Rupture of the posterior horn of the medial meniscus: symptoms and treatment
The knee joint has a rather complex structure. It is composed of the femur and the tibia, the patella (kneecap), ligaments that provide stability to the bones of the joint. Another part of the knee joint are the menisci – the cartilage layer between the femoral and tibial bones. When driving on the knee has a higher load, which leads to frequent injury of its elements. Rupture of the posterior horn of the medial meniscus is one of such injuries.
Lesions of the knee dangerous, painful and fraught with consequences. Rupture of the posterior horn of the meniscus, which can occur in almost any active person is the most common and dangerous injury. It is dangerous primarily to complications, and therefore requires timely identification and treatment.
What is the meniscus
The meniscus is a very important structural unit of the knee joint. They are composed of curved strips of fibrous cartilage between bones of the joint. The shape of a Crescent with the extended edges. It is customary to divide them into zones: the body of the meniscus (middle part); the elongated end parts — posterior and anterior horn of the meniscus.
In the knee joint has two meniscus: the medial (inner) and lateral (outer). They with their ends affixed to the tibia. Medially located in the inner part of the knee and connected with the internal lateral ligament. In addition, he is on the outer edge connected with the capsule of the knee joint, through which is provided a partial circulation.
Cartilaginous portion of the meniscus adjacent to the capsule, contains a significant amount of capillaries and perfused. This part of the medial meniscus is called the red zone. Middle area (intermediate zone) contains a small number of vessels, and very poorly supplied with blood. Finally the inner area (white zone) do not have a circulatory system. Lateral meniscus located in the outer region of the knee. He is more mobile than the medial, and the damage occurs much less frequently.
The menisci perform a very important function. First of all, they act as shock absorbers during movement of the joint. In addition, the menisci stabilize the position of the knee in space. Finally, they contain receptors that send operational information to the cerebral cortex on the behavior of the entire foot.
When you remove the inner meniscus, the contact area of the knee bones is reduced by 50-70%, and the load on the ligaments is increased by more than 100%. In the absence of external meniscus contact area will decrease by 40-50%, but the burden will increase by more than 200%.
Injury to the menisci
One of the characteristic injuries of the meniscus is tearing. Studies show that such injuries can occur not only in humans zanimayushihsya sports, dancing or heavy labor, but also in case of accidental loads, as well as in the elderly. It is established that the meniscus tear is diagnosed on average 70 out of every 100 000 people. At a young age (under 30 years) the damage is acute; with increasing age (40 years and older) begins to dominate the chronic form.
The cause of the meniscus tear can become excessive lateral load in conjunction with twisting of the lower leg. Such loads are typical when performing certain movements (cross-country running, jumping on uneven ground, spin on one foot, prolonged squatting). In addition, the rupture can be caused by diseases of joints, tissue ageing, or pathological abnormalities. Damage can be a sharp strong blow to the knee or a quick extension of the legs. The nature and location of damage is possible to distinguish several types of breaks:
- longitudinal (vertical);
- oblique (patchwork);
- transverse (radial);
- tear anterior horn lateral or medial meniscus;
- rupture of the posterior horn of the meniscus;
- a degenerative tear.
A degenerative tear is associated with changes in the tissues in diseases or due to aging.
The symptoms of meniscus damage
Damage of the meniscus of the knee joint there are two characteristic of the period — acute and chronic. The acute phase lasts 4-5 weeks and is characterized by a number of painful symptoms. The time of damage of the meniscus, usually determined by the sound resembling a crash, and a sharp pain in the knee region. In the first period after the injury, the crackling and pain accompanies man with loads (e.g., traffic on the stairs). In the area of the knee develops swelling. Often a meniscus tear is accompanied by hemorrhage into the joint.
In the acute phase motion of the leg at the knee joint in humans is limited or completely impossible. Due to the accumulation of fluid in the knee region can produce the effect of «floating patella».
Chronic period of meniscus tear is less painful. The attacks of pain occur only during sudden movements of the legs or the reinforced loads. During this period to determine whether the meniscus tear is difficult. For diagnosing injuries of the developed technique, based on the characteristic symptoms.
Symptom science is based on the identification of pain by pressing with your fingers on the outer side of the knee with simultaneous extension of the lower leg. Symptom Landa defines trauma according to the degree of straightening of the leg at the knee joint when the leg lies freely on the surface (with injury to the palm of the hand is placed between the surface and the knee). Symptom of Turner considers the increased sensitivity of the skin on the inner surface of the knee joint and upper tibia on the inner side. A symptom of the blockade establishes the gap in the jamming of the knee when the movement of the person on the stairs. This symptom is characteristic of rupture of the posterior horn of the internal meniscus.
The typical symptoms of rupture of the medial meniscus
Rupture of medial meniscus of the knee joint has a number of characteristic symptoms. Injury to internal posterior horn of the meniscus causes intense pain in the knee region from the inside. When you press your finger in the area of fastening of a horn of the meniscus to knee ligament a sharp pain. Rupture of the posterior horn causes a blockade of movement in the knee joint.
Determine the gap by making flexion movements. It manifests itself as a sharp pain with extension of the legs and rotation of the tibia outwards. Pain also permeates with a strong bent leg at the knee. According to the severity of damage to the meniscus of the knee joint are subdivided into slight, moderate and severe. Small tears (partial) — including horn of the meniscus, characterized by pain and minor swelling in the knee region. Such signs of trauma no longer occur after 3-4 weeks.
The average severity of injury manifested all the symptoms of the acute period, but they are limited and occur during physical exertion, such as jumping, moving up the inclined planes, squatting. Without treatment, this form of injury becomes chronic. This degree is typical of some gaps anterior and posterior horn of the medial meniscus.
In severe injuries the pain and swelling of the knee become explicit; there is hemorrhage in the joint cavity. The horn is completely detached from the meniscus, and its parts are inside of the joints, which causes blockade of movements. Independent movement of the person is hampered. Severe injuries require surgical intervention.
The mechanism of rupture of the posterior horn
Very dangerous the the longitudinal gap (full or partial) usually begins to grow from the posterior horn of the medial meniscus. With the full gap separating the horn part of the meniscus can migrate into the cavity between joints and block their movement.
On the border of the mid-body of the meniscus and the beginning of the posterior horn of the internal meniscus often develop slant breaks. This is usually a partial tear, but the edge may be introduced between the joints. Thus there is a sound like a crack, and pain (shifting pain).
Often the rupture of the posterior horn of the internal meniscus is a blended nature, combining different types of damage. These gaps develop simultaneously in several directions and planes. They are characteristic of degenerative injury mechanism.
Horizontal tear posterior horn medial meniscus originates from the inner surface, develops in the direction of the location of the capsule. This injury causes swelling in the region of the joint space (the characteristic pathology of the anterior horn of the lateral meniscus).
Conservative methods of treatment
Treatment of rupture of the posterior horn of the internal meniscus (and similarly the anterior horn of the medial meniscus) depends on the area of damage and its severity. Based on this determines how conservative or surgical treatment.
Conservative (therapeutic) method is applicable for small gaps and the gap is moderate. This treatment is based on a number of therapeutic measures and often proves to be effective.
The first event — aid when injuries occur. It is necessary to provide to the victim rest; to impose on one knee with the inner side of a cold compress; to carry out the injection of the anaesthetic; apply a bandage plaster. If necessary, clean the puncture fluid.
Usually a conservative approach, long-term treatment for 6-12 months. First, a reduction (reposition) of the knee joint in the presence of blockade. For the lifting of the blockade can be used manual methods. The first 3 weeks should provide the rest, and the knee joint immobilized with plaster splints.
If damaged cartilage is necessary recovery and splicing. With this purpose, appointed a course of treatment with chondroprotectors and hyaluronic acid. As protectors it is recommended to use preparations containing chondroitin and glucosamine. Symptoms of painful and inflammatory processes must resolve with nonsteroidal anti-inflammatory drugs (diclofenac, ibuprofen, indomethacin), and others.
To eliminate swelling and accelerate healing using external funds in the form of ointments (Asan, voltaren, and first days without the other). The process of treatment includes a course of physiotherapy and special exercises. Good effect gives massage treatment.
When severe damage occurs, the need for surgical intervention. At crushing of cartilage, a strong break and displacement of the meniscus, full open front or rear horns of the meniscus need surgery. Surgical treatment is divided into several types: meniscectomy or loose horns; recovery; repair the break; the bond torn horns by means of latches; transplantation of the meniscus.
Recovery is possible when the longitudinal gap of the horn, the separation of the horn from the capsule, the local break without complete separation and in some other cases (if the tissue of the meniscus did not happen degenerative changes).
After the surgery is conducted rehabilitation activities. They include a set of exercises for the development of the knee joint; therapeutic massage and physical therapy methods; acceptance of chondro and non-steroidal means. Sick for up to 12 months must be protected from physical exertion.