction of movement or blockade of the joint;
• the appearance of edema;
• inability to flex or extend the knee.

Treatment of the meniscus of the knee joint with folk remedies: homemade recipes ^

It is worth noting that the treatment of the meniscus at home is not able to fully restore the health of the patient, but is aimed at eliminating pain, reducing swelling or improving motor function. In any case, when the first symptoms appear, you need to contact a specialist who will conduct a thorough examination and prescribe competent therapy.

Meniscus treatment with honey

Honey tincture is used for compresses.

• To prepare it, you need to take a tablespoon of liquid honey and medical alcohol.
• The ingredients should be mixed and melted in a water bath.
• Further, it is recommended to cool the mixture a little so as not to burn yourself, and apply it on a sore knee.
• From above you need to wrap the leg with polyethylene and a woolen scarf.
• Keep the compress for two hours in the morning and evening.

Perform the procedure daily until complete recovery.

Treatment of the meniscus with bile

• It is necessary to purchase a bottle of medical bile at the pharmacy.
• Two tablespoons of the product should be warmed up a little in a water bath and smeared with a knee, wrapped on top with a bandage and a warm scarf.
• The duration of the wrapping procedure is 2 hours.
• You need to put a compress in the morning and in the evening. After a couple of months, the patient's condition will improve.

Meniscus treatment with burdock

A simple yet very effective meniscus treatment is a burdock compress.

• It is necessary to take a fresh leaf of the plant and wrap it around the knee, securing it with a bandage or scarf.
• After 3-4 hours, the sheet must be changed.
• In winter, you can also use dry burdock leaves, after soaking them in well-warm water. In this case, the procedure will last no longer 4, but 8 hours.
• Wraps should be done daily until the pain disappears.

Meniscus treatment with onions

Onion mixture successfully helps to get rid of the disease.

• To prepare it, you need to grate two small onions and add a dessert spoon of sugar to the gruel.
• The prepared drug must be wrapped in several layers of gauze, applied to the knee, and fixed on top with a film and kept all night.
• Wrapping is recommended for a month.

Treatment of the meniscus with horseradish

• Horseradish root should be thoroughly chopped to make a tablespoon.
• Then the raw materials must be placed in a bowl and steamed over low heat.
• It is necessary to crush the horseradish, moisten the cloth in the resulting slurry, attach it to the sore spot and tie it with a handkerchief.
• Keep for 2 hours, then wash off the mixture with warm water.

meniscus treatment with apple cider vinegar

Apple cider vinegar has analgesic and anti-inflammatory properties. It is recommended to take the vinegar solution three times a day.

• You need to add a teaspoon of apple cider vinegar and the same amount of honey to a glass of warm water.
• Drink daily for 10 days.
• Then you can repeat the course after a 3-day break.

Meniscus treatment with pork fat

• It is necessary to take 200 g of internal fat and put it on a low fire.
• When the fat warms up a little, you should add a chopped head of garlic and 2 tablespoons of dried eucalyptus leaves to it.
• When the mass boils, it must be insisted for 2 hours, then passed through gauze and placed in a glass jar.
• In a sore knee, the mixture is recommended to be rubbed twice a day.

meniscus treatment with garlic

Garlic tincture can effectively reduce pain and improve the patient's well-being.

• To prepare it, you need to chop the garlic (2 heads) and add it to apple cider vinegar (0.5l).
• Pour the mixture into a dark bottle and insist for a week.
• The medicine must be rubbed into the affected area twice a day with massaging movements for 10-15 minutes.
• Carry out the procedure until the complete disappearance of pain in the knee.

Treatment of the meniscus with herbs

• To prepare a medicinal tincture, you need to take a tablespoon of birch buds, violet leaves and nettles.
• All components must be crushed, mixed and pour 500 ml of boiling water.
• The mixture should be insisted for 30 minutes and filtered through a sieve or gauze.
• Take 1/4 cup 4 times a day.

Rehabilitation after meniscus surgery

Most often, a meniscal injury requires surgery. The duration of rehabilitation fully depends on the nature and severity of the injury. After stitching meniscus tears, rehabilitation lasts 9-12 months, after removal of the meniscus - 2-3 months. During the recovery period, physiotherapy exercises, independent movement on crutches are shown.

After removing the plaster, physiotherapy is prescribed. It is necessary to do massage and simple passive exercises: put a roller under the heel and perform extensions with the operated leg; lie down, straining the thigh muscles for 10 seconds, etc. Before performing them, you need to consult a specialist.

Preventive measures to avoid damage to the meniscus are to prevent injury while running or walking. Athletes are advised to wear knee pads or use an elastic bandage. An equally effective way of prevention is to strengthen the body through exercise and a balanced diet.

Before any physical activity, you need to warm up and warm up the muscles. To avoid injury, you need to work on strengthening the quadriceps femoris muscle, which works when the knee joint is extended. A very effective exercise is the slow lowering and lifting of a straight leg, performed in a standing position.

Cartilage can be strengthened with a balanced diet. To do this, you need to include protein foods, foods containing calcium, magnesium and potassium in your daily diet. Often athletes use various nutritional supplements that have a positive effect on the joints: collagen, glucosamine or chondroitin.

In general, an active lifestyle and proper diet will not only strengthen the knee menisci, but also increase the vitality of the body.

Often, athletes, as well as people engaged in physical labor and just leading an active lifestyle, complain of joint problems. Very often, the cause of pain and other discomfort is damage to the meniscus of the knee joint. This problem can be dealt with. Treatment of the meniscus is carried out by a wide range of measures, from surgical to folk.

The structure of the knee joint provides its depreciation function when walking

What is a meniscus

The meniscus is a crescent-shaped cartilaginous formation located between the lower leg and thigh at the knee joint. This inter-articular cartilage pad performs a shock-absorbing and stabilizing role, it softens the friction of the surfaces and limits the mobility of the knee joint, preventing injury. During movement, the meniscus stretches and contracts, changing its shape. There are two menisci in the knee joint - inner and outer. The second is more mobile and less prone to damage.

Sports doctors explain that damage to the meniscus of the knee joint is a common problem among skaters, skiers, figure skaters, football players, and ballet dancers. Problems with the meniscus can also overtake people engaged in heavy physical labor. In the risk group are men from 18 to 40 years old. In children, meniscus injuries are extremely rare; up to 14 years of age, this cartilaginous formation is particularly elastic and less prone to tearing.

Main shock absorber in the knee joint

Sometimes problems with the meniscus are observed at an older age. At the age of 50-60, degenerative changes in the joints can affect his condition. One of the most common causes of age-related damage to the meniscus is arthrosis. The meniscus of the knee joint can also suffer from a torn ligament or other injury to the knee.

The condition of the meniscus can be affected not only by injuries, stress, degenerative age-related changes and congenital pathologies that gradually change tissues. Pathology of the meniscus is also caused by some diseases that violate statics, for example, flat feet.

Injuries and surgical methods of exposure

Orthopedists distinguish between three types of damage to the knee meniscus: pinching, partial rupture, and avulsion. The last version of the injury is especially difficult: in this case, the meniscus or part of it is completely separated from the place of attachment. This type of injury requiring urgent surgical intervention is quite rare. Infringement and partial rupture of the internal meniscus are much more often diagnosed.

This injury is characterized by sharp local pain, impossibility of movement, numbness, difficulty in extension and flexion of the knee joint. After a few hours, the symptoms disappear, the mobility of the joint is restored, and the victim can simply forget about the injury. However, over time, the pain returns. Their intensity depends on the nature and strength of the damage. Symptoms include pressure pain, inability to go up or down stairs, pain when crossing the legs, and temporary numbness. In severe cases, atrophy of the muscles of the thigh and lower leg is observed.

Professional athletes are characterized by frequent microtraumas of the meniscus: small tears, bruises, infringements.

Cartilage-shock absorber and the degree of its damage

With such injuries, the disease becomes chronic. Sharp pain is not observed, most of the time the joint remains mobile. However, from time to time, unpleasant sensations appear in the knee area (clicks, slight numbness, tingling). There is atrophy of the thigh muscles.
In case of serious ruptures, up to crushing the meniscus of the knee joint and its separation from the capsule, surgical treatment is necessary. The detached part of the meniscus can be removed completely or partially. If there are tears, the patient may be offered suturing. The choice of operation depends on the general condition of the patient, his age, as well as the nature of the injury. The younger the victim, the faster the recovery after surgery. It usually takes at least 3-6 weeks and takes place on an outpatient basis. To restore joint mobility, physiotherapy procedures and massage are carried out. Mud therapy can be recommended, as well as restorative gentle gymnastics.

Conservative treatment in hospital and at home

For chronic minor injuries, micro-ruptures and periodic infringement of the meniscus of the knee joint, more gentle conservative treatment may be recommended. In the event of a pinched meniscus, the first step is to reduce the joint (reposition). The procedure is performed by a traumatologist, chiropractor or orthopedist in a medical institution.

It may take 3 or 4 procedures to fully reposition the joint. Another option for restoring the functions of the meniscus is traction of the knee joint (hardware traction). This is a longer procedure, usually it is carried out in a hospital. To restore cartilage tissue, several intra-articular injections of preparations containing hyaluronic acid will be required. If swelling is observed, the patient feels pain, then intra-articular injections of ibuprofen, nimulide, voltaren, and corticosteroids are prescribed.

After emergency measures, long-term drug treatment is required, which restores the amount of joint fluid and strengthens cartilage tissues. The most commonly prescribed drugs are glucosamine and chondroitin sulfate. Self-medication is excluded, the exact dosage of the drug is prescribed only by the attending physician. The speed of recovery and the general condition of the patient depend on the accuracy of compliance with his prescriptions.

Usually the course of restorative drugs is 3 months, subject to daily intake. Simultaneously with taking medications, therapeutic exercises and massage are prescribed.

Treatment with folk remedies

From home recipes, various compresses and rubbing are especially effective, reducing pain and returning joint mobility. Before treating the meniscus with folk remedies, it is recommended to consult with your doctor. It is worth considering the individual characteristics of the body. For example, the popular honey compress may be contraindicated for those who have an allergic reaction to bee products.

You can treat the meniscus of the knee with a compress of fresh burdock leaves. The area of ​​the patella is wrapped with a freshly cut sheet, a retaining bandage is applied over it. It is recommended to keep the compress for 4 hours. The procedure is carried out daily until the pain is completely eliminated. If there is no fresh burdock, you can make a compress from dried leaves soaked in a small amount of boiling water. The raw material is evenly distributed over the tissue, then it is applied to the damaged joint for 8 hours.

For knee injuries, treatment may include warming up. Honey compress helps relieve pain in the patella and restore lost mobility to the joint. Equal shares of natural bee honey and purified alcohol are mixed, slightly warmed up. The warm mixture is then applied to the patella area, covered with a woolen cloth and a restraining bandage. For intensive restoration of the meniscus, it is recommended to make a honey compress twice a day, and you need to keep it for at least 2 hours. Treatment with folk remedies usually lasts about a month, then a two-week break should be taken.

An effective prevention and a simple way to treat the meniscus of the knee joint is a tincture of wormwood. A tablespoon of crushed raw materials is poured with a glass of boiling water for an hour, filtered, and then used for compresses. A cloth soaked in tincture should be applied to the damaged joint for half an hour.

Wormwood compresses can be done up to 5 times a day until the pain symptom disappears completely and knee mobility is restored.

The meniscus is a stabilizing pad made up of cartilage fibers that absorb synovial fluid. It is a source of nutrients.

The meniscus in the knee reduces the load in the joint, serves as a barrier that excludes the possibility of contact between the bones.

There is a lateral meniscus (outer) and a medial (inner) meniscus. The medial meniscus of the knee joint has the shape of a semicircle, the lateral meniscus is similar to the letter "C". 60-70% of the meniscus consists of ordered collagen fibers arranged in a circle, about 16% is occupied by special proteins, another 0.6% is elastin.

The structure of both types of menisci is the same, including the anterior horn, posterior horn, and body. With the help of a horn, the meniscus is attached to the bone or to the articular fossa. The blood supply is only in the outer part of the meniscus.

If the meniscus is damaged in this area, then cartilage repair is possible without suturing. Over the years, the number of blood vessels decreases, so injuries take longer to heal. The medial meniscus of the knee joint works in conjunction with the lateral ligament of the knee joint. Therefore, damage to the medial meniscus of the knee joint and ligament usually occurs simultaneously.

Causes of meniscus problems

• permanent loads;
• mechanical impact, falling, jumping or a strong blow resulting in an injury to the meniscus of the knee joint;
• complications after surgery;
• violation of metabolism and blood supply;
• oncological diseases, diseases of the joints;
• age;
• repeated injuries;
• improper rotation of the joint.

​Provocative factors for the development of meniscus disease:

• constant sharp extensor movements;
• overweight;
• congenital or acquired weakness of the ligaments.

Symptoms

The menisci are very susceptible to injury. Symptoms appear depending on the type of damage, the main diseases and their signs include:

• Inflammation of the meniscus. To determine the inflammation of the meniscus is quite simple:
  • swelling is noticeable to the naked eye (see photo below);
  • palpable pain, which may subside over time (with increased stress and circulatory disorders, the pain syndrome increases);
  • restriction of movements;
  • clicks in the knee.

Inflammation of the meniscus

Symptoms of inflammation of the meniscus are often similar to a rupture, so it is not recommended to draw conclusions and prescribe treatment on your own.

• Meniscus tears. The main symptoms of a torn meniscus are:
  • inflammation of the meniscus;
  • incessant pain;
  • joint immobility;
  • crunching during movement;
  • bleeding in the joint is a clear sign that there has been a rupture of the medial meniscus of the knee joint.

Rupture of the meniscus of the knee joint

Symptoms of a meniscus tear do not differ depending on the location of the injury. Whether the lateral meniscus is damaged or the medial meniscus is torn, the sensations will be the same.

Classification of meniscal injuries

The American physician Stoller identified several stages of meniscus injury. His technique allows you to accurately determine the diagnosis and prescribe treatment.

1. First degree The disease is characterized by damage to the posterior horn of the medial meniscus. Physiological reasons cause this violation. The focus of damage is located inside the meniscus, most often a person is unaware of a violation in the joint that has appeared. Usually, the initial degree of damage is detected by chance during a routine examination and is in the nature of inflammation of the meniscus.
2. Meniscus injury grade 2 has a pronounced clinical picture. The overall structure of the bone tissue is not disturbed. The cartilage retains its original shape. In the second stage, damage to the internal meniscus occurs. The person feels discomfort in the knee joint. With the development of degenerative processes in the second stage, a rupture of the meniscus occurs.
3. The most severe 3 degree damage is characterized by a complete rupture of the meniscus of the knee joint. The anatomical structure is disturbed, the cartilage is detached and displaced. The chronic form of the disease occurs precisely at this stage. It is characterized by the inability to perform extensor movements. At this stage, it is impossible to treat a torn meniscus of the knee joint without surgery.

Diagnostics

Non-instrumental studies:

• . The person lies on his stomach, the leg is bent at a right angle and pressed on the heel, while rotating the lower leg and foot. The test is considered positive in the presence of pain;
• McMurry test:
  • the person lies on his back. The knee is in a bent state, as far as possible, and wrapped around the hand. The lower leg is rotated outward, the knee is extended to a right angle. If there is a meniscus tear, the patient will feel pain from the inside of the joint;
  • while in the same position, the person bends the leg at the knee and hip joint at a right angle. One hand grabs the knee, the second makes circular movements of the lower leg in and out. The meniscus tear test is considered positive if clicks are heard.

To confirm the symptoms of a rupture of the meniscus of the knee joint, instrumental studies are used. These include Ultrasound, MRI, x-ray and arthroscopy:

• First of all, X-ray examination and ultrasound are prescribed. The meniscus is not visible on the x-ray, research is necessary to make sure there is no fracture. Ultrasound is prescribed as an addition to x-rays.
• MRI allows you to examine the joint itself and the area around it. This method determines the presence of injury and the degree of damage. Due to the ability to visualize the meniscus in a comprehensive manner, the accuracy of MRI is 95%. Based on this method, the decision is usually made how to treat the meniscus;
• Computed tomography is effective for detecting inflammatory processes. The tomograph creates a series of images that allow you to draw a conclusion about the state of the joint at different depths. This method is most effective in confirming the source of pain, the presence of a fracture, and visualizing bleeding. The meniscus itself cannot be seen using tomography, so the technique is complementary to MRI;
• Diagnostic arthroscopy allows for an accurate diagnosis. The main advantage of the method is the ability to simultaneously diagnose and correct. The data obtained by the arthroscope are displayed on the monitor in real time, so the doctor can perform the necessary manipulations to eliminate some of the consequences of the injury - remove accumulated blood, sew the edges of the meniscus.

meniscus treatment

The treatment for the knee depends on the cause of the inflammation of the meniscus or its rupture. First of all, the patient needs to be calm. Further, depending on the degree and nature of the damage, specific methods of treating a tear of the meniscus of the knee joint are prescribed.

Medical treatment (drugs)

Conservative treatment or, in other words, treatment of the meniscus without surgery is carried out at the expense of drugs of various effects:

• (Ibuprofen, Diclofenac).
• rubbing with an ointment (Voltaren, Ketorol, Alezan).
• cartilage restoration is carried out with the help of such as Chondroitin sulfate.
• Ostenil is prescribed to increase mobility and relieve pain inside the joint capsule. After the first injection, clear signs of improvement are visible. Usually prescribed 5 injections.

Surgery

Treatment of the meniscus without surgery is not often successful and only with minor injury or inflammation. Depending on the degree of damage to the meniscus of the knee joint, several options for operations are possible:

• Meniscectomy- It is used when the meniscus is torn or in the presence of complications. A positive result is observed in 65% of operations, and arthritis of the knees is also among the consequences. Recovery takes a month and a half.
• Recovery- a more gentle method, mainly used among patients not older than 45 years. An important condition for the operation is the stable condition of the cartilage tissue. This is due to the fact that in the presence of pathology, the menisci will be subject to further destruction. The rehabilitation period can last 4 months.
• Arthroscopy- the most progressive type of operation. Only the medial meniscus of the knee joint with a torn posterior horn cannot be treated. The traumatism of this operation is minimal, and the scars after the operation are visible only upon closer examination. Arthroscopy is prescribed when it is impossible to accurately determine the nature of damage to the meniscus of the knee joint. 2 punctures are made for the arthroscope and surgical instruments. The arthroscope allows the surgeon to reach the most remote areas. The meniscus is sutured with non-absorbable threads made of silk, nylon or polypropylene. A positive result is observed in 90% of operations. Contraindications: open knee injury, inflammation of the skin at the puncture site, exacerbation of chronic infections, low joint mobility, low level of recovery of internal organs. Rehabilitation after surgery takes 4 weeks, on the first day the doctor prescribes exercises with minimal stress. From the second day, exercises are prescribed that help start the processes of restoration of damaged tissues and the function of the knee joint.
• Internal fixation of the meniscus- the treatment of meniscus rupture in this way began to be used relatively recently. Minimal trauma and the absence of direct surgical intervention are the main advantages of this operation. Its essence lies in the use of fixators without an incision, due to which rehabilitation takes less time than usual.
• Transplantation is the most expensive operation. The essence of this method is to completely remove the meniscus and replace it with a donor or artificial implant. This operation is recommended in case of complete destruction of the meniscus and the inability to stitch it, as well as when the patient's age does not exceed 40 years. Contraindications: diabetes mellitus, severe diseases of the heart and blood vessels, old age, polyarthritis and atherosclerosis. Both the lateral and medial menisci should be replaced. The peculiarity of the operation is that the implant has to wait a long time, as it must ideally fit the patient. But with a successful outcome of the operation, the risk of rejection is minimal. The duration of the operation is not more than 3 hours. The postoperative period lasts 6 weeks, after which you can enter the usual rhythm of life.

Complementary and alternative treatments without surgery at home.

To reduce discomfort in case of damage to the meniscus of the knee joint and reduce pain, you can use the treatment of folk remedies based on oils and herbs.

Tincture recipe:

• birch buds, violet and nettle leaves, 1 tablespoon each;
• 500 ml of boiling water.

Grind the ingredients, mix them and pour boiling water. Infuse for 30 minutes, then strain. Take 4 times a day, dosage - 1⁄4 cup.

Spasmolytic anti-inflammatory agent. Take in equal proportions clove oil, camphor, menthol, eucalyptus and winter love, as well as aloe juice.

• mix all the ingredients and heat in a water bath.

Apply the resulting mixture to the knee and apply a tight bandage. Repeat 2-4 times a day.

Compresses

Treatment of the meniscus without surgery at home is possible with the help of warm compresses. The following compresses give the maximum effect:

Compress based on honey.

First way:

• mix 1 tablespoon of aloe leaf pulp and 2 tablespoons of honey;
• lubricate the knee with the resulting mixture, wrap the affected area with cling film;
• the duration of the procedure is 1 hour.

This compress removes swelling and stops inflammation.

Second way:

• mix honey and alcohol in a ratio of 1: 1;
• heat in a water bath and apply to the inflamed area;
• leave for 2 hours;
• repeat the procedure twice a day.

Burdock leaf compress.

Burdock leaves should be wrapped around the knee and pressed tightly. You can also use dried leaves. They need to be crushed and steamed in boiling water. Then apply the resulting product and bandage. Hold the compress for 3 hours.

A compress based on a decoction of herbs.

You need to take 1 teaspoon of St. John's wort, calendula, chamomile and sage, pour boiling water. Filter after 1 hour. Put a bandage or soft cloth moistened with herbal decoction on the knee for 30 minutes. Repeat 3 times a day.

Exercises

It is strictly forbidden to use exercises as a treatment without surgery for rupture of the meniscus of the knee joint, since with this injury, first of all, the knee must be immobilized.

Exercises for the treatment of the meniscus are done only at the recovery stage, physiotherapy exercises have a positive effect:

• the first two days perform leg extension. You also need to squeeze the object between the legs, bent at the knees;
• from the third to the tenth, they make a straight leg lift, the starting position is lying on their side and back. Sitting on a chair, you need to straighten your knee. Within 2-3 seconds, hold the straightened leg in a tense state;
• in the third week, it is recommended to walk 2-3 km, ride a bike. Exercise: circular and swing movements of the leg.

Physiotherapy

Physiotherapy after surgery is prescribed in order to enhance cell regeneration, improve blood circulation and metabolism. The main methods of physiotherapy:

• electrical stimulation;
• magnetotherapy;
• laser therapy;
• massage.

In order to increase the efficiency of the patient, they are taught self-massage techniques, the rest of the procedures are carried out directly in the medical institution.

Prevention

Injury to the meniscus of the knee joint does not imply preventive measures. It is impossible to additionally influence the menisci, strengthen them or make them thicker. The doctor can give general advice: walk more carefully, avoid wearing high heels often, use protective knee pads when playing sports.

The knee meniscus is an important component of a fulfilling healthy life. If there are the slightest symptoms of meniscal injury, there is no need to postpone the problem. You should immediately consult a doctor. Only timely diagnosis will reveal how injured the menisci are. Based on this study, the doctor will decide which method of treatment should be applied in a particular case.

Prognosis after treatment

Most often, the treatment of meniscus has a positive outcome. There are several factors that affect recovery:

• patient's age. After 40 years, the rate of tissue repair decreases, which means that the rehabilitation period will take longer;
• weak ligaments can become a factor in re-injury, as the cartilage is subject to displacement;
• place of break. Ragged damage is much more difficult to stitch than damage in one plane, and healing processes take longer;
• freshness of injury to the meniscus of the knee joint. Advanced cases, when the patient self-medicated for a long time, recover much longer.

Complications may occur - purulent inflammation, hemorrhage into the joint or eruption of sutures. No need to wait until the discomfort disappears, you should immediately contact a specialist. To avoid complications, it is necessary to completely exclude heavy physical exertion after surgery.

Related videos

Interesting

A meniscus tear is a closed injury to the knee joint. Traumatization of the meniscus is manifested by the appearance of a sharp joint pain, as well as limiting active and passive movements in it. According to statistics, meniscal injuries occur in approximately 80% of all intra-articular injuries of the knee joint. Most often, with damage to the meniscus, athletes or people of physical labor, whose age does not exceed 45 years, seek medical help.


Damage to the meniscus can lead to blockade of the joint ( a combination of severe pain with restriction of any movements in it). In some cases, an imaginary recovery is observed, after which, with any awkward movement, a re-occurrence of blockade of the knee joint occurs ( relapse). Recurrence of knee blockade can occur several times a week or day and requires conservative or surgical treatment.

Interesting Facts

• Injury to the meniscus in childhood is extremely rare.
• In women, meniscal injury is diagnosed twice as rarely as in men.
• The most common cause of a torn meniscus is an indirect knee injury. This injury occurs due to an awkward outward rotation of the lower leg, together with a combination of high load on the knee joint.
• Sometimes damage or rupture of the meniscus tissue can occur due to chronic degenerative processes in the elderly.
• The shape of the meniscus resembles a trihedral plate.
• A torn meniscus may in some cases be combined with a torn anterior cruciate ligament.

Anatomy of the knee joint

The knee joint is an extremely complex formation in its structure. This joint is complex, since three bones participate in its formation at once - the femur, tibia ( largest leg bone) and patella ( knee cap). Inside the joint between the femur and tibia contains menisci ( cartilaginous plates), which divide the joint into two almost equal chambers. The knee joint belongs to the condylar type joints ( the articular parts of the femur and tibia are represented by the condyles).

Movement in the joint is possible in three directions at once. In vertical ( sagittal) of the plane, the knee joint can make movements of a flexion-extension nature within 130 - 150 degrees. In two other planes ( frontal and horizontal) movements are possible only with a bent knee. Adduction-abduction movements can be carried out only within 5 degrees, and internal or external rotation within 15 - 25 degrees from the neutral position of the joint. Also in the knee joint, it is possible to carry out movement by the type of sliding and rolling. This type of movement is produced by changing the position of the condyles of the tibia in relation to the femur.

The following main elements are involved in the formation of the knee joint:

• epiphyses of the femur and tibia;
• articular cavity;
• joint capsule;
• synovial bags;
• menisci;
• joint ligaments.

Epiphyses of the femur and tibia

From above, the knee joint forms the epiphysis of the femur, and from below - the tibia. The epiphysis of a bone is an expanded terminal section involved in the formation of a joint with an adjacent bone. The articular surface of the condyles ( thickening of the epiphysis) of the femur has a convex shape, and the articular surface of the tibia is concave. The articular surfaces are not congruent ( symmetrical) and therefore menisci are located between them, which somewhat equalize this discrepancy.

The articular surfaces of the tibia and femur are covered with cartilage from above. Cartilage tissue is nothing more than hyaline, which consists of collagen ( tissue-strength protein), chondrocytes ( chief cartilage cells), tissue fluid, organic matter and germ layer ( this layer is located in the perichondrium and ensures the regeneration of cartilage tissue). With mechanical action on the knee joint during walking, the entire load is evenly distributed on chondrocytes, collagen and the growth layer.

Hyaline cartilage is 0.3 - 0.4 mm thick. With constant friction of the articular surfaces, the cartilage always remains smooth, and its elastic properties somewhat soften shocks during movement ( cushioning function).

Also, the patella is involved in the formation of the knee joint. The patella is a sesamoid bone. This type of bone involves the location inside the tendon. The patella is located in the thickness of the tendon of the quadriceps femoris and is involved in the extensor movements of the lower leg. The inside of the patella is covered with massive cartilage, the size of which reaches 0.6 cm. This cartilage helps the patella to move easily between the articular surfaces of the femur and tibia. The main task of the patella is to limit the displacement of the femur and tibia to the sides. Also, the patella increases the efficiency of the muscles, since the knee joint works on the principle of a block.

Articular cavity

The articular cavity of the knee is a closed slit-like space. This cavity is limited by the synovial membrane ( inner layer of the joint capsule), as well as the articular surfaces of the femur and tibia. There are two menisci in the articular cavity of each knee.

joint capsule

The articular capsule or bag of the knee joint plays a protective role and protects the joint from excessive external mechanical impact. The joint capsule is covered from the inside by a synovial membrane. In the knee, the articular bag is weakly stretched, which allows movements of significant amplitude in different planes. The posterior part of the joint capsule is slightly thicker than the rest and contains numerous openings through which the vessels pass. On the femur, the articular capsule is attached in front slightly above the articular surface of the condyle, on the sides - almost at the cartilage. Behind the articular bag is attached along the edge of the cartilaginous tissue of the femur.

In the joint capsule, the following membranes are distinguished:

• Synovial membrane. The inner surface of the articular capsule is lined with a synovial membrane. This shell covers the entire surface of the articular cavity except for the articular surfaces of the epiphyses of the femur and tibia. The main task of the synovial membrane is to produce synovial fluid to nourish the cartilaginous tissue of the joint due to the fact that it contains many small vessels. Also, the synovial membrane increases the mobility of the joint, protects against mechanical impact and, in the case of an inflammatory process in the bone tissue, does not allow it to spread into the joint cavity. This shell forms special outgrowths - villi. The villi increase the surface area of ​​the synovial membrane and are involved in the production of synovial fluid.
• fibrous membrane. Outside, the capsule of the knee joint is covered with a fibrous membrane, which consists of collagen. The fibrous membrane gradually passes into the periosteum. The synovial membrane, like the fibrous membrane, forms synovial bags in several places, which are located next to the joint.

Synovial bags

Synovial bags are located near the muscle tendons or under the muscles themselves. Each of the bursae is filled with synovial fluid to reduce friction between tendons and muscles during movement. Some synovial bags communicate with the joint cavity.

The following synovial bags of the knee joint are distinguished:

• suprapatellar bursa located between the quadriceps tendon and the femur. The suprapatellar bursa communicates with the cavity of the knee joint. If it is completely included in the articular cavity, the upper edge of the joint capsule can rise several centimeters above the upper edge of the patella. In newborns and infants, the suprapatellar bursa never communicates with the cavity of the knee joint.
• Deep patella bag. The deep subpatellar bursa is located between the patellar ligament and the epiphysis of the tibia.
• Subcutaneous prepatellar bursa located in the layer of subcutaneous fat between the patella ( on the front surface) and skin. This bag allows the skin to slide freely over the patella while walking.
• Semimembranosus sac lies between the tendon of the semimembranosus muscle and one of the heads of the gastrocnemius muscle. Sometimes this bag has a message with the cavity of the knee joint.
• Hamstring bag is a protrusion of the capsule of the knee joint, which is located under the tendon of the popliteal muscle. In children under two years of age, the popliteal muscle bag may communicate with the joint cavity.

menisci

Menisci are cartilaginous plates that increase the correspondence ( congruence) articular surfaces of the femur and tibia. The menisci play an extremely important role and are a kind of shock absorbers of the lower extremities, softening the impact of jolts during movement. Also, the menisci distribute the load in the knee joint and limit the range of motion in it.

The menisci are triangular in shape. Each of them has an anterior horn, a body, and a posterior horn. The meniscus is three-quarters composed of collagen fibers that are oriented in different directions. Radial collagen fibers, crossing each other, form a particularly strong network, which gives the meniscus the necessary resistance to mechanical stress. Circular collagen fibers are responsible for uniform load distribution in the longitudinal direction and are found mainly in the middle part of the meniscus. The third type of collagen is represented by perforating strands ( fibers). These strands are not numerous, but they have a very important function - they bind circular and radial collagen fibers and increase strength. The outer edge of the meniscus has a thicker layer of collagen and fuses tightly with the joint capsule, while the inner edge is slightly pointed and faces the articular cavity. It should be noted that a small amount of elastin is also present in the meniscus ( tissue elasticity protein).

It should be noted that in newborns, the menisci are permeated with a network of blood vessels, but by the first year of life, almost all of this network disappears. The menisci of an adult have a blood supply only in the outer part, and every year the number of supply vessels decreases.

There are 3 zones of blood supply to the meniscus:

• red zone has its own network of small vessels. This zone is located near the joint capsule.
• Intermediate zone to a small extent receives food from the red zone.
• white zone characterized by the complete absence of blood vessels that could nourish the tissues of the meniscus. This area is nourished by synovial fluid.

The nutrition of the cartilaginous tissue of the meniscus occurs due to the penetration of nutrients during diffusion ( from synovial fluid), as well as with the help of active transport ( transport of substances from an area of ​​low concentration to an area of ​​high concentration).

There are two menisci in each knee joint:

• internal or medial. The inner meniscus in its shape resembles the Russian letter "C". On the one hand, the medial meniscus is attached to the tibia, and on the other hand, to the outer edge of the articular capsule. The tibial collateral ligament is attached to the central part of the body of the internal meniscus. Limitation of the mobility of the medial meniscus by the articular capsule and the tibial collateral ligament in some situations leads to its rupture.
• External or lateral. The external meniscus resembles a semicircle in shape and covers almost the entire part of the upper lateral articular surface of the tibia. Near the anterior horn of the external meniscus is the site where the anterior cruciate ligament is attached. Menisco-femoral ligaments ( front and back), attached to the posterior horn of the external meniscus, pass slightly anterior and posterior to the posterior cruciate ligament. There is an option when the outer meniscus has a greater than usual area of ​​the articular surface of the disc-shaped form. It should be noted that damage to the lateral meniscus is observed 7–10 times less often than the medial one. This is because the outer meniscus is not so firmly connected to the joint capsule, which limits its mobility.

Ligaments of the joint

The knee joint is strengthened by many ligaments. The ligaments of the joint can be located both in the cavity and outside it. The ligamentous apparatus not only gives strength to the knee joint, but also takes a direct part in the movement.

The following ligaments of the knee joint are distinguished:

• peroneal collateral ligament ( external lateral ligament) From below, it originates from the head of the fibula, and from above it is attached to the external condyle of the femur. The peroneal collateral ligament remains relaxed during flexion and taut during extension. The main task of the peroneal collateral ligament is to hold the lower leg in a physiologically correct position. Also, this ligament takes part in rotational movements ( rotations).
• tibial collateral ligament ( internal lateral ligament) contributes to the retention of the lower leg and limits its excessive displacement outwards. This ligament is directly connected with the medial ( internal) meniscus. Between the internal and external lateral ligaments is a thin layer of adipose tissue.
• Oblique popliteal ligament goes from the external condyle of the femur obliquely down and is woven into the capsule of the knee joint. Also below, the oblique popliteal ligament intertwines with the tendon of the semimembranosus muscle. This ligament greatly strengthens the joint capsule.
• Arcuate popliteal ligament originates from the external condyle of the femur, weaving into the middle section of the oblique popliteal ligament, attaches to the external condyle of the tibia. The arcuate ligament fixes the joint and limits it from excessive lateral displacements.
• Patella ligament is a continuation of the tendon of the quadriceps femoris. The quadriceps tendon, which runs from the top of the patella, attaches to the tibial tuberosity. Most of the bundles of collagen fibers that make up this tendon are the patellar ligament. This ligament almost completely covers the anterior surface of the patella.
• Medial patellar ligament is, in fact, a continuation of the medial tendon ( internal) broad muscle of the thigh. Part of the collagen fibers of the broad medial muscle, heading down, form this ligament.
• Lateral ligament of the patella. Most of the lateral tendon bundles ( outdoor) the broad muscle of the thigh, descending in the vertical direction, forms the lateral supporting ligament of the patella.
• Anterior cruciate ligament takes part in the connection of the surface of the condyle of the femur with the anterior intercondylar field ( the area between the inner and outer condyles) tibia. This ligament is located in the very center of the knee joint. The anterior cruciate ligament prevents the lower leg from moving anteriorly. The anterior cruciate ligament of the knee joint is much more vulnerable than the posterior one.
• Posterior cruciate ligament located just behind the anterior cruciate ligament. The posterior cruciate ligament is needed to keep the tibia from moving too far backwards. This ligament is attached from above to the internal condyle of the femur, and from below to a small depression in the tibia ( posterior intercondylar field). The anterior and posterior cruciate ligaments are covered with a synovial membrane from above and cross each other almost at a right angle. The cruciate ligaments are located inside the joint and consist of a large number of collagen fibers, which gives them considerable strength.

It should be noted that in the ligamentous apparatus of the knee joint there are some intra-articular ligaments that are directly related to the menisci.

There are the following three ligaments that strengthen the menisci:

• Transverse ligament of the knee connects both menisci in front. This ligament is the only one that directly connects both menisci and is not attached to any bony protrusions.
• Anterior meniscofemoral ligament originates from the anterior surface of the inner meniscus, then goes obliquely upward to the outer condyle of the femur.
• Posterior meniscofemoral ligament in its lower part it is attached to the posterior edge of the outer meniscus and follows upward to the inner surface of the inner condyle of the femur.

Causes of meniscal injury

The most common cause of meniscal injury at a young age is a knee injury. Damage to the meniscus can be isolated or combined with other intra-articular injuries of the knee joint. Sometimes a combined injury can lead to rupture of the anterior cruciate ligament and meniscus. In about half of the cases, meniscus rupture is diagnosed along with fractures of the condyles of the tibia. Also, a meniscus tear occurs more frequently in individuals who have previously had an anterior cruciate ligament tear.

There are the following types of meniscus tear:

• traumatic rupture;
• degenerative rupture.

Traumatic rupture

Damage to the meniscus occurs during indirect or combined traumatism. Most often, this mechanism of damage is accompanied by rotation of the lower leg inwards for the lateral meniscus and outwards for the medial.

As a rule, traumatic rupture occurs under the following circumstances:

• the knee joint is supporting;
• in the knee joint there is a rotational movement;
• the joint is slightly bent.

Often, a meniscus tear is observed during forced extension of the knee joint from a bent position, and in some cases during direct injury ( the blow falls directly on the joint itself). In some athletes, repeated injuries of the knee joint are quite often observed, which leads to chronic damage to the meniscus of the joint ( meniscopathy). In the future, any sudden movement in the knee can be the starting point for a meniscus tear ( while squatting or when turning the knee sharply).

Depending on the type of rotation of the lower leg, the following types of meniscus damage are distinguished:

• Damage to the internal meniscus can be manifested by a rupture of the meniscus itself, a rupture of the ligament that fixes the meniscus, as well as a rupture of a pathologically altered meniscus. Most often, damage occurs along the longitudinal axis with a rupture of the middle part of the meniscus. In this case, the anterior and posterior horn of the meniscus remain intact. This gap is called the "handle of the watering can" ( this damage resembles a watering can). Also, ruptures of the anterior or posterior horn of the meniscus often occur. The least common are transverse tears in the central part of the meniscus under the tibial collateral ligament.
• Damage to the outer meniscus in most cases occurs when the lower leg is rotated inwards. For adults, this injury is not typical, since the lateral meniscus has relatively good mobility.

degenerative tear

Degenerative or chronic torn meniscus is seen in people over 45 to 50 years of age. Often, degenerative changes in the knee joint, including at the level of the menisci, occur with repeated microtrauma ( excessive stress during training or during work).

The most common causes of degenerative rupture of the meniscus are the following pathologies:

• Acute rheumatic fever or rheumatism. Rheumatism can lead not only to inflammatory lesions of the membranes of the heart ( cardiac form of rheumatism), but also to lesions of large joints, such as the elbow, knee and/or ankle. Rheumatism most often appears 2-3 weeks after a sore throat or scarlet fever. Rheumatic arthritis ( damage to multiple joints) causes pathological changes in the capsule of the knee joint and leads to swelling of the periarticular tissues, which in some cases can lead to impaired blood supply to the menisci and, as a result, to degenerative changes. Collagen fibers of the meniscus lose their strength and are not able to withstand heavy loads, which leads to their rupture.
• Gout is an acute or chronic disease that is manifested by the deposition of uric acid crystals in the tissues and joints. These crystals, once in the joint, cause an inflammatory process with a pronounced pain syndrome. In some cases, inflammation of the knee joint with gout can lead to injury to the menisci with uric acid crystals. The collagen fibers of the menisci undergo disorganization ( damage to cells and intercellular substance), which is manifested by their thinning and loss of strength.

Symptoms of a damaged or torn meniscus

In case of damage or rupture of the meniscus, it is customary to distinguish between acute and chronic periods. Immediately after an injury, pain of varying intensity occurs in the knee joint, and the knee itself swells. The pain appears at the site of the projection of the meniscus injury, and often along the entire joint space. A damaged or torn segment of the meniscus can significantly interfere with movement in the affected knee joint. If the damage is small, then the patient may complain of painful clicks in the knee or feel some discomfort in it. If there is a rupture of a rather large part of the meniscus, then this leads to blockade of the joint.
A detached fragment of the meniscus, moving to the central part of the joint, makes it impossible to perform certain movements, as a result of which the joint is blocked. In rare cases, a rupture occurs in the part where the few vessels are located ( red zone of the meniscus). Damage in the red zone leads to the accumulation of outflowing blood in the cavity of the knee joint ( hemarthrosis). Hemarthrosis is swelling just above the patella.

When the anterior horn is torn, the knee joint is blocked in such a way that it becomes impossible to fully extend the knee. The victim cannot complete the final 25 - 30º extension. If a rupture occurs according to the “watering can handle” type, then the restriction during extension occurs at the last 10 - 15º. In case of damage or rupture of the posterior horn or body of the meniscus, as a rule, flexion movements are limited in the knee joint.

The pain of a torn meniscus can be severe. This leads to the inability to step on the injured leg. Most often, this is observed with a significant rupture or crushing of one or two menisci, along with a fracture of the epiphyses of the tibia. It should be noted that sometimes the pain practically does not bring discomfort and is detected only during the performance of certain movements, for example, during the descent from the hill or stairs.

After the subsidence of pain and swelling, a chronic period begins ( after 15 - 20 days). There is localized pain, effusion in the joint ( accumulation of fluid in the joint as a result of inflammation), as well as blockade of the joint itself. In some cases, you can resort to a number of special tests.

The following tests are used to confirm the diagnosis of a meniscus tear:

• Baikov's symptom;
• Shteiman's symptom;
• Chaklin's symptom;
• Polyakov's symptom;
• Landau's symptom;
• Perelman's symptom;
• McMurray's symptom;
• symptom of "blockade" of the knee joint.

Baikov's symptom

The knee joint must be bent at a right angle. Next, palpation is performed with a finger ( probing) of the joint space and at the same time passively extend the knee joint. The appearance of a sharp pain indicates damage to the meniscus.

Shteiman's symptom

With the knee bent at an angle of 90º, rotational movements of the lower leg are performed. If the pain syndrome increases with internal rotation, then the medial meniscus is damaged, and if with external rotation, the lateral meniscus is damaged.

Symptom Chaklin
To determine the damage to the meniscus, you can use two variants of the Chaklin symptom. These tests are aimed at identifying damage to the internal meniscus of the knee joint.

To determine the damage to the meniscus, the following Chaklin symptoms are used:

• Click symptom. Flexion and extension movements in the knee joint lead to a characteristic click in the area of ​​the medial meniscus. Also, the lower leg in the area of ​​​​the inner meniscus seems to roll over some kind of obstacle.
• Symptom of the sartorius muscle. If the patient is asked to raise the extended leg, then atrophy of the medial part of the vastus muscle of the byrd can be detected ( decrease in muscle mass), as well as contraction of the sartorius muscle.

Polyakov's symptom

The patient lies on his back and lifts up his healthy leg. He should also slightly raise the torso and lean on the shoulder blades and on the heel bone of the injured leg. With this manipulation, pain occurs in the zone of meniscus rupture.

Landau's symptom

The patient is asked to sit in a cross-legged position ( "in Turkish"). When you try to sit in this position, there is local pain in the knee joint.

Symptom Perelman

Perelman's symptom, as well as Chaklin's symptom, has two variants.

The following Perelman tests are used to determine meniscus damage:

• Stair sign. Pain in the knee joint increases when descending a hill or stairs. Also, pain appears when trying to make a full extensor movement in the knee joint.
• Symptom "galoshes". Previously, this test was carried out using galoshes. The patient was asked to put them on without using hands. Pain in the knee joint appears due to rotational movements of the lower leg.

McMurray's sign

The patient is asked to lie on his back and bend his knees. Next, rotational movements are performed in the knee joint. This manipulation reveals pain in the patient. Also, during the McMurray test, you can hear a crunch in the joint.

Symptom of "blockade" of the knee joint

The symptom of "blockade" of the knee joint is usually carried out in the chronic period. The patient is asked to perform rotational movements in the joint, after which the knee remains in a forced position at an angle of 120º. If the patient tries to flex or extend the knee joint, this leads to the appearance of a pronounced pain syndrome. These painful sensations depend on the degree of infringement of the detached segment of the meniscus that has fallen between the articular surfaces of the bones of the knee joint. Often when the blockade of the joint can be accompanied by a click.

It should also be noted that blockade of the knee joint can also occur in the presence of other intra-articular pathology.

Meniscus rupture must be differentiated from the following diseases:

• Rupture of the anterior cruciate ligament. When the anterior cruciate ligament is torn, in some cases, a specific sound is heard in the depth of the joint - crackling. Also, the rupture of the anterior cruciate ligament is accompanied by a feeling of "subluxation" of the lower leg anteriorly or to the side. Unlike a meniscus tear, this injury in most cases leads to hemarthrosis. The main signs of rupture of the anterior cruciate ligament on palpation are a feeling of "falling through" ( since this ligament occupies a central position in the joint) and the occurrence of instability in the knee joint.
• Reflex contracture represents a limitation of passive movements. This pathology is characterized by the inability to fully bend or straighten the joint, as well as the occurrence of pain in the joint. Reflex contracture can be the result of various direct injuries with damage to the nerves of the knee joint.
• Koenig's disease or osteochondritis dissecans. Koenig's disease causes a small piece of cartilage on the articular surface to flake off, which can move into the joint cavity and cause pain. This pathology is typical for young people aged 15-30 years. Koenig's disease can lead to blockage of the knee joint if a fragment of the patella is separated.
• Goff's disease manifests itself in the form of inflammation of adipose tissue ( Goff's body) knee joint. Over time, the fat layer is completely replaced by connective tissue, which leads to the appearance of edema, as well as pain in the joint. In most cases, Hoff's disease limits full flexion and extension of the knee joint. In the future, this disease leads to blockade of the joint.
• Fracture of the condyles of the tibia. Intra-articular fracture of the condyle of the tibia is manifested by severe pain, swelling of the knee joint, impaired sensitivity of the lower leg and/or foot. Pain is aggravated when trying to stand on the injured leg. In some cases, rupture of intra-articular vessels by bone fragments occurs, which leads to ischemia ( decreased blood supply) tissues and is manifested by pallor of the lower leg and foot.

Diagnosis of meniscal injuries

The diagnosis of meniscus injury is most often established on the basis of patient complaints and an objective examination of the damaged area. To specify the diagnosis, the severity and nature of the damage are prescribed instrumental studies. It is considered inappropriate to prescribe a simple radiography of the knee joint, since the meniscus is not visible on a conventional x-ray. Contrast-enhanced x-rays of the knee joint can help to make a more accurate diagnosis, however, this method has lost its relevance compared to more modern diagnostic methods.

The main methods by which meniscal injuries can be detected are:

• ultrasonography;

Ultrasonography

The principle of operation of ultrasound is based on the fact that different tissues of the body transmit and reflect ultrasonic waves in different ways. The sensor of the ultrasound machine receives the reflected signals, which then undergo special processing and are displayed on the screen of the machine.

Advantages of the ultrasonic research method:

• harmlessness;
• efficiency;
• low cost;
• ease of reading the results;
• high sensitivity and specificity;
• non-invasiveness ( tissue integrity is not compromised).

No special preparation is required for an ultrasound of the knee joint. The only requirement is that intra-articular injections should not be performed a few days before the study. For better visualization of the menisci, the examination is carried out with the patient reclining with legs bent at the knee joints.

Pathological processes in the meniscus, which are detected by ultrasound:

• ruptures of the posterior and anterior horns of the menisci;
• excessive mobility;
• the appearance of meniscus cysts ( pathological cavity with contents);
• chronic injury and degeneration of the menisci;
• detachment of the meniscus from the place of its attachment in the region of the posterior and anterior horns and the body of the meniscus in the paracapsular zone ( area around the joint capsule).

Also, ultrasound of the knee joint can find not only pathological processes, but also some signs that indirectly confirm the diagnosis of meniscus rupture.

Symptoms that indicate damage to the meniscus on ultrasound of the knee joint:

• violation of the meniscus contour line;
• the presence of hypoechoic areas and stripes ( areas of low acoustic density that appear darker on ultrasound compared to surrounding tissues);
• the presence of effusion in the joint cavity;
• signs of edema;
• displacement of the lateral ligaments.

CT scan

Computed tomography is a valuable method in the study of injuries of the knee joint, but it is the lesions of the meniscus, ligamentous apparatus and soft tissues that are determined on CT at a not very high level. These tissues are better seen on MRI, so it is more appropriate to prescribe magnetic resonance imaging of the knee joint in case of damage to the menisci.

Magnetic resonance imaging

MRI is a highly informative method for diagnosing meniscal injuries. The method is based on the phenomenon of nuclear magnetic resonance. This method makes it possible to measure the electromagnetic response of nuclei to their excitation by a certain combination of electromagnetic waves in a constant magnetic field of high intensity. The accuracy of this method in diagnosing meniscal injuries is up to 90 - 95%. The study usually does not require special training. Immediately before the MRI, the subject must remove all metal objects ( glasses, jewelry, etc.). During the examination, the patient should lie flat and not move. If the patient suffers from nervousness, claustrophobia, then he will first be given a sedative drug.

Classification of the degree of meniscus change visualized on MRI (according to Stoller):

1. normal meniscus ( without changes);
2. the appearance in the thickness of the meniscus of a focal signal of increased intensity, which does not reach the surface of the meniscus;
3. the appearance in the thickness of the meniscus of a casting signal of increased intensity, which does not reach the surface of the meniscus;
4. the appearance of a signal of increased intensity, which reaches the surface of the meniscus.

Only changes of the third degree are considered a true meniscus tear. The third degree of changes can also be conditionally divided into degrees 3-a and 3-b. Grade 3-a is characterized by the fact that the rupture extends only to one edge of the articular surface of the meniscus, and degree 3-b is characterized by the spread of the rupture to both edges of the meniscus.

You can also diagnose a meniscus injury by looking at the shape of the meniscus. In normal photographs, in the vertical plane, the meniscus has a shape that resembles a butterfly. A change in the shape of the meniscus can be a sign of damage to it.

A third cruciate ligament symptom can also be a sign of a meniscal injury. The appearance of this symptom is explained by the fact that as a result of the displacement, the meniscus is in the intercondylar fossa of the femur and is practically adjacent to the posterior cruciate ligament.

First aid for suspected meniscus injury

The first thing to do if a meniscal injury is suspected is to ensure immobilization ( immobilization) knee joint. As a rule, the immobilization of the joint is carried out in the position in which the joint was blocked. To do this, you must use a splint bandage or a removable splint ( special type of fastener). It is strictly forbidden to try to eliminate the blockade of the knee joint on your own. This procedure can only be performed by a doctor who has the necessary qualifications.

Further, in order to reduce swelling of the knee joint, it is necessary to apply cold. An ice pack or a handkerchief or gauze soaked in cold water is suitable for this. A cold compress should be applied to the injured knee joint in the most painful place. This procedure will help narrow the superficial and deep vessels and prevent fluid from accumulating in the joint cavity ( decrease in effusion). Also, cold helps to reduce the sensitivity of pain receptors and, as a result, will reduce pain. The duration of the use of a cold compress should be at least 10 - 15 minutes, but not more than 30 minutes.

In the event that a combined injury occurs and the victim complains of severe unbearable pain, it is necessary to use painkillers.

Pain medications used to relieve pain

Name of the drug	Group affiliation	Mechanism of action	Indications
Ketoprofen	Non-steroidal anti-inflammatory drugs. Non-selective inhibitors of cyclooxygenase 1 and 2 ( an enzyme that is involved in the development of the inflammatory process).	They block the production of prostaglandins, which leads to a significant reduction in pain in intra-articular injuries of the knee joint. They have a significant anti-inflammatory and moderate analgesic effect.	Moderate degree of pain syndrome in case of damage to the capsular-ligamentous apparatus of the knee joint ( including the menisci). Inside one tablet 2-3 times a day.
Indomethacin
Diclofenac
Naproxen
Diclofenac
Promedol	Opioid receptor agonists ( substances that regulate pain).	Blocks mu receptors receptors found predominantly in the brain and spinal cord), and also activates the body's antinociceptive system ( analgesic), which leads to a violation of the transmission of pain impulses. It has a pronounced analgesic, moderate anti-shock, as well as a slight hypnotic effect.	Severe pain syndrome with meniscus rupture in combination with other intra- or extra-articular trauma. Inside, 25 - 50 mg, intramuscularly, 1 ml of a 1% solution or 2 ml of a 2% solution.

If you suspect a meniscus injury, you should consult a traumatologist to clarify the exact diagnosis. Also, only a doctor can prescribe treatment ( conservative or surgical). It is not uncommon for patients to come in for a consultation after several injuries with pre-existing meniscopathy. In this case, the recovery period is much longer.

Treatment of meniscal injuries

The choice of treatment depends on the degree of damage to the meniscus, which was established during the diagnostic examination of the knee joint using ultrasound or MRI. The traumatologist chooses a more rational type of treatment in each individual case.

The following methods are used to treat meniscal injury:

• conservative treatment;
• surgery.

Conservative treatment

Conservative treatment is to eliminate the blockade of the knee joint. To do this, you need to punctuate ( make a puncture) knee joint, evacuate the contents of the joint ( effusion or blood) and inject 10 ml of a 1% solution of procaine or 20 - 30 ml of a 1% solution of novocaine. Next, the patient is seated on a high chair so that the angle between the thigh and lower leg is 90º. 15 - 20 minutes after the administration of procaine or novocaine, a procedure is performed to eliminate the blockade of the knee joint.

Manipulation to eliminate the blockade of the joint is performed in 4 stages:

• First stage. The doctor performs traction ( traction) feet down. Traction of the foot can be carried out by hand or with the help of an impromptu device. To do this, a loop of bandage or dense fabric is put on the foot, covering the lower leg from behind and crossing on the back of the foot. The doctor performs traction by inserting the leg into the loop and pressing down.
• Second phase consists in the deviation of the lower leg in the direction opposite to the restrained meniscus. In this case, the joint space expands, and the meniscus can return to its original position.
• Third stage. At the third stage, depending on the damage to the internal or external meniscus, rotational movements of the lower leg inward or outward are performed.
• Fourth stage consists in free extension of the knee joint in full. Extension movements should be effortless.

In most cases, if this manipulation was carried out correctly at all stages, then the blockade of the knee joint is eliminated. Sometimes, after the first attempt, the blockade of the joint persists, and then you can re-perform this procedure, but no more than 3 times. In case of successful removal of the blockade, it is necessary to apply a posterior plaster splint, starting from the toes and ending with the upper third of the thigh. This immobilization is carried out for a period of 5 - 6 weeks.

Conservative treatment is performed according to the following scheme:

• UHF therapy. UHF or ultra-high frequency therapy is a physiotherapeutic method of influencing the body with an electric field of ultra-high or ultra-high frequency. UHF therapy increases the barrier ability of cells, improves regeneration and blood supply to meniscus tissues, and also has a moderate analgesic, anti-inflammatory and anti-edematous effect.
• Physiotherapy. Therapeutic exercise is a complex of special exercises without the use or with the use of certain equipment or projectiles. During the period of immobilization, it is necessary to perform general developmental exercises that cover all muscle groups. To do this, active movements are performed with a healthy lower limb, as well as special exercises - tension of the femoral muscles of the injured leg. Also, to improve blood supply in the injured knee joint, it is necessary to lower the limb for a short time, and then raise it to give it an elevated position on a special support ( this procedure avoids venous stasis in the lower extremity). In the period of post-immobilization, in addition to general strengthening exercises, active rotational movements of the foot, in large joints, as well as alternate tension of all muscles of the injured lower limb should be performed ( thigh and leg muscles). It should be noted that in the first few days after the removal of the splint, active movements should be carried out in a sparing mode.
• Massotherapy. Therapeutic massage is one of the components of complex treatment for injuries and ruptures of the meniscus. Therapeutic massage helps to improve blood supply to tissues, reduces pain sensitivity of the damaged area, reduces tissue swelling, and also restores muscle mass, muscle tone and elasticity. Massage must be prescribed in the post-immobilization period. This procedure should start from the anterior femoral surface. At the very beginning, a preparatory massage is performed ( 2 - 3 minutes), which consists in stroking, kneading and squeezing. Then they move on to more intensive stroking of the injured knee joint, after placing a small pillow under it. After that, rectilinear and circular rubbing of the knee is carried out for 4-5 minutes. In the future, the intensity of the massage should be increased. When performing a massage on the back of the knee joint, the patient should lie on his stomach and bend the leg at the knee joint ( at an angle of 40 - 60º). Massage must be completed by alternating active, passive movements with movements with resistance.
• Reception of chondroprotectors. Chondroprotectors are medications that restore the structure of cartilage tissue. Chondroprotectors are prescribed if the doctor has established not only damage to the meniscus, but also damage to the cartilage tissue of the knee joint. It should be noted that the use of chondroprotectors has an effect on both traumatic and degenerative meniscus rupture.

Chondroprotectors used to restore cartilage tissue

Name of the drug	Pharmacological group	Mechanism of action	Mode of application
Glucosamine	Metabolism correctors ( metabolism) bone and cartilage tissue.	Stimulates the production of cartilage components ( proteoglycan and glycosaminoglycan), and also enhances the synthesis of hyaluronic acid, which is part of the synovial fluid. It has a moderate anti-inflammatory and analgesic effect.	Inside 40 minutes before meals, 0.25 - 0.5 g 3 times a day. The course of treatment is 30 - 40 days.
Chondroitin		Improves the regeneration of cartilage tissue. Contributes to the normalization of phosphorus-calcium metabolism in cartilage. Stops the process of degeneration in cartilage and connective tissue. Increases the production of glycosaminoglycans. It has a moderate analgesic effect.	Externally applied to the skin 2-3 times a day and rub until completely absorbed. The course of treatment is 14 - 21 days.
Rumalon	Reparants and regenerants ( restore damaged areas of cartilage and bone tissue).	Contains an extract of cartilage and bone marrow of young animals, which helps to accelerate the process of cartilage tissue regeneration. Enhances the production of sulfated mucopolysaccharides ( cartilage components), and also normalizes the metabolism in hyaline cartilage.	Intramuscularly, deeply. On the first day, 0.3 ml, on the second day, 0.5 ml, and then 1 ml 3 times a week. The course of treatment should be 5 - 6 weeks.

With correct and complex conservative treatment, as well as in the absence of complications ( re-blockade of the knee joint) the recovery period, as a rule, lasts from one and a half to two months.

Surgery

Surgical treatment is indicated in cases where it is not possible to eliminate the blockade of the knee joint or with repeated blockades. Also, surgical treatment is resorted to in the chronic period.

Indications for surgical treatment of meniscus rupture:

• crushing the cartilaginous tissue of the meniscus;
• hemarthrosis;
• rupture of the anterior or posterior horn of the meniscus;
• rupture of the body of the meniscus;
• rupture of the meniscus with its displacement;
• repeated blockade of the knee joint for several weeks or days.

Depending on the nature and type of damage, the presence of complications, the age of the patient, surgical treatment can be carried out in various ways.

Surgical treatment can be carried out by the following methods:

• Meniscectomy is the partial or complete removal of the meniscus. This surgical operation is necessary in case of destruction of the cartilaginous tissue of the meniscus due to degenerative processes. Meniscectomy is also indicated when all or most of the meniscus is torn off or when various complications appear. This operation has a number of significant disadvantages. Meniscectomy is a very traumatic operation that can lead to chronic arthritis of the knee. Also, one of the disadvantages is the fact that this surgical operation helps only in 60 - 65% of cases.
• Repair of the meniscus is the most gentle for the patient. This operation is mainly used to treat a meniscal tear in young people to preserve the normal biomechanics of the knee joint. The operation to restore the meniscus is carried out under certain conditions.

Peripheral meniscus tear
A peripheral tear may occur in the anterior or posterior horn of the meniscus. As a rule, there is a detachment of a small segment of the meniscus from the attachment zone.

Peripheral tear with an offset to the center
In some cases, a peripheral rupture can occur in the region of the meniscus body, and then the detached fragment of the meniscus cartilage tissue changes its position, falling into the intercondylar zone of the tibia.

Absence of degenerative processes in the cartilaginous tissue of the meniscus
One of the main conditions for the restoration operation is the absence of degenerative processes in the meniscus itself. This type of operation is ineffective, since in the future pathological changes in the meniscus will continue to destroy cartilage tissue.

Vertical longitudinal rupture of the meniscus according to the type of "watering can handle"
Damage occurs in the meniscus body area and resembles a watering can handle. Repair of the meniscus with a vertical longitudinal rupture of the meniscus gives a positive result in most cases.

Patient's age
The operation to restore the meniscus is carried out, as a rule, for patients whose age does not exceed 40 - 45 years. Age is of paramount importance, since in younger people the regeneration process is much faster.

• Arthroscopic method is the safest and most preferred method used for the surgical treatment of injuries and ruptures of the meniscus. For this, diagnostic arthroscopy is performed, followed by suturing of the damaged segment of the meniscus cartilage tissue. Unlike arthrotomy, this method allows you to examine the entire joint as a whole. Also, the advantage of arthroscopy is minimal trauma. In order to sew up the meniscus, special needles with non-absorbable threads are used ( polypropylene, capron, silk). Through the arthroscope an endoscope that allows you to observe the course of surgical manipulations on the joint through a small hole) in the cavity of the knee joint, the damaged meniscus is stitched together. As a rule, two small holes are needed for arthroscopy - one for the arthroscope and the other for surgical instruments. The sutures on the meniscus should be placed perpendicular to the tear line for maximum fixation. The arthroscopic method is used for rupture of the anterior horn or body of the meniscus. A positive effect is observed in 75 - 90% of cases.
• Fixation of the meniscus within the joint is a relatively new method in the treatment of meniscal tears. This method, in fact, is not surgical and is carried out with the help of special fixators. The advantage of this method is that it is less traumatic. To carry out the fastening of the meniscus, you do not need to use special devices ( arthroscope), as well as make incisions in the area of ​​the knee joint to access it. Also, the restoration of the meniscus occurs in less time than with arthroscopy. The essence of the method is the use of special retainers, which can have an arrow-shaped or dart-shaped shape. The desired effect is achieved in 60 - 90% of cases.
• Meniscus transplant is a rather expensive procedure. Transplantation is necessary in case of complete crushing of the meniscus tissue, as well as in the case when other methods are ineffective. It should be noted that in case of chronic degenerative changes in the meniscus tissue, old age, as well as some diseases, meniscus transplantation is contraindicated.

On the 5th - 7th day after arthroscopic surgery, for better restoration of the meniscus tissues, it is necessary to carry out physiotherapeutic procedures. These procedures are carried out through the bandage until the sutures are removed. It is also preferable to use a knee bandage for 20 days after surgery.

Physiotherapeutic procedures in the postoperative period

Type of procedure	Mechanism of therapeutic action	Duration of treatment
UHF therapy	Affects the human body using an electric field of ultra-high or ultra-high frequency. Ultra-high frequency therapy significantly enhances blood flow and lymph flow in the knee joint, improves the synthesis of meniscus cartilage components, normalizes metabolism, and increases the barrier ability of damaged cells. UHF-therapy also has a moderate analgesic, anti-edematous and anti-inflammatory effect.	Daily for 10 - 15 minutes. The course of treatment is 5 - 10 procedures. The low-intensity field is used first, and then the high-intensity one.
Magnetotherapy	The use of a static magnetic field improves the regeneration of meniscus tissue. There is an increase in local immune processes. Improves blood circulation in the knee joint. Normalizes intracellular processes.	Daily for 15 - 20 min. The course of treatment is 10 - 15 procedures.
Electrophoresis of pain medications	The use of direct electric current contributes to the rapid penetration of the anesthetic drug into the superficial and deep tissues of the body. The procedure allows you to act on the affected knee joint and create a drug depot from anesthetics there ( 1% dicaine solution, 1 - 5% novocaine solution, 0.5 - 2% trimecaine solution, 1 - 2% lidocaine solution). It has a pronounced analgesic effect with a long period of action ( due to drug depot).	Daily for 15 - 20 minutes until the pain syndrome stops. Perhaps the introduction of painkillers in combination with adrenaline ( 1 ml 0.1% solution).

It should be noted that in the postoperative period, as well as with conservative treatment, it is necessary to prescribe physiotherapy exercises. In each case, the type of exercises and volume are selected individually. Also, to speed up the recovery period, therapeutic massage is prescribed.

Recovery of working capacity occurs on average within 2 - 3 months and depends on a number of parameters.

The recovery period depends on the following factors:

• patient's age;
• type of damage;
• degree of damage;
• damage zone;
• method of surgical treatment;
• the presence of chronic degenerative processes in the cartilaginous tissue of the meniscus.

Which doctor treats the meniscus of the knee joint?

Which doctor treats the meniscus of the knee joint?

The orthopedist deals with diseases of the musculoskeletal system and any violations in its work. He undergoes appropriate training, which allows you to quickly find the disease and prescribe adequate treatment. If your clinic does not have such a specialist, then a surgeon will replace him.

The traumatologist provides first aid, helps relieve pain and swelling, assesses the degree of injury. That is, it will relieve pain, swelling, and, if necessary, set the joint or meniscus. Also, the traumatologist will give recommendations on how to behave if it is not possible to immediately consult a doctor.

A rheumatologist deals with systemic diseases of bones, joints and connective tissues. They turn to him if meniscus pathologies are accompanied by other disorders: pain in the shoulder or hip joints, inflammation, etc. If the meniscus damage is caused by one of them, then you need to turn to him. As a rule, a surgeon or traumatologist gives a referral to him.

An orthopedic surgeon performs operations on the knee joint. An experienced doctor of this qualification has the skills to conduct open and arthroscopic operations. He accompanies the patient during the period of preparation for surgery and during rehabilitation. Further observation is already carried out by the district surgeon or orthopedist.

A chiropractor treats minor injuries and damage to the meniscus, the muscular system of the knee, without the help of drugs. It uses the technology of massage and gymnastics, which help restore blood flow, strengthen the muscles and joints of the body.