Degenerative changes in the meniscus of the knee joint and types of pathologies. What are degenerative changes in the menisci, why do they appear and why are they dangerous? Degenerative changes in the medial meniscus, grade 1

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What is a meniscus? This is a kind of shock absorber, which is a cartilage pad. Each meniscus, shaped like a horseshoe, consists directly of a body and horns (posterior and anterior), closing the “crescent”.

Where are these cartilage pads located? In those places that experience increased stress, namely in joints such as:

knee, that is, between the femur and tibia (small and large) bones;
sternoclavicular (meaning the articulation of the arm with the chest);
temporomandibular (connection of the base of the skull with the lower jaw);
acromioclavicular (that is, the articulation of the articular surface of the clavicle with the scapula).

There are two cartilage pads connected to each other by a transverse ligament:

Medial (that is, internal cartilage). It is connected to the side located on the inside. The medial meniscus has little mobility.
Lateral (that is, outer cartilage). It is wider and more mobile than the inner meniscus. As a result, his injuries occur much less frequently.

The menisci are extremely important elements of the knee. They perform the function of distributing the load and allow the organ to be in a stable state. If they degenerate, the patient experiences debilitating pain and instability when moving. Over time, a progressive disease can lead to the fact that the mobility of the lower limb is completely lost.

What are degenerative changes in the medial meniscus? How to deal with them? Are there measures to prevent the disease? Let's figure it out.

What are the medial and lateral menisci?

These are anatomical injuries that could occur due to:

atypical joint structure;
diseases;
injuries.

Moreover, it is the medial meniscus that is most often injured due to its rigid fixation and the impossibility of displacement in one direction or another without serious consequences for the knee joint. The horns of the internal cartilage are located quite close to the condyles (that is, thickenings, of which there are two on the tibia: medial and lateral), which creates a difficult situation in the event of any displacement of the bone process. And as a result, either a rupture of the meniscus or its damage.

Aching pain in the knee, discomfort and stiffness in movement due to a meniscus tear can be felt for many months or even years.

Degenerative changes in the medial meniscus are disorders observed in the structure of the organ, which inevitably lead to loss of its functionality (partial and sometimes complete).

Types of meniscus lesions

There are several of them:

Rupture of either the body itself or the posterior or anterior horns. With degenerative changes in the posterior horn of the medial meniscus, it is quite difficult for the patient to flex the knee, and if the functioning of the anterior horn is impaired, it is difficult to extend the knee joint.
Tearing of the meniscus (or part of it) at the attachment site. This injury can completely block the functioning of the knee joint.
A tear of the cruciate or menisci, which is characterized by excessive mobility of the cartilage pads.
Formation of a pathological cavity (i.e. cyst) in the body of the meniscus. It can develop completely asymptomatically for a long time.
Changes of a degenerative-dystrophic nature that can develop after injury (that is, meniscopathy).

Degenerative changes in the posterior horn of the medial meniscus, the anterior horn, or even the body itself can be diagnosed in people belonging to different age categories (even children). The risk group includes primarily those whose professional activities involve active movements. These are dancers, ballet dancers and athletes. But other people should also take care of themselves.

Stages of the disease

Degenerative changes in the medial meniscus of the knee joint undergo several stages of development:

Spicy. Its duration depends on the reasons that provoked the disease.
Chronic. It is at this stage that the acute form can smoothly flow over in 1.5-2 weeks. At this stage, the patient complains of pain, clicking and crunching in the knee joint, which only gets worse. In the knee area, you can palpate the joint ridge.

Classification of damage to cartilage pads

There are 4 degrees of meniscal degeneration according to the classification introduced into medical practice by American orthopedist Stephen Stoller. Moreover, it is unlikely that it will be possible to accurately identify damage to the cartilage pads by eye: this can only be done using MRI. So, the degrees of meniscal degeneration are as follows:

0 degree. No pathological changes are observed, that is, this is simply the norm.
1st degree. In this case, some focal pathologies are observed, but not reaching the edges of the cartilage pad. Grade 1 degenerative changes in the medial meniscus are characterized by minor damage to the cartilage tissue of the horn and can very often develop as a result of injuries received during walking on an inclined plane, squats with a load, or jumping. The patient experiences swelling of the knee joint and feels pain in it.
2nd degree. There is a linear focus of damage to the cartilage pad. Degenerative changes in the medial meniscus of the 2nd degree are characterized by tissue swelling and pain, which only increases. In the knee bursa, there is an accumulation of blood and a separation of the horn of the meniscus, parts of which enter the joint cavity, thereby blocking the motor function of the organ. 2nd degree involves surgical measures.
3rd degree The damage reaches one of the edges of the meniscus, leading to its rupture.

Degenerative changes in the medial meniscus, grade 2. and 1 tbsp. - these are lesions of a borderline nature, but grade 3 is a real meniscus tear. Don't let your health situation get critical! Take care of yourself.

Possible causes of the disease

The reasons for the development of degenerative changes in the medial meniscus can be:

Diseases such as bone tuberculosis, gout, osteoarthritis, syphilis, rheumatism and other pathologies, in the presence of which joint damage occurs.
Sprain.
Physical activity in large volumes - whether it’s working in the country to arrange garden beds or just playing sports.
Frequent knee injuries.

Having excess weight.
Dysplasia (i.e. abnormal development) of the knee joint.
Displacement of the cartilage pad.
Flat feet (dropping of the transverse or longitudinal arches of the foot). In this case, the load on the knee joint increases.
Poor circulation in the extremities.
The result of natural aging of the body as a whole.

Symptoms of pathology

The main signs of degenerative changes in the medial meniscus:

A pronounced inflammatory process (that is, redness and swelling).
Painful sensations of an acute and aching nature.
Some limitation in movements.
The presence of discomfort and a feeling of instability in the knee joint.
Feeling of a foreign body in the knee.
The appearance of crunching and clicking sounds when you try to straighten your leg, for example, when squatting or going down stairs.
Decreased muscle tone in the thigh area.
Blockade of the knee joint in a certain position of the leg, for example, when bending.

Important! At the first signs of degenerative changes in the posterior horn of the medial meniscus, its body, the anterior horn of the external cartilaginous pad, or all together, you must contact a medical institution for help.

What to do if you have a knee injury

First of all, you need to immediately call “emergency help”. Next you should do the following:

We put the patient in bed, providing him with complete rest.

Apply either a cold compress or something from the freezer wrapped in cotton cloth to the inner thigh.
We give the patient painkillers.

Diagnostics

If a patient has a knee joint injury, which manifests itself quite clearly, then it is not difficult for a specialist to determine the pathology. If the damage is moderate and does not occur in an obvious form, then the diagnosis becomes more complicated. In this case, the following types of instrumental examination are prescribed (based on signs of degenerative changes in the medial meniscus):

MRI and CT scans, with which you can assess the severity of pathological changes in the knee joint. Volumetric imaging allows you to do this with a high degree of accuracy.
X-ray. During the study, an image of the knee joint is obtained in two projections, which allows one to determine the stage of the pathology. The disadvantage of radiography is that degeneration can be determined solely by indirect signs, that is, the method does not provide an accurate picture of the pathological process.
Ultrasound. It is highly informative and non-invasive. Using this method, almost all elements of the knee joint can be observed. With ultrasound, there is no radiation exposure to the body at all.
Arthroscopy. Using a special device (endoscope) inserted into the cavity of the knee joint through small incisions, the specialist determines the condition of the synovial (articular) fluid and tissues of the knee. Using a video camera, the specialist watches a picture of what is happening on the monitor.

On a note! The diagnostic procedure smoothly turns into a therapeutic one, since in the process it eliminates the dangerous consequences of the injury, including ruptures or avulsions.

Treatment of degenerative changes

Treatment of degenerative changes in the medial meniscus depends on the causes of damage to the joint and the existing disorders. It can be either conservative or surgical. But first of all, specialists do the following:

In case of blockade of the knee joint, manual therapy is used to realign the joint.
In the first 3-4 days after injury, exudate - liquid - is actively released into the joint capsule. Specialists take this fluid (do a puncture) several times in order to reduce swelling and restore motor function. After the procedure, the joint cavity is washed with antiseptic agents.
Often at the beginning of treatment (in order to reduce the load on the damaged cartilage pad), the knee joint is fixed using either a special orthopedic device or a plaster cast.

Drug treatment should be comprehensive:

Hormone therapy. Drugs in this group have an anti-inflammatory effect and are especially good for pathologies of a rheumatic nature (for example, Hydrocortisone or Diprospan). The best effect is achieved by direct injection of the drug into the joint cavity.

Painkillers. For example, to relieve inflammation or pain, drugs such as Ibuprofen, Dona, Caver or Sinarta (all of which belong to the group of non-steroidal drugs) have a good effect.
Muscle relaxants. They are prescribed to reduce joint stress and relieve muscle spasm (for example, Mydocalm).
Chondroprotectors. Drugs such as Chondroitin, Glucosamine or hyaluronic acid help to quickly restore the functioning of the meniscus.
Various ointments help fight edema (for example, Voltaren, Dolgit or Diclofenac).

Important! All medications can only be prescribed by a doctor. Remember: self-medication is dangerous.

Physiotherapeutic methods have a good effect in the fight against the disease:

Electrophoresis. Using this procedure, it is possible to coat the damaged surface with small particles of the drug, thereby ensuring their deep penetration into the tissue cells.
Iontophoresis. This procedure, based on the process of ion migration under the influence of a small direct current, eliminates swelling.
Ultrasound therapy.
UHF.
Shock wave therapy.
Applications with mountain wax(ozokerite) or paraffin.
Exercise therapy.

Don’t forget about such a simple method as massaging the damaged area of the knee.

Surgical measures are prescribed in case of cyst formation, multiple meniscus tears and necrosis. The following operations can be performed:

Arthroscopy. In this case, a special device called an arthroscope is inserted through two small (up to 1 cm) incisions and the damage is removed. This surgical intervention is classified as minimally invasive surgery.
Replacement of a damaged meniscus with a prosthesis.

Important! All operations are performed only after acute inflammation of the knee joint has been relieved. The operated person should avoid any physical activity.

In order for treatment results to be positive, it is necessary to promptly contact a medical institution for help. Moreover, it is necessary to prepare for long-term therapy, since it will take about 0.5-1 year to cope with degenerative-dystrophic changes in the menisci.

Is rehabilitation necessary?

Of course, it is necessary, especially after operational activities. What is the purpose of rehabilitation:

restoration of muscle tone of the injured limb;
normalization of blood circulation;
reduction of pain syndrome;
restoration of full function of the knee joint.

A set of exercises and the frequency of their implementation are developed individually for each patient, guided by the severity of the injury or the complexity of the pathology. Moreover, after surgery, exercise therapy begins 2 months after the operation, and with conservative treatment - 15-20 days after the injury.

Prevention

To avoid degenerative changes in the medial meniscus, you should follow simple precautions:

Eat a balanced diet, do exercises and constantly monitor your body weight. Excess weight has an adverse effect on joints.
To avoid troubles with the knee, it is better to fix it with an elastic bandage or special pads.
You should not suddenly get involved in physical work or sports: you must first warm up the muscles, stretching them and gradually increasing the load.
Frequently undergo a general examination to identify pathologies that contribute to the development of degenerative changes in the cartilage lining, and begin their timely treatment.
We recommend that you wear comfortable shoes when playing sports to reduce the risk of falling to zero.

The human body is often compared to cars: the heart is the engine, the stomach is the fuel tank, and the brain sets the whole device in motion. Where are the shock absorbers in humans? Of course, in places that experience increased load: there are cartilaginous discs between the vertebrae, and in the knee joint there are two “shock absorbers” - the menisci. Lateral (external) and medial (internal). The results of degenerative changes in the menisci, although they will not stop the activity of the body as a whole, will definitely cause a lot of unpleasant sensations.

Degenerative changes are anatomical damage to an organ resulting from injury, atypical joint structure or disease. Degeneration of the meniscus is most often the result of injury, sometimes not even obvious: one unsuccessful rotation of the tibia can cause damage to the cartilage disc, which is accompanied by severe pain.

Most often, due to the anatomical structure, the medial meniscus undergoes degeneration. If the outer cartilage, which cushions the movement of the knee joint, does not have rigid fixation and moves to any side if necessary, then the medial one is rigidly fixed in the joint, and its horns are in close proximity to the condyles. One sharp turn of the shin - and the meniscus does not have time to escape from the displaced process of the bone, the result is its damage or rupture.

Degenerative changes can be different:

If you are haunted by aching pain in your knee, which either disappears or appears with renewed vigor, you can already assume that there are changes in the meniscus. About 90% of pathologies of the knee joint are caused by damage to the “shock absorber”.

Symptoms largely depend on the nature of the pathology. Ruptures are accompanied by severe pain, blockade of the leg in a bent state and swelling. With serious damage to the medial meniscus, hemorrhage into the joint cavity often occurs - hemarthrosis. Significant swelling and severe pain are also characterized by meniscal cystosis.

Tears and detachments from the attachment site are often chronic in nature and are manifested by periodic pain and a feeling of impediment in movement.

There is a diagnostic test: go up and down stairs or slopes. With pathology of the meniscus, the pain in the knee intensifies when moving down.

Secondary degenerative-dystrophic transformations in the medial meniscus, that is, those arising due to other pathologies of the body or diseases, are also characterized by a chronic course. Often in such cases there are clicks and rolling* of the joint during movement after a long period of rest, and sometimes there is pain in the knees. The increase in symptoms occurs gradually as the cartilage layer thins and salts or uric acid crystals accumulate in it (the latter in case of gout). In the absence of adequate treatment, the final stage of meniscopathy becomes contracture - a stable violation (limitation) of joint mobility.

* Rolling – sensations of pathological mobility, instability and displacement of the articular surfaces of bones.

The following symptoms are common to all types of meniscal degeneration:

soreness,
swelling,
blockage of the joint in a bent position or sensation of a foreign body in the knee,
clicks and crunches,
numbness of the knees after a long period of inactivity.

The anatomical features of the location and structure of the menisci determine the high incidence of pathologies both among young people and among mature people. Most often, athletes, ballerinas, dancers suffer from ruptures, damage and cystosis - that is, people who are in constant motion and experience high loads.

Other possible reasons:

Diagnostics

In case of acute injuries to the meniscus, there is usually no doubt - blockade of the knee in a characteristic position, pain and clicks when straightening allow a correct diagnosis to be made in 90% of cases.

It is not always possible to determine degenerative-dystrophic transformations during examination due to the absence of clear symptoms and, often, a positive reaction to special tests. In such cases, instrumental research methods are resorted to:

Treatment methods

Therapy for degenerative changes in the menisci completely depends on the nature of the damage. Acute injuries serve as a direct indication for the use of conservative treatment methods:

First of all, a puncture of the joint is performed, eliminating its swelling and restoring mobility. Sometimes several procedures are required, since active exudation (secretion of inflammatory fluid) in the joint lasts up to three to four days.
Analgesics are prescribed, preference is given to narcotic drugs (Promedol and its derivatives), because other drugs in this case, as a rule, are not able to relieve the patient of pain.
Chondroprotectors provide the body with the necessary substances to restore the damaged area of the meniscus.
Anti-inflammatory drugs.
At the rehabilitation stage, physiotherapeutic methods are used as an auxiliary means - ozokerite, UHF, iontophoresis, shock wave therapy.
For 14 days, a splint is applied to the straightened leg to secure the joint in the required position.

In case of ruptures, surgical intervention is indicated: instruments are inserted into the knee joint through two miniature incisions and the damaged area is sutured. Serious injury may require the cartilage lining of the joint to be removed and replaced with an artificial one. All surgical procedures are performed only after signs of inflammation have subsided.

Chronic dystrophies, joint dysplasia and abnormal development of the ligamentous apparatus require exclusively surgical treatment.

If the cause of degeneration is chronic diseases, such as rheumatism and gout, along with surgical methods, the underlying disease is also treated (diet, immunocorrectors and other methods).

Degenerative transformations of the menisci are a fairly common pathology that requires immediate consultation with a specialist. The future functioning of the joint depends on the timeliness of treatment, and delays can cause the spread of degenerative processes to other elements of the joint. Therefore, do not delay your visit to the doctor, take care of yourself and be healthy!

A degenerative change is a disruption of the normal structure of the meniscus, leading to partial or complete loss of its functions. The cause of the pathology may be injury, active sports, heavy physical work, or excessive stress on the knee joint. Degenerative processes in the menisci can be a consequence of natural aging of the body.

Degenerative changes in the knee joints are common among older people, athletes and overweight people. The process usually involves cartilage, ligaments, menisci, and synovium. In severe cases, the articular surfaces of the bones that form the knee joint are damaged.

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The development of degenerative processes in the menisci can be triggered by their frequent trauma, displacement, and impaired blood supply and/or nutrition. Most often, the pathology develops against the background of chronic inflammatory and degenerative-destructive diseases of the joints. Traumatic knee injuries can also be a cause.

Deforming osteoarthritis is the most common disease of the musculoskeletal system. The pathology develops predominantly in people over 50 years of age. Among people over 60 years of age, it is detected in 97% of cases. Knee joints are affected in 70-80% of patients with osteoarthritis.

Gonarthrosis is characterized by degenerative-dystrophic changes in almost all structures of the knee joint. The menisci are damaged due to poor blood supply, lack of nutrients in the synovial fluid and constant trauma from dilapidated cartilage.

Factors contributing to the development of gonarthrosis:

excess body weight;
hard physical work;
hormonal and metabolic disorders;
postmenopausal period;
previous knee surgeries;
inflammatory diseases of the joints;
osteoporosis.

Deforming gonarthrosis can lead to permanent loss of ability to work and disability in just a few years. According to statistics, this happens in 25% of patients within 5 years from the moment the first symptoms of the pathology appear. Early diagnosis and timely treatment help avoid unwanted consequences.

Meniscal degeneration is detected in 27% of patients with grade I deforming gonarthrosis. At later stages - stages 2 and 3 - pathology develops in almost all patients.

Frequent trauma or any damage to the meniscus can lead to the development of degenerative processes in it. The provoking factor may be a sudden movement or an unsuccessful turn of the shin. Injuries most often affect the medial meniscus, located on the inside of the joint. This is due to the peculiarities of its structure and localization, which do not allow it to avoid pinching by the condyles of the femur.

Post-traumatic degeneration of the menisci is more common among athletes, heavy physical labor workers and people leading an overly active lifestyle. Pathology can be detected at any age.

Do not confuse degeneration with traumatic ruptures, tears, avulsions, etc. The former are characterized by a long, slowly progressive course with further development of complications. The latter occur acutely due to injury.

Degeneratively changed menisci tear with particular ease. But traumatic injuries themselves often become the cause of degenerative changes. These two pathologies are interrelated and often develop in parallel.

The cause of meniscal dystrophy can be rheumatoid or gouty arthritis, brucellosis, tuberculosis, and yersiniosis. The development of pathology can also be provoked by hypothyroidism, systemic vasculitis and some connective tissue diseases (scleroderma, systemic lupus erythematosus, etc.).

Degenerative-dystrophic changes in the menisci that occur against the background of other diseases are usually called meniscopathies.

The pathology is differentiated by the location of the foci of degeneration. They can be located both in the body and in the anterior or posterior horns. Most often, degenerative changes are detected in the posterior horn of the medial meniscus. This is due to the peculiarities of its structure and location.

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Depending on the severity of pathological changes, 4 stages of degeneration are distinguished. They can only be detected and identified using magnetic resonance imaging (MRI).

Classification according to Stoller:

0 degree – characterized by the absence of pathological changes;
I degree – focal changes are noticeable in the thickness of the meniscus, not reaching its edges;
ІІ degree – the presence of a linear focus of destruction that does not reach the edges of the meniscus;
III degree – pathology reaches one of the edges, which leads to tearing.

We can talk about a true meniscus tear if the III degree of degeneration according to Stoller is detected.

Table 1. The most common consequences of degenerative changes

Pathology	Description	Symptoms
Gap	Characterized by a violation of the integrity of the meniscus in the area of the body, anterior or posterior horn	Severe pain in the knee, preventing the patient from walking normally. If the posterior horn is damaged, it becomes difficult for a person to bend the leg, and the anterior horn - to straighten it.
Breakaway	The pathologically altered meniscus or its fragment is completely torn away from its attachment site	The articular mouse formed as a result of avulsion migrates through the synovial cavity, often causing blockade of the knee joint. The person experiences severe pain and limited mobility of the knee
Hypermobility	Manifested by abnormal mobility of both menisci due to rupture of the transverse knee ligament connecting them	Aching pain in the knee, aggravated by walking, running, squatting, descending stairs and other physical activity
Cyst	The pathology is characterized by the formation of a fluid-filled cavity in the meniscus cartilage	It may remain asymptomatic for a long time. When a cyst ruptures in the knee, there is usually a sharp pain

Meniscus tears can be traumatic or degenerative. The appearance of the latter is usually preceded by aching pain, stiffness and discomfort in the knee for several months or even years.

The menisci are important structures of the knee joint. They play a huge role in distributing the load and providing the necessary stability to the knee. It is thanks to them that the knee joint can work and function normally. Their degeneration leads to pain, instability and impaired mobility of the lower limb. The knee joint becomes loose and its functioning is gradually impaired.

When complications occur (ruptures, avulsions, etc.), a person experiences pain, discomfort and a feeling of instability in the joint. The discomfort intensifies when going down stairs and squatting. Some patients complain of characteristic clicking, crunching and a feeling of a foreign body moving in the knee when moving.

Damage and deformation of the menisci contribute to the appearance of degenerative processes in other structures of the joint. As a result, a person develops deforming osteoarthritis.

The simplest method for diagnosing pathology is radiography of the knee joints in 2 projections. But it is informative only in the last stages of deforming osteoarthritis. The degeneration itself cannot be seen on radiographs, but can only be suspected by the presence of indirect signs.

Modern methods for diagnosing degenerative changes in the menisci of the knee joint:

Ultrasound. It is a non-invasive and highly informative research method that allows you to see almost all structures of the knee joint (ligaments, tendons, meniscus cartilage, hyaline cartilage). The advantage of ultrasound diagnostics is the absence of radiation exposure to the body;
MRI. A modern method that allows you to identify meniscal degeneration and other pathological changes in the knee joint at the earliest stages. Magnetic resonance imaging is widely used to diagnose arthrosis deformans;
arthroscopy. An invasive research method that allows you to examine the cavity of the knee joint from the inside. Mainly used for severe knee injuries. In 70% of cases, diagnostic arthroscopy turns into therapeutic. During such an operation, doctors, under visual control, eliminate ruptures and other dangerous consequences of the injury.

To slow down the development of degenerative processes, patients are prescribed corticosteroids, chondroprotectors, hyaluronic acid preparations and agents that restore the normal composition of synovial fluid. Their intra-articular administration is most effective. For local injection therapy (LIT), Diprospan, Kenalog, Alflutop, Noltrex, Cel-T and some other drugs are most often used.

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If degenerative changes in the medial or lateral meniscus are accompanied by a rupture, the patient requires surgical intervention. The operation is performed using arthroscopy.

In childhood, pathology is most often a consequence of dysplasia - improper formation of the knee joint during intrauterine development. The baby is born with defects in the structure of bones, cartilage, muscles and ligaments. All this subsequently causes the development of degenerative changes in the menisci.

Unlike adults, children with injuries more often damage the lateral meniscus. Blockades of the knee joint in childhood and adolescence are rare.

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Menisci are crescent-shaped layers inside the knee joint between the surfaces of the thigh and tibia bones, consisting of cartilage tissue.
There are medial (inner) and lateral (outer) menisci. Conventionally, the meniscus of the knee joint (MKS) is divided into the posterior horn, the anterior horn and the body.
Cartilaginous discs evenly distribute the load on the knee joint, reduce surface friction and act as a shock absorber during movement.
Degenerative changes are the loss of function and the process of reverse development of cartilage that occurs as a result of injury, developmental abnormalities, or after an illness. The outer meniscus is less susceptible to injury than the inner meniscus due to better mobility.

separation of cartilage at the attachment site;
rupture of the body, anterior or posterior horn;
excessive mobility due to damage to the intermeniscal ligaments;
cyst formation;
meniscopathies are degenerative-dystrophic changes that develop after injuries.

Types of dystrophic lesions

Degenerative changes in the ISS occur in people of all ages. The risk group includes patients whose activities involve active movements: ballerinas, athletes, dancers.

changes in the development and formation of tissues (dysplasia);
gout, rheumatism, osteoarthritis, bone tuberculosis and other diseases affecting the knee joint;
sprain;
flat feet (change in foot shape);
excessive physical activity;
obesity.

Symptoms of lesions of the meniscus of the knee joint depend on the causes of the disease.
There are acute and chronic knee injuries.
The main symptoms include joint swelling, redness, limited mobility, and pain. In case of serious damage, blood may enter the joint cavity.

The duration of the acute stage depends on the causes of the disease.
After ten to fourteen days, the acute stage becomes chronic. At this stage, the patient complains of pain that intensifies with movement. A characteristic sign is the appearance of crunching and clicking sounds when walking; when palpated, the joint ridge is determined. The cartilage tissue becomes thinner, joint instability develops, and the muscles of the thigh and lower leg atrophy. The patient is advised to lie down more so as not to put stress on the injured leg.
If left untreated, meniscopathy may develop contractures (limited joint mobility).

pain syndrome;
swelling;
limitation and stiffness of movements;
cracking and crunching when bending and straightening the knee;
blockade of the joint in a bent position.

In the first degree of degenerative changes in cartilage tissue, minor damage to the horn, swelling and pain of the knee occur. After three weeks, the symptoms described above disappear. The development of the first degree of dystrophic changes in the medial meniscus is possible with injuries received during jumping, squatting with a heavy load, or walking on an inclined plane.
In the second (severe) degree, the pain intensity increases and tissue swelling increases. Blood accumulates in the joint capsule, the horn of the meniscus comes off and its parts fall into the joint cavity, causing blockage of movements. At this stage, surgery is indicated.

Damage to the lateral ISS is more common in childhood and adolescence.
Main symptoms:
pain in the area of the collateral ligament tissue;
pronounced inflammatory process in the synovium (synovitis);
discomfort and pain in the area of the fibular fold;
decreased muscle tone of the anterior thigh.

If the outer cartilage is torn, the knee is at an angle of 900 and the patient can unblock it himself. The symptoms of this pathology are mild and difficult to diagnose due to the variability of pain. There is a congenital anatomical anomaly, which is sometimes confused with a rupture of cartilage tissue - a disc-shaped (solid) lateral meniscus. When ruptured, the cartilage is shaped like a disc. A continuous external meniscus is determined mainly in adolescents, but it also occurs in older people.
The most common damage to the internal ISS are ruptures of its middle part while the ends are intact.

Types of damage:
rupture of the ligament fixing the organ;
rupture of the cartilage itself;
rupture of cartilage tissue.
Blocking the knee with limited flexion temporarily provokes separation of the anterior horn of the ISS with pinching. After unblocking, movement in the joint is restored. A more serious injury, in which the knee joint locks, bends, and pops out, includes injury to the posterior horn of the internal meniscus.

Acute injuries to the ISS in 85–90% of cases are diagnosed based on characteristic signs:
blockade of the knee joint in a certain position of the leg;
the appearance of pain and clicking when trying to straighten the lower limb.

To clarify the diagnosis, instrumental research is used:
X-rays are used to determine the stage of degenerative damage. In the first degree, the image shows an uneven narrowing of the articulation gap; in the second, bone growths appear on the articular surfaces.
Having done an MRI and CT, the degree of damage and tissue of the knee joint are determined in a three-dimensional image: articular surfaces, ligaments, articular cavity and bones. In the sagittal (imaginary vertical) plane, the cartilage cushion is shaped like a butterfly. When the meniscus ruptures, it adjoins the posterior cruciate ligament, enters the intercondylar fossa of the femoral bone, and the symptom of “double posterior cruciate ligament” is determined.
Arthroscopy allows you to determine the condition of tissues and joint (synovial) fluid using an endoscope inserted into the joint cavity through minimal incisions.

Treatment methods for changes in the ISS depend on the causes, stage and form of the disorders. Acute injuries are treated conservatively.
Immediately after the injury, the patient must be provided with complete rest.
Apply a cold compress or ice pack to your inner thigh.
To relieve severe pain, narcotic analgesics are used, since other painkillers do not bring relief to the patient.
The damaged limb is immobilized (immobilized) by applying a plaster cast for two weeks.
In order to eliminate swelling and restore movement in the knee joint, a puncture is performed. In the first three to four days of active release of fluid (exudate) into the joint capsule, the cavity is punctured several times.

The duration of treatment for degenerative-dystrophic changes in the menisci ranges from six to twelve months.
During the blockade, reposition (reduction) of the knee joint is carried out using manual methods.
To restore damaged cartilage tissue of the ISS, hyaluronic acid and chondroprotectors are prescribed.
Non-steroidal anti-inflammatory drugs are used to relieve pain and signs of inflammation (caver, dona, sinarta, ibuprofen, indomethacin).
To reduce swelling and speedy recovery of damaged ISS of the first or second degree, ointments (dolgit, diclofenac, voltaren) are used externally on the skin.
Physiotherapeutic procedures (UHF, shock wave therapy, ozokerite, iontophoresis) and exercise therapy are prescribed.
Massaging the affected area of the knee has a good restorative effect.

In case of the second severity of degenerative changes in the internal meniscus (tears, displacement, separation of the anterior and posterior horn of the ISS, crushing of the cartilage), surgical intervention is indicated.
It includes: removal of cartilage completely or a damaged horn, suturing the rupture, fixing detached horns, transplantation.
A minimally invasive surgical operation includes arthroscopy, in which an arthroscope is inserted through two incisions up to one centimeter, the torn part of the meniscus is removed and its inner edge is aligned.

The following prostheses are most often used during transplantation:
To replace worn out internal or external ISS, a sliding prosthesis is used.
Surface substitutes are used for more pronounced destruction (abrasion) of cartilage tissue.
The knee joint is replaced using a rotary prosthesis secured with pins in the femur and tibia.
A hinged prosthesis allows you to completely replace the entire joint and guarantee its stabilization.
All operations are carried out only after signs of acute inflammation have reduced.
After surgery, rehabilitation measures are carried out to restore the functions of the knee joint, namely: therapeutic exercises, massage and physiotherapeutic procedures.
Physical activity is strictly contraindicated for the operated patient.

In the treatment of degenerative damage to the ISS, a significant role is given to therapeutic exercises and massage, due to the fact that the restoration of damaged tissue occurs faster with adequate physical activity, prevents the development of contractures and allows you to regain the lost range of motion in the joint.
Exercise therapy during immobilization is carried out for undamaged parts of the lower limb, and when the plaster cast or splint is removed, gymnastics is aimed at restoring the joint. The load is gradually increased by adding exercises with weights and on simulators.

Rehabilitation goals:
pain reduction;
improved blood circulation;
return of muscle tone of the damaged limb;
restoration of the full range of motion of the knee joint.
A set of exercises and their intensity are developed by the doctor individually for each patient based on the complexity of the disease and the injury suffered.
With conservative treatment of meniscal injuries, exercise therapy begins two to three weeks after injury, and after surgery - two months later.

If a person takes care of his health and adheres to basic preventive measures, then the risk of ISS injuries is reduced by 90–95% of cases.
It is necessary to play sports in stable, well-fixed and comfortable sports shoes that can minimize the risk of falling.
To distribute the load evenly and safely, fix the knee using special pads (knee pads, orthoses, bandages) or an elastic bandage.
Before physical work or playing sports, it is necessary to warm up, gradually increasing the range of movements, warming up the muscles and joints.
Monitor your body weight, do exercises and eat rationally, but do not overeat, as excess weight increases the load on the joints.

Degenerative changes in the ISS are very common and manifest themselves in various types of pathologies, some of which require immediate consultation with a doctor to clarify the diagnosis and prescribe adequate treatment. A timely visit to a specialist will help maintain the functionality of the knee and prevent the involvement of other joint tissues in the pathological process.

Degenerative changes in the meniscus of the knee joint occur for various reasons, the most common of which are: excessive loads and degenerative processes that develop in elderly patients. These cartilage pads perform an important function - they protect the hard tissues of the joint. In addition, the menisci play the role of shock absorbers. They take on a significant part of the load, thanks to which the structure of articular cartilage and bone heads is preserved longer.

There are lateral (outer) and medial (inner) meniscus. Both cartilages may undergo changes. Degenerative processes usually develop under the influence of a number of factors:

congenital pathologies;
joint diseases;
injuries.

Most often, meniscal pathology develops in old age, when the structure of cartilage tissue changes.

The risk group also includes people who regularly experience significant physical activity: professional athletes, loaders, etc. Any careless movement can lead to degenerative changes in the lateral meniscus or medial cartilage. When injured, the integrity of the ligaments is disrupted and cartilage and bone tissue are affected. Changed position of bones or torn ligaments cause redistribution of the load on the joint. As a result, mucinous degeneration of the meniscus develops.

The nature of pathological processes may be different. Sometimes a cyst develops in the meniscus - this is a neoplasm in the cartilage tissue, which contains fluid inside. This condition is defined as mucoid degeneration.

There is another type of pathology - meniscopathy. In this case, there are dystrophic changes in the structure of cartilage tissue caused by a chronic disease of the musculoskeletal system (osteoarthritis, rheumatism) or injury.

In addition, degenerative damage to the inner meniscus or outer cartilage may occur. Consequences:

separation from the attachment point;
excessive mobility;
violation of the integrity of the meniscus.

The symptoms will be different in any case. The more serious the damage, the more severe the pain.

Most types of joint pathologies affect the menisci. When injured, symptoms appear immediately. If degenerative processes are a consequence of a disease of the musculoskeletal system, the discomfort increases gradually. Damage to the medial meniscus may be accompanied by hemorrhage into the joint cavity. This condition is called hemarthrosis. Symptoms common to all pathologies:

pain of varying intensity;
swelling;
skin redness;
extraneous sounds (clicks) appearing in the knee area when moving;
change in joint shape;
difficulty moving, a feeling of interference in the knee;
blockade of the leg, which manifests itself in a bent position.

If mucoid degeneration occurs, swelling occurs. This condition is accompanied by intense pain. The most common sign of degenerative processes is an extraneous sound (clicking) made by the joint when moving.

Injuries usually involve rolling, a condition in which there is excessive mobility in the knee. This may be a consequence of displacement or separation of the meniscus from the attachment site.

In case of injuries, the pathology is much easier to identify, since in this case the symptoms appear acutely. Damage to the outer meniscus occurs more often because this cartilage is more mobile.

If there is a blockage of the joint in a certain position, a crunch occurs, in most cases this means that pathology is developing in the meniscus. But moderate degenerative and dystrophic processes do not occur so clearly, which complicates diagnosis. Signs may not appear soon, but only if the disease of the musculoskeletal system develops sufficiently strongly.

To confirm the diagnosis if the external or internal meniscus is damaged, additional examination is prescribed:

Radiography. In this case, the pathological process can be determined using a contrast agent.
MRI. More accurate method. With its help, the degree of wear of cartilaginous tissues, as well as their damage, is detected in a timely manner.
CT scan.
Endoscopy. An arthroscope is used to examine the inside of the knee joint. This method allows you to identify pathology by examining tissues using a small video camera, which is inserted into the joint cavity and transmits the image to the monitor.

For most types of pathologies in the menisci of the knee joint, conservative treatment is ineffective. This method can improve the condition of medial cartilage deformities. Medications help prevent the development of pathology: they stop the inflammatory process, eliminate pain and swelling. However, if you are deciding how to treat a joint with degenerative changes in the meniscus, you should know that conservative therapy does not completely cure the knee.

When the first symptoms appear, it is necessary to reduce the load on the affected joint. First, you need to eliminate the signs of the acute form of the disease, since in this state it is prohibited to carry out any manipulations. To prevent displacement, a fixing bandage or splint is applied for 2 weeks.

For hemarthrosis, puncture is indicated. This procedure removes accumulated blood. Thanks to this, swelling and pain intensity are reduced, and mobility is partially restored.

Analgesics are prescribed. Drugs in this group eliminate pain. This cannot always be done using non-steroidal drugs (Ibuprofen, Diclofenac), therefore, in case of pronounced degenerative processes in the meniscus, narcotic drugs are prescribed - Promedol and the like. In some cases, it is recommended to use anti-inflammatory drugs. Glucocorticosteroids are injected into the joint.

After removing the splint, when the manifestations of the acute condition have been eliminated, they proceed to the next stage - physiotherapeutic procedures (phonophoresis, UHF, ozokerite, iontophoresis), as well as exercise therapy.

Physical exercise strengthens muscles, which helps reduce stress on the joint and menisci in particular. At the initial stage, static exercises are performed. In this case, there is no load on other parts of the body; only the muscles of the affected limb are involved.

These are drugs of a special group. They are offered in different forms: injections, tablets. The main purpose of such medicines is to restore cartilage tissue and stop degenerative processes. In addition, chondroprotectors significantly reduce the likelihood of developing pathology in the future. They deliver nutrients to the joint.

For degenerative changes in the meniscus, the following is prescribed:

Protekon. This combined drug relieves pain, prevents the development of inflammation, and restores cartilage tissue.
Don. A drug that affects metabolic processes in cartilage.
Teraflex. The composition includes substances that are related to compounds contained in cartilage tissue. Indications for use: any degenerative-dystrophic processes in the joints that are the result of chronic diseases, for example, osteoarthritis.
Artron. The drug helps restore cartilage exposed to intense physical activity, as well as injuries and diseases of various types.

Serious pathologies (strongly developed degenerative processes, deformation, separation from the attachment site) cannot be treated with a conservative method. In such cases, the joint is restored through surgery. The entire knee may need to be replaced with a prosthesis. A sliding, rotational, hinged or surface prosthesis is used.

A degenerative change is a disruption of the normal structure, leading to partial or complete loss of its functions. The cause of the pathology may be injury, active sports, heavy physical work, or excessive stress on the knee joint. Degenerative processes in the menisci can be a consequence of natural aging of the body.

Degenerative changes in the knee joints are common among older people, athletes and overweight people. The process usually involves cartilage, ligaments, menisci, and synovium. In severe cases, the articular surfaces of the bones that form the knee joint are damaged.

Causes of meniscus degeneration

Gonarthrosis

Classification of degenerative changes

The pathology is differentiated by the location of the foci of degeneration. They can be located both in the body and in the anterior or posterior horns. Most often, degenerative changes are detected in. This is due to the peculiarities of its structure and location.

Depending on the severity of pathological changes, 4 stages of degeneration are distinguished. They can only be detected and identified using magnetic resonance imaging (MRI).

Classification according to Stoller:

0 degree – characterized by the absence of pathological changes;
I degree – focal changes are noticeable in the thickness of the meniscus, not reaching its edges;
ІІ degree – the presence of a linear focus of destruction that does not reach the edges of the meniscus;
III degree – pathology reaches one of the edges, which leads to tearing.

We can speak about the truth if the third degree of degeneration according to Stoller is identified.

Table 1. The most common consequences of degenerative changes

Pathology	Description	Symptoms
Gap	Characterized by a violation of the integrity of the meniscus in the area of the body, anterior or posterior horn	Severe pain in the knee, preventing the patient from walking normally. If the posterior horn is damaged, it becomes difficult for a person to bend the leg, and the anterior horn - to straighten it.
Breakaway	The pathologically altered meniscus or its fragment is completely torn away from its attachment site	The articular mouse formed as a result of avulsion migrates through the synovial cavity, often causing blockade of the knee joint. The person experiences severe pain and limited mobility of the knee
Hypermobility	Manifested by abnormal mobility of both menisci due to rupture of the transverse knee ligament connecting them	, intensifying, descending and other physical activity
Cyst	The pathology is characterized by the formation of a fluid-filled cavity in the meniscus cartilage	It may remain asymptomatic for a long time. When a cyst ruptures in the knee, there is usually a sharp pain

Meniscus tears can be traumatic or degenerative. The appearance of the latter is usually preceded by aching pain, stiffness and discomfort in the knee for several months or even years.

What does meniscal degeneration lead to?

When complications occur (ruptures, avulsions, etc.), a person experiences pain, discomfort and a feeling of instability in the joint. The discomfort intensifies when going down stairs and squatting. Some patients complain of the appearance of characteristic clicks and the feeling of a foreign body moving in the knee when moving.

Damage and deformation of the menisci contribute to the appearance of degenerative processes in other structures of the joint. As a result, a person develops deforming osteoarthritis.

Diagnostic methods

Modern methods for diagnosing degenerative changes in the menisci of the knee joint:

. It is a non-invasive and highly informative research method that allows you to see almost all structures of the knee joint (ligaments, tendons, meniscus cartilage, hyaline cartilage). The advantage of ultrasound diagnostics is the absence of radiation exposure to the body;
. A modern method that allows you to identify meniscal degeneration and other pathological changes in the knee joint at the earliest stages. Magnetic resonance imaging is widely used to diagnose arthrosis deformans;
arthroscopy. An invasive research method that allows you to examine the cavity of the knee joint from the inside. Mainly used for severe knee injuries. In 70% of cases, diagnostic arthroscopy turns into therapeutic. During such an operation, doctors, under visual control, eliminate ruptures and other dangerous consequences of the injury.

If degenerative changes in the medial or lateral meniscus are accompanied by a rupture, the patient requires surgical intervention. The operation is performed using arthroscopy.

Manifestations in children and adolescents

Unlike adults, children with injuries more often damage the lateral meniscus. Blockades of the knee joint in childhood and adolescence are rare.

Degenerative changes can be different:

separation from the attachment point; rupture of the horns and body of the meniscus; excessive mobility as a result of rupture of the intermeniscal ligaments; cyst - the formation of cavities filled with fluid inside the cartilage; meniscopathies are dystrophic changes that develop under the influence of minor injuries, as well as as a complication of gout, osteoarthritis, rheumatism, tuberculosis and a number of other diseases.

Tears and detachments from the attachment site are often chronic in nature and are manifested by periodic pain and a feeling of impediment in movement.

There is a diagnostic test: go up and down stairs or slopes. With pathology of the meniscus, the pain in the knee intensifies when moving down.

* Rolling – sensations of pathological mobility, instability and displacement of the articular surfaces of bones.

The following symptoms are common to all types of meniscal degeneration:

pain, swelling, blockage of the joint in a bent position or the sensation of a foreign body in the knee, clicking and crunching, numbness of the knees during a long period of inactivity.

Other possible reasons:

dysplasia – abnormal formation of the knee joint; gout, syphilis, tuberculosis, rheumatism and other diseases that can affect joints; sprains of ligaments, as well as their incorrect formation; flat feet (low shock absorption of the foot is compensated by increased load on the knee); high physical activity; excess weight.

MRI allows you to obtain a three-dimensional image of all tissues of the knee: the articular surfaces of the bones, the ligamentous apparatus and the joint itself. During arthroscopy, an endoscope is inserted into the joint cavity through a miniature incision, with which the condition of the tissues and synovial fluid is monitored (on a monitor).

Therapy for degenerative changes in the menisci completely depends on the nature of the damage. Acute injuries serve as a direct indication for the use of conservative treatment methods:

First of all, a puncture of the joint is performed, eliminating its swelling and restoring mobility. Sometimes several procedures are required, since active exudation (secretion of inflammatory fluid) in the joint lasts up to three to four days. Analgesics are prescribed, preference is given to narcotic drugs (Promedol and its derivatives), because other drugs in this case, as a rule, are not able to relieve the patient of pain. Chondroprotectors provide the body with the necessary substances to restore the damaged area of the meniscus. Anti-inflammatory drugs. At the rehabilitation stage, physiotherapeutic methods are used as an auxiliary means - ozokerite, UHF, iontophoresis, shock wave therapy. For 14 days, a splint is applied to the straightened leg to secure the joint in the required position.

Chronic dystrophies, joint dysplasia and abnormal development of the ligamentous apparatus require exclusively surgical treatment.

If the cause of degeneration is chronic diseases, such as rheumatism and gout, along with surgical methods, the underlying disease is also treated (diet, immunocorrectors and other methods).

There are places in the human body where increased stress is felt. These include the cartilage discs between the vertebrae and the menisci of the knee joint. Over time, degenerative processes occur in the lateral (outer) and medial (inner) menisci.

The result of this pathology can cause a sick person a lot of discomfort.

The concept of degenerative changes should be understood as anatomical deformation of an organ of varying degrees (according to Stoller), which was the result of:

injuries; diseases; atypical joint structure.

Meniscal degeneration is often the result of injury, which is not always obvious. An ordinary unsuccessful turn of the shin can be a prerequisite for the destruction of cartilage tissue, accompanied by severe pain.

Often the medial disc may be damaged. If, when the outer cartilage, which absorbs the motor activity of the knee joint, is damaged, there is no rigid fixation, then the cartilage moves to one side.

In this case, its horns will be located next to the condyles. With a sharp turn of the tibia, the meniscus may not have time to escape from the displaced process of bone tissue and immediately damage or even rupture occurs.

Degenerative lesions of the menisci can be different:

rupture of the horn and body of the external and internal meniscus; complete separation from the attachment point; excessive mobility due to rupture of the ligaments between the menisci; cystic neoplasms inside the cartilage cavities of the knee joint; meniscopathy – dystrophic changes that occur under the influence of minor injuries and as a result of complications of gout, tuberculosis, rheumatism and osteoarthritis.

If a person is constantly tormented by aching pain, each time arising with renewed vigor, then it is quite possible that he has begun to experience pathological changes in the posterior horn of the medial meniscus. In almost 90 percent of cases, changes in the knee joint are associated with damage to the natural “shock absorber” of the lower extremities.

Symptoms will largely depend on the nature of the pathology itself. The gap is always accompanied by:

severe painful sensations; blockade of the lower limb in a bent state; extensive swelling.

Serious damage to the medial meniscus occurs against the background of hemorrhage into the joint cavity (hemarthrosis). Swelling and pain are also characteristic of meniscal cystosis. All tears and detachments are chronic in nature, they can manifest as temporary pain and a feeling of interference with motor activity.

For self-diagnosis, you can conduct a special test. You need to go up and down the stairs. If there is a pathology of the meniscus, then as it descends, the pain in the knee joint will intensify significantly.

The chronic course is accompanied by secondary degenerative and dystrophic changes in the posterior horn of the medial meniscus (caused by other diseases). As a rule, in such situations, clicking and a feeling of pathological joint mobility (rolling) will be noted. This process is especially noticeable in movement after a prolonged state of rest. It can often present as pain in the knees.

As the disease progresses, symptoms gradually increase. The cartilage layer becomes thinner, and salts or uric acid crystals accumulate underneath it. If the patient does not seek adequate medical help, then the final stage of meniscopathy will be contracture.

It should be understood as a stable impairment and significant limitation of joint mobility.

The following symptoms are common to any degree of degeneration:

pain; edema; crunching and clicking sounds; joint blockade; swelling of the knee joint with prolonged absence of movement.

The high incidence of pathologies among patients of any age is caused by the special anatomical structure and location of the posterior horn of the menisci. As a rule, damage and cysts occur in those people whose activities are associated with high physical activity and significant stress (dancers, ballerinas, athletes).

Degenerative changes in the menisci can be caused by:

dysplasia (improper formation of the knee joint); diseases affecting the joints (gout, tuberculosis, rheumatism, syphilis); sprained ligaments and their inadequate formation; flat feet (low shock absorption of the foot, compensated by excessive load on the knees); too much physical activity; overweight.

If the patient suffers from an acute form of damage to the medial meniscus, then in this case there will be blockade, pain and characteristic clicks when straightening the knee joint. This makes it possible to establish an almost 100 percent correct diagnosis.

Degenerative damage and changes in the internal meniscus cannot always be detected by visual examination due to the lack of clear, vivid symptoms and even a positive reaction to the tests performed.

In such a situation, you should resort to instrumental diagnostic methods:

Magnetic resonance imaging, MRI of the knee joint (classification according to Stoller is used). The study helps to obtain a three-dimensional picture of almost all tissues of the knee joint; arthroscopy. Thanks to a miniature incision, a special endoscope is inserted into the joint cavity. It can be used to monitor the condition of synovial fluid and tissues.

Therapy for degenerative changes in the meniscus of varying degrees completely depends on the nature of the damage. Acute injuries serve as a direct indication for the use of conservative treatment methods:

joint puncture. The procedure is necessary to eliminate pain, swelling and restore mobility. In some cases, several alternating procedures may be required at once, for example, when exudation of the knee joint does not stop for several days; prescription of analgesics. As a rule, preference is given to narcotic drugs, for example, Promedol. This is important, because other remedies for lesions of the posterior horn of the medial meniscus are not able to relieve the patient from excruciating pain; use of chondroprotectors. Drugs in this group provide the patient’s body with all the necessary substances, which has a beneficial effect on the restoration of the affected area of the meniscus; use of anti-inflammatory drugs (for problems of varying degrees).

During the rehabilitation period, ozokerite, iontophoresis, shock wave therapy and UHF will be excellent auxiliary methods.

Treatment may require splinting the affected limb (for 2 weeks). This will help ensure reliable fixation of the joint in the required position.

If there has been a rupture, then in such cases mandatory surgical treatment is indicated; the surgeon will perform:

two small incisions; insert instruments into the cavity of the knee joint; sew up the damaged area.

If the degenerative changes in the menisci are severe, then it may be necessary to remove the cartilage and replace it with artificial one.

Almost all surgical procedures should be performed only in a state of remission.

Surgery is only necessary for:

chronic dystrophy; joint dysplasia; abnormal development of ligaments.

If you consult a doctor in a timely manner, degenerative damage to the internal meniscus will be stopped at the very beginning of its development.

Degenerative changes in the meniscus are its anatomical damage that occurs after injury, a previous disease, or an atypical joint structure. Most often, pathological changes in the menisci occur as a result of injuries, when the cartilage disc is damaged and provokes attacks of pain. Degenerative damage to the internal meniscus occurs more often in men than in women. It occurs in almost half of the cases.

The human body is an extremely complex mechanism and its work must always be adjusted. Articular cartilage acts as shock absorbers, which normalize and facilitate joint mobility. Cartilage tissue, located in the knee joint in the form of menisci, helps reduce surface friction, improve joint rotation and limit mobility. There are two menisci in the knee joint: the outer (lateral) and the inner (medial).

Degenerative changes in the cartilage pads of the knee joint are characteristic injuries that are the result of injuries (often in athletes); they can be complicated by the course of the disease or structural features of the joint. Among all joint diseases, degenerative changes in the menisci are in first place.

Signs of change are:

rupture of the horns and the body of the meniscus itself; the formation of a hollow cyst that is filled with fluid; the development of meniscopathy, a process of degeneration that occurs as a result of rheumatism, tuberculosis; cartilage tear; rupture of the ligaments that connect the menisci.

The meniscus is the cartilage layer inside the knee joint, which mainly performs a shock-absorbing function. Ruptures of the joint pads can occur after injuries that occur in young people during physical activity, and can also be degenerative, which occur in older people and can develop without injury against the background of degenerative changes in the meniscus, which is a variant of the course of knee arthrosis.

Failure to treat a traumatic rupture can lead to it subsequently becoming a chronic pathology.

To diagnose a meniscus tear, it is necessary to perform an ultrasound and MRI. Meniscal tears can occur in the anterior horn, posterior horn, and body of the meniscus. Damage to the meniscus can lead to mechanical obstruction of movement and cause pain syndromes.

The loose part of the meniscus provokes the destruction of adjacent cartilage.

A traumatic meniscus tear causes swelling and pain in the knee joint. If the rupture occurs in a place where there are vessels, hemarthrosis occurs. It manifests itself as swelling above the kneecap. When the cartilage pad is damaged, the part that becomes loose and loose can interfere with free movement of the knee. Small tears can cause painful clicking or a feeling of stiffness. With large ruptures, blockade of the joint may occur due to the fact that the torn fragment of the cartilage pad is moved to the center of the joint and provokes “jamming” of the joint.

When the posterior horn of the meniscus is torn, the process of flexion is limited; when the body of the meniscus or its anterior horn is torn, pain occurs during the process of extension in the knee joint. Pain syndromes caused by a rupture of the posterior horn of the meniscus can be so severe that it is impossible to step on the leg, and sometimes a meniscus rupture manifests itself only as pain when making certain movements.

With an acute tear of the anterior cruciate ligament, swelling may develop faster and be more pronounced. Damage to the lateral cartilaginous pad also occurs. Degenerative cartilage tears can occur with the slightest physical exertion, especially when it comes to the older generation. A degenerative tear of the medial meniscus often damages the adjacent cartilage that covers more of the tibia and femur.

General symptoms of cartilage damage:

clicks and crunches; swelling; soreness; when staying in one position for a long time, the knees become numb; joint blockade with bent knees.

The structure and anatomical features of the location of the menisci cause a high incidence of pathologies in different age categories. At risk are athletes who are susceptible to ruptures, damage and cystosis.

Possible causes of cartilage lining tears:

improper formation or sprain of ligaments; flat feet; improperly formed knee joint; the presence of gout, syphilis, tuberculosis, rheumatism and other diseases that can affect the joints; excess weight.

Damage to the external meniscus of the knee joint.

Injury to the lateral meniscus in adults is extremely rare. This happens more often with children and adolescents. As a result of this type of injury, blockage is rare.

Symptoms of a lateral meniscus injury include:

pain syndromes in tissues in the area of the collateral ligament; pronounced synovitis; unpleasant sensation of pain in the area of the fibular ligament; low tone in the muscles of the front of the thigh.

If the outer cartilage is torn, the knee joint can be bent at a right angle and the patient himself can unlock it. In general, the signs of this injury are not very pronounced. Diagnosing such an injury is quite problematic due to inconsistent pain. A congenital developmental anomaly is possible - a solid (disc-shaped) external meniscus. It can easily be confused with a cartilage tear. With this pathology, the cartilage has the shape of a disc. Signs of a continuous external meniscus may appear in adolescence, and can also be detected at an older age.

A common injury to the medial meniscus is a tear. Basically, the middle part ruptures while the ends remain intact.

There are three types of medial meniscus injuries:

rupture of the ligament that secures the internal organ; rupture of the cartilage itself; rupture of cartilage tissue.

A tear with pinching of the anterior horn of the internal meniscus provokes blocking of the knee joint, which does not cause flexion of the knee. This phenomenon is temporary, since unblocking will restore movement in the joint. Damage to the posterior horn of the medial meniscus is a more serious injury. this causes the knee to lock, pop out, and buckle.

The process of damage to the left and right cartilage to the same extent.

Causes of meniscus degeneration include:

sharp extension of the leg; deposition of mucin in tissues; severe injury; rheumatism; gout.

Diagnosis of the disease can be done using the following studies:

Magnetic resonance imaging; Ultrasound; CT scan; Radiography; Diagnostic arthroscopy.

In order to make an accurate diagnosis - a meniscus tear, you should consult a specialist. You need to tell him under what circumstances you experience pain. Any changes in the menisci cause pain. During the examination, the hip and knee joint are examined. With effusion, there may be suspicion of the development of hemarthrosis or synovitis.

X-ray – performed for any pain in the knee joint. It is carried out in the following projections:

Lateral projection; Direct projection in a standing position and with knees bent at 45°; Axial projection.

MRI – allows you to see the cartilage in several planes, assess the condition of other periarticular and articular formations, which is important if there are doubts about the diagnosis. MRI is up to 95% accurate in diagnosing meniscus problems. In the sagittal plane, the cartilage pad takes on a butterfly shape. When a rupture occurs, the symptom of a “double posterior cruciate ligament” occurs when the meniscus is adjacent to the posterior cruciate ligament and ends up in the intercondylar fossa of the femur.

After diagnostics and confirmation of the diagnosis, the specialist prescribes complex therapeutic methods, including a set of such measures:

performing a puncture from the knee joint; prescription of physiotherapy: phonophoresis, UHF, iontophoresis, ozokerite; prescribing analgesics, drugs containing narcotic substances (Promedol), NSAIDs, chondroprotectors (provide the body with substances that help restore the damaged area of the meniscus).

For 2 weeks, a splint is applied to the straightened leg, which ensures fixation of the joint in the desired position. In case of ruptures, chronic dystrophy, joint dysplasia, surgical intervention is performed. If gout or rheumatism is present, the underlying disease that triggered the process of degenerative changes is also treated.

The main treatment method for knee cartilage pathologies is surgery. Arthroscopy is performed, the operation is carried out through two incisions one centimeter long. The torn part of the meniscus is removed, and its inner edge is aligned. After such an operation, the recovery period depends on the patient’s condition, but on average it ranges from 2 days to several weeks.

Degenerative changes in the menisci are the most common injuries among people of all ages. They can be of different types (depending on the location of the damaged area) and of varying degrees. Damage to the meniscus of the knee joint mainly occurs in athletes, as well as in many other people with a specific type of activity. The presence of dystrophic changes in the knee leads to disruption of the motor system.

Therefore, it is important to start treatment on time to avoid consequences. Treatment usually takes a long time, you need to be patient. Pathologies such as a rupture of the medial meniscus or degenerative-dystrophic changes in the meniscus of the knee joint can lead to serious consequences.

If you notice symptoms or signs of these types of injuries on your knee (described below), you should consult a doctor immediately. After undergoing appropriate examinations, the extent of the disease is revealed, and then a course of treatment is prescribed. To understand how important a healthy knee meniscus is, you need to know what function it performs. The menisci, cartilaginous tissue in the knee, serve to reduce friction between the joints of the knee and reduce limited movement. In turn, the menisci (internal and external) help improve the rotation of the entire joint. Thus, any damage or degenerative rupture complicates walking, creates pain, and sometimes inflammatory processes.

The menisci are an important part of the knee joint; they look like cartilage plates and perform a shock-absorbing function, while preventing the knee joint from being injured and displaced. Degenerative changes in the meniscus lead to disruption of the motor activity of the joint and can cause serious complications.

Degenerative changes are very common and can affect people of all ages. But the pathology is more common in adults and older people, especially men. This disease requires complex and long-term treatment from a competent specialist, so you should consult a doctor at the first unpleasant symptoms.

Degenerative changes in the posterior horn of the medial meniscus represent a violation of the integrity of the cartilage, its damage. In general, there are two menisci - medial and lateral, but it is the medial one that is more susceptible to damage, since it is less elastic and quite thin, and is located at the junction of the femur and the articular capsule.

In addition, the meniscus itself consists of an anterior, posterior horn and body. Most often, it is the posterior horn area that is damaged. This pathology is in the first place for problems in the knee joints, and if it is not treated on time, it becomes chronic.

Meniscal degeneration always occurs due to injury or joint disease, such as arthrosis in the elderly or arthritis. If the injury is treated at the wrong time or incorrectly, the risk of pathology increases greatly. The meniscus may not heal properly and become displaced, and then rupture. As a result, the entire knee joint suffers.

Kinds

Degenerative changes in the medial meniscus are divided into the following types:

Gap;
Separation from the attachment point;
Meniscopathy, this pathology occurs as a result of other diseases, such as rheumatism;
Cyst in the cartilage area;
Excessive mobility due to torn ligaments.

With degenerative changes in the medial meniscus, a person makes a sudden movement, for example, straightening the knee, and the cartilage cannot withstand the pressure and moves, and it can tear and even get stuck in the knee joint, completely limiting its mobility.

Causes

The following causes of degenerative changes in the medial meniscus are identified:

Problems with joint formation in children;
Diseases that can affect joints, for example, arthritis and arthrosis, rheumatism, gout, as well as syphilis, tuberculosis, etc.
Having excess weight;
Flat feet, since in this case the foot ceases to absorb shock and the load goes to the knees;
Knee and meniscus injuries.

Athletes are more susceptible to the disease, as they constantly make sudden movements and their body undergoes enormous stress. In this case, there is a high risk of accidental injury during exercise and subsequent disruption of the knee joint.

The disease also often occurs in older people who suffer from joint diseases, such as arthritis. In this case, degenerative changes occur in the entire joint, it is gradually destroyed and its motor activity is disrupted.

In childhood, degenerative changes in the meniscus usually do not occur, since in children the body recovers quickly, and the cartilage tissue is very elastic and difficult to be injured. But with strong impacts, for example during a car collision, meniscus injuries are also possible. In children, they need to be treated especially carefully to avoid consequences in adulthood.

Symptoms

Degenerative changes in the meniscus appear in two forms: acute and chronic. When the posterior horn of the medial meniscus is damaged, a person experiences aching pain when walking and running. Damaged menisci do not perform their function well and the knee joints begin to suffer under load.

If a meniscus rupture occurs, severe and sharp pain appears, which intensifies when trying to bend the leg at the knee, and when walking. There is also a violation of the motor activity of the joint, the person limps and cannot bend the knee normally.

If the integrity of the meniscus is damaged, swelling of the tissue around the knee joint appears, and hemorrhage into the joint cavity is also possible. The same symptoms appear in cases where cystic neoplasms appear in the meniscus area.

Often, with chronic degeneration of the posterior horn of the medial meniscus, a person is bothered by mild pain in the knees during exercise. The pain also intensifies when the patient walks down the stairs. In chronic pathology, a clicking sound appears in the knee when moving; often similar sounds occur after prolonged standing.

It is important to note that symptoms always worsen over time as the cartilage tissue gradually breaks down. If the patient is bothered by knee pain, he needs to be examined as soon as possible, otherwise the disease can become very complicated.

Diagnostics

Only an experienced doctor can diagnose the disease correctly, since the symptoms can often be similar to other joint pathologies, and each disease is treated in different ways.

A specialist can quickly identify pathology when examining a patient, since joint mobility is usually observed, and the patient complains of characteristic pain. The doctor also observes swelling and blockade of the joint due to displacement of the meniscus, if present. During the interview, the patient can talk about at what moments he is bothered by pain and what it may be associated with.

To confirm the diagnosis and clarify the size of the rupture and its location, the patient is referred to an ultrasound and MRI of the knee; arthroscopy may also be indicated. If an ultrasound reveals the presence of blood in the joint, then a puncture of the knee is necessarily performed, and the resulting contents are sent for histological analysis.

To detect the presence of infections, blood and urine tests are prescribed. If there are signs of other pathologies, the patient is referred for examination to other specialists. Modern diagnostic methods help to accurately identify diseases and prescribe effective treatment in the shortest possible time.

Treatment

Depending on the severity of the disease, the doctor chooses treatment methods. For minor meniscus disorders, conservative treatment is usually used, but for tears and displacement of the meniscus, surgery is indicated. In any case, the effective method should be chosen by the attending physician based on tests.

Conservative treatment is as follows:

The patient is prescribed medications. These are non-steroidal anti-inflammatory drugs, analgesics or corticosteroids. It is also recommended to take chondroprotectors and injections of hyaluronic acid into the knee to restore cartilage.
Therapeutic puncture is performed in cases where blood is found in the knee. The fluid must be removed to prevent joint inflammation from developing.
If the meniscus is displaced, it is adjusted manually with novocaine anesthesia, or with hardware traction of the limb.
To fix the joint in the correct position, a plaster cast is applied, or wearing is prescribed.

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