Menisci are cartilage discs connecting the femur to the tibia. They play the role of shock absorbers and maintain the stability of the knee joint.
In some sports, in particular in football and hockey, meniscus rupture is one of the most common injuries. However, you can get it without doing sports, for example, kneeling, crouching or lifting something heavy. The risk of injury increases with age as the bones and tissues around the knee wear out.
Functions and structure
The meniscus is a trihedral cartilaginous formation located between the tibia and femur. It consists of about 70% collagen fibers. It also includes special protein compounds. In the outer part, the meniscus thickens. It interacts with the transverse, anterior and posterior meniscus ligaments.
There are two varieties of menisci in the knee joints: external (lateral) and internal (medial). The outer one is ring-shaped. It is more mobile, so lateral meniscus injuries are less common.
The shape of the medial meniscus is c-shaped. Sometimes it has the shape of a disk - in such cases it is a bit larger in size. Since the tibial collateral ligament is located in the middle , the mobility of the meniscus is limited, which leads to more frequent injuries.
The cartilaginous disc is attached to the capsule of the knee joint. It consists of a body, a front horn and a back horn.
These cartilage formations provide stability and help distribute body weight, keeping bones from rubbing. In addition, they help to concentrate nutrients in the tissues that cover the bones of the thigh and lower leg. As shock absorbers, menisci reduce the pressure exerted on the knee joint.
Also, with their help, the motor ability of the knee joint is stabilized, the load is distributed and pressure on its surface is reduced, friction between the tibia and femur is reduced, and the range of motion is limited.
Symptoms and Diagnosis
A torn meniscus usually causes swelling and localized pain in the knee. The pain intensifies when twisting or squatting. Sometimes a fragment after a break can move inside the knee and “block” it, limiting mobility.
In addition, the symptoms are:
- a squat crunch that indicates that the horn of the medial meniscus has been torn;
- the presence of bleeding in the joint area (most often occurs when the medial meniscus ruptures).
Sometimes, when a lateral meniscus ruptures, the symptoms are confused with the symptoms of arthritis of the knee joint with softening of the articular cartilage. In some situations, chronic joint inflammation causes similar symptoms. In this case, additional clarifying diagnostic procedures are required.
When establishing a diagnosis, the patient’s complaints, the degree of manifestation of symptoms are taken into account, the damaged area is examined. In this case, attention is drawn to the possible causes of the gap. The diagnosis is confirmed by instrumental examinations:
- radiography with a contrast agent;
- ultrasound examination (ultrasound) ;
- computed tomography (CT);
- magnetic resonance imaging (MRI).
Diagnostic arthroscopy may also be performed.
Types of injuries
The gap can occur in one or more directions. Traumatic injuries are usually vertical, while those resulting from degenerative changes in the lateral meniscus of the knee joint are usually horizontal.
The most common type of injury is radial rupture. It is directed from the medial rim to the lateral and runs along the radius. Such damage is also bent. It can pass along the meniscus, in a circle. Another view is the “bucket handle-shaped” gap. It is dangerous because the “bucket handle” can roll over and fall on the other side of the femoral head, as a result of which the joint will be blocked.
The gap may also be:
- longitudinal vertical;
- patchwork oblique;
- radially transverse;
- with damage to the front or rear horn.
Degenerative breaks can occur not only due to aging processes, but also as a result of repeated injuries. Damage can also be complete and partial, with or without displacement. Rupture of the anterior horn of the lateral meniscus is less common than similar damage to the posterior. The chronic course of the disease and untimely treatment can lead to damage to the cartilage and the anterior cruciate ligament.
Groups and risk factors
Lateral meniscus tears are most common in athletes. Traumatic injuries usually result from significant lateral load and twisting of the lower leg, as well as with hyperflexion (excessive bending). Degenerative breaks are more common in people over 40 years old and can occur without much injury. Smokers are at a higher risk of such damage.
Most often, such disorders in the body are found in people over 30 years old. In those younger, such injuries are less common, since the meniscus is still quite elastic. It weakens with age, and injuries occur more often, even from simple movements, such as crouching or moving on an uneven surface.
In addition, such damage to the lateral meniscus can occur in the following cases:
- with too sharp abduction of the lower leg;
- in the presence of rheumatism and gout, which lead to degenerative changes and tramming;
- due to secondary injuries, bruises or sprains;
- with significant physical activity in combination with high body weight;
- in case of congenital weakness of joints and ligaments;
- with chronic inflammation of the knee joint.
Therapy
The treatment for rupture of the lateral meniscus will depend on its size, type and location. Most likely, the doctor will recommend rest, taking painkillers and applying cold to reduce swelling. Physiotherapy may also be suggested. This will help strengthen the muscles around the knee and maintain its stability.
During the first few days after the injury, cold is applied every 4 hours for 15-30 minutes. This helps minimize pain and discomfort. Using an elastic bandage and taking non-steroidal anti-inflammatory drugs like Ibuprofen will also help relieve swelling. With this treatment, you can gradually return to normal activity.
If these procedures do not help or the injury is too severe, your doctor may recommend surgery. For diagnosis, magnetic resonance therapy (MRI) can be done or a study performed using an arthroscope. This instrument is equipped with a camera that allows doctors to view joints from the inside.
During the examination, the degree of damage is established. Damage to the lateral meniscus of the 2nd degree, as well as breaks of the 1st degree, most often do not require surgical intervention. Medications can temporarily reduce pain and swelling, but they cannot help self-repair damage. With more serious injuries, such as damage to the anterior horn of the lateral meniscus of the 3rd degree, the likelihood of surgery is very high. If the operation is not performed, in the best case, edema and pain will be eliminated, and the patient will be able to resume normal activities. In the worst case, the knee will be “blocked” as a result of damage, significantly limiting its mobility.
Features of surgical treatment
When the lateral meniscus is torn, the operation is to remove or cut off the torn segment using an arthroscope and specially designed tools. Since only its outer quarter has blood supply, stapling will be successful when a rupture occurs in this vascular region. Gaps in the non-vascular region are unlikely to heal and, therefore, must be removed.
Degenerative changes in the anterior horn of the lateral meniscus are a source of discomfort for a significant number of patients. The effectiveness of treatment in conditions of chronic degeneration remains low. Over time, complex breaks can occur. Non-surgical therapy focused on non-steroidal anti-inflammatory drugs and physiotherapy can relieve pain and also improve the mechanical function of the knee joint. For patients unresponsive to conservative therapy, arthroscopic partial meniscectomy can provide short-term pain relief, especially in combination with an effective regular physiotherapy program. Patients with overt symptoms and meniscus abnormalities may benefit from arthroscopic partial meniscectomy, but surgery does not guarantee success, especially with concomitant articular pathology.
During a general arthroscopic meniscectomy, the entire meniscus is removed.
Contraindications
The doctor may refuse to perform the operation in the following cases:
- in the patient’s state of health, in which it is impossible to use anesthesia (diseases of the cardiovascular, respiratory, urinary systems in the decompensation stage);
- in the presence of infectious diseases of the knee joint;
- in old age;
- in the presence of purulent infections in the body;
- in case of significant damage to the capsule of the knee joint, as well as contracture, ankylosis, adhesions, complete rupture of ligaments;
- with a history of stroke or heart attack;
- in the presence of cancer.
Types of operations
Depending on the degree and location of the injury, the age of the patient and some other factors, different types of surgical intervention are performed:
- arthroscopic surgery;
- arthroscopic partial meniscectomy;
- arthroscopic complete meniscectomy.
A meniscus recovery operation can also be performed, which allows you to maintain its structure and performance. Internal bonding is carried out without incisions. For this, special clamps are used. In the case of complete destruction of the cartilage and the ineffectiveness of other methods of treatment, a meniscus transplant can be performed.
Preparation for surgery
Before the day of the procedure, the patient must undergo an examination, including blood tests, x-rays, MRI, ECG, fluorography. If you have any health problems before surgery, such as a cold, fever, infection, rash, you should notify your doctor.
During the week before the operation, it is advisable to adjust your lifestyle: follow a light diet, abandon bad habits.
Arthroscopy of the knee
This method of surgical treatment is considered minimally invasive. During such an operation, the doctor makes small incisions. An arthroscope is inserted into them, allowing a detailed examination of the gap, which is then stitched.
This operation is performed if:
- the injury was recently;
- the rupture occurred in an area that is well supplied with blood;
- the patient is young.
The rupture site is important because if it occurred in an area where there is no blood supply, there is a high probability of a seam divergence, the edges cannot grow together, and another operation will be necessary.
With such an operation, the meniscus and joint functions are preserved, good forecasts of further treatment, and a minimal risk of arthritic changes.
The disadvantages of this treatment method are associated with difficulties in determining the necessary indications, the complexity and high cost, as well as the high risk of complications and a long recovery period.
When performing arthroscopic stitching, the joint is not opened, which reduces the possibility of infection and trauma to the joint. This type of operation is most often used for rupture of the horn of the meniscus.
Operation
The procedure is performed under general anesthesia. The leg is bent at a slight angle, then small incisions are made through which an arthroscope and instruments are inserted into the joint cavity. The joint is washed to remove blood clots, after which the edges of the torn meniscus are sutured. To do this, use surgical thread or absorbable staples.
In the absence of any complications, the patient is discharged after a few days. Further rehabilitation takes place on an outpatient basis. The recovery period after such an operation is approximately a month.
The most common complications with this method of treatment include infection of the tissues or the discrepancy of a poorly applied suture.
The arthroscopic procedure for diagnosing and repairing a meniscus rupture lasts about one hour. If the surgeon can see the damage with an arthroscope, he can determine if there is a chance to stitch it, or whether partial or complete removal will be necessary. In the event that recovery is possible, the procedure completes arthroscopic surgery. Another incision is made, and the doctor inserts surgical instruments to restore the meniscus. The operation includes suturing the torn edges, which further contributes to its healing. Using this method, only 10% of such injuries are restored. In most cases, a partial meniscectomy is required when the damaged part is removed and the healthy tissue remains intact.
If the cartilage is in good condition, despite a partial rupture of the lateral meniscus, restoration of its integrity is preferable to removal, even partial. Gaps at the outer edges, called peripheral capsular lesions, can be repaired with arthroscopic surgery. In addition, tears that extend vertically through the meniscus can often be stitched through arthroscopic surgery, leaving it intact.
Arthroscopic meniscectomy
In the case of more serious damage, respectively, a more complex operation is performed. It is called arthroscopic meniscectomy, which can be partial or complete.
This type of surgery is considered a minimally invasive procedure used to treat torn meniscus cartilage in the knee. This only removes the broken segment. Some patients require the help of physiotherapists after surgery. The average time to return to all activities is 4-6 weeks after surgery.
Efficiency
Removing a torn segment, in particular, with damage to the anterior horn of the lateral meniscus of the 3rd degree, very effectively restores the function of the knee for a long period. With total removal, there is a chance of arthritis in 10-15 years.
A torn segment must be removed relatively quickly (within a few months) so that it does not damage the articular cartilage. Delay can lead to muscle atrophy and articular contracture, making it harder for the patient to eventually restore normal function after surgery.
Complications and Risks
Patients should understand that not all the consequences of rupture of the lateral meniscus of the knee joint are restored. Cartilage in the knee may simply be worn over time, which will prevent the surgeon from stitching it. In this case, the doctor will remove it completely and eliminate any other problems in the knee.
Complications of arthroscopic meniscectomy include infection and deep vein thrombosis (clot formation). There is also a certain risk when using anesthesia.
The risk of infection reduces the use of intravenous antibiotics. If a blood clot forms, anticoagulants are prescribed to the patient to prevent it from increasing or moving.
Surgical procedures and the risks associated with surgical intervention in case of damage to the anterior horn of the lateral meniscus will depend on the condition of the patient and his individual needs. Patients should keep in mind that their age plays an important role in the success of the procedure. Reconstructive surgery is usually most effective for people under the age of 30 who have undergone the procedure during the first two months after an injury. For people older than 30 years, the probability of success of the operation decreases, because the meniscus tissue naturally begins to deteriorate and weaken with age.
Recovery and rehabilitation
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