Overview
Meniscus - is the formation of cartilage tissue, resembling a crescent moon, the controller performs the role absorber to reduce the frictional forces within the joint. In a healthy person in each knee joint of two such education: the external and the internal lateral medial. Each of them consists of a body and two spurs (front and rear).
Due to its mobility and density of the lateral meniscus is damaged in 3-4 times less. more there are internal meniscus injury. This is due to its limited mobility due to fusion with the lateral internal ligament of the joint.
Power intra-menisci is carried out differently. In their outdoor departments there is an active blood supply, and the recovery process is carried out without complications. Break the inner part of a much more dangerous because it lacks capillaries and regeneration takes place at minimum speed, and rehabilitation can take several months.
Causes
Athletes, dancers, people of heavy physical labor are particularly susceptible to this type of injury. By the nature of their activities they have to deal with
increased load on knees. Basically medical help treat people of working age and retired. Children and adolescents up to 14 years rarely suffer from this problem because of the elasticity of cartilage.The main cause of meniscus tear is a severe injury that occurred on the background of predisposing factors:
- weakness of ligaments and joints;
- insignificant injury against the background of degenerative changes in the cartilage tissue;
- excess weight;
- longer stay in the "squatting" in circulation "single file";
- sharp twisting of the knee without separation of the foot from the surface;
- jumping and running on an uneven surface in those with joint problems;
- chronic nature intoxication (launches the development of pathological processes in the cartilage tissue).
Chances meniscus tear in the fall on their knees, or after hitting the front, so the active sports and games sports that require sudden movements and quick reactions are one of the most common causes injury.
Patients in old age is rarely ask for help with acute loss of meniscus integrity of their problems are often chronic and associated with pathological changes in cartilage tissue. In her blood circulation, causing its depletion, degeneration, brittleness and provokes the formation of cysts.
Classification
Systematization is conducted on several grounds. Depending on the origin was isolated traumatic pathology (acute) and degenerative tears.
Orthopedic patients are often men from 20 to 40 years, who, because of injuries to an acute condition in the knee fold. In the elderly dominated by chronic and age-related degenerative processes in the form of rheumatism and arthrosis, spoke provocateurs is damaged meniscus.
Localization gap may be different. When both traumatic several parts indicate the combined character damage. Depending on the severity of the injury and meniscus matter what zone it ruptured, the method of treatment is chosen. Experts identify cartilage damage following:
- Rift meniscus near the place of its attachment, horizontal tear in the posterior horn of the medial disc or its complete detachment. Such injury is considered the most severe damage to the cartilage and is found in 10-15% of patients with problems in this area.
- partial rupture observed in half of the cases. Usually occur tears of the posterior horn, at least in the body of the meniscus or the anterior horn.
- jamming intra-articular meniscus sometimes causes blocking movement of the joint. Such injuries occur in 40% of cases, and if the joint reduction can not be done, they can complete the operation.
Anatomically, the gap may be as follows:
- oblique patchwork;
- transverse groove;
- "Watering can handle," or vertical longitudinal;
- horizontal;
- razmozhzhenie, grain, multiplanar gap (degenerative processes);
- combined.
Destructive processes in the joint cartilage is a reaction to inflammatory processes. Sometimes it is quite a small load to ruptured tissue. In old age, is dominated by degenerative and combined fractures. Patients up to 50 years, vulnerable to damage, longitudinal and oblique type.
symptoms
Symptoms vary the severity of the injury. Slightly damaged cartilage being felt a crunch and clicks in the knee, frequent aching and discomfort.
Loss of meniscus tissue integrity is usually combined with other injuries in the knee joint, so its diagnosis is difficult. At diagnosis pay attention to the following symptoms:
- Pain syndrome. Severe intolerable pain is felt at the moment of injury, and within 1-2 minutes after that. Before you feel the pain, you can hear a click. After some time, pain diminishes, the victim can move independently, but most often it is possible to him with difficulty. After sleeping there is a sensation of a foreign body in the knee. When you try to flick acute pain and subsides at rest, sometimes it reminds of itself only when descending the stairs.
- joint blockade. Stopper knee is characteristic of the posterior horn of medial meniscus tear. The joint is not able to make movements due to the fact that the meniscus or a portion thereof enters between the bones and blocks their normal motor function. Sometimes in the knee joint space manages to find himself meniscus. blockade phenomenon is also common for dislocation and torn ligaments.
- Accumulation of blood within the joint. Hemarthrosis observed in the case when there is a tear of the meniscus body, riddled with a network of small blood vessels. The knee swells and swells.
- joint swelling. This feature appears immediately after the break, but usually after 2-3 days.
Degenerative lesions are somewhat different: they are erased symptoms, pain manifested periodically, felt clicks and rentals in the joint, an exacerbation of swollen tissue, impaired mobility, but the full joint blockade comes.
Diagnostics
External signs of meniscal injury are nonspecific and are similar to other diseases. Similar symptoms can be observed in arthritis, severe bruises and sprains. Establishing an accurate diagnosis only by the history of collecting and visual inspection is not always reliable. A more accurate method is considered to apply painful trial - when you try to limb rotation in the knee joint causing severe cutting pains. However, these techniques are quite approximate to the more informative diagnostic methods include the following:
- X-ray examination;
- MRI;
- CT scan;
- arthroscopy.
If the inside of the knee joint accumulates fluid, the puncture is made the joint cavity to facilitate the diagnosis and treatment of pain.
Modern techniques have significant advantages. MRI allows you to explore soft tissue structures of the joint detail, and using arthroscopy can not only visually assess the state of the joint, but also to the recovery operation immediately.
Treatment
The diagnosis and treatment of diseases of the joints involved in orthopedics. When choosing a method of treatment into account the location, complexity of the damage and injury conditions. Entrapment and primary tear treated therapeutically.
Conservative treatment includes:
- Reposition (joint reduction in its blockade).
- Removing the puffiness by puncture. The procedure may be single or multiple, depending on the amount of liquid discharge intensity of blood and exudate into the joint cavity.
- For relief of acute pain appointed non-hormonal anti-inflammatory drugs, analgesics, and ice packs.
- Appointment chondroprotectors and hyaluronic acid preparations for the restoration of the joint structures. Annual treatment and lasts 3-6 months.
- Fixation of limbs by using the tire is not less than 2 weeks.
- Physiotherapy treatments and rehabilitation (massage, exercise therapy).
If treatment is started immediately and was carried out correctly, then there is every chance to avoid surgery. Surgical intervention is required in the event that a therapeutic treatment has not led to positive results. The principle that guides surgeons, is to maintain the functioning of the knee joint and the resumption of its functions.
Staple meniscus is possible only in the zone of its active blood supply. Complete removal of cartilage (meniscectomy) considered worldwide harmful and inefficient operation. Most often used methods partial (partial) meniscectomy. During such manipulations completely removed free of the cartilage and the rest is done restoration.
The most modern kind of surgical treatment of meniscal tears is arthroscopy. This low-impact method makes it possible to produce all manipulations 2-3 small holes with a camera and therapeutic tool. The main terms of the effectiveness of cross-linking of the meniscus is the availability of fresh cartilage tear in the body. These factors influence the probability of fusion of fabrics and successful outcome of manipulation.
In the case where the meniscus rupture occurred as a result of degenerative changes caused by tuberculosis, Osteoarthritis, gout or other diseases assigned treatment aimed at getting rid of the underlying cause.
complications
regeneration processes in the cartilage tissue are slowed down, since it is composed of fibrous structures and has no own blood supply, all of the nutrients and oxygen are transported to it from nearby tissues. In more than a year can take this regard, the restoration of the meniscus. Some patients are faced with the following complications:
- restriction of mobility or loss;
- cartilage damage and the onset of osteoarthritis;
- fracture, rupture, displacement.
The most severe consequences to break the meniscus believe contracture and ankylosis, where the foot loses mobility. To prevent the development of complications, must be timely to begin treatment and strictly adhere to medical recommendations.
prevention
Simple preventive measures can help prevent the vast majority of injuries. In order to prevent gaps in the cartilage of the knee joint tissue is necessary Avoid sudden movements. During exercise to better protect the joints with special bandages or knee pads. Shoes must be stable, comfortable. To strengthen cartilage tissue recommended moderate exercise: Running, cycling, race walking. Of great importance for the prevention of injuries is a healthy lifestyle, monitoring the general health and prompt treatment of any disease.
Forecast
- localization of the gap;
- the patient's age;
- state ligamentous apparatus;
- prescription gap.
- regular pain in the knee joint;
The probability of resumption of normal operation of the joint is reduced in patients with weakness of ligaments, and people under the age of 40 years have a better chance of recovery than older.
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