Damage to the meniscus: grading stoller

Diagnosis and classification of meniscus lesions

The knee joint is complex in its structure - it contains menisci. These formations serve to separate the joint cavity into two halves. When moving, they play the role of stabilizer - after the articular surfaces they are displaced in the necessary direction.

They are also necessary as a shock absorber - when walking and running, their "softening" occurs, and the shocks are almost not transmitted to the trunk.

This function causes the most frequent damage to these formations with injuries of the lower limb.

In 90% of cases, the medial (or internal) meniscus is involved in the process.

Meniscus is a dense plate of cartilage, located inside the joint capsule. In the knee, two such formations are the medial and lateral menisci.

Outwardly they resemble a semicircle in shape, and on the cut they have the shape of a triangle. In their structure, the front and back parts (or horns) and the central body are distinguished.

The tissue of these plates differs from the usual cartilage - it contains a large number of ordered collagen fibers.

And the changes occur along the length of the fibers - longitudinally.

Traumatic injury of the meniscus

At the heart of this type is always the injury of the knee joint. It can be direct - for example, with a sharp impact on the inner surface of the knee or jump from a height. In this case, there is a sharp decrease in the volume of the joint cavity, and the meniscus is crushed by the articular surfaces of the bones.

Indirect variant of damage is predominant.

A typical mechanism of occurrence is a sharp movement in the knee (flexion or extension), at which the leg is slightly turned outward and inward.

Since the medial meniscus is less mobile, then with a sharp displacement it breaks away from the capsule and the collateral ligament. When displaced, it falls under the pressure of bones, which leads to its rupture.

Symptoms

Depending on the degree of damage to the cartilaginous plate, the amount of manifestation will change. At the heart of the changes is the magnitude of the meniscus rupture, its displacement and the amount of blood flowing into the inside of the joint (hemarthrosis).

1. Light Art. characterized by mild or moderate pain in the knee. Movement disorders are not expressed - there is only increased pain when jumping or squatting. Above the knee cap - a small edema.
2. Average art. The severity is manifested by severe pain in the joint, reminiscent of the intensity of the bruise. The leg is in a semi-bent position, unbending is impossible even with the help. Walking is possible, but with lameness and periodic "blockades" - the cessation of any mobility. Edema intensifies and becomes bluish.
3. With a heavy art. pain acute and unbearable, most palpable around the patella. The leg is half-bent and fixed - any displacement leads to increased soreness. Edema strong, sometimes injured knee twice as much healthy. The skin around the knee is cyanotic-purple.

If the medial meniscus is injured, then, regardless of the degree of damage, it is possible to identify special symptoms:

• Reception Bazhova - with pressure from the inside of the patella and the extension of the leg soreness increases.
• Symptom Turner - sharply sensitive skin around the knee.
• Sign of Land - in the position of lying under the injured knee, the palm passes freely.

Degenerative meniscus damage

This type of changes in the medial meniscus is based on frequent long-term microtrauma or various chronic diseases.

The first option is usually found in professional athletes or people with heavy physical labor.

Gradual degenerative wear of the cartilaginous plates and reduction of the processes of their restoration lead to a sudden damage to the medial meniscus.

Of the common diseases, degenerative changes cause gout and rheumatism. In the first case, accumulation occurs in the joint of salts, which gradually destroy the cartilage. With rheumatism, however, blood supply is impaired as a result of the inflammatory process.

A characteristic sign of this type of damage is the age of the victims - not earlier than 40 years. The appearance can be spontaneous - even with a sharp rise from the chair. In contrast to traumatic damage, manifestations are rather weak, special symptoms are usually not determined.

1. Pain is a constant sign - aching, not pronounced, intensifies with sudden movements.
2. There is a small edema above the kneecap, which has the property of increasing. But this happens slowly (for several days) and is not accompanied by a discoloration of the skin.
3. Mobility in the leg is usually not limited. Characteristic only the emergence of blockades - with sharp bending or extension suddenly stop any movement in the joint.

Damage diagnostics

Even the most detailed collection of complaints and symptom determination is not enough to accurately assess cartilage plate changes.

This is due to their inaccessibility to direct examination - they are located inside the knee cavity.

Thus, even study is excluded by palpating even their edges - the entire meniscus apparatus is reliably protected by lateral ligaments.

They always start with ray methods - radiographs of the knee joint in two projections. In itself, it is of little informative, since it reflects the state of only the bony apparatus of the knee.

Radiography with contrasting

The initial use of this method is explained by its availability and cheapness.

In case of severe damage, it immediately allows you to determine the degree of change without resorting to more complex studies.

The introduction of contrast agents allows you to accurately characterize the structure of the knee from the inside, determining the defects of the meniscus.

With different in nature changes in the medial meniscus, a violation of this form occurs - depending on the amount of penetration of the contrast, three degrees are distinguished in this defect.

1. The first art. characterized by a change in the internal angle of the wedge not more than a third of its width.
2. The second art. is manifested by penetration of the contrast into the medial angle by half or more than two-thirds of its width (but without disturbing its integrity).
3. For the third art. characteristic is the total filling of the medial angle with the presence of shadows in its field (fragments of the meniscus).

Magnetic Resonance Study of Stoller

Despite the fact that this method is new and relatively expensive, its informativeness in terms of degenerative changes is simply irreplaceable.

Special training is not required - only patience is needed, as this is a long-term study.

Also it is impossible to pass it with metal objects on the body - be it earrings, piercings, rings, various implants (pacemaker, artificial joints, etc.).

Depending on the degree of damage, four degrees of Stoller variation are distinguished.

• Zero art. Is a normal, healthy meniscus.
• The first art. The appearance of a point signal inside the cartilaginous plate, which does not reach the surface, is characterized.
• With the second art. there is already a linear formation, but not yet reaching the edge of the meniscus.
• For the third degree, a signal is characteristic, which reaches the edge, violating its integrity.

Ultrasound

The method of ultrasound is based on a different density of tissues.

The sensor signal, reflecting from the internal structures of the knee, allows you to see changes in cartilage plates, the presence of detached fragments and blood inside the joint.

The only negative - he does not "see" through the bones, which severely limits his field of view on the knee joint.

Treatment methods

The choice of the method of care is carried out on the basis of changes in the cartilaginous plate.

At a slight and moderate degree of damage (without disruption of integrity) a complex of conservative measures is performed.

If there is a complete discontinuity, then surgical treatment is performed to preserve the function of the limb.

A source: http://MedOtvet.com/diagnostika-sustavov/diagnostika-i-klassifikaciya-povrezhdenii-meniskov.html

What degree of damage does the meniscus give to Stoller?

The degree of damage to the meniscus is determined by MRI (magnetic resonance imaging). The study allows to diagnose the localization of the disease and to appoint competent treatment.

American orthopedist and doctor of medicine David Stoller singled out and characterized 3 degrees of pathological process. Changes in the integrity of the meniscus are classified based on the physiological criteria determined during the MRI. The procedure is effective, but costly.

However, only the data of the tomograph give a complete picture of the condition of the meniscus of the knee joints.

Principles of determining the degrees of disease

MRI is a non-invasive method based on visualization of bone structures on the computer screen. The tomograph reveals the slightest violations of the integrity of the cartilage.

Pathological changes of the meniscus are displayed on the monitor and are examined by a specialist. This method is based on layer-by-layer scanning of tissues.

The construction of a qualitative and reliable image is possible thanks to the magnetic field. There is an effect of nuclear resonance. The protons of the atoms, of which the meniscus consists, are involved.

The energy released is fixed by a special sensor. The image is built using digital processing.

In modern medicine, there are 4 basic principles that allow diagnosing the neglect of the disease:

• examination of the severity of the lesion;
• study of signal intensity;
• detection of localization violations;
• revealing the prevalence of pathological changes.

The main criterion for Stoller's classification is the severity of the destruction of the cartilaginous tissue, of which the meniscus of the knee joint consists.

At present, for the diagnosis and the appointment of effective therapy, orthopedists around the world use the technique of the American doctor of medical sciences.

Stoller's classification makes it possible to carry out surgical intervention on time and to keep the knee mobility in full.

The initial stage of the pathological process

Most often, the horn of the medial meniscus is damaged. Infringement is caused physiologically. From this begins the development of the pathological process. If the 1st degree of the disease is diagnosed, do not panic.

The result of MRI shows that the signal of increased intensity is dotted and does not reach the cartilage. The pathological focus is localized within the meniscus.

Density of patients and healthy tissues is different, this is clearly visible on the monitor during the MRI.

At the initial stage of development of pathology the following symptoms are manifested:

• slight pain in the knee during physical exertion;
• slight swelling;
• joint crunching during knee bending or bending;
• periodic instability and unsteadiness of gait.

The human body adapts to the appearance of disturbances. After 3 weeks compensatory functions are activated, the symptoms cease to be noticeable.

In this case, it is extremely difficult to detect pathology, since the patient has no visible reason to consult a doctor.

The initial degree of damage is found during routine examination or MRI of the knee joint for a completely different purpose.

What is the 2nd degree of damage

The results of MRI provide an opportunity to distinguish the initial stage from more serious violations.

If the signals of increased intensity are linear and do not exceed the boundaries of the cartilage, a damage to the meniscus of degree 2 is diagnosed.

The general anatomical structure of the bone tissue is not disturbed. Cartilage does not come off and retains its natural form.

A feature of the 2nd degree in Stoller is a pronounced clinical picture.

The pathological condition is diagnosed immediately after the manifestation of the first symptoms and the person's treatment to the orthopedist. Most often, the internal meniscus is damaged.

He is not as mobile as the outside, and he needs chondroprotectors. The 2nd degree of pathology is characterized by:

• constant pain in the joint;
• increased discomfort during prolonged standing;
• a crunch and clicks in the knee joint with the motion of the foot;
• swelling and redness of the knee;
• soreness of soft tissues;
• loss of balance;
• violation of coordination of movements.

If a person suffers from the 2nd degree of damage to the meniscus by Stoller, conservative treatment is prescribed.

This stage of the pathological process is prone to progression, so it is important to follow all the orthopedist's recommendations.

The development of the degenerative-dystrophic process sometimes leads to the rupture of the meniscus.

What is the 3rd degree of damage

The most difficult stage of the pathological process requires special attention from the physician and the patient. A great role is played by the timeliness of applying for qualified medical care and the orthopedic literacy.

The third degree is characterized by a complete rupture of the knee joint meniscus. Signals of increased intensity are horizontal and reach the surface of the cartilage. The anatomical structure is disturbed, it is clearly visible on the computer screen during an MRI.

Physicians allocate a sub-step 3a. It is characterized not only by detachment, but also by the displacement of the cartilage.

Squats with a lot of weight, high jumps, accidents in the home or at work can be the cause of the violation of the integrity of the cartilage tissue. The clinical picture is sharp and sharp.

The third stage of pathology is characterized by the following symptoms:

• hemarthrosis (hemorrhage into the joint cavity);
• sharp or rapidly growing pain;
• limited movements;
• forced position of the tibia at an angle of 30 °;
• accumulation of reactive effusion;
• redness of the knee.

At the third degree of meniscal damage, the pathology from the acute form often turns into a chronic one. At any time, the disease can become aggravated again.

Relapse manifests itself brightly. The joint can suddenly jam, so the person will not be able to unbend his leg.

In this case, only surgical intervention will help.

To the orthopedist it is necessary to address at the first signs of possible infringement. The doctor will send the patient to the MRI to determine the severity of the disease. The results of the study will help to diagnose and prescribe the right therapy.

A source: https://OrtoCure.ru/travma/menisk/stepeni-razryva-meniska.html

The degree of damage to the inner and medial meniscus by Stoller (2 and 3 degrees)

In its structure, the knee joint is complex, because in addition to the many components, it includes menisci. These elements are necessary for dividing the joint cavity into two parts.

During movements, the meniscus plays the role of an internal stabilizer - together with the articular surfaces it moves in the right direction.

When walking or running, menisci are needed as shock absorbers, as they soften shocks, as a result of which the human body practically does not feel any jolts.

However, it is this ability of the meniscus that causes their frequent injuries. In 90% of injuries, the internal or medial meniscus is damaged.

The structure of the knee

Meniscus is a dense cartilaginous plate located inside the joint cavity. The knee has two such elements - lateral and medial menisci. Their appearance resembles a semicircle, and in the section they have the form of a triangle. The meniscus consists of the posterior region (horn) and the central (body).

The structure of these plates differs from that of conventional cartilage. It contains a huge amount of collagen fibers located in a strict order.

Horns of the meniscus contain the largest concentrations of collagen. This explains the fact that injuries are more susceptible to the inner and central parts of the meniscus.

These structures lack specific fixation points, so when moving they are displaced inside the joint cavity. Limitations in mobility exist in the medial meniscus, they are provided by the presence of an internal collateral ligament and fusion with the lining of the joint.

Injury of the meniscus and its characteristic features

This pathology occurs as a result of a knee injury.

Damage can be direct, for example, a sharp blow to the inner surface of the knee joint or a jump from a height.

The cavity of the articulation decreases sharply in the volume, and the meniscus is injured by the terminal surfaces of the joint.

Trauma in the indirect variant is predominant. A typical mechanism of its occurrence is a sharp bending or extension of the knee, while the leg is slightly turned inside or out.

Since the medial meniscus is less mobile, a sharp dislocation results in its detachment from the collateral ligament and capsule. When displaced, it undergoes bone pressure, which results in tearing and knee ligament tearing.

The severity of the symptoms of the pathology depends on the degree of damage to the plate of cartilage. Displacement of the meniscus, the size of its rupture, the amount of blood poured into the joint are the main changes that entail trauma.

There are three stages of discontinuity:

1. The lung stage is characterized by mild or moderate pain in the knee joint. Movement disorders are not observed. The pain is worse when jumping and squatting. Above the knee cap is hardly noticeable edema.
2. The stage of the middle is expressed by severe pain in the knee, which in intensity is akin to a bruise. The leg is always in a half-bent position, and extension is impossible even by a violent method. When walking, noticeable lameness. From time to time there is a "blockade" - complete immobility. Puffiness builds up, and skin integuments acquire cyanosis.
3. In a difficult stage, the pain becomes so acute that the patient simply can not tolerate it. The most painful area is the patella. The leg is in a fixed, semi-bent state. Any attempt at bias leads to increased pain. The edema is so strong that the diseased knee can be twice as large as a healthy knee. The skin around the joint is cyanotic-purple.

If the damage occurred in the medial meniscus, the symptoms of the injury are always the same, regardless of its degree.

• The symptom of Turner - the skin around the knee joint is very sensitive.
• Reception Bazhova - if you try to unbend the leg or press down on the kneecap from the inside - the pain intensifies.
• Sign of Land - when the patient lies in a relaxed position, under the knee joint the palm passes freely.

To confirm the diagnosis, the doctor assigns a radiograph to the patient, in which a special liquid is injected into the cavity of the affected joint.

Degenerative changes in the meniscus

At the base of changes in the posterior horn of the medial meniscus often lie various chronic diseases and prolonged microtrauma.

The second option is typical for people of hard physical labor and professional athletes.

Degenerative wear of the cartilaginous plates, which occurs gradually, and a decrease in the possibility of their regeneration provokes sudden damage to the internal meniscus.

Since the meniscus feeds due to intra-articular exudate, the above-described processes cause their "starvation." In turn, due to damage to collagen fibers, the strength of the meniscus decreases.

This damage is typical for people over forty. Pathology can occur spontaneously, for example, a sharp rise from a chair. In contrast to injury, the symptoms of the disease are rather weak and may not be determined.

1. A constant sign is a slight aching pain, which, with sudden movements, increases.
2. Above the knee cap small puffiness appears, which slowly but gradually increases, while the color of the skin remains unchanged.
3. Mobility in the joint is usually preserved, but from time to time "blockades" occur, which can be triggered by sharp flexion or extension.

Diagnostic Methods

To correctly assess the changes that have occurred in the cartilaginous plates, the definition of symptoms and the collection of detailed complaints - the measures are inadequate. Menisci are not accessible for direct examination, as it is inside the knee joint. Therefore, even the study of their edges by the method of palpation is excluded.

To begin with, the doctor will appoint a radiotherapy of the joint in two projections. In view of the fact that this method demonstrates only the condition of the bone apparatus of the knee joint, it carries little information to determine the degree of damage to the meniscus.

To assess the intra-articular structures, air and contrast agents are used. Additional diagnosis is carried out using MRI and ultrasound.

Despite the fact that the MRI of Stoller today is a completely new and expensive method, its advisability in terms of studies of degenerative changes is undeniable. No specific training is required for the procedure. The only thing you need from a patient is patience, because the research is quite lengthy.

On the patient's body and inside there should be no metal objects (rings, piercings, earrings, artificial joints, pacemaker, etc.),

Depending on the severity of the changes in Stoller, four degrees are distinguished:

1. Zero is a healthy, normal meniscus.
2. The first is a point signal inside the cartilaginous plate, which does not reach the surface.
3. The second is a linear formation, but it does not yet reach the edges of the meniscus.
4. The third - the signal reaches the very edge and breaks the meniscus integrity.

The method of investigation by ultrasonic waves is based on a different density of tissues.

Reflecting from the internal knee structures, the sensor signal shows degenerative changes in the cartilaginous plates, the presence of blood inside the joint and detached fragments.

But this signal can not be seen through the bones, therefore, in the study of the knee joint its field of visibility is very limited.

The choice of the method of treatment is based on changes in the meniscus plate.

With a mild and moderate degree of degenerative changes (without compromising integrity), a complex of conservative therapy is prescribed.

In the case of a complete rupture, surgical treatment is performed to preserve the function of the limb, in particular, arthroscopy is prescribed, an operation with minimal trauma.

A source: http://sustav.info/travmy/meniscus/stepeni-povrezhdeniya-meniska-po-stoller.html

How to treat the rupture of the medial meniscus?

Various injuries, including ruptures of meniscuses of the knee joint are not uncommon. According to statistics, they occur in about 60-70 people per 10, 00 population per year. There are horizontal and radial discontinuities.

And often meniscus injuries are accompanied by damage to other joint structures. One such combination is the rupture of the anterior cruciate ligament together with the meniscus. Also, about half of people with a fracture of the condyles of the tibia meet a rupture of the medial meniscus.

Main symptoms

During this pathology, two periods are distinguished: acute and chronic. The acute period has a duration of up to 2-3 weeks.

The patient can tell the situation after which the pain in the knee joint began to appear.

However, if the gap has occurred as a result of degenerative changes, then the provoking factor may not be.

Very often, if this is a traumatic injury, the patient may hear a crunch in the knee. Sharp soreness develops.

Subsequently, pain can manifest itself in different ways. If the amount of damage is great, then a person can not step on his leg at all.

But there are also cases when soreness appears only with certain movements.

Another important symptom is the knee joint block. It appears because the section of the meniscus that has come loose or not attached to the capsule moves inside the knee joint.

Depending on the localization of the discontinuity, movements that a person can not produce are usually different.

For example, a rupture in the region of the hindbrain results in a restriction of flexion, while injuries to the body and anterior horn block the extension of the knee.

In addition to pain and mobility limitation in the knee joint area, there may be other symptoms indicative of damage.

• So, in the joint area there is edema, which in an acute period prevents to diagnose what damage there is in the knee.
• At a sufficiently large amount of damage, hemarthrosis may occur. There is swelling of blood in the joint space.
• As a result of the accumulation of inflammatory or bloody effusions, the doctor may find a symptom of a "floating patella" upon examination.
• A few weeks after the onset of the rupture, there may be weakness in the anterior group of hamstrings.

Diagnostics

If pain occurs in the knee joint, you should consult an orthopedic trauma specialist.

Even better, if there is an opportunity to consult a doctor who deals with knee joint injuries. First, the doctor must find out the cause of the development of the lesion.

Whether there was any trauma a provoking factor of development of symptoms, whether there are any chronic knee joint injuries.

Then the entire lower limb is examined. The volume of movements in the hip and knee joint is studied. Examination of the thigh for possible atrophy of the muscles of the anterior group is performed.

Special tests are carried out, for knee extension (test Roche, Baikov and others).

Rotation tests are also performed, based on the appearance of pain in the process of rotational movements in the joint (techniques for Bragard and Steineman).

As a result of inflammation, joint compression and increase in size, it is often impossible to determine the injury only when viewed.

For this, the methods of X-ray and magnetic resonance imaging are used.

Radiography

The X-ray of the joint is a cheaper technique, and often is not inferior to MRI in terms of informativeness. This procedure is performed in several projections:

1. Direct projection, standing, with legs straight and bent at 45 degrees.
2. Lateral projection.
3. Axial projection.

On the roentgenogram, a decrease in the lumen of the joint space is usually sought. If this symptom is present, then probably a volumetric damage to the meniscus or articular cartilage. This makes useless incomplete resections.

Radiography in the axial projection is necessary to exclude chondromalation of the patella.

Also, an overview radiograph is used to check for the presence of "intraarticular mice" (loosely lying inside the joint of the body), subluxation or dislocation of the patella.

MRI

In some cases, MRI is used to diagnose gaps. Such a study allows one to obtain images of the meniscus itself and surrounding tissues in several planes.

Also in this study, there is no X-ray irradiation.

The disadvantages of this technique include the high cost of the procedure itself and the possibility of overdiagnosis, followed by additional procedures.

In the image with MRI, the normal meniscus is a uniform, low-intensity surface. In children, it can be stronger, since the blood supply to the cartilage is better. There is a classification according to Stoller, which characterizes the level of pathological changes in the tissues of the meniscus.

There are four degrees of changes in total:

• 0 degree - unchanged healthy meniscus.
• I degree - there is a focus of the amplified signal, which is located in the thickness of the meniscus, not reaching its edges.
• II degree - the presence of a high-intensity linear signal, which is also located in the tissues, not reaching the edge.
• III degree - a signal of any shape and high intensity, which reaches the edge of the meniscus tissue. The third degree is a true rupture.

Magnetic resonance imaging provides almost one hundred percent accuracy of the establishment of the rupture. One of the diagnostic criteria is the appearance of an amplified signal in the area of ​​the meniscus on adjacent slices.

Methods of treatment

Since the rupture and simple damage to meniscuses occur quite often, it is necessary to know how they are treated.

The treatment for ruptures, depending on the complexity of the lesion, can be conservative and surgical. Separately, it should be noted the suture and the transplantation of the meniscus.

These techniques are used very rarely and do not always give the right result.

Traditional Therapy

Conservative treatment consists primarily in the elimination of pain syndrome. An injection of an anesthetic is given. By puncture, the accumulated fluid or blood is evacuated from the joint cavity. After this, it is necessary to ensure that the knee is damaged and stabilized.

However, do not for a long time completely immobilize the knee. The imposition of a heavy plaster bandage leads to itching, the development of pressure sores and, most importantly, contractures.

These are persistent limitations of movement in the joint, which need to be restored with the help of physiotherapy, injections of botulinum toxin and other methods.

Unfortunately, this is not always possible.

Medicamentous and physiotherapeutic treatment is performed with ruptures of the posterior horn or small radial ruptures. Most often these are breaks of 1 and 2 degrees according to Stoller.

Operative intervention

When indications for surgery should not be postponed for a long time. The reason for this is the damaging effect of the detached piece of the meniscus.

When moving, the cartilage that covers the femur and tibia is destroyed. The process of chondromalacia (defibration and destruction of cartilage) has 4 degrees of severity.

1. At the first degree, softening takes place, but without defibration.
2. At the second degree, the cartilage tissue is broken.
3. The onset of the third stage is characterized by the formation of an inguity or "dent" in the cartilaginous plate.
4. The fourth stage is the complete disappearance of the cartilage.

Meniscatectomy

In historical terms it is important to know about arthrotomic meniscetectomy. Through a large (5-8 cm) incision, the cartilage was completely removed.

However, this operation in the long term gave a large number of complications and did not bring any visible improvement in about 40% of the operated.

Of the complications should be allocated to the development of arthritis.

This operation was replaced by arthroscopic (partial) meniskectomy. The operation is performed using an arthroscope, which allows visualizing the intra-articular cavity.

Stitching is carried out with non-absorbable threads. This method is used more often when the anterior horn and body of the meniscus break.

Approximately 80% of cases are full restoration of the knee joint.

Joint replacement

The development of transplantation has led to the possibility of a complete replacement of our natural shock absorber. The evidence refers to the complete destruction of the meniscus, when the damage causes great problems to the patient. Or when restoration by other means is not possible.

Contraindications include:

• Severe concomitant diseases.
• Elderly age.
• Degenerative changes of the knee joint.

A meniscus rupture is quite a serious pathology, requiring careful diagnosis and proper treatment.

In addition, rehabilitation is also necessary, including the use of chondroprotectors, limiting physical activity and various methods of physical therapy.

In general, this pathology is almost completely corrected by means of modern medicine.

A source: https://prospinu.com/povrezhdenie/razryv-medialnogo-meniska.html

How to treat knee joint meniscus damage

Treatment of knee joint meniscus damage

Damage to the knee joint meniscus, symptoms and treatment is a problem for people who are not used to sit in one place and those who are actively involved in sports.

In the knee system, the meniscus plays a very important role, and his trauma can seriously affect the motor abilities of a person. Any damage to the internal meniscus of the knee joint requires urgent measures and effective treatment.

Poorly healed injuries can lead to the development of various articular pathologies and early disability.

Anatomical and physiological features

The meniscus of the knee joint is a three-faceted cartilaginous lining that separates the femoral and tibia.

The main tasks of such gaskets are to amortize sudden shocks, redistribute the load, reduce contact stress in the joint area of ​​the bones and stabilize the joint.

With bending motion in the joint, more than 80% of the load is perceived by the meniscus, and when the leg is extended, up to 70% of the load.

The inner C-shaped meniscus connects the tibia with the outer capsular boundary of the joint. In its middle, a tibial band is fixed.

This fixation of the medial meniscus reduces its mobility, which is the reason for its more frequent damage (destruction). The outer meniscus closes almost the entire top of the lateral region of the tibia joint.

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 to the inner element.

How is the knee joint meniscus

Both types of meniscus have in their structure such main components: the body, as well as the front and rear horn. The composition of the meniscus is almost 75% formed by collagen fibers with a multidirectional orientation.

The interlacing and orientation of the fibers ensures a very high strength of the structure.

The outer end of the meniscus is made up of a thickened layer of collagen and firmly attached to the joint capsule, while the inner end is slightly pointed and oriented into the articular cavity.

The increased elasticity of the meniscus provides a small amount of a specific protein (elastin). This structure makes the meniscus almost more, times more elastic than the cartilage, which determines the functions of reliable cushioning elements.

If we consider the system of blood flow, then menisci have a specific character.

In them the following zones are distinguished: the red area, which contacts the capsule and has its own blood network; intermediate zone, fed by red zone, and a white zone in which there are no blood vessels, and nutrition occurs as a result of diffusion of nutrient components from the synovial fluid. In the fixation system of the meniscus, the following main ligaments that strengthen the structure are distinguished: a transverse ligament connecting the menisci to each other, the frontal and hind femoral ligaments.

The nature of the problem

In spite of the considerable stresses caused by meniscuses, in a normal state they are able to perform their functions. Another thing is the appearance of excessive loads, exceeding the strength of the fibers.

Such efforts arise, as a rule, with abnormal turns of the shin in the knee, when landing after a jump from a great height or squats with a large load.

In general, damage to the knee joint meniscus, especially damage to the medial meniscus, is a fairly common phenomenon, most often affecting men. The most common type is a sports injury.

Damage to the meniscus has the form of a rupture in its body or complete separation in the place of attachment to the capsule or bone end.

The defeat of the meniscus can have an absolutely isolated character, but is often combined with damage to other joint elements. As a rule, the lateral and cruciate ligaments, articular capsule suffer.

Almost half of pathologies are combined with a fracture of the condyles of the tibia. A rupture of the body can occur with complete separation and movement of the torn part, or in the form of a partial rupture, when the bond between the elements is not completely broken.

Etiological features of pathology

In the etiology of meniscus lesions, there are two main mechanisms: traumatic and degenerative type.

The traumatic mechanism causes lesions of an absolutely healthy joint at any age of the person at occurrence of excessive loading.

The most common injuries: damage to the inner meniscus - a sharp turn of the shin with a significant amplitude in the outer direction, and the lateral meniscus - by rotating it inward.

Traumatic destruction of the medial meniscus often occurs in the longitudinal direction with destruction at its central site. Typical is the defeat of the "handle of the watering can when the middle of the body is destroyed, but both horns are not destroyed.

At the same time, the lesion of the anterior and posterior horn is quite often observed. Transverse ruptures occur much less frequently. Rupture of lateral fibers in an adult does not belong to typical lesions due to the high mobility of this meniscus.

More common is a trauma in adolescence, when the tissues are not yet strong enough.

Types of rupture of the knee joint meniscus

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.

With the weakening of the meniscus structure, their destruction can occur under loads that are normally not critical.

The provoking causes triggering a degenerative mechanism are the following:

• rheumatism;
• polyarthritis;
• gout;
• the age factor;
• supercooling;
• metabolic disease.

Symptomatic manifestation of pathology

If a trauma such as a meniscus injury is obtained, the symptoms depend on the degree of injury and the involvement of other articular elements. The most characteristic sign is pain syndrome.

It can be localized at the point of rupture, it is more often felt throughout the joint space.

If the damage is not too great and the parts do not separate, then there are pains in the form of clicks and discomfort appears.

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

If a piece of anterior horn comes off, the function of the joint to extend the leg is violated, and when the horn is destroyed, the joint is bent.

Gradually, the joint can accumulate exudate - exudate as a result of the inflammation process.

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

1. Baikova: with the extension of the leg, bent at right angles, with the help of a doctor, intense pain should appear;
2. Steinman: rotation of the tibia by the doctor when the leg is bent at right angles. To determine the location of the injury, the turn is made in different directions. If the pain occurs when the calf is rotated inwards - the medial element is affected, when it appears in the opposite direction of the turn - the outer meniscus.
3. Chaklin: detection of a click in the articular zone with flexion and extension movements (a click symptom) and a tailor symptom - thinning of the wide femoral muscle.
4. Polyakova: pain occurs when a healthy limb is raised from a lying position, while lifting the body with support on the shoulder blades and the heel of the affected limb.
5. Landau: pain syndrome occurs when taking a pose "sitting in Turkish".
6. Perelman - there are two types: "ladder" - increased pain syndrome when walking on the stairs or any elevation down; "Galosh" - the pain manifests itself when turning the shins.
7. McMurray: pain and crunch are detected with rotational motion of the knee in a lying state with bent limbs.

Basic tests for the diagnosis of meniscus rupture of the knee joint

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

Diagnostics

The primary diagnosis is based on the results of the examination and testing. The next step is to clarify the pathology - radiography and ultrasound of the knee joint.

However, it should be taken into account that the X-ray does not give a clear picture of the meniscus lesion, but helps to establish the involvement of bone tissue in the process.

An accurate diagnosis is made based on the results of computed tomography and MRI.

As a more reliable method, the WHO recommends an MRI. In particular, the Stoller meniscus damage is established by this method. When the Stoller classification is used, the degrees and damage to the meniscus are subdivided as follows:

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

Principles of treatment

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 administered.

An important stage of treatment is the direction of the meniscus to its place. If the procedure is carried out correctly, the blockade of the joint is removed.

Further treatment includes the following procedures: UHF exposure, exercise therapy by individual program, therapeutic massage, the appointment of chondroprotectors for the restoration of cartilage (Glucosamine, chondroitin, Rumalon). If necessary, drugs are used to stop pain and relieve inflammation.

Surgical intervention is performed in the following circumstances:

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

Operation at rupture of a meniscus of a knee joint

As the operational impact, the following technologies can be used: meniscectomy (complete or partial removal);

• operation for the resuscitation of the meniscus;
• arthroscopy (stitching of the destroyed elements through a small hole in soft tissues);
• fixation of elements with the use of special ways of fastening the detached fragments);
• transplantation method.

Damage to the meniscus is common, but quite dangerous, trauma. In the event of such a pathology, it is necessary to provide first aid and to call an ambulance. How to treat the damage, can only install a doctor.

A source: http://AntiRodinka.ru/kak-lechit-povrezhdenie-meniska-kolennogo-sustava