A meniscus tear of the knee: causes, symptoms, treatment
Damage to the meniscus of the knee: symptoms, treatment and surgery
The knee joint is one of the largest in the human body. He has quite a complicated structure and includes a lot of cartilage and ligaments.
In addition, the composition of the body is little soft tissue, which could protect it from damage.
That is why a knee injury is diagnosed quite often, and one of the most common injuries is the meniscus tear.
The structure of the meniscus
The meniscus is a cartilage formation having the shape of a Crescent. It is located between the tibia and femur and is a kind of seal between the articular ends of the bones.
The meniscus performs a number of functions, chief of which is the attenuation of the movement and protection of articular cartilage. In addition, it performs a stabilizing function, which aims to increase mutual compliance of all the articular surfaces in contact with each other. The meniscus also helps to significantly reduce friction in the joints.
In the knee joint has two meniscus:
The outer meniscus is more mobile, and therefore much less damaged compared to internal.
Certain features and blood supply of the meniscus. The fact that babies usually have all their fabric permeate blood vessels, but in nine months from the inside of the vessels fully disappear. As they Mature the blood supply to the meniscus is deteriorating. From this point of view there are two zones – red and white.
Classification of damage
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There are such varieties of meniscus of knee joint:
- Separation from the attachment. This can occur in the area of the body of the meniscus in pericapsular area or in the region of the front and rear horns.
- Ruptures of the body of the meniscus. This can happen in transchondral region, and also in the posterior and anterior horns.
- Various combinations of such damages.
- Excessive mobility of the menisci. It can be degeneration of the meniscus or a tear in his ligaments.
- Chronic degeneration or trauma of the meniscus, cystic degeneration.
Tears of the menisci can also have several varieties:
In complexity there are complete and incomplete tears.
The reasons for the gap
It’s quite common, and this injury usually get people who exercise, skiers, tennis players, figure skaters, football players. Typically, these injuries occur in people 18 to 40 years, with men affected more often than women. In children under the age of 14 tears of the meniscus are fairly rare, which can be attributed to the anatomical features of the body.
Sometimes the torn meniscus is not injured. Most often this occurs when inflammation or degenerative processes in the knee joint. Often this is the fault of osteoarthritis. Sometimes traumatic injuries of the meniscus accompanied by rupture of ligaments and other injuries of the knee joint.
Symptoms of injury
The symptoms associated with damage to the meniscus of the knee joint at the initial stage of the disease: nonspecific inflammation, sudden lack of movement, local pain, the presence in the cavity of blood or exudate.
At this stage it is quite difficult to make a correct diagnosis, since there are no signs of damage to the meniscus.
After 2-3 weeks, these symptoms disappear and the symptoms appear, which is inherent to the injury of the meniscus:
- Local tenderness.
- The presence of effusion.
- Infiltration of the capsule.
- Pain cushion in the area of the joint space.
- Ankylosis, which is associated with the pinching of the meniscus.
- The typical clicking sound when bending the joint.
- The increase in temperature in the area of the affected joint.
- Atrophy of the muscles of the thigh and lower leg – occurs in some cases.
The chronic form of the disease is observed in the case of systematic damage to the meniscus. There are no pronounced symptoms. Sometimes occur:
- pain in the area of the joint space;
- atrophy of the quadriceps.
To confirm the damage to the meniscus, it is possible to perform various tests:
- Symptom Baikova pain appear when pressing on the joint gap during extension of the knee, bent at a right angle.
- Symptom Landa – pain appears when trying to sit down in Turkish.
- Symptom of Shteiman – painful sensations arise in the bent at the right angle of the knee when performing rotational movements.
- Polyakova symptom – pain occurs in the supine position with raised healthy leg and torso raised, the patient must rely on the heel of the damaged leg and shoulder.
- Symptom Mac-Murray – pain is worse when rotating bent at a right angle the legs outwards or inwards. This allows you to judge the injury of the medial or lateral meniscus.
- Symptom of Turner decrease or increase sensitivity in the area of the inner surface of the knee.
- Symptom Perelman – the appearance of pain when descending stairs.
- Symptom Chaklin – voltage or flattening of the Sartorius muscle during extension of the tibia.
To avoid trouble you should know what to do with the dislocated leg. As it turns out first aid and subsequent treatment you can find here.
The symptoms of rupture of the medial and lateral meniscus of the knee is also have some differences. So signs of trauma to the medial meniscus include:
- intense pain on the inner side of the joint;
- pinpoint pain when pressed in the place of attachment of the ligament to the meniscus;
- pain during strong flexion of the legs;
- «blockade» of the knee;
- pain when turning the lower leg outwards.
Signs of trauma to the lateral meniscus include:
- pain in the external part that occurs when the voltage of the knee joint;
- pain when you rotate the tibia inwards;
- muscle weakness in the area of the front of the thigh.
The consequences of a torn meniscus of the knee joint can be quite severe and lead to disability. Timely diagnosis is of great importance.
Diagnosis of damage
The correct diagnosis can only physician. Before to conduct research, the specialist should ask about all symptoms and to perform inspection of the knee joint and leg. Then the doctor will examine the joints on the subject of the accumulation of fluid and will check for muscle atrophy.
Experienced trauma on the basis of these data you will be able to make a diagnosis with 95% accuracy. However, in order to obtain absolute certainty, you need to pass additional tests:
- ultrasound examination;
- magnetic resonance imaging.
With the development of any unpleasant sensations in the region of the joint is obligatory to make the x – ray is the easiest and most accessible method of research. In more complex situations is assigned to the MRI – it gives the possibility, in addition to the joint, to check periarticular education.
Regardless of the severity of the injury the victim should give first aid. For this the patient must provide full rest, apply a cold compress and an ACE bandage in the knee joint area. To prevent or remove swelling, you need to put the leg just above chest level.
Conservative methods in the treatment of meniscus tear of the knee joint include the use of non-steroidal painkillers. These include ibuprofen, meloxicam, diclofenac.
To restore cartilage requires chondroprotector – they contribute to the improvement of metabolic processes in the recovery of the fabric. Such drugs include chondroitin sulfate and glucosamine. To increase water-holding characteristics of the cartilage and prevent inflammation, can be assigned to dietary Supplement collagen ultra.
Used for grinding various ointments – ketorol, Alezan, voltaren, first days without. If you experience pain and limited mobility can enter the drug Ostenil inside the joint capsule.
If treatment of damage to the meniscus of the knee medicine for brought the desired result, surgery will be scheduled.
Indications for surgery in the meniscus tear of the knee joint are:
- Rupture and displacement of the meniscus.
- The blood in the cavity.
- Crush the tissue of the meniscus.
- The separation of the body and horns of the meniscus.
- The lack of effect from medical treatment for several weeks.
In such situations, it may be assigned to surgery, which is carried out by different methods:
Meniscectomy or removal of the meniscus
This operation is shown in the separation of a large part of the meniscus, the decomposition of cartilage tissue, the development of complications. This procedure refers to the rather traumatic and leads to elimination of the pain only in 50-70 % of cases.
The restoration of the meniscus
If possible, surgeons try to preserve the meniscus. Recovery is possible in the following situations:
- separation of the meniscus from the capsule;
- vertical longitudinal tear;
- peripheral tear of the meniscus;
- the lack of degenerative processes in cartilage;
- young age.
Successful surgery depends on the duration and location of the tear. Localization of damage in the red or intermediate region and the patient’s age to 40 years increases the likelihood of a successful outcome.
This method is considered the most modern and least traumatic. During the procedure using the arthroscope visualize the injury and perform surgery. This method can be applied when rupture of the body or anterior horn of the meniscus. Read more about it.
Approximately 70-85 % of cases, the cartilage completely fused and the knee joint regains its function.
Transplantation of the meniscus
The indications for such surgery for torn meniscus the knee joint is considered to be the crushing of the meniscus and a significant deterioration in the quality of human life. In this contraindications to transplantation are: older age, knee instability, degenerative processes, and General somatic diseases.
The pinning of the meniscus special clamps
Using this procedure, fails to bind the meniscus, without additional incisions. For this purpose, absorbable clips first or second generation.
It is important that the period of rehabilitation after the injury. It includes:
- Performing special exercises for the development of the knee joint.
- The use of chondroprotectors and non-steroidal anti-inflammatory drugs.
- Massage, physiotherapy.
- The lack of loads throughout the year.
Rehabilitation after such injuries include five stages:
- Stage 1 – its duration is 4-8 weeks. At this stage you should try to maximize the range of motion in the injured joint to reduce swelling.
- Stage 2 – lasts about 2.5 months. It should completely restore locomotor activity, to eliminate swelling, to start to train weakened muscles.
- Stage 3 – must be fully restored locomotor activity in sports, to regain muscle strength. At this stage, actively engaged in physical therapy and returned to normal life.
- Stage 4 – should be able to actively play sports without pain, and increase muscle strength of the injured leg.
- Stage 5 – you should restore all the functions of the joint.
To prevent rupture of the meniscus, it is necessary to use special knee braces during sports activities – this will help to minimize the risk of injury.
It is also recommended to perform special exercises that will help strengthen the muscles, make chondroprotector and drugs that improve peripheral circulation.
A meniscus tear is a common knee injury, which significantly affects the quality of human life. Therefore, when any damage is to contact an experienced trauma surgeon – he will be able to make the correct diagnosis and find treatment.