How to treat edema of the knee joint
The meniscus rupture is the "favorite" trauma of dancers,football players, tennis players and other athletes, especially team sports players. However, not everyone knows that ordinary people, whose activities are not connected with constant physical activities, can get such a problem. And even older people - with the least burden, if there is a prerequisite for this like the disease with arthrosis.
What is a meniscus rupture? First we will understand what a meniscus is. It is a fibrous cartilaginous tissue that performs an important cushioning function in the joint. In addition to the most "popular" knee joint, in the human body such cartilage is present even in the clavicle and temporomandibular joints. but rupture of the knee joint meniscus is the most frequent and dangerous from the point of view of the development of complications .
The structure and function of the meniscus
In a healthy knee joint such cartilaginousThere are two tabs: external (lateral) and internal (medial). They both look like a crescent moon. The outer meniscus is more mobile and dense, so its traumatization is quite rare. The inner is fused with the capsule and tibia, which makes it more rigid. Consequently, the rupture of the medial meniscus is the most frequent injury of the cartilage of the knee joint.
Each of the meniscuses consists of three elements: body, rear and anterior horns. A part of the meniscus is penetrated by a capillary network - it forms a red zone of cartilage. This area is the most dense and is near the edge. Closer to the center is the thinnest part of the cartilage - a white zone, completely devoid of blood vessels. It is important, in what area there is a rupture: the meniscus will recover most likely if the "live" part of the cartilage is damaged.
Once it was believed that a complete removala damaged meniscus is a simple solution to the problem. Then it turned out that he performs very important functions for the bones and cartilage of the joint: cushioning and protective, and his absence is the right path to arthrosis.
The kind, area and strength of the meniscus damage depends on which treatment will be optimal, and whether there is a chance to save cartilage. The most unfavorable in terms of the prognosis is a complete unilateral separation of the meniscus. the easiest - oblique tear of the white part. Types of possible damage to cartilage:
- complete detachment of the meniscus from the attachment point orthe fracture near (10-15%) is the most severe cartilage trauma. The heavy horizontal rupture of the posterior horn of the medial meniscus also applies here. Requires surgery, during which the "dangling" part of the tissue is removed, which has the property of being jammed, blocking the joint and destroying the near-bony cartilage;
- partial fracture of the meniscus occursapproximately half the cases of cartilage trauma. Sore throats occur most often in the hindquarter, but are also common in the middle (body), the front horn is least likely to be affected. In turn, incomplete damage can be oblique, longitudinal, horizontal, transverse, as well as internal - breaking the meniscus by the type of handle of the watering can;
- pinching of the meniscus occurs in 40% of casesseparation and rupture of the cartilage, when the damaged part is lifted and blocks the joint. If closed joint correction does not help, urgent surgical intervention is required.
Medicine knows only one clear reasonthe occurrence of such a common injury as a rupture of the horn of the medial meniscus of the knee joint is an acute injury. However, not every aggressive effect on the joint leads to damage to the cushioning cartilage. It is necessary to allocate such predisposing factors which can cause, for example, rupture of a back horn of a meniscus:
- torsion on one leg without detachment of the limb from the surface;
- energetic running and jumping with unstable joints or on an uneven surface;
- long sitting "squatting" or active walking "with a goose";
- strong load with a significant excess weight;
- minor trauma in degenerative joint diseases;
- congenital weakness of joints and ligaments.
In most cases, acute rupture of the medialthe knee joint meniscus comes from the unnatural position of the joint elements at the time of injury or pinching of the cartilage between the tibia and the femur. Meniscus rupture is often combined with other knee joint injuries, so differential diagnosis is sometimes difficult.
Symptoms on the basis of which it is possible to suspect a rupture of the internal meniscus of the knee joint:
- pain - is very sharp at the time of injury infor 1-2 minutes. The appearance of acute pain in the knee may be preceded by something like a click. After a while strong painful sensations can weaken, a person can even walk, although through strength. However, in the morning there is a feeling of "nail" in the knee. When trying to sharply bend or unbend the leg, the pain intensifies, at rest, it subside slightly. Intense pain is characteristic of young people;
- blockade or "jamming" of the joint - very frequentA sign characterizing the rupture of the horn of the inner meniscus. A blockade occurs when the torn or torn part of the meniscus is bent between the bones and disrupts the motor function of the joint. True, this can also occur from torn ligaments;
- hemarthrosis (blood in the joint) appears when the meniscus zone, permeated with capillaries, is torn;
- swelling of the joint - occurs, as a rule, for 2-3 days.
Signs for hardware diagnostics
Sharp rupture of the posterior horn of the medial meniscuswith arthroscopy can be distinguished from chronic (chronic) or degenerative in the state of cartilage and fluid. The "fresh" rupture has smooth edges, without disassembly, there is a blood clotting (hemarthrosis), and in chronic cases - cartilage is broken, there is swelling from the accumulation of synovial fluid, and the nearby bone cartilage is also damaged.
Meniscus rupture on MRI (a picture in the sagittalplane): if both cartilages are normally in the form of a butterfly (bow), then any change in this shape suggests a rupture of the meniscus. Also, the appearance of an "extra" bundle should be alerted.
If an acute rupture of the cartilage is not cured immediately, thentime pathology takes a chronic course. Meniscopathy is formed, in which the degradation of the cartilage surface of the bone occurs quite often (in 30-40% of cases) because of changes in the structure of the joint. And this is a symptom of arthrosis of the knee joint, in this case - gonarthrosis. How to treat a meniscus rupture?
Primary tearing and jamming can and should be donetreat therapeutically. Of course, there are emergency cases of meniscus damage, when surgical intervention may be required immediately, but in most situations conservative treatment is first performed. Treatment of a meniscus rupture without surgery usually involves several stages that can be very effective if the disease is not triggered:
- Repositioning (reposition) of the joint when it is jammed (blockade). Manual methods and hardware traction are helpful (the process takes a little longer here);
- Elimination of edema. Anti-inflammatory drugs (hormones and NSAIDs) are prescribed;
- Rehabilitation. Various methods of physiotherapy, massage and exercise therapy are used;
- Restoration of cartilage tissue of the meniscus. This is a long, but very important, process of preventing arthrosis. Treatment with chondroprotectors and hyaluronic acid is carried out for approximately 3-6 months each year.
In addition, analgesic treatment will be required: a break in the meniscus in a number of cases is accompanied by a fairly strong pain syndrome. As analgesics, the most optimal means for diagnosing the hindbust rupture of the medial meniscus are treatment: diclofenac, indomethacin, ibuprofen, nimesulide, paracetamol and their analogs, movalis, piroxicam.
When the meniscus is broken, the question of the imposition of gypsumusually takes a doctor. As a rule, after manual adjustment of the joint blockage, it takes about 3 weeks of immobilization at a certain angle, and this is possible only with the help of a rigid fixation.
The main principles of surgical interventionwhen the meniscus is damaged, the organ is safely preserved and its functions restored. If all other measures are useless, and surgery is necessary: the meniscus tear, first of all, is tested for the possibility of stitching. This is real if its "red zone" is damaged. Types of possible surgery for cartilage rupture:
- Arthrosis is the kind of operation that is bestto avoid. Leading experts no longer use it. If such a removal of the meniscus is prescribed, it is "old-fashioned" and "poor" in those hospitals where there is no modern equipment. The only justified option is extensive joint damage, when other surgical methods are ineffective. However, this does not apply to surgery on the meniscus;
- meniscectomy - complete removal of the meniscus (arthrotomy). Since the late 80's. all over the world is recognized as ineffective and harmful;
- partial meniscatectomy (incomplete) - not only the "dangling" cartilage is removed, but its restoration is performed - the edge is cut to an even state;
- transplantation and endoprosthetics - transplantation of an artificial or donor meniscus. It is produced very rarely due to poor implant survival;
- arthroscopy - the most modern kindsurgical treatment of joints, characterized by low traumatism. The principle is this: in the knee in certain places, two punctures of 1 cm are made. In one of them an arthroscope (video camera) is introduced and physiological saline is given, the other serves for various instruments and manipulations with the joint;
- stitching of the meniscus - arthroscopic surgery forrestoration of cartilage. It is effective only in the thickest (about 4 mm) "living" zone, where there is a chance that it will grow together. In addition, the gap should be fresh. Rupture of the knee joint meniscus - operation: the video allows you to observe the various stages of arthroscopy about the damage to the cartilage of the knee joint.
Restoring the function of the joint is the most important process in the treatment of a damaged meniscus. Rehabilitation of the knee joint should take placeunder compulsory supervision of a specialist - a rehabilitation physician or orthopedist. He will appoint the most optimal set of measures. If desired, you can carry out restorative treatment at home, but the best option will still be stay in the hospital, where there is everything you need, at least in the initial period.
The most important method of postoperativerehabilitation is considered therapeutic exercise and massage, as well as modern hardware methods with a dose load for muscle stimulation and joint development after surgery. On average, the full restoration of the joint after arthroscopy takes about 2-3 months. To lead a habitual way of life it is possible already in 1 month after operation.
After a surgical operation on the meniscus itselfa long-term problem is intra-articular edema - it prevents the normal restoration of functions. For its removal, lymph drainage massage has proved to be the best.
When the disease breaks the horn of the innerMeniscus treatment has, in most cases, a favorable prognosis in the event that it was conducted in a timely and correct manner. Modern orthopedics has for this a large number of effective means. A less favorable prognosis may be with severe combined injuries of the knee joint. In the long term, with an unresolved rupture of cartilage as a complication, the development of arthrosis is possible.
My name is Sergey, I'm 27 years old playing football since I was 10 years old.
January 4th, 2015. in the hall, at the end of training, on an equal place turned his leg and the knee of his right leg flew out.
Having made an MRI, I received the following conclusion:
Degeneration-closed injury / horn of the medial and anterior horn of the lateral meniscus.
Contusion / bruise / lateral condylar femur.
Slight expression of synovitis.
Tell me, after such a conclusion, can I continue to play, should I use any ointments or drink vitamins? How to restore the leg?
Now I go with bandage (orlett), once a week in the pool.
Can I go to the gym, shake my leg?
Thank you, Yours faithfully Sergey.
Good article, but there is absolutely no information about fixing the joint with kinesiotypes ... Add video with the technique of applying the knee joint in case of damage to the PKC and meniscus
Tell me please what band is better to buy,an arthoscopy of the knee joint was performed. Diagnosis is the partial rupture of the medial meniscus. I am now recovering and going to continue to professionally sport. (volleyball) What do you recommend a hinged knee or stabilizer band? There are a lot of models that I do not know.