Change in the menisci of the knee joint. Degenerative changes in the menisci: symptoms, causes, methods of treatment. Classification of degenerative changes

What is a meniscus? This is a kind of shock absorber, which is a cartilaginous gasket. Each meniscus, shaped like a horseshoe, consists directly of the body and horns (back and front) that close the "crescent".

Where are these cartilage pads located? In those places that experience increased stress, namely in such joints 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 lower jaw);
acromioclavicular (that is, the articulation of the articular surface of the clavicle with the scapula).

There are two cartilage pads connected by a transverse ligament:

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

The menisci are extremely important elements of the knee. They perform the function of distributing the load and allow the body to be in a stable state. In the case of their degeneration, the patient experiences debilitating pain and instability when moving. Over time, a progressive disease can cause mobility to lower limb will be completely lost.

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

What are the medial and lateral menisci

These are anatomical injuries that could occur due to:

atypical structure of the joint;
diseases;
injury.

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 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 case of any displacement of the bone process. And as a result - either a rupture of the meniscus, or its damage.

Aching pain syndrome in the knee, discomfort and stiffness in movement with a torn meniscus can be felt for many months or even years.

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

Types of meniscus lesions

There are several of them:

Rupture either of the body itself, or of the posterior or anterior horns. With degenerative changes in the posterior horn of the medial meniscus, it is quite difficult for the patient to bend 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 point of attachment. This damage can completely block the work of the knee joint.
Rupture of the cruciate or menisci, which is characterized by excessive mobility of the cartilage pads.
The formation of a pathological cavity (that is, a cyst) in the body of the meniscus. Maybe long time develop completely asymptomatically.
Changes of a degenerative-dystrophic nature that can develop after an 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 take care of themselves too.

Stages of the disease

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

Sharp. Its duration depends on the causes that provoked the disease.
Chronic. It is in this stage that the acute form can smoothly flow in 1.5-2 weeks. At this stage, the patient complains of pain, clicking and crunching in the knee joint, which only get worse. In the knee area, the articular ridge can be palpated.

Classification of damage to cartilage pads

There are 4 degrees of meniscus degeneration according to the classification, which was 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 with the help of MRI. So, the degrees of meniscus degeneration are as follows:

0 degree. No pathological changes are observed, that is, it is simply the norm.
1 degree. In this case, some focal pathologies are observed, but not reaching the edges of the cartilage lining. Degenerative changes in the medial meniscus of the 1st degree are characterized by minor damage to the cartilage tissue of the horn and can very often develop as a result of injuries sustained in the process of walking on an inclined plane, squatting with a load or jumping. The patient has swelling of the knee joint, and he feels pain in it.
2 degree. The presence of a linear focus of damage to the cartilage lining is observed. Degenerative changes in the medial meniscus of the 2nd degree are characterized by tissue swelling and pain, which only increase. In the bag of the knee, there is an accumulation of blood and a detachment of the horn of the meniscus, parts of which enter the joint cavity, thereby blocking the motor function of the organ. 2nd degree involves operational measures.
3 degree Damage reaches one of the edges of the meniscus, leading to its rupture.

Degenerative changes in the medial meniscus 2 tbsp. and 1 tbsp. - these are borderline lesions, but the 3rd degree is a real meniscus rupture. Do not bring the situation with your health to critical! Take care of yourself.

Possible causes of the development 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 joints are affected.
Sprain.
Physical activity in large volumes - whether it's work in the country for arranging beds or just playing sports.
Frequent knee injury.

The presence of excess weight.
Dysplasia (that is, abnormal development) of the knee joint.
Displacement of the cartilage lining.
Flat feet (drooping of the transverse or longitudinal arches of the foot). In this case, the load on the knee joint increases.
Circulatory disorders in the extremities.
The result of the 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).
Pain is sharp and aching.
Some limitation in movement.
The presence of discomfort and a feeling of instability in the knee joint.
Sensation of a foreign body in the knee.
The appearance of a crunch and clicks with any attempt to straighten the 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 outer cartilage lining, or all at once, you should contact a medical institution for help.

What to do if you have a knee injury

First of all, you must immediately call "emergency help". Next, do the following:

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

On the inner surface of the thigh, we apply either a cold compress, or something from the freezer wrapped in cotton.
We give the patient painkillers.

Diagnostics

If the 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 research are prescribed (based on the signs of degenerative changes in the medial meniscus):

MR-tomography and CT, which can be used to assess the severity pathological changes in the knee joint. A three-dimensional image allows you to do this with a high degree of accuracy.
Radiography. In the course of the study, a picture of the knee joint is obtained in two projections, which allows you 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 give an accurate picture of the pathological process.
ultrasound. It is highly informative and non-invasive. With this method, almost all elements of the knee joint can be observed. With ultrasound, the radiation load on the body is completely absent.
arthroscopy. With the help of a special device (endoscope) inserted into the cavity of the knee joint through small incisions, the specialist determines the state of the synovial (articular) fluid and tissues of the knee. Through a video camera, a picture of what is happening, the specialist observes 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 an injury, including tears or avulsions.

Treatment of degenerative changes

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

In case of blockade of the knee joint with manual therapy carry out the reduction of the joint.
In the first 3-4 days after the injury, exudate is actively released into the joint bag - liquid. 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 lining), the knee joint is fixed using either a special orthopedic apparatus or a plaster cast.

Medical treatment should be comprehensive:

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

Painkillers. For example, to relieve inflammation or pain good effect give drugs such as Ibuprofen, Dona, Kaver or Sinarta (all of them belong to the group of nonsteroidal drugs).
Muscle relaxants. They are prescribed to reduce the joint load and relieve muscle spasm (for example, Mydocalm).
Chondroprotectors. Preparations such as "Chondroitin", "Glucosamine" or hyaluronic acid contribute to the fastest restoration of the functioning of the meniscus.
Various ointments help fight edema (for example, Voltaren, Dolgit or Diclofenac).

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

A good effect in the fight against the disease is given by physiotherapeutic methods:

Electrophoresis. Using this procedure, it is possible to cover the damaged surface with small particles of the drug, thereby ensuring their deep penetration into tissue cells.
Iontophoresis. This procedure, based on the process of ion migration under the influence of a small direct current, allows you to eliminate puffiness.
ultrasound therapy.
UHF.
Shock wave therapy.
Applications with mountain wax(ozocerite) or paraffin.
exercise therapy.

Do not forget about such a simple method as massage of the damaged area of the knee.

Operative measures are prescribed in case of formation of cysts, multiple ruptures of menisci and necrosis. The following operations can be performed:

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

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

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

Do you need rehabilitation

Of course, it is needed, especially after operational measures. What is rehabilitation aimed at?

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

A set of exercises and the frequency of their implementation are developed for each patient individually, guided by the severity of the injury or the complexity of the pathology. Moreover, after surgical intervention, 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, simple precautions should be taken:

Eat a balanced diet, exercise and constantly monitor body weight. Overweight adversely affects the joints.
To avoid trouble with the knee, it is better to fix it with an elastic bandage or special pads.
You should not abruptly engage in physical work or sports: you must first warm up the muscles, kneading them and gradually increasing the load.
More often undergo a general examination in order to identify pathologies that contribute to the development of degenerative changes in the cartilage lining, and begin their timely treatment.
We recommend doing sports in comfortable shoes to reduce the risk of falling to zero.

June 12, 2017 No comments

Menisci are layers inside the knee joint between the surfaces of the bones of the thigh and lower leg in the form of a crescent, consisting of cartilage tissue.
There are medial (inner) and lateral (outer) menisci. Conventionally, in the meniscus of the knee joint (ISS), the posterior horn, anterior horn and body are isolated.
Cartilage discs evenly distribute the load on the knee joint, reduce surface friction and act as a shock absorber when moving.
Degenerative changes are the loss of function and the process of reverse development of cartilage resulting from trauma, developmental anomalies, or after a disease. The outer meniscus is less prone to injury than the inner meniscus due to better mobility.

Types of dystrophic lesions

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

The most common reasons

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 the shape of the foot);
excessive physical activity;
obesity.

Clinical manifestations

Symptoms of lesions of the meniscus of the knee joint depend on the causes of the disease.
Distinguish between acute and chronic knee injury.
The main symptoms include swelling of the joint, redness, limited mobility, pain. In severe injuries, blood can enter the joint cavity.

Stages of the disease

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, aggravated by movement. A characteristic feature is the appearance of a crunch and clicks when walking, when feeling, the articular roller is determined. Cartilage tissues become thinner, joint instability develops, thigh and lower leg muscles atrophy. The patient is advised to lie more so as not to load the injured leg.
If left untreated, meniscopathy may develop contractures (restriction of joint mobility).

General clinical symptoms of degenerative damage to the ISS

pain syndrome;
puffiness;
restriction and stiffness of movements;
clicks and crunch when bending and unbending the knee;
blockade of the articulation in a bent position.

Degrees of damage to the ISS

In the first degree of dystrophic changes in the cartilaginous tissue, minor damage to the horn, swelling and soreness 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 when jumping, squatting with a heavy load, moving along an inclined plane.
In the second (severe) degree, the intensity of pain increases, swelling of the tissues increases. Blood accumulates in the joint bag, the meniscus horn breaks off and its parts enter the joint cavity, causing blockade of movements. At this stage, a surgical operation is indicated.

Forms of manifestation of diseases

Damage to the lateral ISS is more common in childhood and adolescence.
Main symptoms:
pain in the tissue area of the collateral ligament;
a pronounced inflammatory process in the synovial membrane (synovitis);
discomfort and pain in the area of the peroneal fold;
decreased muscle tone of the anterior femoral part.

If the external cartilage is torn, then the knee is at a 90° angle and the patient can unlock it himself. The symptoms of this pathology are mild and difficult to diagnose due to the inconsistency of pain. There is a congenital anatomical anomaly, which is sometimes confused with a rupture of cartilage tissue - a disk-shaped (solid) lateral meniscus. When torn, the cartilage is in the shape of a disc. A continuous external meniscus is determined mainly in adolescents, but also occurs in older people.
The most common damage to the internal ISS is the rupture of its middle part with the integrity of the ends.

Types of damage:
rupture of the ligament that fixes the organ;
rupture of the cartilage itself;
cartilage rupture.
Blocking the knee with limiting its flexion temporarily provokes the separation of the anterior horn of the ISS with pinching. After unlocking, movement in the joint is restored. A more serious injury, in which blocking, bending and popping out of the knee joint occurs, includes injury to the posterior horn of the internal meniscus.

Diagnostics

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

To clarify the diagnosis, resort to instrumental research:
With the help of x-rays, the stage of degenerative damage is determined. At the first degree, the image shows an uneven narrowing of the joint gap, at the second - bone growths appear on the articular surfaces.
Having made an MRI and CT scan, the degree of damage and tissues of the knee joint are determined in a three-dimensional image: articular surfaces, ligamentous apparatus, articular cavity and bones. In the sagittal (imaginary vertical) plane, the cartilage lining is butterfly-shaped. When ruptured, the meniscus 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 of degenerative changes

Methods of therapy for changes in the ISS depend on the causes, stage and form of disorders. Acute injuries are treated conservatively.
The patient immediately after the injury must be provided with complete rest.
Apply a cold compress or ice pack to the inner thigh.
To stop a strong pain syndrome, narcotic analgesics are used, since other painkillers do not bring relief to the patient.
The injured limb is immobilized (immobilized) by applying a plaster cast for two weeks.
In order to eliminate edema and restore movement in the knee joint, it is punctured. 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 is from six to twelve months.
With the blockade, the knee joint is repositioned (reduced) using manual methods.
To restore the 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 (keyver, dona, sinarta, ibuprofen, indomethacin).
To reduce edema and speedy recovery of the damaged ISS of the first-second degree, ointments are used externally on the skin (dolgit, diclofenac, voltaren).
Physiotherapeutic procedures (UHF, shock wave therapy, ozocerite, iontophoresis) and exercise therapy are prescribed.
Massage of the affected area of the knee has a good restorative effect.

With the second degree of severity of degenerative changes in the internal meniscus (ruptures, displacement, separation of the anterior and posterior horns of the ISS, cartilage crushing), surgical intervention is indicated.
It includes: removal of cartilage of a completely or damaged horn, suturing of the gap, fixation of detached horns, transplantation (transplantation).
A minimally invasive surgical procedure 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.

In transplantation, the following prostheses are most often used:
A sliding prosthesis is used to replace worn-out internal or external ISS.
Surface substitutes are used for more pronounced destruction (abrasion) of cartilage tissue.
With the help of a rotational prosthesis, fixed with pins in the femur and tibia, the knee joint is replaced.
A hinged prosthesis allows replacing the entire joint and guaranteeing its stabilization.
All operations are carried out only after reducing the signs of acute inflammation.
After the surgical operation, rehabilitation measures are carried out to restore the functions of the knee joint, namely: therapeutic exercises, massage and physiotherapy.
Physical activity for the operated patient is categorically contraindicated.

Exercise therapy and massage

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

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

Prevention

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 go in for sports in stable, well-fixed and comfortable sports shoes that can minimize the risk of falling.
For even and safe distribution of the load, fix the knee with special pads (knee pads, orthoses, bandages) or an elastic bandage.
Before physical work or sports, it is necessary, gradually increasing the range of movements, to warm up, warming up the muscles and joints.
Control 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 various types pathologies, some of which require immediate medical attention to clarify the diagnosis and prescribe adequate treatment. A timely visit to a specialist will help preserve the functionality of the knee and prevent the involvement of other joint tissues in the pathological process.

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

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

Causes of meniscus degeneration

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

Gonarthrosis

Deforming osteoarthritis is the most common disease of the musculoskeletal system. Pathology develops predominantly in people over 50 years of age. Among people over the age of 60, it is detected in 97% of cases. The 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 traumatization with dilapidated cartilage.

Factors contributing to the development of gonarthrosis:

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

Deforming gonarthrosis can lead to permanent disability 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 to avoid undesirable consequences.

Meniscus degeneration is detected in 27% of patients with deforming gonarthrosis of the 1st degree. At later stages, pathology develops in almost all patients.

Injuries

Frequent trauma or any damage to the meniscus can lead to the development of degenerative processes in it. A provoking factor can be a sharp movement or an unsuccessful turn of the lower leg. In trauma, the medial meniscus, located on the inside of the joint, is most often affected. This is due to the peculiarities of its structure and localization, which do not allow it to avoid being pinched by the condyles femur.

Post-traumatic meniscus degeneration is more common in athletes, hard workers, and people who lead an overly active lifestyle. Pathology can be detected at any age.

Do not confuse degeneration with traumatic ruptures, tears, tears, etc. The former are characterized by a long, slowly progressive course with further development complications. The second arise acutely due to trauma.

Degeneratively altered menisci are torn with particular ease. But traumatic injuries themselves often cause degenerative changes. These two pathologies are interrelated and often develop in parallel.

Other diseases

The cause of meniscus dystrophy can be rheumatoid or gouty arthritis, brucellosis, tuberculosis, yersiniosis. The development of pathology can also provoke 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 commonly called meniscopathies.

Classification of degenerative changes

Pathology is differentiated according to the localization of foci of degeneration. They can be found both in the body and in the anterior or posterior horns. Most oftendegenerative changesare detected inposterior 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).

Stoller classification:

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

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

Table 1. The most common consequences of degenerative changes

Pathology	Description	Symptoms
Gap	It is characterized by a violation of the integrity of the meniscus in the region 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, the anterior one - to unbend
Separation	A pathologically altered meniscus or its fragment is completely detached from its attachment site	The articular mouse formed as a result of detachment migrates through the synovial cavity, often causing blockade of the knee joint. A person has severe pain and limited mobility of the knee
hypermobility	Manifested by abnormal mobility of both menisci due to rupture of the transverse ligament of the knee that connects them	Aching pain in the knee, aggravated by walking, running, squatting, going down stairs and other physical activity
Cyst	The pathology is characterized by the formation of a meniscus in the cartilage filled with a liquid cavity	May be 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 causes meniscal degeneration

Menisci are important structures of the knee joint. They play a huge role in distributing the load and providing the desired stability of 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.

With the appearance of complications (ruptures, separations, etc.), a person experiences pain, discomfort and a feeling of instability in the joint. Unpleasant sensations are aggravated when descending stairs and squatting. Some patients complain of the appearance of characteristic clicks, a crunch and a feeling of movement of a foreign body in the knee during movements.

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

Diagnostic methods

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 one can only suspect it 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. Modern Method, which allows to detect meniscal degeneration and other pathological changes in the knee joint at the most early stages. Magnetic resonance imaging widely used for the diagnosis of deforming arthrosis;
arthroscopy. An invasive research method that allows you to examine the cavity of the knee joint from the inside. It is mainly used for severe knee injuries. In 70% of cases, diagnostic arthroscopy turns into a therapeutic one. During such an operation, doctors, under visual control, eliminate tears and other dangerous consequences of an injury.

Treatment

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

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

Manifestations in children and adolescents

In childhood, pathology is most often the result of dysplasia - improper formation of the knee joint during fetal 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.

In contrast to adults, in children with injuries, the lateral meniscus is more often damaged. Blockades of the knee joint in childhood and adolescence are rare.

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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 stress: there are cartilaginous discs between the vertebrae, and in the knee joint there are as many as two “shock absorbers” - 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 certainly deliver a lot of unpleasant sensations.

What are degenerative meniscus changes?

Degenerative changes are anatomical damage to an organ resulting from trauma, atypical joint structure, or disease. Meniscus degeneration is most often the result of trauma, sometimes even unobvious: one bad rotation of the lower leg 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 dampens the movement of the knee joint, does not have a rigid fixation and shifts to any side if necessary, then the medial cartilage is rigidly fixed in the joint, and its horns are in close proximity to the condyles. One sharp turn of the lower leg - 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:

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

Characteristic symptoms

If you are haunted by aching pain in the knee, which then disappears, then appears with new force- we can already assume the presence of changes in the meniscus. About 90% of pathologies of the knee joint are due to damage to the "shock absorber".

Symptoms largely depend on the nature of the pathology. Tears 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 articular cavity often occurs - hemarthrosis. Significant swelling and severe pain are also characterized by meniscal cysts.

Tears, detachments from the place of attachment are often chronic and are manifested by the periodic appearance of pain and a feeling of interference in movement.

There is such a diagnostic test: go up and down a ladder or slope. With pathology of the meniscus, when moving down, the pain in the knee increases.

The chronic course is also characterized by secondary degenerative-dystrophic transformations in the medial meniscus, that is, those that have arisen due to other pathologies of the body or diseases. Often in such cases there are clicks and rolls * of the joint in motion after a long rest, 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 - with gout). In the absence of adequate treatment, the final stage of meniscopathy becomes contracture - a stable violation (restriction) of joint mobility.

* Rentals - sensations of pathological mobility, instability and displacement of the articular surfaces of the bones.

Common to all types of meniscus degeneration are the following symptoms:

pain,
swelling,
blockage of the joint in a bent position or sensation of a foreign body in the knee,
clicks and crunches,
swelling of the knees with a long absence of movement.

Causes of degeneration

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

More possible reasons:

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

Diagnostics

With acute injuries of the meniscus, there is usually no doubt - blockade of the knee in a characteristic position, pain and clicks during straightening make it possible to establish the correct diagnosis 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, resort to instrumental research methods:

MRI allows you to get 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 the help of which the state of tissues and synovial fluid is monitored (on the monitor).

Treatment Methods

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

First of all, the joint is punctured, eliminating its swelling and restoring mobility. Sometimes several procedures are required, since active exudation (release 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 stage of rehabilitation, physiotherapeutic methods serve as an auxiliary means - ozocerite, UHF, iontophoresis, shock wave therapy.
For 14 days, a splint is applied to the straightened leg, which ensures fixation of the joint in the required position.

In case of ruptures, surgical intervention is indicated: through two miniature incisions, instruments are inserted into the knee joint and the damaged area is sutured. A serious injury may necessitate the removal of the cartilage lining of the joint and its replacement with an artificial one. All surgical manipulations are performed only after the 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 (diets, immunocorrectors and other methods).

Degenerative transformations of the menisci is a fairly common pathology that requires immediate medical attention. The functioning of the joint in the future depends on the timeliness of treatment, and delays can cause the spread of dystrophic processes to other elements of the joint. Therefore, do not postpone the visit to the doctor, take care of yourself and be healthy!

Source

Under degenerative changes, it is customary to understand the existing anatomical damage to the articular element that has arisen as a result of an injury previously received by a person.

As medical practice shows, degeneration of the menisci in most cases just occurs as a natural consequence of injury(often it can even be non-obvious damage).

For example: there was an unsuccessful rotation of the lower leg, which resulted in damage to the cartilaginous disc itself. In the future, in parallel, there are quite painful sensations.

Frequent phenomena are degenerative changes in the medial meniscus, which is associated with the peculiarities of its anatomy. Comparing the medial meniscus with the external cartilage, it is worth noting that the second one does not have a sufficiently rigid fixation in the knee joint, therefore, it can easily move in any direction if such a need arises.

The medial meniscus is rather rigidly fixed. At the same time, its horns are located in close proximity (even dangerously close) to the condyles, which often prevents the meniscus from slipping away from the impact of dangerous processes during a sharp turn of the lower leg. In this case, there is damage to the meniscus, its subsequent rupture, which will certainly cause severe complications, pain and discomfort when walking.

Types of degenerative changes in the meniscus

Having considered what are degenerative changes in the menisci, it is necessary to analyze the classification of the damage itself:

Separation from the place of direct attachment of the meniscus to the bone, which causes severe pain and inability to fully function of the knee joint;
Rupture of horn protrusions, the body of the meniscus itself, the result is a throbbing pain;
Observation of excessive mobility knee joint, which occurs as a result of rupture of the ligaments between the menisci;
Cyst formation, which takes place directly inside the cartilage (in this case, it is a cavity filled with liquid);
Characteristic meniscopathies, which are the corresponding changes of a dystrophic nature, the development of which takes place under the influence of even the most minor injuries. As a rule, meniscopathy can be positioned as a complication of gout, tuberculosis, rheumatism, and other diseases.

Degenerative damage to the menisci of the knee joint has characteristic symptoms that appear regularly and do not allow a person to feel good while walking.

For example, it can be pain in the knee, the damaged part emits aching vibrations that can be felt later in the entire leg.

Painful manifestations here either disappear or reappear, intensifying over time - if this is the case, then we can safely establish the fact that the cause of such a manifestation is precisely the damage to the meniscus, which is of a degenerative nature.

Citing rather sad statistics on this issue, it is worth noting that about 90% of all possible pathologies are due to damage meniscus.

The treatment of such an ailment should be treated with the greatest possible attention.

Actually, the symptomatology, its subsequent manifestation will largely depend solely on the nature of the pathology itself.

If we take into account that there are degrees of the disease (first, second, etc.), therefore, the painful manifestations will differ fundamentally from each other each time, not allowing the most accurate determination and coordination of their actions on the issue of treatment, the use of universal medications.

You can set the following characteristic manifestations that allow you to feel a degenerative rupture of the meniscus:

The rupture is accompanied by quite strong painful sensations, there is also a blockade of the entire leg when it is in a half-bent state, even swelling is formed, which will be noticeable immediately;
If there is a change in the lateral and internal knee joints, blood can often enter the joint cavity, which is also called hemarthrosis;
Severe painful manifestations, swelling, meniscus cysts, which will require immediate medical attention and surgical intervention;

A degenerative meniscal tear has another characteristic feature. Detachments and tears can be chronic and manifest themselves in the future as recurring painful sensations, a kind of interference in the process of movement that cannot be ignored.

To view and identify such a disease, you can try to conduct a relatively simple experiment: it will be enough to go up and down the stairs, when moving down there will be pain in the knee joint, therefore, it will indicate possible problems with the meniscus.

Considering what the treatment of the disease that has arisen can be, it is worth paying attention to the causes of the damage. For example, it may be the initial weakness of the meniscus itself, even a genetic pathology. All these points should be paid attention to when establishing the subsequent process of treating the disease.

Nonetheless, causes of meniscal degeneration may be associated with excessive exercise, which is fed to the injured limb by excessive weight and many other factors.

If there are acute injuries of the meniscus itself - the diagnosis is beyond doubt, this can be determined by the blockade of the knee in the appropriate position. When straightening, a painful sensation appears, peculiar clicks are felt, which makes it possible to establish an accurate diagnosis in more than 90% of cases.

The situation is more complicated with the definition of degenerative-dystrophic transformations that take place in the knee.

This is due to the direct absence of characteristic symptoms and manifestations in the patient, a positive result for the passage of a variety of procedures.

As practice shows, in these cases it is worth resorting to special methods, among which it is customary to distinguish the following 2 methods:

MRI, which will enable the specialist to obtain the most three-dimensional image of all tissues in the area of the knee joint. It can be the articular surfaces of the bones, the apparatus of the ligaments, and even the joint itself. The use of this technique will make it possible to quite clearly see the result in all these cases;
Carrying out arthroscopy, namely, a miniature incision is made, after which a specially prepared endoscope is inserted into the joint cavity, with its help, the doctor can easily observe the current state of the tissues and the flow of synovial fluid. This can be done on a conventional monitor, ensuring maximum measurement accuracy.

MRI of the menisci of the knee joint How to treat degenerative damage to the menisci?

It's time to consider how to treat the disease that has arisen. It is worth noting in this case that therapy will completely depend solely on the nature and development of the damage itself.

If there are acute manifestations of the development of the disease, It is worth highlighting the following conservative treatment methods:

Performing a knee puncture, capable of eliminating its subsequent puffiness, restoring the mobility of the entire element. In some cases, it may be necessary to carry out several procedures, which may be associated (for example) with the course of the process of active exudation;
Prescribing a variety of analgesics medical personnel, among which a special place is occupied by narcotic drugs that can best relieve the patient from pain;
Appointment of numerous chondroprotectors, able to maximize the saturation of the body itself with all the necessary substances for the subsequent restoration of the damaged area;
Taking anti-inflammatory drugs that will help avoid complications and will not cause an infectious disorder;
When it comes to rehabilitation after an injury, it is worth noting use of appropriate physiotherapy methods, among which a separate place is given to ozocerite, iontophoresis, UHF;
doctors practice splinting the injured leg for up to two weeks, as a result of which the maximum possible fixation of the joint is ensured, any twitching, even a slight impact, is excluded.

With the right and timely approach, the disease is treated without problems.

Degenerative changes in the menisci of the knee joint occur for various reasons, the most common of them: excessive loads and dystrophic 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 act as 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.

Causes of degeneration

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;
injury.

Most often, the pathology of the meniscus develops in old age, when the structure of cartilage tissues 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. In case of injury, the integrity of the ligaments is violated, and the cartilaginous and bone tissues are affected. The changed position of the 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 can be different. Sometimes a cyst develops in the meniscus - this is a neoplasm in the cartilaginous tissues, inside of which fluid is contained. 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 cartilaginous tissues caused by a chronic disease of the musculoskeletal system (osteoarthritis, rheumatism) or trauma.

In addition, degenerative damage to the inner meniscus or outer cartilage can occur. Effects:

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

Signs in any of the cases will be different. The more severe the damage, the more pronounced the pain.

Symptoms

Most types of joint pathologies affect the menisci. With injuries, symptoms appear immediately. If degenerative processes are the result of a disease of the musculoskeletal system, 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;
puffiness;
skin redness;
extraneous sounds (clicks) that appear in the knee area when moving;
change in the shape of the joint;
difficulty in movement, there is a feeling of interference in the knee;
blockade of the leg, which manifests itself in a bent position.

If mucoid degeneration occurs, edema occurs. This condition is accompanied by intense pain. The most common sign of degenerative-dystrophic processes is an extraneous sound (click) emitted by the joint during movement.

With injuries, rentals usually occur - conditions in which excessive mobility in the knee is felt. This may be due to displacement, separation from the place of attachment of the meniscus.

Diagnostics

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

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

To confirm the diagnosis in case of damage to the external or internal meniscus, an 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. With the help of an arthroscope, an internal examination of the knee joint is performed. This method allows you to identify pathology when examining tissues using a small video camera, which is inserted into the articular cavity and transmits the image to the monitor.

Therapeutic measures

For most types of pathologies in the menisci of the knee joint, conservative treatment is ineffective. This method can improve the condition with deformations of the medial cartilage. Medications help prevent the development of pathology: stop the inflammatory process, eliminate pain and swelling. However, if the question is how to treat the 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 forbidden to carry out any manipulations. To exclude displacement, a fixing bandage or splint is applied for 2 weeks.

With hemarthrosis, a puncture is indicated. This procedure removes the accumulated blood. Due to this, swelling, pain intensity decreases, mobility partially returns.

Prescribe analgesics. These drugs relieve pain. This is not always possible to do using non-steroidal drugs (Ibuprofen, Diclofenac), therefore, with 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 tire, when the manifestations of the acute condition have been eliminated, they proceed to next step- physiotherapeutic procedures (phonophoresis, UHF, ozocerite, iontophoresis), as well as exercise therapy.

Physical exercise strengthens the muscles, which helps to reduce the load 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.

Chondroprotectors and surgery

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

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

Protecon. This combined drug relieves pain, prevents the development of inflammation, restores cartilage tissue.
Don. Medicine, which has an impact on metabolic processes in cartilage.
Teraflex. The composition includes substances that are related to the compounds contained in cartilage tissue. Indications for use: any degenerative-dystrophic processes in the joints, which are the result of chronic diseases, such as osteoarthritis.
Artron. The drug helps to restore cartilage exposed to intense physical exertion, as well as injuries and diseases of a different nature.

Serious pathologies (highly developed degenerative processes, deformation, detachment from the place of attachment) cannot be treated with a conservative method. In such cases, the joint is restored by surgery. The entire knee may need to be replaced with a prosthesis. Use a sliding, rotational, hinged or superficial prosthesis.

There are places in the human body where there is an increased load. These include cartilaginous discs between the vertebrae and the menisci of the knee joint. Over time, degenerative processes of the lateral (external) and medial (internal) menisci occur.

The result of this pathology can deliver a sick person a large number of unpleasant sensations.

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

trauma;
diseases;
atypical joint structure.

Meniscus degeneration is often the result of an injury that is not even always obvious. The usual unsuccessful rotation of the lower leg can be a prerequisite for the destruction of cartilage, accompanied by severe pain.

The medial disc can often be damaged. If, with damage to the external cartilage, which absorbs the motor activity of the knee joint, there is no rigid fixation, then the cartilage is displaced to one side.

His horns in this case will be located next to the condyles. With a sharp turn of the lower leg, the meniscus may not have time to escape from the displaced process bone tissue and immediately there is damage or even its rupture.

Degenerative lesions of the menisci can be different:

rupture of the horn and body of the outer and inner meniscus;
complete separation from the attachment point;
excessive mobility due to torn 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, etc.

How do changes manifest themselves?

If a person is constantly tormented by pains of a aching nature, each time arising with renewed vigor, then it is quite possible that he has begun 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 break is always accompanied by:

strong 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 is also characteristic of a meniscal cyst. All tears and detachments are chronic, they can be manifested by temporary pain and a feeling of interference with physical 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 when descending down, the pain in the knee joint will increase 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, clicks and a feeling of pathological joint mobility (rolling) will be noted. Such a process is especially noticeable in motion after a long state of rest. It can often present with pain in the knees.

With the development of the disease, there is a gradual increase in symptoms. The cartilage layer becomes thinner, and salts or uric acid crystals accumulate under it. If the patient does not seek adequate medical care, then the final stage of meniscopathy will be contracture.

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

Common for any degree of degeneration should be called the following symptoms:

pain;
edema;
crunch and clicks;
joint blockade;
swelling of the knee joint with prolonged lack of movement.

Causes of degeneration

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, injuries and cysts occur in those people whose activities are associated with high physical activity and significant loads (dancers, ballerinas, athletes).

Degenerative changes in menisci can be caused by:

dysplasia (incorrect formation of the knee charter);
diseases affecting the joints (gout, tuberculosis, rheumatism, syphilis);
stretching of the ligaments and their inadequate formation;
flat feet (low depreciation of the foot, offset by excessive load on the knees);
overweight.

Diagnostic methods

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

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

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

magnetic resonance imaging, (the stoller classification 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 articular cavity. With it, you can monitor the condition of the synovial fluid and tissues.

Treatment Methods

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

joint puncture. The procedure is necessary to eliminate pain, swelling and restore mobility. In some cases, several successive procedures may be required at once, for example, when the 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 save the patient from excruciating pain;
the use of chondroprotectors. Preparations of 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;
the 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 of the affected limb (for 2 weeks). This will help ensure that the joint is securely fixed in the desired position.

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

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

If the degenerative changes in the menisci are severe, then the cartilage may need to be removed and replaced with an artificial one.

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

The operation is exceptionally necessary for:

chronic dystrophy;
joint dysplasia;
abnormal development of ligaments.

With a timely visit to the doctor, degenerative damage to the internal meniscus will be stopped at the very beginning of development.

Article publication date: 03/24/2014

Article last updated: 03/29/2019

What are degenerative meniscus changes?

Degenerative changes can be different:

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

Characteristic symptoms

If you are pursued by aching, which then disappears, then appears with renewed vigor - it can already be assumed that there are changes in the meniscus. About 90% of pathologies of the knee joint are due to damage to the "shock absorber".

Symptoms largely depend on the nature of the pathology. Tears are accompanied by severe pain, blockade of the leg in a bent state and swelling. With a serious one, hemorrhage often occurs in the articular cavity -. Significant swelling and severe pain are also characterized by meniscal cysts.

Tears, detachments from the place of attachment are often chronic and are manifested by the periodic appearance of pain and a feeling of interference in movement.

There is such a diagnostic test: go up and down a ladder or slope. With pathology of the meniscus, when moving down, the pain in the knee increases.

The chronic course is also characterized by secondary degenerative-dystrophic transformations in the medial meniscus, that is, those that have arisen due to other pathologies of the body or diseases. Often in such cases there are clicks and rolls * of the joint in motion after a long rest, 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 - with gout). In the absence of adequate treatment, the final stage of meniscopathy becomes - a stable violation (limitation) of joint mobility.

* Rentals - sensations of pathological mobility, instability and displacement of the articular surfaces of the bones.

Common to all types of meniscus degeneration are the following symptoms:

pain,
swelling,
blockage of the joint in a bent position or sensation of a foreign body in the knee,
clicks and crunches,
swelling of the knees with a long absence of movement.

Causes of degeneration

More possible reasons:

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

Diagnostics

MRI allows you to get 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 the help of which the state of tissues and synovial fluid is monitored (on the monitor).

Treatment Methods

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

First of all, the joint is punctured, eliminating its swelling and restoring mobility. Sometimes several procedures are required, since active exudation (release 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 stage of rehabilitation, physiotherapeutic methods serve as an auxiliary means - ozocerite, UHF, iontophoresis, shock wave therapy.
For 14 days, a splint is applied to the straightened leg, which ensures fixation of 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 (diets, immunocorrectors and other methods).

Owner and responsible for the site and content: Afinogenov Alexey.

Your comments and questions to the doctor:

Julia | 03.10.2019 at 08:19

Good afternoon. I really want to know your opinion. My daughter, 13 years old, had an injury 2 years ago, on alpine skiing, an unsuccessful knee rotation led to Chondromalacia of the patella of the 2nd degree, a degenerative change in the posterior horn of the medial meniscus of the knee joint, synovitis. We have been given this diagnosis. The doctor prescribed a course of treatment with chondroprotectors (dona, structum500, piaskledin300). Tell me, please, these drugs will not harm a child of 13 years old (in the instructions, the restrictions are up to 18 years). And what treatment would you recommend. Thank you very much in advance.

Olga | 09/14/2019 at 16:13

Good evening. What is the relationship between gout and menisci? Or rather, why menisci can hurt because of gout, as written in your article. And what to do to stop meniscus degeneration. I was diagnosed with this 2 years ago.

Sergei Lopukhov | 08/27/2019 at 07:34

I play football. The result of an MRI of the knee joint: MRI signs of degenerative changes in the anterior cruciate
ligaments.
MRI signs of injury to the posterior horn of the medial meniscus, grade II according to Stoller. MR-
signs of degenerative changes in the lateral meniscus.

Svetlana | 07/21/2019 at 10:50

Hello.
MRI of the right knee joint in standard projections received T2 WI and RDFSaT.
Joint congruence is preserved. The joint space is moderately narrowed. The contours of the bones are even. The structure of the bones is homogeneous. Articular cartilage without visible defects. In the joint cavity, suprapatellar and deep ifrapatellar bags, a large effusion is determined. The patellar ligaments are preserved, the displacement of the patella is not determined. The tendon of the four head muscles of the thigh and the own ligament of the patella is not interrupted, their structure is homogeneous.
The height of the medial meniscus is reduced, a slightly hyperintense signal is detected in the structure of the posterior horn, which does not pass to the articular surfaces. The height of the lateral meniscus is somewhat reduced, the structure is homogeneous. The anterior cruciate ligament is preserved. The posterior cruciate ligament showed no signs of injury. The course of the medial collateral ligament is preserved, the structure is homogeneous. The course of the lateral collateral ligament is not interrupted, the structure is not changed. The hamstring tendon is not interrupted.
Conclusion: MRI picture of medial meniscus degeneration. Synovitis
Do I need an operation?
Sincerely, S.

Svetlana | 07/01/2019 at 12:10

good afternoon, doctor. Girl, 12 years old, has been doing judo for 2 years.
X-shaped. Apparently there was an injury, but she didn’t feel it. And then she began to notice that her knee hurts when she sits for a long time. MRI: tendinitis of the patellar ligament. Variant of the structure of the patella (significant in the development of patellar insufficiency). degenerative and post-traumatic changes, meniscite) Initial manifestations of degenerative changes in the joint. I would like to know how to treat it, what are the consequences, whether it is possible to continue playing sports (after all, when she moves, nothing hurts).

Alla | 03/29/2019 at 16:41

Hello. On a series of MR-tomograms weighted by T1 and T2 in three projections, T2-tirm and PD-FS (fat suppression), bone-traumatic changes are not detected.
The structure of the bone tissue is not changed, uniform. The cortical layer of bones at the level of the study is even and clear.
In the cavity of the joint, its bags, inversions, a slightly increased amount of fluid is determined, somewhat more pronounced in the patella inversion and in the posterior sections of the joint.
The joint space is not narrowed, the congruence of the articular surfaces of the bones that make up the joint is preserved.
There is some unevenness of the articular cartilage of the patella in the central sections, without signs of a decrease in its height. Articular cartilage in other departments is not reduced in height, uniform.
Lateral meniscus correct form, not lowered in height, its boundaries are clear, even, the MR signal is homogeneous.
The medial meniscus is of regular shape, not reduced in height, its boundaries are even, clear, the MR signal is heterogeneous, mainly in the region of the posterior horn, due to the presence of an area of increased MR signal that does not interrupt the boundaries of the meniscus.
The anterior cruciate ligament can be traced throughout, without features.
The posterior cruciate ligament can be traced throughout, without features.
The integrity of the collateral ligaments is preserved, their contours are even, clear, the signal is not changed.
Own ligament of the patella without features.
Goff intensity without singularities.
Visible soft tissues without pronounced changes.

CONCLUSION: MR-signs of degenerative changes in the medial meniscus (grade 2), mild synovitis. Indirect MRI - signs of initial manifestations of chondromalacia of the patella (grade 1).
Thanks in advance.

Zinaida | 03/17/2019 at 08:15

Good day! I am 51 years old. In 2015, the uterus and ovaries were removed. And after the operation, my weight reached 93 kg, before the operation it was 80. My height is 162. I drink femoston 1/5. I am struggling with weight, but so far there are no special results .. until I let it increase any more. But this is a small digression from my problem.
A year ago, my knees started hurting. Previously, they didn’t bother me much, they crunched a little, but I didn’t feel much pain. Did an MRI. And this is the result I got. I would very much like to know your opinion. Please tell me if you need surgery (knee arthroscopy) or you can get by with a conservative method. Thanks in advance for your reply!
MRI EXAMINATION OF THE KNEE JOINTS № 0191
(MagFinder 0.32Tl)

Left knee joint. On the obtained images in the joint cavity, the upper inversion is determined by an additional significant amount of effusion. Subchondral sclerosis of the articular surfaces that form the knee joint. The joint space is narrowed. The intercondylar eminences, the upper and lower poles of the patella are pointed. MRI signal from the bone marrow of the femur, tibia and patella is not changed. Hyaline cartilage is preserved.
In the posterior horn of the internal meniscus with the transition to the body of the meniscus, an irregularly shaped hyperintense area is determined, which communicates with the plateau. tibia.
In the posterior horn of the external meniscus, a linear, slightly hyperintense area is defined, which runs along the plateau of the tibia and does not emerge on its surface.
The anterior cruciate ligament can be traced in fragments, at the site of its attachment to the tibia, a limited accumulation of fluid is visualized, at the site of its attachment to the femur, an area of inhomogeneous MR signal.
The external lateral ligament is deformed, heterogeneous, with hyperintense inclusions.
The posterior cruciate and internal lateral ligaments are intact.

Conclusion: Rupture of the anterior cruciate ligament. Chronic damage to the posterior horn and the body of the internal meniscus against the background of degenerative changes. Deforming osteoarthritis of the left knee joint 1 tbsp. Degenerative changes in the posterior horn of the outer meniscus. signs of synovitis. Tenosynovitis of the anterior cruciate ligament. Tendonitis of the external lateral ligament.

Right knee joint. On the obtained images in the joint cavity, upper inversion, crow's foot pouch, an additional significant amount of effusion is determined. A limited accumulation of fluid is visualized in the popliteal region measuring 18.2x73.6 mm.
Subchondral sclerosis of the articular surfaces that form the knee joint, marginal bone growths. The joint space is narrowed. Intercondylar eminences are pointed. The MRI signal from the bone marrow of the femur is heterogeneous. Hyaline cartilage is preserved.
In the posterior horn of the internal meniscus, an irregularly shaped hyperintense area is determined, communicating with the tibial plateau.
In the posterior horn of the external meniscus, a linear, slightly hyperintense area is defined, which runs along the plateau of the tibia and does not emerge on its surface.
In the projection of the anterior horn of the outer meniscus, a limited accumulation of fluid measuring 5.2x8.4 mm is determined. In the projection of the posterior horn of the outer meniscus, there is a similar accumulation of fluid measuring 5.1x8.1x12 mm.
The anterior cruciate ligament can be traced along its entire length, deformed, heterogeneous, torn, in the place of its attachment to the tibia, a limited accumulation of fluid is visualized, in the place of its attachment to the femur, a patch of heterogeneous MR signal.
The external lateral ligament is deformed, heterogeneous, with hyperintense inclusions.
The posterior cruciate and internal lateral ligaments are intact.

Conclusion: Chronic damage to the posterior horn of the internal meniscus against the background of degenerative changes. PCC damage. Deforming osteoarthritis of the right knee joint 2 tbsp. Degenerative changes in the posterior horn of the outer meniscus. signs of synovitis. Parameniscal cysts of the external meniscus. Tenosynovitis of the anterior cruciate ligament. Tendonitis of the external lateral ligament. Baker's cyst.

Olga | 03/06/2019 at 07:01

Good afternoon. My daughter in 2012. I had an injury to my right knee joint and was in the hospital with a gibs. During these years, if he turns around uncomfortably or stumbles with his right foot, then his knee hurts. They made an MRI conclusion: at the time of the study, the MRI picture of the gap
anterior cruciate ligament of the right knee. Intra-articular vypod. Vypod in the suprapatellar suture. Degenerative changes in articular cartilage with areas of chondromalacia. Damage. posterior horn of the medial meniscus (Stoller class III). I would like to hear a professional opinion, do you need surgery? daughters 39 years old Inv. childhood 2 gr.

Natalia | 02/19/2019 at 09:35

Good afternoon.
Started to disturb the right knee 3 years ago. There were no injuries. Previously, once every 3-4 months, then more and more often, now maybe once or twice a week. When turning the right leg outward (while the body remains stationary), the knee is blocked and I cannot move my leg. There is no pain, only stiffness and fear. After about a minute, through force I move my leg and there is a click in the place of the knee and everything falls into place. There is no pain.
A month ago, I started running on a treadmill to maintain my figure.
I went to an orthopedist and ordered an MRI. The result of MRI is a picture of degenerative damage to the lateral and medial menisci of the II degree. Degenerative damage to the anterior cruciate and lateral collateral ligaments. Gonarthrosis I st.
The doctor forbade running more expensive, only light physical activity. He ordered Don to drink for 6 weeks, and if changes do not occur, he is offered to do the blockade.
I want to hear your opinion on my diagnosis and treatment options. And is it really impossible to use a treadmill, maybe you can leave walking on it?
I will be grateful for the answer

Faith | 04.02.2019 at 12:08

Good afternoon! I have gonarthrosis of the knee joint. Degenerative damage to the menisci. They suggested doing an operation. But they said it wouldn't help much. Tell me what to do?

Maria | 02/03/2019 at 10:27

Hello. My son is 13 years old, fell ill in May 2018. Pain and lameness of the left knee appeared, the knee swells when walking for a long time. Larsen-Johanson syndrome, arthritis of the left knee joint. Act.1.fn 1. Examination: MRI picture of osteochondropathy of the patella, dystrophic changes in the tendon of the patella (Larsen-Johanson syndrome,) moderate degenerative changes in the medial meniscus; effusion in the joint cavity. X-ray images are signs of bilateral Larsen-Johanson syndrome, bilateral insertional tendinopathy of the patella ligament (changes are more pronounced on the left.) The treatment of rheumatologists and orthopedists contradict each other. Treated: nemisulide 50 mg 1 time per day for a month, physiotherapy, folk remedies horseradish leaf wrap. Wearing a corset. The child also has combined flat feet.

Enter your name | 01/30/2019 at 11:44

Hello, I have echo signs of degenerative-dystrophic changes in the right knee joint of the 2nd degree. chondromallations of the 2nd degree. degenerative changes in the menisci. I am a full 57 years old. I got up on a chair and got this injury. Please tell me how can I cure this without orerative intervention? Thanks in advance!))

Nina | 01/24/2019 at 20:52

Good afternoon! I am 31 years old. I have been doing it myself in the gym 3 times a week for 2 years with interruptions during pregnancy, before pregnancy I was engaged in dancing. For the first time in my life, I decided to start running and immediately ran 5 km at the end of October (it was already cool and it was pouring light rain). Not immediately, but after a couple of days, the right knee on the outer right side ached (when descending the stairs or when you sit for a long time or in the evening after activity). I have been on treatment for three months now, but the pain does not go away. Alflutop injections for 10 days, Mexidol injections for 10 days, chondroprotectors chondroguard for 10 days, ointment and vitamins, physiotherapy, massage, exercise therapy, aertal for 7 days. X-ray protocol: Rg- signs of osteoarthritis of the right knee joint of 1-2 degrees. OS. Fabella along the posterior-lateral surface of the lateral condyle of the femur. MRI protocol: visible pathological changes were not revealed. Moderately pronounced degenerative changes in the posterior horn of the medial meniscus. Which study to believe: X-ray or MRI? What exactly is knee pain? The orthopedist offers prp-therapy to the joint. But I did not find positive reviews about it. The rheumatologist says in no case any injections into the joint, I think this is not the case. Whom to listen to? What other treatment will help in my case?

Love | 01/22/2019 at 05:43

Hello. Three years ago I slipped, there was pain and swelling of the knee, and it hurt from time to time. I took diclofenac and the pain stopped. Didn't go to the hospital. But recently it started to hurt a lot, I did an MRI, Conclusion: partial damage to the anterior cruciate ligament. Partial rupture of the posterior horn of the medial meniscus of the 3rd degree. Dystrophic changes in the anterior horn of the lateral meniscus of the 2nd degree. Solitary parameniscal cysts of the medial meniscus. Minor synovitis. Gonarthrosis 1 degree. Baker's cyst. Please tell me what to do with this diagnosis. Thank you!

Tatyana | 12/19/2018 at 07:36

Question to Alex admin on 12/17/2018 at 11:51 am (previously posted by Tatyana on 12/15/2018 at 8:28 pm)
Thank you very much for your answer. Swimming is contraindicated for degenerative changes in the menisci?
Is it better to start swimming now or wait? A sudden aggravation occurred in mid-November of that year, on both knees. Now I walk normally, I am engaged in exercises. Are injections highly desirable? After all, concomitant diseases are hardly allowed, for example: hypertension of the 1st degree, all sorts of other things, ... nodular goiter (postoperative hypothyroidism), mastopathy ...

Tatyana | 12/15/2018 at 20:28

Dear doctors!
I am 59 years old, now I walk, it hurts a little, as I slept, I forget about the illness. Stiffness in the morning.
Conclusion of the ultrasound of the knee joints.:
Anterior access
Suprapatellar bag of the right joint - 3.0x0.7cm, left joint 7.0x 1.5cm
Synovial membrane of the right joint -2mm, left joint -3-4mm
The effusion in the torsion of the right knee joint is visualized in a moderate amount,
left - largely, inhomogeneous
The articular surfaces of the femur and tibia are uneven: with sharpened edges of the condyles on the right and with osteophytes on the left
Hyaline cartilage of the articular surface of the medial and lateral condyles
of the femur of a heterogeneous structure, with an uneven clear contour, thickness:
on the right - 1.6 mm on the lateral condyle, 1.3 mm on the medial condyle; (N= 2.6mm and
more)
on the left - 1.4mm on the lateral condyle, 1.1mm on the medial condyle (N= 2.6mm and
more)
Own ligaments of the patella of a homogeneous structure, uniform thickness. Tendons of the quadriceps femoris with a fibrous component
Medial/lateral access
Lateral ligaments with fibrous component (more in left IJ)
Menisci with hypo- and hyperechoic component, the greatest changes (stratification) -
in the posterior horn of the medial meniscus of the left joint
The iliac-tibial tract at the site of attachment to the tibia and tendon of the popliteal muscle and biceps femoris without structural changes.
Posterior access
Popliteal cyst on the right: 1.7x0.3cm. left-3.0x0.7cm and 2.9x0.5cm
CONCLUSION: US signs of bilateral sipovit (more on the left), Baker's cysts (on the right, an unfilled cyst) and gonarthrosis. Degenerative changes in the medial meniscus on the left-2-3st, menisci on the right and lateral meniscus on the left-2st, as well as lateral ligaments. Tendinosis of the tendons of the quadriceps femoris.
There was an exacerbation due to the brush, now it has subsided. There is no way to bend your knees less than 90 degrees, a month has already passed. In conclusion, why not a word about the condition of the menisci...?? The recommendation is this: to undergo magnetotherapy (I go), NVSP ointment, I chose ibuprofen + Dimexide. If magnetic therapy does not help, I will be offered injections for three months with Hyaluronic Acid. I wanted Piascledin, I took a course a long time ago, and I liked that I forgot about the crunch. And now I almost do not feel the crunch. Or is it already like a placebo with such destruction? Only synovitis does not allow to bend completely. What should I do next? The left knee suffered more, the right one began to hurt a week later. Both are so sudden. Yes, I fell this year, the last time in September, but on one knee. And also arthrosis of the wrist joint on both sides, but tolerable.
Can you exercise on an exercise bike? Thanks in advance. I'm desperate.

Gulnara | 05.12.2018 at 18:40

Good afternoon doctor! I am 48 years old. I have never been involved in sports, 4 months ago I hit my knee on a stone. MRI results: - articular surfaces are congruent.
- In the posterior horn of the medial meniscus, the damage zone is of the type of delamination with its dislocation to the outside by 1/3; manifestations of degenerative changes in the lateral meniscus;
- cartilaginous surfaces of articular bones are minimally unevenly thinned;
- cruciate ligaments are not changed, the usual signal;
- the medial collateral ligament is edematous; another joint-forming ligamentous apparatus without visible changes;
- medial tibial epiphysis and medial femoral condyle with areas of bone marrow edema; epiphyses with minimal osteophytes, visible sections of the metaphyses of articular bones are not changed;
- the shape of Goff's fat body is not changed, signs of edema in the tibiofibular portion;
- moderate overproduction in torsion and joint cavity;
- there are no zones of potological intensity in the patella, its contours are clear, even, the cartilage is not changed;
- there are no zones of pathological signal intensity in the popliteal fossa;
-periarticular soft tissues are swollen from the anterior and lateral surfaces.
CONCLUSION: MR- signs of osteoarthritis of the left knee joint 1 tbsp according to Zecker; condition after puncture; damage to the posterior horn of the medial meniscus with its dislocation to the outside by 1/3 (Stollor III) degenerative changes in the lateral meniscus; contusion bone marrow edema in the medial femoral condyle and medial tibial epiphysis; signs of distortion of the medial collateral ligament; moderate suprapatellar bursitis, synovitis.
The doctor said that he needed to have an operation. But the surgeon with whom I wanted to do the operation will be able to perform it only in a month and a half. Is it worth it to rush and do it with another surgeon, just because of the urgency. I remind you that 4 months have already passed since the injury. I wore a tutor for almost a month. Now my knee continues to hurt and I can’t fully walk and bend my knee. And with such an MRI conclusion, is it possible to stitch the meniscus or will it be necessary to remove the damaged part of the meniscus? What would be better in my case - to sew or remove the damaged part of the meniscus? Can I take Glucosamines before surgery? Really looking forward to the answer! Thanks in advance!

Sergei | 29.11.2018 at 11:52

Hello! Sometimes when straightening the left knee, a sharp pain was felt, which immediately passed. After the MRI, they wrote in the conclusion: Dystrophic changes in the horn of the medial meniscus, arthrosis of the 0th degree. Periodically I drink a course of chondroprotectors and pierced the course of Alfuton. The pain went away for a while, but now it's back. Please tell me what to do in my case? Is it possible to cure a joint with conservative methods?

Elena | 11/20/2018 at 05:22

Good afternoon. I suffer from pain in my right knee after a fall (I went skiing).
MRI showed: degenerative changes in the meniscus I st according to Stoller. Infringement of the posterior sections of Goff's fat body. Mediopatellar fold syndrome. Minimal articular protrusion.
A consultation with an orthopedic traumatologist was scheduled.
The pain in the rut is aching, especially in the evening and at night, especially after exercise.

Valentine | 11/14/2018 at 10:27 am

Hello. I had an MRI of my left knee.
Conclusion: Osteoarthritis grade 2, Degenerative changes in the medial meniscus grade 3, lateral meniscus grade 2, Synovitis, Bone marrow edema of the medial condyle of the tibia.
Can you advise something?
Thank you!

Claudia | 29.10.2018 at 20:19

HELLO! My knee hurts a lot, I have been suffering for a whole month, painkillers do not help, Fermatron plus pumped, does not help. got an mri. Conclusion MR picture of degenerative changes in the internal meniscus of the 2nd degree according to stoller. degenerative changes in the lateral meniscus of the 1st degree. moderate degenerative changes in the anterior cruciate ligament. suggest surgery. Please tell me what to do?

Anna | 10/15/2018 at 08:57

Hello, if you answer I will be very grateful to you.
The right knee is very disturbing, as a result, two MRI scans were performed with a difference of a year:
1 MRI conclusion: MR picture of partial traumatic damage to the ACL and internal lateral articular ligaments, damage / degeneration of the medial meniscus (Stoller .2 class), gonarthrosis (grade 1), causing contusion changes in adjacent bones, lateralization of the kneecap, edema of the paraarticular tissue.
2MRI was compared by a radiologist with 1: MO-picture of lateral subluxation of the patella against the background of moderate hyperplasia of the femoral condyles, moderate degenerative changes in the ACL at the site of rupture of the posterior cruciate ligament in the upper third of the initial degenerative changes in the menisci. When compared with the previous MRI - no significant changes.
The doctor in the city hospital in my city says that you just need to smear the knee. The doctor from MONIKI wrote in the conclusion that arthroscopic resection of the lateral meniscus and ACL plasty is needed. Tell me what to do? Is an operation required? Thanks!!

Geser | 10.10.2018 at 03:08

Hello! at the summer Olympics, he injured his knee joint, had an MRI. The results are - MRI signs of degeneration 2 tbsp. anterior horn of the lateral meniscus. synovitis. Mediopatellar synovial fold. Small focus of enostosis of the tibia. Please tell me what to do in my case

Fania | 09.10.2018 at 03:29

Conclusion mri. Degenerative changes in the posterior horn of the medial meniscus, cysts in the popliteal fossa. What treatment do I need. I don't remember any major injuries.

Alex admin | 08.10.2018 at 11:10

Hello Kundyz. Degenerative changes are not completely cured, they can and should be slowed down. Treatment must be comprehensive. Prescribes treatment orthopedist or traumatologist. What do you need for effective treatment, described in this article.

Alex admin | 08.10.2018 at 11:07

Hello Ruslan. You don't need an operation. Contact your local doctor (orthopaedist or traumatologist) to prescribe treatment: anti-inflammatory pills and / or injections, physiotherapy (laser, magnet), applications, therapeutic massage, etc. Give the joints temporary rest and no stress or weight lifting.

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

Degenerative changes in the cartilage pads of the knee joint are characteristic lesions 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 meniscus are in the first place.

Signs of change are:

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

The meniscus is called the cartilaginous layer inside the knee joint, which mainly performs a shock-absorbing function. Ruptures of the joint linings can occur after injuries that occur in young people with 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.

Lack of treatment for a traumatic rupture can lead to the fact that it later becomes a chronic pathology.

To diagnose a meniscus rupture, an ultrasound, MRI is necessary. Meniscus tears can be in the anterior horn, posterior horn, and in the body of the meniscus. Damage to the meniscus can lead to mechanical obstruction of movement, and cause pain syndromes.

The dangling part of the meniscus provokes the destruction of neighboring cartilage.

Features of the menisci of the knee joint

The meniscus is considered to be a layer that is located inside the knee, connecting the superficial bones of the thigh to the lower leg. It has the shape of a crescent, consists of a body, back and front horns. It is cartilage tissue. Thanks to these cartilage discs, the load on the knee joints is evenly distributed, and friction is reduced.

If we compare the meniscus with a car, then we can say with accuracy that this is a kind of shock absorber that helps to move around. The meniscus can be external or internal.

The inner meniscus is the medial one. In the medial meniscus, degenerative changes occur much more often than in the outer one. This is due to the fact that the rigidity of fixation is more vulnerable. The meniscus layer inside is connected to the ligamentous apparatus of the joints, which are located inside.

Outside, the medial cartilages are articulated with the articular cavity. It is in this outer edge that a large number of blood vessels are concentrated. All this creates a rigid fixation. It is noted that when the internal meniscus is removed, the load on the ligaments doubles at once. Therefore, this meniscus is an important fragment of the knee joint.

The outer meniscus is the lateral one. Unlike the inner layer, the outer layer is damaged less often, since the way it is fixed is completely different. It is located on the outside of the knee joint and is more mobile. With dystrophic disorders of the external meniscus, the contact area of the joint surfaces is reduced by half. When resection (removal) of the lateral plates, the load on the ligamentous apparatus increases by almost 200%.

In cases where the patient has experienced a degenerative-dystrophic rupture of the meniscus of the knee joint in an acute form, confirm the diagnosis quickly enough, due to the fact that in this period of time the symptoms of the pathology are pronounced. There are certain difficulties in the chronic form of pathology. In this situation, the patient is assigned to undergo a certain examination.

MRI of the knee

Ultrasound procedure.

CT scan.
Magnetic resonance imaging - a three-dimensional image of all tissues is shown.
X-ray.
Arthroscopy - shows the general condition of the tissues, as well as the synovial fluid.

The course of treatment is directly related to the severity of the damage. Degenerative changes in the medial meniscus are treated with conservative methods. In cases where the patient has an accumulation of blood in a part of the affected joint, he is prescribed strict bed rest, the complete exclusion of stress on the injured knee.

It must be remembered that all procedures and exercises begin to be performed only when the elimination of the inflammatory process. In situations where conservative treatment did not show the desired result, or the patient had a rupture of the internal meniscus, surgical intervention is prescribed, since surgery is the only way to help.

DI is an anatomical damage to any organ. It can be a complication after an injury, due to an improper structure of the articular joints or some kind of disease. As a rule, DI of the meniscus is a complication after an injury, sometimes even a minor one: if the lower leg is moved incorrectly, the cartilage is damaged, and this brings severe pain to the victim.

Statistically, DI most commonly affects the medial meniscus (MM). When comparing the MM with the lateral one, which provides cushioning to the knee during movement, does not have a rigid fixation and moves if necessary, the MM is clearly fixed, and its horns are located close to the condyles.

DI manifests itself:

detachment from the attachment site;
MM rupture;
strong mobility due to rupture of intermeniscal ligaments;
cyst (the appearance in the cartilage of neoplasms containing fluid);
meniscopathy.

Types of damage to the menisci according to Stoller

Stages of the disease

There are acute and chronic DI. The duration of the acute stage is influenced by the factors that provoked its occurrence. If the victim ignores the disease, it will go from an acute stage to a chronic one in 1.5-2 weeks. The patient will begin to develop pain, aggravated by any movement. For some time there will be a crunch and clicks.

Causes of a meniscus lesion

The structure and anatomical features of the location of the menisci cause a high incidence of pathologies in different age categories. Athletes who are prone to ruptures, injuries and cysts are at risk.

Possible reasons cartilage rupture:

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.

Varieties of degenerative changes

First of all, you need to understand what it is - degenerative-dystrophic changes in the knee joint. In fact, these are various damages and deviations from the norm. The main types of such violations:

Degenerative rupture of the medial meniscus of the knee joint;
Damage to the ligaments located between the menisci;
The formation of a cyst inside the cartilage cavity with the presence of fluid;
The occurrence of meniscopathy;
Ruptures of the body and horns.

With degenerative changes in the posterior horn of the medial meniscus, irreversible processes begin, since it is in this area that there are no blood vessels, so the posterior horn can only feed on joint fluid. And with dystrophic disorders, its circulation slows down.

Classification of degenerative changes in the knee joint according to severity based on stoller:

Stage No. 1 is characterized by focal disorders. The pain syndrome is still insignificant, but swelling can be seen.
Degree No. 2 - the focus becomes linear, it does not reach the edges yet. Pain increases, joint mobility decreases, and swelling increases.
Stage 3: The lesion spreads throughout the meniscus, up to the edge. The pain is accompanied even at rest, the knee joint is immobilized (jammed). The color of the skin changes.

Diagnosis of the disease

Injury to the lateral meniscus is extremely rare in adults. This happens more often with children and teenagers. As a result of such an injury, blockade rarely occurs.

Symptoms of a lateral meniscus injury include:

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

With a rupture of the external cartilage, 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 intermittent pain. A congenital anomaly of development is possible - a continuous (disc-shaped) outer meniscus.

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

There are three types of damage to the medial meniscus:

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

Tearing with pinching of the anterior horn of the medial meniscus causes blockage of the knee joint that does not cause knee flexion. This phenomenon is temporary, as unblocking will restore movement in the joint. Damage to the posterior horn of the medial meniscus is a more serious injury. in this case, blocking, jumping out and bending the knee occurs.

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

Causes of meniscal degeneration include:

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

Diagnosis of the disease can be carried out using the following studies:

Magnetic resonance imaging;
CT scan;
radiography;
Diagnostic arthroscopy.

In order to identify the exact diagnosis - a meniscus tear, you should consult a specialist. He needs to tell him under what circumstances you experience pain. Any change in the menisci causes pain. On examination, the hip and knee joint are examined. With effusion, hemarthrosis or synovitis may be suspected.

Reasons for the development of dystrophic processes

The main causes and factors of dystrophic disorders in the meniscus:

Anatomically malformed meniscus. Most often it is a congenital form of the disease.
Injury to the knee joint - sprain, dislocation, impact, etc. Injury can occur due to a sharp bending of the knee, inaccurate abduction towards the lower leg.
Degenerative changes in the ACL of the knee joint (anterior cruciate ligament) - its ruptures, which causes meniscus dystrophy.
Lifting an overwhelming load.
Physical overload.
Obesity. In this case, there is an excessive load on the knee joints.
Diseases of infectious etiology - rheumatoid arthritis, tuberculosis, syphilis, yersiniosis, brucellosis, etc.
Gout, rheumatism, osteoarthritis.
Scleroderma, lupus erythematosus and other connective tissue pathologies.
Vasculitis, dysplasia, hypothyroidism, flat feet.

If the injury occurred in the medial meniscus, then rotation of the lower leg to the outside is observed. If in the lateral - the lower leg turns inward.

Who is at risk:

Degenerative damage to the medial meniscus is most often accompanied by various ruptures - cartilage, cartilage tissue, ligaments. If at the same time the anterior horn is pinched, then the knee joint is necessarily blocked - the patient cannot bend or straighten the knee. As a therapeutic procedure, the usual unlocking is used.

Diagnostic methods

As a rule, signs of degenerative changes in the posterior horn of the medial meniscus help to correctly diagnose. These include:

blocking the knee in a certain position;
pain and clicking when straightening the lower limb.

To confirm the primary diagnosis, the specialist will use:

Radiography. This technique allows you to determine the degree of CI. The initial stage is characterized by an uneven decrease in the joint gap, the second stage is characterized by the appearance of bone growth on the surface of the joint.
MRI or CT. They help to determine the scale of damage to the tissues of the knee.
arthroscopy. Thanks to this diagnostic method, the doctor can see the state of the tissues and joint fluid.

Arthroscopy

With dystrophic changes in the menisci, there are no pronounced symptoms, except for blockade and clicks. Therefore, it is not always possible to determine the disease visually and palpationally. Therefore, a hardware inspection is carried out. There are two most informative methods:

Magnetic resonance imaging displays the state of the ligamentous apparatus, joint, cartilage tissues on the monitor.
Arthroscopy using an endoscope. During diagnostic procedure the doctor makes a microscopic incision, after which a miniature endoscope is inserted into the joint cavity. The tissue structure and synovial fluid are assessed.

Researching

Radiography - is performed for any pain in the knee joint. It is carried out in such projections:

Lateral projection;
Direct projection in a standing position, and when bending the knees at 45o;
Axial projection.

MRI - allows you to see the cartilage in several planes, to assess the condition of other periarticular and articular formations, which is important if there are doubts about the diagnosis. MRI in diagnosing problems with the meniscus has an accuracy of up to 95%. In the sagittal plane, the cartilaginous lining takes on the shape of a butterfly.

Therapeutic methods

Arthroscopy

The choice of treatment for DI MM depends on the cause, degree of development and form of pathology. For the treatment of acute injuries, conservative methods are used:

The victim is given complete peace of mind.
Ice or any cold object is applied to the thigh.
To relieve pain, a person is given a strong analgesic, since other medicines with an analgesic effect do not bring the desired result.
The injured leg is immobilized with a plaster cast for 14 days.
A knee puncture is performed to relieve swelling and improve movement. At first, the exudate will be released in large quantities, so the puncture is carried out 2-3 times.

Meniscal DI can be treated within 6-12 months:

to remove the blockade of the joint, it is reduced;
to restore damaged MM cartilage, the patient is prescribed hyaluronic acid or a chondroprotector;
NSAIDs (Sinarta) are prescribed to minimize pain and inflammation;

Sinarta

removal of puffiness and acceleration of healing of MM of the first and second stages are performed thanks to ointments for external use (Diclofenac);

diclofenac

physical procedures and physiotherapy exercises are prescribed;
a good result shows a massage of a sore knee.

At grade 2 according to Stoller (rupture, displacement, separation of the anterior / posterior horn of the MM, crushing of the cartilage), the patient is indicated for surgery. During the event, the patient:

remove cartilage;
sew up the gap;
fix torn horns;
perform the transplant.

A good result shows arthroscopy. This technique involves making two small incisions in the knee through which the arthroscope is inserted. Then the torn piece of the meniscus is removed, and the edges are aligned.

The following prostheses are suitable for transplantation:

Sliding. It is applied at wear of LM and MM.
Surface. It is used to replace severely damaged cartilage.
Rotary. Replaces knee.
Articulated. Replaces the joint and provides it with stability.

The operation is performed only after the relief of inflammation. During the rehabilitation period, the patient is prescribed exercise therapy, massage sessions and physical procedures.

Physical education, massage

Exercise therapy and massage play an important role in the treatment of meniscal DI. They allow:

restore damaged tissue;
prevent the occurrence of complications;
restore joint movement.

If the injured leg is in a cast, physiotherapy exercises spend for her healthy areas. When the cast or splint is removed, exercises are performed to restore the joint. The load increases gradually, weights and simulators are added.

Rehabilitation is carried out for:

pain relief;
improve blood circulation;
restoration of muscle tone of the sore leg;
return of full motion of the knee joint.

Only a qualified specialist should deal with the selection of a set of exercises and their intensity. To do this, he analyzes the complexity of the pathology and the injuries suffered by the patient.

If the patient was treated conservatively, he can start exercise therapy 14-21 days after the injury. If an operation was performed, exercise therapy can be used only after eight weeks.

Massage

Folk methods

Folk recipes will help enhance the effect of traditional therapy:

Mix alcohol and honey in equal amounts, mix thoroughly. Apply to the injured knee for 2-2.5 hours, secure with a bandage and wrap with a towel. It is advisable to do the procedure before going to bed.
Grind a large onion, add a teaspoon of sugar, mix. Apply at night to the affected joint, wrap with cling film and a scarf.
For a week and a half, apply a compress with medical bile to the knee.
Apply burdock to the affected joint for eleven hours.

The method of treatment is selected based on the type of meniscus lesion and severity. The doctor must take into account the characteristics of each organism, since the drugs have contraindications. The bulk of the drugs are injected into the joint. Some are consumed orally and topically.

Medical therapy:

A puncture is prescribed, due to which swelling is stopped, the motor ability of the knee joint is restored. The puncture is carried out for 3-4 days, since it is necessary to remove a large amount of inflammatory exudation (pathological fluid that is formed during inflammatory processes).
To stop the pain threshold, the doctor prescribes analgesics of narcotic origin. These are drugs based on promedol.
To eliminate the inflammatory process and pain, non-steroidal anti-inflammatory drugs are used: Ibuprofen, Diclofenac.

Ibuprofen Diclofenac

If the previous groups of drugs did not give positive result, it is considered appropriate to use hormone therapy. Steroids have powerful anti-inflammatory effects. Means: "Hydrocortisone", "Diprospan".

Hydrocortisone Diprospan

For the speedy recovery of the knee joint, the specialist prescribes chondroprotectors. They nourish the damaged cartilage layer with useful substances. Preparations: Chondroitin, Glucosamine, hyaluronic acid.
Muscle relaxants are used to reduce the load on the knee joint and stop muscle spasms. It could be Mydocalm.

Chondroitin Glucosamine Mydocalm

For a period of 2 weeks, a splint is applied at least, which allows you to fix the knee joint in the correct position.

Activities for the rehabilitation period:

Physiotherapeutic procedures are mandatory: UHF, ozocerite therapy (mountain wax treatment), iontophoresis, and so on.
Therapeutic and physical culture complex - restores mobility, strengthens the muscular system that supports the knee joint. Exercises are developed, depending on the cause and course of the disease. That is, they are individual. Classes are conducted by an experienced specialist in a specialized institution. If only conservative therapy was used, exercises can be done after a couple of weeks, if surgery was performed - after 2 months.
It is advisable to visit a massage therapist.

When there are severe gaps, surgical intervention is prescribed. At the moment, a minimally invasive operation is used - arthroscopy. The surgeon makes small incisions and then removes part of the damaged meniscus with miniature instruments (meniscectomy).

If the lesion is extensive, the meniscus is removed completely, after which the implant is placed.

Indications for surgical intervention are significant damage to the cartilage layer, tissue crushing, and the presence of a cyst.

Folk recipes used as an aid. They cannot replace drug therapy, but will help alleviate the patient's condition. So what can you do at home:

Make compresses from natural ingredients. To do this, take a couple of onions, peel them and grate them on a fine grater or pass through a meat grinder. Add to the mixture 1 tbsp. l. Sahara. Put the mass on a gauze bandage and apply to the knee joint. Secure with cling film and woolen cloth. You can keep the compress for several hours.

Onion Sugar

Combine equal proportions of medical alcohol (not vodka) with natural honey. Put in a water bath until the honey is completely dissolved. Lubricate your knees liberally with this mixture. Be sure to secure with a bandage. Wear such a compress for no more than 2 hours. Do it twice a day.
Another compress, which is applied in the same way as in the previous case. Used medical bile, which is sold in a pharmacy. Before applying, the liquid needs to be slightly warmed up.

Alcohol Honey Medical bile

Depending on the nature of the damage, the doctor chooses a type of therapeutic measures, the task of which is to combat the manifestations of pathology.

If the symptoms of the disease are acute, conservative therapy is recommended. After the puncture, the doctor prescribes potent painkillers designed to reduce the manifestations of acute pain.

The next treatment stage includes the use of chondroprotectors, anti-inflammatory drugs and physiotherapy. Two weeks later, after the limb has partially regained its mobility, a splint is placed on it to fix the joint.

If the damage to the joint is in the nature of an injury, as well as in the case of a chronic manifestation of the disease, the best treatment would be surgery.

In order to keep the knee joint healthy, it is recommended to get a qualified consultation from a Koleno21 specialist at the first signs of degenerative changes. This is the only way you can stop the attack and prevent its further spread.

Treatment

Treatment can be difficult, expensive and lengthy, but it is definitely worth it. If you do not start treating a person on time, then you can completely deprive yourself of the opportunity to fully walk. Usually prescribed complex therapy:

physiotherapy;
drug treatment;
tire fixation.

There are cases when an operation is indispensable, it is performed by an orthopedic surgeon. During the operation, either the damaged part is cut off, or one of the menisci is completely removed, or it is sewn up.

The meniscus performs an important function in the body - it is a shock absorber for the legs. It, like the entire knee joint, you need to try to protect:

Strengthen the muscles of the knee joint.
Set the exercise technique with a professional trainer, and only with improvements can you use the knee exercises on the video.
Wear the right shoes.
Eat foods rich in collagen and elastin.

The necessary macronutrients are found in many foods, but most of them are in jelly and seafood.

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

puncture from the knee joint;
appointment of physiotherapy: phonophoresis, UHF, iontophoresis, ozocerite;
the appointment of 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 the fixation of the joint in the desired position. With ruptures, chronic dystrophy, joint dysplasia, surgery is performed. In the presence of gout or rheumatism, the treatment of the underlying disease that provoked the process of degenerative changes is also carried out.

The main method of treatment of pathologies of the knee cartilage is surgical intervention. 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 condition of the patient, but on average it ranges from 2 days to several weeks.

Degenerative changes in the menisci of the knee joint are common injuries in any age group. Damage is typical for athletes, but ordinary people are also quite common.

The occurrence of dystrophic changes leads to the fact that the motor system is disturbed. Accordingly, it is very important to undergo a course of treatment in a timely manner in order to prevent the consequences. That is why, when the first symptomatology occurs, you need to go for a consultation with doctors without wasting time. The course of treatment takes a long time.

To fully understand the severity of the damage, you need to know what the meniscus is for. This is a cartilage tissue that plays the role of a shock absorber in the joint, as well as stabilizing the knee. The meniscus affects the improvement of rotational movements of the entire joint.

Preventive actions

To prevent degenerative changes in the ISS, follow simple rules:

So, if you stick to preventive measures, you can avoid injury to the meniscus.

If you experience even minor pain in the knee area, be sure to visit a specialist. This will allow timely detection of inflammatory processes and prevent the development of dystrophic changes.

Degenerative changes in the menisci - what is the danger

Degenerative changes are called acquired anomalies of the anatomy of the organ, the cause of which is mechanical damage or any, perhaps even unconscious, injury to the joint. Unlike the outer, more mobile and mobile meniscus, the inner one is rigidly connected to the lateral knee ligament, which often leads to injuries accompanied by severe pain.

The most common degenerative cartilage changes are:

Violation of the integrity of the ligament at the attachment points of both horns or the body in the paracapsular region.
Transchondral ruptures of the body and horns of the meniscus.
Meniscopathies of various etiologies, which lead to complications after infectious and a number of autoimmune diseases.
Rupture of intermeniscal ligaments, leading to pronounced degenerative changes in the joint.

Clinical picture

The manifestations of the disease are quite diverse and directly depend on the nature of the damage. The following signs of degenerative changes can be considered common:

Pronounced pain syndrome.
A distinctly audible crunch and single clicking sounds in the knee joint.
Inability to fully extend the leg.
The illusion of the presence of a foreign body in the knee.
puffiness
Morning stiffness of movement, disappearing after attempts to disperse.

Disease prevention

If you maintain your health and follow preventive recommendations, the likelihood of developing meniscal DI is minimal. For sports, you need to choose comfortable sneakers with a well-fixed sole. In this way, you can protect yourself from falling.

In order for the knees to be loaded evenly, they must be fixed with an elastic bandage, knee pads, an orthosis or a bandage. Before any power loads, it is necessary to warm up the muscle tissue and joints.