Knee joint meniscus injuries: causes, symptoms, diagnosis, treatment

ICD-10 code

• M23.6. Other spontaneous ruptures of the ligament (s) of the knee.
• M23.8. Other internal knee lesions.
• S83.2. The meniscus rupture is fresh.

Epidemiology of knee joint meniscus damage

Injuries meniscus ranks first among the intra-articular injuries of the knee and reach 77%.

[1], [2], [3],

What causes damage to the knee joint meniscus?

The mechanism of rupture of the meniscus is more often associated with compression of it between joint surfaces during sharp flexion or extension in the knee joint, especially in combination with hip rotation with a fixed shin. Damage to the inner meniscus occurs 5-10 times more often than the outer one. This is due to the fact that the medial meniscus is more firmly fused with the capsule of the joint and the tibial collateral ligament, which make it less mobile. Meniscus ruptures can be longitudinal, like "handles of the watering can", as well as the front or rear horns. The last happen 4 times less often than the breaks in the front.

Symptoms of knee joint meniscus damage

Following the typical mechanism of injury, there is a sharp pain in the knee joint and a restriction of active and passive movements - "blockade of the joint". Attempting to move in it, especially towards the extension, sharply increases pain.

Often, under the effect of treatment or spontaneous blockade of the knee joint disappears, pain syndrome and the phenomenon of secondary synovitis decrease. There comes an alleged "recovery". But in the future the slightest awkward movement, repeating the mechanism of injury, can cause a relapse of the blockade of the knee joint. Sometimes it is cruel and does not disappear without medical assistance, and in some cases the patient eliminates it by means of swinging and rotational movements of the shin. Pain in the joint lasts 1-2 days, synovitis is insignificant or absent. Patients do not apply for medical care. Such attacks of blockades begin to recur and can occur several times a month, a week or even a day, which forces the patient to seek medical help.

Diagnosis of knee joint meniscus damage

Examination and physical examination

When palpation, tenderness is revealed along the joint articulation in the projection of the meniscus. The joint swells. Hemarthrosis and reactive effusion of synovial fluid create a picture of the presence of free fluid in the knee joint - symptoms of swelling and ballotation of the patella. Shin in forced position: bent at an angle of 30-40 °.

When examining patients with chronic meniscus ruptures, they reveal the signs characteristic of this untreated trauma.

Atrophy of the hip muscles is one of the objective signs of knee joint disease. If you ask the patient to lift the leg that has been unbent at the knee joint, you can reveal the flattening of the abdomen of the inner wide thigh muscle on the side of the lesion and the more clearly outlined contours of the sartorius muscle - Chaklin's symptom.

The knee joint is slightly bent, it is always possible to bring a palm (a symptom of the "palm") under the patient lying on the couch. AM Landa described this symptom as a symptom of flexion contracture.

When palpating the joint gap in the area of the damaged meniscus with the knee joint bent, moderate soreness is determined, and if the finger is left in this place and the patient's leg is unbent, the pain is significantly strengthened - a symptom of N.I. Baykov.

In many patients, a positive symptom of VP is revealed. Perelman: down the stairs is more difficult because of the pain than the ascent.

Laboratory and instrumental research

Since a fracture of the meniscus is not visible on the survey radiograph of the knee joint, resort to the introduction of contrast agents or air. But such studies are not always reliable. At present, arthroscopy has helped the clinical diagnosis of internal injuries of the knee joint.

Differential diagnosis of knee joint meniscus damage

In an acute period, pathology is differentiated from rupture of the capsule and ligament apparatus, bruise and intraarticular fracture; in the chronic stage - from meniscopathy, meniscus and meniscus cyst. 

[4], [5], [6]

Treatment of knee joint meniscus damage

Conservative treatment of knee joint meniscus damage

If there is a blockage of the knee joint, it is eliminated. Dot the knee joint, evacuate the contents and inject 10 ml of 1% procaine solution into the cavity. The patient is put on a high stool or table so that the thigh lies on the sitting plane, and the shank hangs at an angle of 90 °. After waiting 10-15 minutes from the beginning of anesthesia, they begin to remove the blockade.

Manipulation is performed in four stages:

• the first stage - traction for a stop to the bottom;
• the second stage is the deviation of the lower leg in the direction opposite to the restrained meniscus;
• the third stage - the rotation of the shin to the inside and outside;
• the fourth stage - freely, effortlessly unbent shin.

If the attempt failed, it should be repeated, but no more than 2-3 times. After removing the blockade, put a back gypsum lingette from the fingertips to the upper third of the thigh for 3-4 weeks, designate UHF, static gymnastics. After the end of immobilization, a restorative treatment is performed.

Surgical treatment of knee joint meniscus damage

With repeated blockades, surgical treatment is shown in the same way as in cases where the blockade was not conservatively managed to be eliminated. The operation consists in opening the joint with parapatellar access and its revision. When a torn meniscus is identified, it is resected all over. The left mobile sections of the meniscus (usually the hindquarter) can again give the "blockade" of the knee joint. The wound is layer-by-layer closed. Apply a posterior gypsum longe for 2 weeks. Walking on crutches is shown for 3 weeks. LFK and physiotherapy are prescribed from the 3rd day.

Estimated period of incapacity for work

Restoration of joint and disability functions occurs in 8-10 weeks.

[7], [8]