The main causes of meniscus damage are as follows:
• Dislocations or subluxations,
• Falls and knees,
• Unnatural extension of the knee,
• When a meniscus is twice injured in the same place, a chronic disease occurs.
• Other joint diseases: arthritis and arthrosis, gout and rheumatism.
• Metabolic disease,
Frequent trauma to the knee, untreated joint diseases and constant pressure on the knee can lead to chronic diseases, which is very dangerous. The meniscus cartilage is destroyed, they can no longer perform their functions, cracks or erosion can occur on the surface of the joint. Key risk factors:
• Hard physical work,
• Professional activities in the field of football, skiing or figure skating,
• Frequent and prolonged squatting,
• Weak muscles and ligaments.
Symptoms of a meniscus injury
For diseases associated with the meniscus, two forms of the course are characteristic - acute and chronic.
In the acute period, the symptoms are as follows:
• The pain in the knee is so strong that a person cannot stand on his foot,
• Inability to bend or bend the knee,
• Possible accumulation of blood in the joint due to vascular damage.
If the appeal to a specialist is postponed for 2-3 weeks, then the disease becomes chronic. And the symptoms appear slightly different:
• Acute stitching pain even at rest,
• The knee joint completely loses the ability to move,
• muscles atrophy,
• A click is heard in the knee joint when trying to move,
• A swelling is visible and an increase in the temperature of the skin around the knee is observed,
• The knee joint is greatly increased in size.
Meniscus injuries are easily confused with other diseases of the knee joints, as their symptoms are similar. Therefore, you can not start treatment without consulting a qualified specialist.
Meniscus treatment without surgery
Initially, the knee is anesthetized by puncture in the joint and getting rid of the accumulated fluid. If necessary, eliminate articular blockade. To ensure a state of rest, use a gypsum plaster or splint for up to 6 weeks. The appointment of non-steroidal anti-inflammatory drugs and cold compresses is prescribed. Treatment of the meniscus of the knee is not limited to taking medication and immobilization. Therefore, after eliminating pain and inflammation, a physical therapy course and physiotherapy are prescribed (acupuncture, kinesiology, hirudotherapy, massage, mud therapy, laser exposure). First, it is recommended to start walking with the help of auxiliary devices (cane, walkers, crutches) and, observing your own health, gradually resume normal activities.
Using mud to treat meniscus
With a correctly selected complex, treatment of the meniscus of the knee joint will take about 7 weeks, after which you can resume playing sports.
Causes of meniscus problems
- constant loads
- mechanical impact, falling, jumping or a strong blow resulting in trauma to the meniscus of the knee joint,
- complications after surgery
- metabolic and blood circulation disorders,
- oncological diseases, diabetes, joint diseases,
- repeated injuries
- improper rotation of the joint.
Provoking factors for the development of meniscus disease:
- constant sharp extensor movements,
- congenital or acquired ligament weakness.
Menisci are very susceptible to damage. Symptoms appear depending on the type of damage, the main diseases and their symptoms include:
- Meniscus inflammation. Determining meniscus inflammation is quite simple:
- swelling is visible with the naked eye (see photo below),
- noticeable pain, which can subside over time (with increased loads and circulatory disorders, the pain syndrome intensifies),
- restriction of movements
- clicks in the knee.
Symptoms of meniscus inflammation are often similar to a gap, so it is not recommended to draw conclusions and prescribe treatment on your own.
- Meniscus tears. The main symptoms of meniscus rupture:
- meniscus inflammation,
- ongoing pain
- joint immobility
- crunching while moving,
- bleeding in the joint is a clear sign that a rupture of the medial meniscus of the knee joint has occurred.
Symptoms of a meniscus rupture do not differ depending on the location of the lesion. Whether the lateral meniscus is damaged or the medial meniscus ruptures, the sensations will be the same.
Meniscus damage classification
The American doctor Stoller identified several stages of meniscus damage. His technique allows you to accurately determine the diagnosis and prescribe treatment.
- First degree The disease is characterized by damage to the posterior horn of the medial meniscus. Physiological causes cause this violation. The lesion is located inside the meniscus, most often a person does not suspect a violation in the joint. Typically, the initial degree of damage is detected accidentally during a routine examination and is in the nature of meniscus inflammation.
- Meniscus damage 2 degrees has a pronounced clinical picture. The general structure of bone tissue is not disturbed. Cartilage retains its original shape. In the second stage, the inner meniscus is damaged. A person feels discomfort in the knee joint. With the development of degenerative processes in the second stage, the meniscus ruptures.
- The heaviest 3 degree damage is characterized by a complete rupture of the meniscus of the knee joint. The anatomical structure is disturbed, cartilage is torn off 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 rupture of the meniscus of the knee joint without surgery.
Non instrumental research:
- Epley's test. A person lies on his stomach, bends his leg at right angles and presses on the heel, while shin and foot are rotated. The test is considered positive in the presence of pain,
- McMurry test:
- man is laid on his back. The knee is bent as far as possible and is clasped by the hand. The tibia is rotated outward, the knee is bent to the right angle. If there is a rupture of the meniscus, the patient will feel pain from the inside of the joint,
- being in the same position, the person bends the leg at the right angle in the knee and hip joint. One hand grabs the knee, the second makes circular movements of the lower leg in and out. A meniscus damage test is considered positive if clicks are heard.
To confirm the symptoms of rupture of the meniscus of the knee joint, instrumental studies are used. These include Ultrasound, MRI, X-ray and arthroscopy:
- First of all, an x-ray examination and ultrasound are prescribed. The meniscus is not visible on the x-ray, a study is necessary to make sure there is no fracture. Ultrasound is prescribed as an addition to an x-ray.
- MRI makes it possible 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 comprehensively visualize the meniscus, the accuracy of MRI is 95%. Based on this method, a decision is usually made how to treat the meniscus,
- computed tomography is effective in detecting inflammatory processes. The tomograph creates a series of images that make it possible to draw a conclusion about the condition of the joint at various depths. This method is most effective for confirming the source of pain, the presence of a fracture, and the visualization of bleeding. The meniscus itself cannot be examined using tomography, so the technique is complementary to MRI,
- diagnostic arthroscopy allows you to make 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 carry out the necessary manipulations to eliminate some of the consequences of the injury - remove the accumulated blood, sew the edges of the meniscus.
Conservative treatment or, in other words, meniscus treatment without surgery is carried out due to drugs of different actions:
- non-steroidal anti-inflammatory drugs (Ibuprofen, Diclofenac).
- rubbing with an ointment (Voltaren, Ketorol, Alezan).
- Cartilage repair is performed using chondroprotectors such as chondroitin sulfate.
- Ostenil is prescribed to increase mobility and relieve pain inside the joint bag. After the first injection, there are clear signs of improvement. Usually 5 injections are prescribed.
Treatment of a meniscus without surgery is successful infrequently 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 for separation of the meniscus or in the presence of complications. A positive result is observed in 65% of operations, and knee arthritis 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 a stable state of cartilage. This is due to the fact that in the presence of pathology, 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 rupture of the horn can be treated. The injuries of this operation are 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 the damage to the meniscus of the knee joint. 2 punctures are made for arthroscope and surgical instruments. An arthroscope allows the surgeon to reach the most distant sites. The meniscus is sewn with non-absorbable threads 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 sites, 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 function of the knee joint.
- Meniscus internal fixation - treatment of meniscus rupture with this method began to be used relatively recently. Minimal trauma and the absence of direct surgical intervention are the main advantages of this operation. Its essence is the use of fixators without an incision, due to which rehabilitation takes less time than usual.
- Transplantation - 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 sew 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, advanced age, polyarthritis and atherosclerosis. Both lateral and medial menisci are subject to replacement. The peculiarity of the operation is that the implant has to wait a long time, as it should ideally suit the patient. But with a successful outcome of the operation, the risk of rejection is minimal. Duration of operation no 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 to reduce pain, treatment with folk remedies based on oils and herbs can be used.
- birch buds, violet and nettle leaves, 1 tablespoon each,
- 500 ml of boiling water.
Grind the ingredients, mix them and pour boiling water. Insist 30 minutes, then strain. Take 4 times a day, dosage - 1⁄4 cup.
Antispasmodic anti-inflammatory drug. Take in equal proportions clove oil, camphor, menthol, eucalyptus and winter-loaf, 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 dressing. Repeat 2-4 times a day.
Treatment of a meniscus without surgery at home is possible with the help of warming compresses. The maximum effect is given by the following compresses:
Honey based compress.
- mix 1 tablespoon of aloe leaf pulp and 2 tablespoons of honey,
- grease the knee with the mixture, wrap the affected area with cling film,
- the duration of the procedure is 1 hour.
This compress removes edema and stops inflammation.
The second way:
- mix honey and alcohol in a ratio of 1: 1,
- warm in a water bath and apply to the inflamed area,
- leave for 2 hours
- repeat the procedure twice a day.
It is strictly forbidden to use exercises as a treatment without rupture of the meniscus of the knee joint, since with this injury, first of all, the knee needs to be immobilized.
Exercises for the treatment of meniscus are done only at the recovery stage, physical therapy has a positive effect:
- the first two days perform leg extension. Still need to squeeze the object between the legs bent at the knees,
- from the third to the tenth they raise the straight leg, the starting position is lying on the side and back. Sitting on a chair you need to straighten your knee. Keep your straight leg tense for 2-3 seconds,
- in the third week it is recommended to walk 2-3 km, ride a bicycle. Exercise: circular and swinging leg movements.
All exercises are recommended to be performed under the supervision of an instructor. It is forbidden to kneel and squat the whole rehabilitation period.
Physiotherapy after surgery is prescribed in order to enhance cell regeneration, improve blood circulation and metabolism. The main methods of physiotherapy:
- electrical stimulation
- laser therapy
In order to increase patient efficiency, they teach self-massage techniques, the rest of the procedures are carried out directly in the medical institution.
Injury to the meniscus of the knee does not imply preventive measures. Menisci cannot be additionally impacted, strengthened or made thicker. The doctor can give general recommendations: walk carefully, avoid wearing high heels frequently, use protective knee pads during sports.
The knee meniscus is an important component of a full healthy life. If there are the slightest symptoms of meniscus damage, do not postpone the problem. Seek immediate medical attention. Only timely diagnosis will reveal how injured menisci are. Based on this study, the doctor will decide which treatment method should be used in a particular case.
Prognosis after treatment
Most often, the treatment of menisci has a positive outcome.There are several factors that influence recovery:
- patient 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 of repeated injury, since cartilage is subject to displacement,
- break place. Torn damage is much more difficult to sew than damage in one plane, and healing processes take longer.
- freshness of the trauma of the meniscus of the knee. The neglected cases when the patient has been self-medicating for a long time are much longer restored.
Complications are possible - purulent inflammation, hemorrhage in the joint or teething. 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.
Types of injuries
- meniscus pinching
- cartilage rupture
- separation from the cartilage of its part
- degenerative changes in cartilage
To make a diagnosis, the doctor interviews the patient, examines the damaged knee, applies specific pain tests. As diagnostic methods, radiography is in demand, which allows to exclude a bone fracture and ultrasound, giving an assessment of the condition of the cartilage and ligamentous apparatus.
It is more advisable to use MRI, which allows for a single diagnostic procedure to get a complete picture of the state of all elements of the joint and evaluate how badly the meniscus of the knee is injured.
- interrogation of the patient and history taking
- specific pain tests
- Ultrasound (ultrasound)
- MRI (magnetic resonance imaging)
If a cartilage displacement has occurred, the traumatologist will be able to quickly restore joint mobility by repositioning (decreasing) the meniscus. In the future, the patient will be recommended to wear a retaining bandage, knee brace or elastic bandage for 2-3 weeks. In all other cases, the patient will have a longer and more multifunctional therapy.
First aid is provided immediately after injury. It includes complete rest of the limb, immobilization (immobilization) of the knee and the application of a cold compress, which will help less damage to the damaged joint. To prevent or relieve edema, the affected leg is placed on a raised platform.
The choice of treatment
When choosing a treatment method: conservative or surgical, as well as the place of treatment: in a hospital or at home, a traumatologist evaluates a set of parameters and chooses a more rational treatment of the knee meniscus.
Parameters that affect the choice of treatment:
- severity and nature of the injury
- survey results
- patient age
- cartilage condition
The age of the patient with this choice is one of the main parameters. This is due to the fact that with age, the amount of collagen in the meniscus decreases, its nutrition deteriorates. Cartilages lose their elasticity, their structure becomes weaker. Patients over 45 years of age rarely have a meniscus treatment of the knee joint without surgery, because there is a minimal chance that the gap will grow together on its own.
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With severe injuries, accompanied by severe pain, hemarthrosis and blockade of the joint, hospitalization is indicated. With minor injuries, you can be treated at home.
Do not engage in self-diagnosis and self-medication. The diagnosis is made only by the doctor, and he also decides how to treat the meniscus: in a hospital or at home.
Symptoms and signs of meniscus damage
Symptoms arising from injuries depend on the severity of cartilage tissue damage. The following types of damage are distinguished:
Microtrauma. With minor tears, bruises and injuries affecting the internal structures of the cartilage, the symptoms are minimal or nonexistent. The mobility of the knee is maintained. Slight pain, swelling, discomfort and clicks in the joint may be present when moving.
The gap. With this injury, both the size of the gap and its location matter. Based on them, the treatment method is selected. Symptoms also depend on the severity of the injury, but there is always swelling, pain of varying degrees of intensity, aggravated by movement, limiting joint mobility. With severe breaks, hemarthrosis can join.
Separation of part of the cartilage. With this injury, the meniscus is torn into several parts, while the torn piece can remain in its place or fall into the joint cavity. When the meniscus is displaced, the joint always blocks. This is a serious injury occurring with severe pain, swelling, hemarthrosis, loss of mobility. To eliminate it, only surgical treatment is used.
Pinching. With this injury, the cartilage retains its integrity, but is displaced in the joint cavity. Its displacement causes severe pain and blocking of the joint, but for treatment it is enough to reposition (decrease) the meniscus.
If pinched, compressed (squeezed), bruised or slightly torn, conservative treatment of the meniscus without surgery is performed. A joint puncture may be needed to remove the accumulated exudate. It is necessary to avoid excessive load on the joint, in some cases a temporary restriction of mobility is applied for a period of not more than 3 weeks.
With prolonged immobilization of the joint, adhesion of the cartilaginous surfaces occurs, leading to joint contracture and causing a persistent limitation of the amplitude of movements.
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- chondroprotectors (arthra, glucosamine, elbon, chondroitin sulfate, etc.)
- NSAIDs (meloxicam, nise, ibuprofen, diclofenac, etc.)
- Exercise therapy
If the meniscus is very painful, then painkillers of a wide spectrum are prescribed. Comprehensive drug treatment includes non-steroidal anti-inflammatory drugs (NSAIDs) in the form of tablets, ointments, injections and chondroprotectors. They help relieve pain, inflammation and restore cartilage.
To achieve a sustainable effect, chondroprotectors should be drunk for at least 3 months. No need to self-medicate and take drugs without prescribing a doctor.
Meniscus recovery will be faster if physiotherapy, exercise therapy and massage are added to medical treatment. The physiotherapeutic component includes muscle strengthening muscle stimulation, as well as laser therapy and magnetotherapy, which improve metabolic processes in cells. In parallel with the above methods of treatment, traditional medicine recipes can be used at home, the most popular of which are compresses, tinctures and coniferous baths.
If conservative methods failed to cure the meniscus or there are signs of severe cartilage damage, resort to surgical treatment. Severe injuries: separation of a part of the meniscus, deep rupture, fragmentation are indications for surgical intervention. Depending on the nature of the damage, the presence of complications, the age of the patient, surgical treatment can be carried out in various ways:
- complete or partial removal (meniscectomy)
- stitching (restoration) of the meniscus
When a small part is removed, it is removed, and the edge of the cartilage is leveled. A complete meniscectomy is indicated for severe degenerative changes in the cartilage. It is a very traumatic operation and leads to arthrosis. Meniscus stitching and repair is used to treat tears only in patients no older than 45 years old, provided there is no degenerative process in the cartilage.
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Alternative methods of treatment
With minor microtraumas and minor damage to cartilage, a good addition to medications will be the treatment of meniscus with folk remedies. Homemade preparations are made from natural ingredients and have a delicate effect on the affected area.
It must be remembered that alternative methods of treatment are symptomatic therapy that does not affect the cause of the disease. They can alleviate symptoms, relieve signs of swelling, reduce pain, but cannot restore the structure of a badly damaged meniscus.
At home, warming compresses are used to relieve puffiness, improve blood circulation and nutrition of the joint. To prepare them, use burdock leaves, aloe pulp with honey, onions with sugar, mud from salty sources. Before use, the composition for the compress is heated to 36-37 ° C and applied to the diseased joint. From above the knee is wrapped with cling film, insulated with a woolen scarf and fixed. The compress is held for several hours (from 1 to 3-4), sometimes left overnight.
Lubricate the knee with various tinctures and apply an insulating bandage. The procedure can be repeated several times a day for 20-30 minutes. For tinctures use wormwood, garlic, nettle, birch leaves, etc. Coniferous baths have a positive effect - they relax muscles, relieve swelling, reduce soreness, and improve blood circulation.
Meniscus injuries are located in a very wide range. They can manifest as a small bruise or a complete rupture of the cartilage. Symptoms of damage are individual and depend on many factors. Untreated natural shock absorber injuries can cause meniscopathy and arthrosis. If you have a knee injury, be sure to consult a doctor. He will carry out the necessary diagnostics, diagnose and prescribe treatment if necessary.
Compliance with all the instructions of the attending physician will allow you to cure the meniscus and avoid complications that can lead to irreversible changes in the knee joint.
Causes of meniscus problems
In the cavity of the knee joint there are two cartilaginous formations - the meniscus of the knee. Their main purpose is depreciation during movement and protection of articular cartilage. They limit excess mobility and reduce friction in the knee joint.
Causes of tearing or tearing of the meniscus: a sharp sliding hit with a heavy object on the knee, falling on the edge of the step with the patella or injury, accompanied by a sharp turn of the lower leg outward or inward.
Repeated injuries or bruises lead to a chronic disease of meniscopathy, and subsequently to rupture of the meniscus. As a result of chronic microtrauma, gout, rheumatism, general intoxication of the body, degenerative meniscus changes develop. During an injury, the meniscus breaks and ceases to fulfill its main purpose, becoming for the body an almost alien body. And this body will slowly destroy the articular surface. An untreated injury passes into deforming arthrosis, and a person often becomes disabled.
This disease is more prone to football players and athletes playing sports, people who spend most of their time working on their feet.
It happens that the meniscus can be damaged as a result of a combined injury, when a strong blow hits the knee and the lower leg abruptly turns in or out.
For injuries, ice is applied immediately (or something cold)
Symptoms of Damage
Often at the initial stage, a disease such as a 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 meniscus rupture.
- A pronounced pain of a spilled nature, after a while it is located on the inner or outer surface of the knee.
- Difficulty climbing and descending stairs.
- Trophy of muscle tissue is sharply reduced.
- When the joint is bent, a characteristic click occurs.
- The joint is enlarged in volume. With this symptom, treatment begins immediately.
- Pain in sports.
- The rise in temperature in the joint.
Symptoms of damage are often non-specific, the same symptoms can occur with severe bruises, sprains, arthrosis, so a thorough examination of the patient is required from the doctor.
Depending on the injury, the meniscus can tear off the capsule, tear laterally or longitudinally, and may be squeezed. The external meniscus is quite mobile, so it is more often squeezed, and tears occur at the meniscus fixed in the cavity of the knee joint.
Naturally, when the knee joint is damaged, your movements are severely constrained
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 life activity, the doctor chooses the method of treatment of the meniscus of the knee: conservative or surgical.
But first aid, regardless of the severity of the injury, the victim is immediately provided with complete rest, a cold compress and the application of an elastic bandage on the knee joint. To prevent or relieve swelling, the patient’s leg is placed a little higher than the chest level.
The doctor at the clinic recommends that the patient take a picture to make sure the bones are intact. And to exclude the presence of internal damage, an ultrasound scan is performed. In the diagnosis of meniscus damage, a special role is played by computed tomography and magnetic resonance imaging. But a complete picture of the damage allows you to see the arthroscopy of the knee joint.
If only a meniscus shift occurred, then an experienced traumatologist will be able to quickly deal with the problem. Then, for about three weeks, gypsum is applied, after which rehabilitation therapy is prescribed.
The traditional treatment of the disease includes non-steroidal pain medications: Meloxicam, Ibuprofen, Diclofenac.
To restore cartilage, the joint needs chondroprotectors, which improve the metabolism in regenerative tissue and intraarticular fluid - this is Glucosamine, Chondroitin sulfate. Dietary supplement Collagen Ultra prevents inflammatory processes and is involved in the restoration of cartilage, increases its water-holding properties.
To rub the joint, ointments of Alezan, Ketoral, Dolgit, Voltaren, Balsam stone are used.
With limited mobility and pain, the drug Ostenil is administered inside the joint bag. Improvement occurs after the first injection. At least five ampoules are required for the course of treatment.
If possible, you can use bee stings or Tentorium cream, which contains bee venom.