Buckling of knee causes: The request could not be satisfied
3 Signs It Is Time To Have Your Knee Examined
For many with knee pain, it can be difficult to determine what are symptoms of soreness or overexertion and those symptoms that may indicate something more serious. Below is a helpful guide to determine when it may be time to have your knee examined by one of the orthopedic specialist at Total Orthopedics and Sports Medicine at one of our 5 locations throughout Long Island, Brooklyn and the Bronx.
1. Your Knee Catches or Locks Up
If you have catching or locking going from sitting to standing, or bending your knees, it may be a sign of cartilage degeneration in your kneecap or even a meniscal tear. Usually pain and locking is felt on the front of the knee when it is your kneecap and on either side of the knee when it is a meniscal tear. It is important to have this condition addressed as cartilage degeneration is progressive and can result in increased pain and weakness.
2. Your Knee Gives Out
The knee giving out, or buckling, is a nonspecific reflex of the quadriceps muscle that occurs when the knee is in a painful position and the quadriceps muscle releases causing the knee to buckle. Several conditions can cause the knee to give out and it is important to have the specific cause diagnosed by an orthopedic specialist to start the appropriate treatment for this painful condition.
One of the most common reasons this occurs is due to patellofemoral problems (problems between the knee cap and the thigh bone). In other cases, buckling of the knee can be caused by instability of the kneecap due to repeated dislocations of the kneecap. Another cause of buckling can be from instability caused by ligament injuries such as an ACL tear.
3. Pain is Radiating to the Back of Your Knee
Pain in the back of the knee can be something that happens immediately after a traumatic injury or something that progresses over time. The pain usually gets worse when walking, running, squatting or climbing stairs. Several conditions can cause this type of pain and include arthritic conditions, tears of the back of the meniscus or, in some cases, from a large Bakers Cyst that forms in the back of the knee.
Seeking Treatment for Knee Pain
Assessment by one of our awarded orthopedic surgeons can diagnose the problem causing the pain and tailor a treatment plan that is specific for the problem.
The awarded team at Total Orthopedics and Sports Medicine focuses on both the surgical and non-surgical treatment of bone, joint injuries, ligament and tendon injuries. Renowned experts Dr. Charles Ruotolo and Dr. Richard McCormack lead our Knee Team.
Fortunately, many patients can be treated non-surgically with a combination of conservative modalities coordinated by the Total Orthopedics and Sports Medicine Team. If surgery is necessary, the practice uses a multidisciplinary approach to create a treatment plan that focuses on the patient’s lifestyle and activities and helps them get back to those activities quickly and effectively. Total Orthopedics and Sports Medicine has locations throughout Long Island, Brooklyn and the Bronx.
7 reasons for knee buckling: symptoms, diagnosis and treatment
Imagine running to catch that bus your late for and your knee gives way! Or whilst playing your favourite sport, you experience your knee buckling underneath you.
Having your knee give way can be a scary thought. Not many people think about the reasons why your knee gives way until it happens to them.
It’s at this point that knowing what’s going on and how to fix it becomes very important.
Prefer to skip ahead?
1. ACL Injury
3. Torn Meniscus
4. Ligament Tears
5. Patella Instability
6. Quadriceps Insufficiency
7. Synovial Plica Syndrome
8. Other Causes For Knee Buckling
This article is about highlighting the main reasons your knee gives way. Starting with the most common reasons, and then working down to those that may not occur so frequently.
The aim is not only to inform you, but to help you do what you need to overcome this condition.
Let’s start from the top with the number one reason that your knee gives way!
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ACL injuries are very common and can have lasting effects on your knees. The Medical Journal of Australia reports that in Australia, there are upwards of 17,000 injuries per year.
Looking at the statistics you can see that the rate of ACL injury is only increasing with increased population and participation in cutting sports such as netball and soccer.
The amount of reconstructions being performed are also increasing, with Australia currently having the highest amount of ACL reconstructions in the world.
Acute ACL tears are usually obvious. Some people describe a loud snap that can be heard from several meters away. Within 30 minutes there will be swelling which could make the knee twice its normal size.
Normal symptoms of an ACL tear include:
- Knee swelling
- Knee giving way
- Loss of range into knee flexion and extension
- Pain during walking
Giving way or buckling of the knee occurs because the ACL’s main function is to stop the shin bone from sliding forward during twisting movements. Without the support of this ligament, the shin will move forward and cause the knee to buckle.
There has been a change in trends for in the management of ACL injuries as further research emerges. It was normal up until a few years ago to operate on all knees to restore normal function and stop the knee buckling.
Now a trial of non-surgical management is recommended for at least 3 months before a decision about surgery is made. This is because there are now high-level studies that show even athletes can return to high level sport without an ACL.
Many clinicians now advocate for conservative therapy because there is a big chance it will be successful. Even if conservative therapy isn’t a success, (meaning your knee continues to give way) you can always have the surgery later with no increased risk of damaging the knee.
It may be beneficial in the early stages to trial a knee brace to help avoid the knee giving way. We have recommended one brace from Amazon here:
If you do opt for surgery, there are some common side-effects after the operation, numbness in the knee being one of them.
Rehabilitation for ACL injury is unique as every person will present differently. However, there are some core elements which will remain the same, these involve:
- Lower limb and core strengthening
- Running and cutting drills
- Lower limb control during jumping and single leg tasks
- Sport specific drills as you improve
- Education on safe return to sport and load management
ACL taping can also be part of the management of this condition, click here to watch ACL taping in youtube.
It will also be important to start a graded return to running program. You can find out details of how to grade up your running with pain here.
For further information on ACL injuries, please see our ACL injury page.
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#2 – Osteoarthritis
With the baby boomer generation coming of age, we are seeing a rise in the total number of people with knee osteoarthritis.
This is a condition that generally progresses as we age and is characterised by the break-down of healthy cartilage in your knee. Other signs include the formation of osteophytes which are little bony spurs on the outside of the joint and the breakdown of ligaments in the knee.
Keep in mind, some people will have arthritic changes on X-ray and NO pain. This brings me to explaining some of the common symptoms for arthritis
Symptoms of arthritis will progress as the condition worsens (this may take years, there is no way of knowing medically), they typically include:
- Morning pain and stiffness
- Stiffness and pain when standing after prolonged sitting
- Cracking, grinding
- Swelling and gradual loss of range
- Knee buckling (giving way) and locking can be rarer symptoms
Although having your knee giving way is a rarer symptom of osteoarthritis, it is important to take note. Mechanical symptoms like knee buckling, means the knee is not stable and these symptoms warrant a referral to your local orthopaedic surgeon.
Unfortunately, there isn’t yet a long-term cure for knee osteoarthritis currently. But don’t think that all hope is lost, because there is good evidence that weight loss as small as 5% can reduce symptoms by up to 50%.
Exercise is the current gold standard treatment for knee osteoarthritis. A good starting point is general cardiovascular fitness and quadriceps strengthening.
You can find a basic quadriceps exercise here.
Sometimes simple braces can help to reduce swelling when the arthritis is aggravated, we would recommend something like this:
If this isn’t working, then surgical management may be considered. The best surgical solution at current, is to eventually replace the knee with an operation called the total knee replacement.
Total knee replacement surgeries are very common and usually provide excellent results. Some risks associated will be numbness after surgery, and the risk of infection.
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#3 – Torn Meniscus
Meniscal tears can be associated with giving way of the knee. There are many different types of meniscal tears, but the ones associated with giving way of the knee are usually the bigger ‘bucket handle’ type tears.
Meniscal tears are usually sustained with twisting movements under load. They can occur with forceful movements, but sometimes they can result from something as simple as getting up from sitting. For some patients it will feel like the back of the knee gives way.
Usually acute meniscal tears will happen to younger people, and these are more likely to be bigger bucket handle tears. As we age, our meniscus are more prone to tearing, but these are more degenerate tears as a result of osteoarthritis.
If the tear is sizeable, then it is possible that locking and giving way of the knee occur. Other symptoms will involve, pain with weightbearing, swelling, inability to fully straighten the knee.
For large bucket handle tears, surgery is usually required to mend the tear and try to preserve as much of the meniscus as possible. If the knee isn’t giving way and locking, then it is appropriate and safe to trial physiotherapy and see how it goes.
A ligament tear can take up to 12 months to heal because of the poor blood supply to the meniscus to don’t be concerned if it’s not better in a couple of weeks. By 3 months you should be make progress but may still have pain associated.
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#4 – Ligamentous tears of the knee
The knee has four major stabilising ligaments that give it stability through range. One I previously mentioned is the ACL. If you have tears in the other 3 ligaments, you may also experience giving way of the knee.
PCL (posterior cruciate ligament)
Right next to the ACL, on the inside of the knee, we also have a PCL. This ligament helps to stop your shin bone from hyperextending.
This ligament is usually injured with dashboard car injuries, where the shin is forced into the dash and the knee hyperextends.
If your PCL is torn, you won’t feel stable when you fully straighten the knee and the knee can give out backwards and buckle.
MCL (medial collateral ligament)
The major inside stabiliser of the knee is your MCL. This ligament stops the knee from buckling inwards.
The MCL is damaged when your knee is forced inwards. As you are forced into being knock kneed, the MCL is stretched and can partially or fully tear.
LCL (lateral collateral ligament)
Much like the MCL, your LCL stops the knee from bowing outwards. It is put under strain when there is a force that pushes the knee out, like a kick to the inside of the knee.
The solution to ligament injuries heavily relies on how much of the ligament is torn. For most of these the first step would be to get appropriate imaging like an MRI to assess the damage.
Small and medium sized tears can usually be helped with bracing the knee first, followed by physiotherapy and progressive exercises. Braces would need to have support on the inside and outside of the knee like these:
If the ligaments are fully torn they will usually require surgery to fix it.
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#5 – Patella instability
Patella instability is defined by constant dislocations of your knee cap. It can be difficult to manage, and I have had patients whose knee will dislocate up to two and three times a day.
This condition affects between 7-49 people out of every 100,000. The knee cap usually dislocates outwards and after your first dislocation you are much more likely to dislocate again.
The most problematic part of patella instability is the knee cap dislocating. This will usually happen in the early phase of knee bend as there is not much groove for the knee cap to sit in.
Sometimes as your knee dislocates, your knee gives way at the same time. This is due to the sudden loss of power of your quadriceps muscle as it attaches onto the knee cap.
Other symptoms could include grinding, clicking and discomfort or pain in the knee. If left untreated it can lead to kneecap pain at the front of the knee, commonly known as patellofemoral pain.
If the knee is constantly giving way or buckling, then surgery may have to be considered. I would still always give strengthening a go first, because if this works it will save you money and potentially prevent any problems resulting from surgery.
If you want to try strengthening, you need to make sure your knee control is just right. Online physiotherapy will be perfect to help in this journey as we can construct an exercise program that will be perfect for your needs.
Some basic exercises to start with would be squats and side bridges. From here you would move closer to single leg strength exercises and motor control around the hip.
Surgical options would include a repair of your MPFL (medial patella-femoral ligament), a tibial tuberosity transfer or a lateral retinaculum release.
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# 6 –
Your quadriceps muscle is located on the front of your thigh. It’s the major muscle responsible for straightening the knee.
Sometimes your knee gives way because of a lack of strength in this muscle – also called an insufficiency. There can be numerous reasons for this muscle being weak:
- Pain inhibition (if your knee is very sore, your brain can switch of the quadriceps muscle)
- Weakness post-surgery – ACL or TKR, or meniscus repairs
- Nerve impingement in the back
- Deconditioning from lack of use – with people who are very sedentary
With quadriceps insufficiency you will feel like your thigh muscles are weak. You may not really trust your leg and would prefer to use crutches or other walking aids. Your knee might lock backwards into extension and if it comes unlocked the knee buckles.
If you have weakness due to pain inhibition, there may be associate injuries with your knee causing your quadriceps to not work as well.
The major treatment for quadriceps insufficiency is strength training. Now your body is very good at cheating as your attempting to strengthen weak muscles. I remember having a young fit guy who could still climb stairs with no use of his quadriceps!
The key in early strength training is isolation. You want to really isolate the quadriceps, so they can’t get out of doing the work.
I have attached a video for my favourite exercise to begin with in quadriceps training below:
When your quadriceps strength is improving its often good to begin a more generalised strength program. We have some exercises including calf raises to strengthen your calves in our Achilles Tendinopathy ulimate guide.
Also if the calves are weak and causing concern, taping can help to keep some stability through the ankle. And it’s important to know what shoes to wear for support!
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# 7 –
Synovial Plica Syndrome
These are folds in the membrane around your joint in the knee. They are thought to be left over material from the development stage of birth. Kind of like your appendix, they don’t serve much of a purpose except to get irritated in some people.
Usually the plica will get caught in the front and inside part of your knee. It can get caught rubbing against your knee cap through movements which involve bending the knee.
Synovial plica syndrome is more common in the younger years of life up to about 30 years old. There is wide variation in the exact prevalence of this condition, however it’s thought to occur in about 10% of the population. (I think it could be less than this)
Your knee giving way is not a common symptom of this condition. The reason I included this diagnosis is people will report a ‘pseudo-locking’ where the knee feels like it locks. This is also often described as giving way.
Other common symptoms include:
- Knee pain
- Clicking, clunking, catching
- A popping sensation with squats or loaded knee bends
These symptoms will usually be activity dependent, however there may be an aching that remains after.
This condition will commonly occur due to a lack of quadriceps strength and control around the knee joint. Look at the quadriceps insufficiency section for an exercise to help get your quadriceps strength back.
Often this will respond well to Physiotherapy, including taping, exercise, load management (load mx blog) and some over the counter pain killers. This condition can be treated via online physiotherapy as the mainline treatment will involve exercises on hip and knee control.
If physiotherapy isn’t giving full pain relief the next option would be a cortisone injection. I would recommend only trying one of these as there is no further benefit to try additional doses and they can affect tendon integrity over time.
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Other Causes For Knee Buckling
Osteochondral Lesion (OCD)
An osteochondral lesion is where a piece of cartilage is torn or broken away from the knee joint. This causes a small ‘hole’ in the cartilage, where usually it’s smooth.
People with OCD will experience pain in the knee, occurring usually with weight-bearing. They can experience knee buckling due to the uneven nature of the cartilage.
Other symptoms may include a dull ache in the knee, especially after activity.
Osteochondral lesions often require surgery to treat them as cartilage doesn’t have good blood supply.
The Bottom Line
Knee buckling can be due to all sorts of ailments. We went through some of the main culprits, but there are still more like multiple sclerosis that can give you knee buckling symptoms.
If you have knee buckling, feel free to book your consultation with Click Physiotherapy for a video conference and we can discuss treatment of this with you in person!
Frequently Asked Questions about knee buckling:
Why does my knee buckle?
Buckling in the knee caused due to a number of different reasons including; meniscal damage, weak muscles, arthritis, ligament damage and more.
How do I prevent my knee giving way?
This will depend on the reason for your knee giving way. Giving way can be treated with physiotherapy to strengthen muscles in conditions like ACL injuries or arthritis, however the knee may need surgical management if there is major instability in the knee.
When do I see a doctor if my knee gives way?
If you are concerned about your knee, it is a good idea to see your doctor. They can help diagnose the cause of giving way and then refer you for the most appropriate treatment.
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Treatments that reduce knee buckling may help prevent falls in older adults — ScienceDaily
Symptoms of knee instability in older adults may indicate an increased risk of falling and of experiencing the various physical and psychological effects that can result from falling, according to a study published in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR). The findings indicate that determining effective treatments for knee instability should be an important priority as clinicians care for aging patients.
Knee buckling, often described as a knee “giving way,” is a symptom of knee instability that frequently affects older individuals, in particular those with knee pain and knee osteoarthritis (OA), and may be caused by muscle weakness and balance difficulties. If knee instability leads to frequent falls and fall-related injuries, exercises and other interventions that stabilize the knee may help maintain older individuals’ health and quality of life. To investigate this potential link, Michael Nevitt, PhD, of the University of California, San Francisco, and his colleagues prospectively studied 1842 participants in the Multicenter Osteoarthritis Study (MOST) who were an average of 67 years old at the start and who had, or were at high risk for, knee osteoarthritis.
At the end of 5 years, 16.8 percent reported knee buckling, and at the end of 7 years, 14.1 percent had recurrent (?2) falls. Bucklers at year 5 had a 1.6- to 2.5-times higher likelihood of recurrent falls, fear of falling, and poor balance confidence at year 7. Those who fell when a knee buckled at the start of the study had a 4.5-times, 2-times, and 3-times higher likelihood 2 years later of recurrent falls, significant fall injuries, and fall injuries that limited activity, respectively, and they were 4-times more likely to have poor balance.
“Falls, injury from falls and poor balance confidence are extremely common and debilitating problems in older people. The present study has demonstrated for the first time that knee instability and knee buckling are important causes of these problems in the very large segment of the older population suffering from knee pain,” said Dr. Nevitt. “Fortunately, it may be possible to treat knee instability and prevent knee buckling with targeted exercises. Joint replacement surgery can also improve knee stability.” He added that pain is the predominant symptom of knee osteoarthritis, and symptoms of instability such as knee buckling and falls may be overlooked by treating professionals. The most important immediate impact of these findings on patient care is that health professionals should query their patients with knee OA about instability, buckling, and falls, and work with them to take preventive actions, including proper use of walking aids, leg strengthening, and appropriate footwear.”
Materials provided by Wiley. Note: Content may be edited for style and length.
Cuses knee buckling | Blog Maywood Physical Therapy
Cuses knee buckling
Knee buckling can be a sign of injury or damage to the knee. It can increase the risk of falling and can prolong recovery from knee problems.
Knee buckling is relatively common among adults. In one study, 11.8 percent of adults aged 36–94 reported at least one episode of knee buckling in the past 3 months. It can affect people of all ages and levels of fitness.
In this article, we look at the causes of knee buckling, exercises that can help, treatment, and when to see a doctor.
Knee buckling is a complicated condition with many different potential causes.
Many people associate knee buckling with osteoarthritis. However, one study found that more than half of the participants who reported episodes of knee buckling did not show any signs of arthritis in X-rays.
The complex structure of the knee joint can make it difficult to determine what is causing knee buckling.
The knee consists of two joints, which allow it to move in different directions. The knee has support from:
- tendons, which connect the leg muscles to the knee bones
- ligaments, which connect the knee bones together
- cartilage, which allows smooth movement of the joints and acts as a shock absorber
It is possible to damage any of these different parts, sometimes in combination with other injuries to the knee. This can lead to instability in the knee and knee buckling.
Certain factors may be related to knee buckling. These include knee pain, which can occur for a variety of reasons, and weak muscles at the front of the leg.
The following may also contribute to the likelihood of knee buckling:
- Arthritis, which can cause severe pain in the knees and create joint instability. Disease, injury, and worn cartilage can all lead to arthritis.
- A torn meniscus, which interferes with the normal motion of the knee.
- A fragment of bone or cartilage becoming trapped between the bones.
- Tearing of any of the ligaments, which can occur as a result of a blow to the knees or a sudden twisting motion.
- Partial or complete dislocation of the kneecap.
- An inflammation of the synovial folds of the knee, or plicae, which can be painful and cause the knee to pop, crack, or buckle.
- Multiple sclerosis is an autoimmune condition that attacks the central nervous system. It can cause muscle weakness and tightness, in addition to balance and sensory problems, which may all contribute to knee buckling.
- Damage to the femoral nerve, which controls the muscles that straighten the leg, can lead to a sensation of the knee giving way.
Exercises and physical therapy
Certain exercises can strengthen the leg muscles and improve knee
stability, which may help to prevent or reduce knee buckling.
A doctor or physical therapist can design an exercise program to address
the needs of a person worried about knee buckling. This will usually focus on:
- strengthening the muscles that support the knee and keep the kneecap in proper alignment
- Increasing the range of motion in the upper and lower legs
- Reducing stiffness
- Promoting flexibility
Specific exercises will stretch and strengthen:
- the quadriceps — the muscles in the front of the legs
- the hamstrings — the muscles in the back of the legs
- the calves — the muscles in the back of the lower legs
- the gluteal muscles — the muscles in the buttocks
Following a knee rehabilitation program will help a person by:
- improving their ability to bend and straighten their legs
- increasing the weight their legs can support
- building strength in their inner and outer thighs, and expanding their range of motion
It is important to start these exercises very slowly and gently. People need to gradually build up strength and flexibility in their legs and knees before moving on to tougher exercises.
However, to make progress, it is important for people to challenge themselves a little, both at home and in Physical Therapy sessions. It can be hard to achieve the right balance, but a trained therapist can help to ensure that the level of exertion is suitable.
People who experience knee buckling may also need to adapt their exercise habits. For example, a person with arthritis may need to switch from high-impact activities, such as running or tennis, to lower-impact activities, such as swimming or cycling.
Cycling can also help to build strength in the upper legs, which will contribute to improved stability in the knee.
Knees Buckling? Don’t Ignore It
Going “weak in the knees”—that is, having your knees give way when you put weight on them—is a sign of knee instability. Knee buckling increases your risk of falling, and it’s particularly common in people who have arthritis or knee pain. But you don’t have to have arthritis to have a knee give way.
You may have had a knee buckle at one time or another. If you were lucky, you were able to regain your balance and steady yourself before you took a tumble. But you might not be so lucky next time around: Your risk of falling, and possibly incurring serious injuries, when your knee unpredictably buckles could increase within two years of your first knee-buckling incident, according to a new study.
Until recently, the consequences of knee buckling had not received much attention in the medical literature and scientific research. But the new study, in last February’s Arthritis Care and Research, takes a closer look at knee instability and its role in causing falls. The authors conclude that doctors should be paying closer attention to patients’ complaints of knee weakness.
Fear of falling
Knee buckling may be a result of balance difficulties and muscle weakness, particularly in the quadriceps, the group of muscles that runs down the front and sides of the thigh. Some studies estimate that knee instability during weight-bearing activities, such as going up or down stairs or simply walking, occurs most commonly in people with knee osteoarthritis or knee pain.
To measure the little-studied consequences of knee buckling, researchers asked 1,842 people, ages 55 to 84, who either had, or were at high risk for, knee osteoarthritis if they recalled an episode of knee buckling any time within the past three months. Nearly 17 percent of the participants recalled their knees buckling, and 20 percent of those participants reported they fell as a result.
The researchers checked back with the participants two years later to determine whether they had experienced any additional knee-buckling episodes. They found that those who reported knee buckling at baseline were four and a half times more likely to have fallen at least once more during the previous year, twice as likely to be significantly injured from a fall, and three times as likely to be injured enough to cause disability. Those who had a knee-buckling incident but didn’t fall were twice as likely to fall within two years because of a knee giving way.
Of major concern among the researchers was the number of people—69 percent—who told them that, after they fell, they lost confidence in their balance and gained a fear of falling—so much so that they compensated by limiting their daily activities. But curtailing activity to avoid falling isn’t a good solution: It will most certainly lead to a downward health spiral.
“Avoiding physical activity can result in further decline in muscle strength and general overall physical condition, putting you at even greater risk of falling,” says John A. Flynn, M.D., M.Ed., medical director of the Spondyloarthritis Center at Johns Hopkins University School of Medicine in Baltimore. “This deconditioning will eventually lead to loss of mobility and function and will likely have a psychological impact in the form of depression, anxiety, dependency, and social isolation.”
Speak up before you fall down
Such consequences, say the researchers, are preventable in people whose buckling knees are caused by muscle weakness or poor balance with interventions that include quadriceps-strengthening exercises and balance and agility training. Doctors must do their part in first identifying these patients and patients should bring up the subject if their doctors don’t.
Unless prompted by their doctors, most patients don’t mention incidences of their knees giving way. The researchers suspect that doctors don’t always consider knee buckling and its consequences in their arthritis patients because they’re more focused on pain relief and regaining function. As a result, the researchers are encouraging doctors to routinely ask patients whether they’ve experienced any knee buckling or instability.
“Don’t wait for your doctor to ask about these symptoms,” Flynn says. “Since pain is the most common knee-arthritis symptom, other symptoms like buckling can sometimes be overlooked. Ask your doctor about options that can help you stay active and reduce your fall risk. In addition to recommending exercise, he or she may suggest losing excess weight that could be putting strain on your knees; upgrading your footwear to shoes or slippers with low heels and thin, slip-resistant soles; and using a walking aid such as a cane.”
Exercise to get you steady on your feet
Ask your doctor to refer you to a physical therapist who can develop an exercise program for you. A typical exercise program should include:
• Range-of-motion exercises, such as yoga or tai chi (an exercise that involves gentle
stretching movements), to keep your joints and muscles flexible.
• Aerobic exercise that’s easy on the joints, such as swimming, walking, and bicycling,
to keep your heart and lungs healthy and control your weight.
• Strengthening exercises, especially ones that target your quadriceps.
• Balance and agility exercises to reduce your risk of falling.
(Originally published Aug. 25, 2016; updated Feb. 24, 2017)
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HealthAfter50 was published by the University of California, Berkeley, School of Public Health, providing up-to-date, evidence-based research and expert advice on the prevention, diagnosis, and treatment of a wide range of health conditions affecting adults in middle age and beyond. It was previously part of Remedy Health Media’s network of digital and print publications, which also include HealthCentral; HIV/AIDS resources The Body and The Body Pro; the UC Berkeley Wellness Letter; and the Berkeley Wellness website. All content from HA50 merged into Healthcentral.com in 2018.
By Dr. Russ Riggs •
It’s probably happened to you at least once; you’re walking along just fine, maybe headed up a flight of stairs and your knee suddenly gives out. This phenomenon is referred to as “knee buckling”. Many orthopedists believe this is a protective response by your body to protect the knee joint from damage. However, if you’re experiencing this issue often, or in combination with popping and locking of the knee joint, there may be a more serious issue going on, such as an acute injury to your ACL or degenerative joint damage in the form of osteoarthritis (OA).
What causes it?
There are a variety of reasons why your knee may regularly be buckling. The most common are an acute injury such as tears in the meniscus, or ACL. Or chronic inflammation and cartilage damage has started to take place in the knee joint.
Unfortunately, it’s likely your lifestyle and activities are adding to the issue. If you are involved in high-impact sports such as long-distance running or skiing, you might repeatedly be spraining or injuring your knees, which can damage or tear ligaments and the meniscus. Over time, these injuries erode the stability of the knee joint as well as initiate the inflammation cascade of OA. In addition to soft tissue injuries, bone spurs can occur and bone fragments can get broken off that then float around the joint which can lead to knee buckling.
Why is it a problem?
In most cases, knee buckling is an indicator of a more serious issue such as an ACL tear. But for some individuals, especially the elderly, knee buckling itself can cause even bigger problems. Clinical research indicates that knee buckling may cause falls and fractures and could help explain the risk of hip fracture in people who suffer from osteoarthritis.
“One U.S study, which looked at over 2000 people with osteoarthritis, found that about 12 percent experienced at least one knee-buckling incident in the past three months. Out of these people, 13 percent fell when the buckling occurred. It also turned out that knee pain, muscle weakness, as well as poor physical function were related to the buckling.”
How can it be treated?
A physical therapist or doctor is usually able to diagnose the cause of your knee buckling through a series of mobility tests, a manual exam, and imaging such as ultrasound. Once they’ve determined the cause of the buckling, they’ll be able to devise a treatment plan to fix the issue.
For minor acute injuries, often the R.I.C.E (rest, ice, compression, elevation) method is utilized. Physicians may also recommend NSAIDS for short-term pain control and to reduce swelling in the knee. If compensation patterns or joint weakness and stability need fixing, a knee brace might also be utilized.
Some stretches and exercises can often help with minor weakness and stability issues:
In some severe cases, surgery may be necessary if conservative treatments are not successful in addressing the issue. If you’re experiencing chronic knee pain, or your knee is frequently popping, locking, and giving out you should get an exam to determine what’s causing it and treat the underlying cause.
WHAT DO YOU KNOW ABOUT KNEE BUCKLING?
Knee buckling is when one or both of your knees give out. It’s also referred to as knee instability or weak knees. While it’s often accompanied by pain, this isn’t always the case. Knee buckling can be a sign of injury or damage to the knee. It can increase the risk of falling and can prolong recovery from knee problems.
Frequent knee buckling also raises your risk of falling and seriously injuring yourself, so it’s important to figure out the underlying cause.
Symptoms of knee instability in older adults may indicate an increased risk of falling and of experiencing the various physical and psychological effects that can result from falling, according to a study published in Arthritis Care & Research, a journal of the American College of Rheumatology (ACR). The findings indicate that determining effective treatments for knee instability should be an important priority as clinicians care for aging patients.
The knee consists of two joints which allow it to move in a variety of directions.
These joints are supported by three types of tissue.
Cartilage, which acts as a shock absorber and allows smooth movement of the two joints of the knee.
Ligaments, which connect the joints of the knee.
Tendons, which connect the muscles of the leg to the bones of the knee.
Most common causes of knee buckling are:
2. Torn ligaments
3. Bone fragments
4. Dislocation of the kneecap
Common characteristics of a buckling knee
If you think you have a buckling knee, you might be experiencing:
· Loss of knee strength when weight is placed on it
· Pain surrounding the knee
· Difficulty standing or walking properly
· Knee Swelling or inflammation
· Cracking or popping sound from the knee when being stretched
8 Possible Buckling Knee Conditions:
. Meniscal injury
.Knee (mcl) sprain
.Patellofemoral pain syndrome
.Repeated kneecap dislocation (patellar subluxation)
.Knee sprain (lcl)
Certain exercises can strengthen the leg muscles and improve knee stability, which may help to reduce knee buckling.
Physical therapist can design an exercise program to address the needs of a person worried about knee buckling. This will usually focus on:
1. Strengthening the muscles that support the knee
2. Increasing the range of motion in the upper and lower legs
3. Reducing stiffness
4. Promoting flexibility
5. Keep the kneecap in proper alignment
A typical knee rehabilitation program will run for 4–6 weeks. However, it is usually best to continue doing these exercises for as long as possible to maintain the health of the knees.
Specific exercises will stretch and strengthen:
a) The quadriceps — the muscles in the front of the legs
b) The hamstrings — the muscles in the back of the legs
c) The calf — the muscles in the back of the lower legs
d) The gluteus muscles — the muscles in the buttocks
e) Improving their ability to bend and straighten their legs
f) Increasing the weight their legs can support
g) Building strength in their inner and outer thighs, and expanding their range of motion
It is important to start these exercises very slowly and gently. People need to gradually build up strength and flexibility in their legs and knees before moving on to tougher exercises.
However, to make progress, it is important for people to challenge themselves a little, both at home and in physical therapy sessions. It can be hard to achieve the right balance, but a trained therapist can help to ensure that the level of exertion is suitable.
For examples: Cycling can also help to build strength in the upper legs, which will contribute to improved stability in the knee.people who experience knee buckling may also need to adapt their exercise habits.
In conclusion, sensations of knee instability, slipping or shifting without the knee actually buckling are common, even more so than knee buckling. Both of these conditions are associated with increased fear of falling, low balance confidence, activity limitation, and poor physical function. Get an appointment with your physical therapy now.
Patellofemoral Arthrosis and Patellar Replacement Surgery | [Patellofemoral arthrosis Patellofemoral arthrosis and patellar replacement
Patellofemoral arthrosis of the knee joint
In addition to the femur and tibia, the patella (patella) is another component of the knee joint. It performs its main function in flexion and extension of the leg. When the leg is bent, the patella moves up and down, like a groove in the bone of the upper leg between the two condyles.© Istockphoto.com / MedicalArtInc
Patellofemoral arthrosis of the knee joint causes degenerative changes in the back of the patella (patella). As a result of retropatellar arthrosis, arthritic pain occurs primarily when a person descends from a staircase or from a mountainous surface.
In addition to the femur (Femur) and tibia (Tibia) bones, the patella is another component of the complex structure of the knee joint. The functionality of the knee joint also depends on the condition of the patella.Retropatellar arthrosis occurs most often in bricklayers, tilers – people who do their work mainly on their knees, or in people whose work is related to physical activity. Patellofemoral arthrosis can also occur due to unsuccessful surgery or deformation of the patella (knee dysplasia). Patellofemoral arthrosis of the knee is also seen in runners. Women suffer from this disease more often than men.
In arthrosis, the articular cartilage between the patella and the femur wears out due to pressure and inflammation (wear of the articular cartilage).
The condition of the patella is of great importance for the extensor movement of the knee joint while walking or standing. When a person bends the leg, the patella slides along the patellar groove of the femur, and when it unbends, it shifts forward. At this moment, patients feel a “failure” in the joint, but in fact, dislocation is rare. Full functionality of the patella is very important even after knee surgery. Immediately after surgery, our knee specialists recommend restoring movement in the joint and foot, as this improves the blood supply to the muscles of the lower limb and prevents edema and thrombus formation.When bending or extending the leg, the patella moves up and down along the grooves of the tibia and femur, preventing their displacement. Additional fixation is provided by the patellar-meniscus ligament and the tendon of the quadriceps femoris muscle.
Patellofemoral arthrosis, X-ray: In this picture, the patient is lying on his back with the legs bent at the knees. The picture shows the state of the joint space with two femoropatellar joints. On the left you can see the satisfactory condition of the joint space.The patella (patella) and the patellar surface of the femur are more than 3 mm apart. apart. On the right, patellofemoral arthrosis is visible: the patella and femur touch each other, the cartilage layer is completely worn. © Gelenk-Klinik.de
Anatomical image of a healthy knee and patella, lateral and cruciate ligaments, as well as a meniscus. Patellofemoral arthrosis occurs between the two condyles of the femur, the so-called femoropatellar sliding groove.Each person’s patella and patellar femur are shaped differently. In some patients, the structure of these elements leads to instability of the femoropatellar joint. In this case, there is a high standing of the patella (patella alta) or its slight protrusion. The above factors can cause retropatellar arthrosis. © Istockphoto.com/MedicalArtInc
The beginning of degenerative changes in the patellofemoral joint is marked by softening of the articular cartilage.This pathology is called “Chondromalacia”, during which morphological changes are observed in the cartilage of the patella. The onset of the disease can be acute knee injuries, but most often the basis of the disease is a chronic overload of the patellofemoral joint.
Patellofemoral arthrosis is often accompanied by tibiofemoral (tibial-femoral) arthrosis of the knee joint. Often, arthrosis also affects the lateral (external) part of the knee joint. Thus, patellofemoral arthrosis is more often accompanied by X-shaped (valgus) deformity of the external tibiofemoral part of the knee joint.
In 5-10% of patients, arthrosis behind the patella appears in an isolated form, without affecting important components of the knee joint. In this case, patellofemoral arthrosis must be treated with special care to prevent damage to the entire knee joint.
Patellofemoral arthrosis: causes
Causes of patellofemoral arthrosis
- Dysplasia of the patella and patellar surface of the femur (47%)
- Injuries: Fractures, osteochondral injuries (8%)
- Idiopathic factors: Excess weight, excessive exercise (41%)
- Patella hypermobility, muscle imbalance (4%)
Very often, patellofemoral arthrosis occurs due to instability of the patella, which causes insufficient tension in the ligaments that fix and support it.Violation of the natural functions and forms of the patella is also the cause of this ailment. Changes in the shape of the patella can cause it to move out of its normal position and be forced out of its sliding support. Such violations are often accompanied by instability and dislocation of the patella.
Knee arthrosis: internal and external injuries. The patella with obvious damage to the cartilage of the femoropatellar joint. The formation of bone growths (osteophytes) is characteristic at the progressive stage of arthrosis.© Viewmedica
Well-known factors such as excess weight put stress on the patellofemoral joint, especially in older people.
In younger patients, patellofemoral arthrosis is caused mainly by deformity of the knee joint or deformation of the patellar surface, overload and deformation of the patella. Trauma is another cause of this disease.
Reconstruction of the anterior cruciate ligaments after fracture by using a portion of the patella tendon can also cause patellofemoral arthrosis of the knee.
Isolated patellofemoral pathology without disturbing the forms and functions of other parts of the knee joint is very often accompanied by an O-shaped curvature of the legs (varus deformity).
Patellofemoral arthrosis: Symptoms
Symptoms of patellofemoral arthrosis
- Pain in the front of the knee.
- Pain when climbing stairs.
- Pain on getting up from a chair after a long sitting position.
- Puffiness and hyperthermia.
- Pain in the squatting position.
- Crunching sounds in joints.
Patients with patellofemoral syndrome usually have pain in the front of the knee, which occurs primarily after going downstairs, getting up from a chair, bending the knees, or squatting. Often, patients feel a crunch in the joint behind the patella or numbness. Sometimes the knee appears to be quite motionless, especially when bone rubbing against bone in the joint between the patella and the femur.Inflammatory diseases cause fever in the patellofemoral joint and knee effusion.
Stages of patellofemoral arthrosis
- 1st stage: Mild arthrosis, more than 3 mm. cartilage layer.
- 2nd stage: Moderate arthrosis, the distance between the patella and the patellar surface of the femur is less than 3 mm.
- 3rd stage: Severe arthrosis, contact between the patella and the femur.
- 4th stage: Very severe arthrosis, continuous bone contact, lack of cartilage.
Examination of edematous pain in the knee with accumulation of fluid, which can be caused by damage to tendons and ligaments, as well as articular cartilage. With the help of ultrasound, the doctor examines the motor elements of the knee joint. © Gelenk-Klinik / Prof. Dr. Sven Ostermeier
How is patellofemoral arthrosis of the knee joint diagnosed?
- Is there bilateral knee pain?
- Are knee injuries present?
- Is there knee swelling?
- Does your knee hurt when you start to move your leg?
- Is there a feeling of stiffness in the knee in the morning?
- Does the knee pain get worse when walking?
- Is there general knee weakness?
- Is the maximum possible walking distance shortened by knee pain?
- Are there limitations in knee movement?
When taking a medical history, the patient tells the doctor about his pain and symptoms.For the effectiveness of the examination and the correct diagnosis, the doctor determines whether the patient has had repeated pains in the front of the knee and dislocations of the patella.
The patient is also asked questions about accidents in which a patellar injury could occur. In addition, factors such as physical activity during work and patellar subluxation play an important role in the diagnosis. First, a clinical examination is done, during which a specialist checks the knee joint for mobility and stability and observes the patient’s gait.At the same time, the doctor pays special attention to the mobility of the patella during flexion. Also, a qualified orthopedist of our Gelenk-Klinik in Freibour determines the degree of knee swelling and checks if the knee temperature has risen due to arthrosis caused by the inflammatory process.
The diagnosis of patellofemoral arthrosis depends on the symptoms of the disease. During preventive medical examinations of patients without any complaints of pain in the patella, experts still note a crunchy sound or excessive mobility of the patella.These patients never went to the doctor with knee pain and therefore did not need medical intervention.
X-ray of the patellofemoral joint
Patellofemoral arthrosis causes a mismatch in the shape of the patella in relation to the patellar surface of the femur. By examining the movement pattern of the patella during flexion and extension of the leg, the specialist can narrow down the range of possible causes of the disease. © Prof. Dr. Sven Ostermeier
X-ray of the knee joint in frontal projection is one of the most important methods for diagnosing the joint space in the patellofemoral joint.During this examination, the patient’s legs are bent. In this way, a more accurate distance of the patella to the patellar femur can be determined. In addition, specialists at the Gelenk-Klinik in Freiburg, Germany, perform a lateral X-ray of the knee: If the image shows a narrowing of the joint space, this indicates a gradual wear of the cartilage due to the inflammatory process.
Magnetic resonance imaging (MRI)
An MRI scan makes sense if there is a suspicion of deformity or an inconsistency in the shape of the patella in relation to the patellar surface of the femur.In addition to deformations, this examination also shows the consistency of the cartilage layer.
Patellofemoral arthrosis of the knee joint: Conservative treatment
Most injuries to the posterior surface of the patella are treated conservatively. For example, a temporary pathology such as “runner’s knee” occurs in younger patients and is treated with the right exercise and physical therapy. When diagnosing this injury, avoid unnecessary training loads, as pain on the front of the knee may recur.
Physiotherapy and lifestyle adaptation
The symptoms of patellofemoral arthrosis are stabilized by strengthening the muscles of the thigh, as well as losing excess weight. Patellar pain can be reduced by avoiding stresses such as squatting and climbing stairs. Stretching exercises improve lateral (lateral) mobility and movement of the patella in the patellar femur.
In case of severe pain in the patella, orthopedic prostheses (orthoses) help, which temporarily limit the mobility of the patella and relieve it of stress.The specialists of our clinic will provide you with qualified assistance in choosing this type of pain treatment.
Pain therapy and medicines
With the help of pain relievers and anti-inflammatory drugs (non-steroidal anti-inflammatory drugs), control the course of the disease.
For complex inflammations, an injection of cortisone helps. However, this method is not recommended to be used continuously. Intra-articular lubricant (hyaluronic acid) injections improve the knee’s ability to slide, but is not used as a form of etiotropic therapy for retropatellar arthrosis.This form of treatment can be successful only if there is a certain amount of articular surface, as well as with a long-term positive result.
Limits of conservative treatment
When the cartilaginous surface is absent and the bones rub against each other, conservative treatment is almost powerless. Highly qualified orthopedic surgeons of the Gelenk-Klinik clinic will consider each case individually and will try to help the patient with conservative methods.If the doctor determines that conservative treatment will not bring the desired result, the patient will be offered other forms of treatment for patellofemoral pathology.
Patellofemoral arthrosis of the knee joint: Surgical treatment
Soft tissue operations
Soft tissue operations for pain in the anterior part of the knee
- Mobilization of the lateral-patellar ligament supporting the patella
- Reconstruction of the medial-patellofemoral ligament
- Operation of the vastus medial muscle
Patellofemoral arthrosis and its symptoms in the early stages are improved by operatively changing the strength and direction of traction of the various ligaments leading the patella.The choice of surgery method depends on the affected area behind the patella. By contracting or lengthening the tendons, adaptation of the patella to the patellar surface of the femur is achieved.
Transplantation of autologous cartilage cells
Autologous cartilage cell transplantation involves the transplantation of the patient’s autogenous articular cartilage into the damaged area behind the patella. This method makes sense only when only one articular surface is damaged. If both articular surfaces are damaged, this method of surgical treatment is not performed.
In case of minor damage to the cartilage, it is possible to build it up again. During arthroscopic intervention, a small portion of the size of a grain of rice is detached from the less congested retropatellar cartilage. With the help of the obtained cartilage mass, a large number of cartilage cells are formed in a special laboratory. After 6-8 weeks, these cells are transplanted to the affected area behind the patella. After about 3 months, strong cartilaginous tissue with stable hydraulic permeability is formed from the cartilage cells.Autologous cartilage cell transplantation is suitable for younger patients. The regeneration of the cartilaginous surface prevents arthritic diseases, as well as the implantation of a patellofemoral prosthesis.
Partial patellofemoral prosthesis: A metal implant in the thigh between the two femoral condyles covers the patellar surface of the femur. The connection between the polyethylene and titanium implants on the back of the patella forms a sliding surface. Our specialists prefer HemiCAP constructions over cemented implants.© 2med
Partial patellofemoral knee joint prosthesis
Reasons for implantation of a prosthesis
- Isolated arthrosis of the patellofemoral joint.
- Unsuccessful conservative treatment.
- Unsuccessful surgical treatment on the ligaments.
- Pain and limitation in everyday life.
- Good condition of menisci
- Good condition of cruciate ligaments
- Joint stability and range of motion are normal.
The progress of medical technology in the manufacture of prostheses, as well as the modern understanding of how the patellofmoral joint works, contribute to the improvement of treatment results.
The results of the operation for the implantation of a partial patellofemoral prosthesis depend entirely on the quality of the examination, medical indications, as well as on the exact placement of the components. The key to success here is experience.
The patient’s weight plays an important role in the preservation of the prosthesis: The more a person weighs, the less the retropatellar prosthesis is preserved.
When is a partial patellofemoral prosthesis implanted?
If the articular cartilage and patella are in the stage of destruction or are completely worn out, it makes no sense to carry out joint-preserving treatment.However, if the other part of the knee joint is intact – the inner and outer tibiofemoral joints between the femur and the lower leg bone – partial knee replacement is a very good alternative.
Advantages of partial patellofemoral prosthetics
To prevent patellofemoral arthrosis from affecting the main components of the knee joint, timely surgery is necessary. With this intervention, our specialists preserve the natural structure of the knee joint and replace only the damaged area.A timely operation of partial patellofemoral prosthetics prevents complete arthroplasty for many years.
When is it prohibited to perform partial patellofemoral prosthetics?
- Rheumatic inflammations
- Osteoporosis in advanced stage
- Bacterial infections
- Instability of soft tissues and tendons
If arthrosis also affects other parts of the knee joint, isolated patellar replacement surgery is no longer meaningful.
In order for the patellofemoral prosthesis to last for many years, operations on the knee joint should not have been performed to correct its instability and shape. The longitudinal axis of the knee joint should be straightened. Hallux valgus or varus deformity is undesirable. However, if patients are treated with a similar pathology of the legs, doctors perform an accompanying intervention such as a tibial osteotomy to straighten the axis.
For a more accurate explanation of the reasons and contraindications for partial patellofemoral prosthetics, the patient should contact experienced specialists.
Total arthroplasty is a good method of treating arthrosis of the knee joint. However, unipolar / partial prosthetics allows you to preserve the ligaments and parts of the cartilaginous bone tissue in healthy parts of the knee, and also helps to improve flexion functions.
HEMICAP® Patellofemoral Prosthesis
Over the last years of the development of endoprosthetics, the patellofemoral prosthesis HEMICAP® has proved itself to be a good one. The implantation of this type of prosthesis is carried out without the use of cement.The posterior part of the prosthesis has a bone-preserving rough structure. A screw is inserted into the tibial spine through a small incision under the control of an arthroscope. Thanks to a special structure similar to the real one, local damage to the cartilage is compensated and the original position of the joint is restored. The firm connection between the surface of the prosthesis and the bones allows patients to exercise without pain.
Lateral x-ray after implantation of a patellofemoral prosthesis.
Implantation of other prostheses involves the use of cement, but bone anchorage with HemiCAP® provides long-term stability of the implant even without cement.Unlike other cemented patellofemoral joint prostheses, HemiCAP® implantation does not involve bone separation. Modern medicine offers various types of such prostheses in order to restore the shape of any patellar surface of the femur.
The posterior surface of the patella is not always covered with a polyethylene implant: If the cartilaginous surface is still intact, it is preserved and used for sliding the prosthesis.
If the cartilage structure behind the patella is severely damaged, a polyethylene implant is used to achieve maximum sliding.A sliding plastic “liner” made of durable highly crosslinked polyethylene is inserted on both sides of the patella ..
Local arthrosis can be stopped with the HEMICAP patellofemoral prosthesis without the use of cement and the need to remove the bone matter from the femoropatellar joint.
This replacement in the knee joint preserves the original functions in the knee. Experienced specialists of our clinic observe the anatomical shape of the knee joint and thus maintain the sliding of the articular surfaces without pain.Often, this operation is carried out in a minimally invasive form, which shortens the postoperative period and is much easier for patients to tolerate.
Implantation of cemented patellofemoral prosthesis
During this intervention, the articular surface is freed from the remaining cartilage and then leveled. To strengthen the sliding surfaces, a small particle is carefully separated from the cartilaginous surface. When a patellofemoral prosthesis is implanted, the back of the patella is covered with a matching polyethylene “liner”.When replacing a worn joint, a portion of the tibia and femur is excised and replaced with a metal component. The components of the patellofemoral prosthesis are fixed with strong bone cement.
90,000 common causes and effective treatment in Krasnoyarsk
Knee pain: common causes and effective treatment in Krasnoyarsk
| Advantages of treatment in our clinic:
The knee is one of the largest joints, and at the same time it is very vulnerable. Every day, this joint withstands a lot of stress – when walking or running. Several triggers cause pain and swelling of the kneecap. If you notice such symptoms in yourself or a loved one, you should as soon as possible seek help from the clinic of vertebrology of Professor Savyak. A timely started treatment course will not allow the problem to become chronic.
Causes of pain in the knee joint
The most common causes of leg discomfort are:
- Injury. Occurs due to a sharp fall, impact, twisting. This damages cartilage, ligaments, tendons, or bone.
- Arthritis. This is an inflammatory process. It is accompanied by limited mobility and a feeling of heat in the affected area.
- Osteoporosis. Occurs from low calcium levels, usually in people over 45.
- Circulatory disorders. Vascular pain sometimes occurs in adolescents during active growth.
- Arthrosis. Causes stiffness, crunching, without proper therapy leads to joint deformation.
How is knee pain treated in the Savyak clinic
Getting rid of discomfort when contacting us occurs already at 1-2 sessions. To achieve and consolidate such a result, as well as to eliminate the cause of unpleasant sensations, methods proven by many years of practice are used:
- traction on the ANATOMATOR traction and massage table;
- arthrotherapy – author’s technique by Oleg Savyak, aimed at soft and painless restoration of joint function;
- manual therapy – restores mobility;
- electrophoresis and phonophoresis with caripain: the limitation of passive joint movements is eliminated;
- reflexology – impact on nerve endings;
- medical nutrition for the skeletal system – taking safe phytopreparations, chondoprotectors and tablets containing calcium.
The success of therapy largely depends on timeliness and an integrated approach. Do not start the disease and contact only experienced specialists – in the clinic of Professor Savyak, doctors with experience in vertebrology from 10 to 40 years work. Sign up without delay!
| Savyak Oleg Bogdanovich
Vertebrologist, neurosurgeon, manual therapist
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90,000 Knee arthroscopy.Damage to menisci
In the knee joint between the femur and the tibia there are menisci – lunate cartilage layers that increase the stability of the joint, increasing the contact area.
Both the external (lateral) and internal (medial) meniscus are conventionally divided into three parts: the posterior (posterior horn), middle (body) and anterior (anterior horn).
In shape, the inner (medial) meniscus of the knee joint usually resembles the letter “C”, and the outer (lateral) – a regular semicircle.Both menisci are formed by fibrous cartilage and attach anteriorly and posteriorly to the tibia. The medial meniscus, in addition, is attached along the outer edge to the capsule of the knee joint by the so-called coronary ligament. The thickening of the capsule in the region of the middle part of the body of the meniscus is formed by the tibial collateral ligament. Attaching the medial meniscus to both the capsule and the tibia makes it less mobile than the lateral meniscus. This lower mobility of the inner meniscus leads to the fact that its tears are more frequent than tears of the outer meniscus.
The lateral meniscus covers most of the upper lateral articular surface of the tibia and, unlike the medial meniscus, has the shape of an almost regular semicircle. Due to the more rounded shape of the lateral meniscus, the anterior and posterior points of its attachment to the tibia lie closer to one another. Slightly inward from the anterior horn of the lateral meniscus is the attachment site of the anterior cruciate ligament. The anterior and posterior menisto-femoral ligaments, which attach the posterior horn of the lateral meniscus to the medial femoral condyle, run in front and behind the posterior cruciate ligament and are also called Humphrey’s ligament and Vriesberg’s ligament, respectively.
Lateral menisci extending to the articular surface more than normal are called disc-shaped; they are reported to occur in 3.5% to 5% of people. In simple terms, a disc-shaped lateral meniscus means that it is wider than the normal outer meniscus of the knee. Among the disc-shaped menisci, one can distinguish the so-called continuous disc-shaped (completely covering the outer condyle of the tibia), semi-disc-shaped and Vrisberg variants. In the latter, the posterior horn is fixed to the bone only by the Vrisberg ligament.
Solid disc-shaped outer meniscus of the knee joint
Along the posterior-outer surface of the joint, through the gap between the capsule and the lateral meniscus, the hamstring muscle penetrates into the joint cavity. It is attached to the meniscus by thin bundles, apparently performing a stabilizing function. To the joint capsule, the lateral meniscus is fixed much weaker than the medial and therefore easier to displace.
The microstructure of the meniscus is normally represented by the fibers of a special protein – collagen.These fibers are predominantly oriented circularly, i.e. along the meniscus. A smaller part of the collagen fibers of the meniscus is oriented radially, i.e. from edge to center. There is another option for fibers – perforating. There are the least of them, they go “randomly”, connecting circular and radial fibers.
a – radial fibers, b – circular fibers (there are most of them), c – perforating, or “random” fibers
Fibers are radially oriented mainly at the surface of the meniscus; crossing, they form a network that is believed to ensure the stability of the meniscus surface to shear force.Circular fibers make up the bulk of the meniscus core; this arrangement of fibers ensures the distribution of the longitudinal load on the knee joint. In terms of dry matter, the meniscus consists of approximately 60-70% of collagen, 8-13% of extracellular matrix proteins and 0.6% of elastin. Collagen is mainly represented by type I and in small amounts by types II, III, V and VI.
In newborns, the entire meniscus tissue is permeated with blood vessels, but by the age of 9 months, the vessels completely disappear from the inner third of the menisci.In adults, the vasculature is present only in the outermost part of the meniscus (10-30% of the outer edge), and with growing up, the blood supply to the meniscus only deteriorates. It should be noted that blood supply to the meniscus deteriorates with age. From the point of view of blood supply, the meniscus is divided into two zones: red and white.
Cross section of the knee joint meniscus (in the cut it has a triangular shape). Blood vessels enter the meniscus from the outside. In children, they penetrate the entire meniscus, but with age, the blood vessels become smaller and in adults, blood vessels are present only in 10-30% of the outer part of the meniscus adjacent to the joint capsule.The first zone is the border between the joint capsule and the meniscus (red-red zone, or R-R). The second zone is the border between the red and white zones of the meniscus (red-white zone or R-W zone). The third zone is white-white (W-W), i.e. where there are no blood vessels.
The part of the lateral meniscus, around which the hamstring tendon penetrates into the knee joint, is also relatively poor in vessels. The cells of the inner two-thirds of the meniscus receive nutrients through diffusion and active transport from the synovial fluid.
Photograph of blood vessels in the lateral meniscus (a contrast agent was injected into the bloodstream). Note the absence of blood vessels where the hamstring tendon runs (red arrow).
The anterior and posterior horns of the meniscus, as well as its peripheral part, contain nerve fibers and receptors, which, presumably, are involved in proprioceptive afferentation during movements in the knee joint, i.e. signal to our brain about the position of the knee joint.
Why are menisci needed?
At the end of the 19th century, menisci were considered “non-functioning remnants” of muscles. However, as soon as the importance of the function performed by the menisci was discovered, they began to be actively studied.
Menisci perform different functions: they distribute the load, absorb shocks, reduce contact stress, act as stabilizers, limit the range of motion, participate in proprioceptive afferentation during movements in the knee joint, i.e.That is, they signal to our brain what position the knee joint is in. Chief among these functions are the first four – load distribution, shock absorption, contact voltage distribution and stabilization.
When flexing and extending the knee at 90 degrees, the menisci account for approximately 85% and 50-70% of the load, respectively. After removal of the entire medial meniscus, the area of contact of the articular surfaces decreases by 50-70%, and the stress at their junction increases by 100%.Complete removal of the lateral meniscus reduces the area of contact between the articular surfaces by 40-50% and increases the contact stress by 200-300%. These changes, caused by meniscectomy (i.e., an operation in which the meniscus is completely removed), often lead to a narrowing of the joint space, the formation of osteophytes (bony spines, growths) and the transformation of the condyles of the femur from rounded to angular, which is clearly visible on radiographs. Meniscectomy also affects the function of the articular cartilage. Menisci are 50% more elastic than cartilage and therefore play the role of reliable shock absorbers during shocks.In the absence of a meniscus, the entire load during impacts without shock absorption falls on the cartilage. Finally, the medial meniscus prevents the tibia from moving forward relative to the femur when the anterior cruciate ligament is damaged. If the anterior cruciate ligament is intact, the loss of the medial meniscus has little effect on the anteroposterior displacement of the tibia during flexion and extension of the leg at the knee. But if the anterior cruciate ligament is damaged, the loss of the medial meniscus increases the forward displacement of the tibia by more than 50% when the knee is bent by 90 °.In general, the inner two-thirds of the menisci are important for increasing the contact area of the articular surfaces and shock absorption, and the outer third for distributing the load and stabilizing the joint.
How common are knee meniscus tears?
Meniscus tears occur with a frequency of 60-70 cases per 100,000 population per year. In men, meniscus ruptures occur 2.5-4 times more often, with traumatic ruptures prevailing between the ages of 20 and 30, and ruptures due to chronic degenerative changes in the meniscus at the age of 40.It happens that a meniscus rupture occurs at 80-90 years of age. In general, the inner (medial) meniscus of the knee joint is more likely to be damaged.
Photos taken during arthroscopy of the knee joint: a video camera (arthroscope) is inserted into the joint cavity through a 1-centimeter incision, which allows you to examine the joint from the inside and see all the damage. On the left is a normal meniscus (no razvlecheniya, elastic, smooth edge, white), in the center – a traumatic meniscus rupture (the edges of the meniscus are smooth, the meniscus is not frayed).Right – degenerative meniscus rupture (the edges of the meniscus are frayed)
At a young age, acute, traumatic ruptures of the menisci are more common. An isolated rupture of the meniscus can occur, however, combined damage to the intra-articular structures is also possible, when, for example, the ligament and the meniscus are damaged at the same time. One of these concomitant injuries is rupture of the anterior cruciate ligament, which in about every third case is accompanied by a rupture of the meniscus. At the same time, the lateral meniscus, which is more mobile, like the entire outer half of the knee joint, breaks approximately four times more often.The medial meniscus, which becomes the limiter of the anterior displacement of the tibia when the anterior cruciate ligament is damaged, often breaks when the anterior cruciate ligament is already damaged. Ruptures of the meniscus accompany up to 47% of fractures of the tibial condyles and are often observed in fractures of the femoral shaft with concomitant effusion into the joint cavity.
Traumatic ruptures. At a young age, meniscus tears are more common as a result of trauma.As a rule, the rupture occurs when twisting on one leg, i.e. with axial load in combination with rotation of the lower leg. For example, such an injury can occur during running, when one leg unexpectedly stands on an uneven surface, when landing on one leg with torsion of the body, but a meniscus rupture can occur with another mechanism of injury.
Usually, immediately after a rupture, pain in the joint appears, the knee swells. If the meniscus rupture affects the red zone, i.e. the place where there are blood vessels in the meniscus, then there will be hemarthrosis – an accumulation of blood in the joint.It is manifested by bulging, swelling above the patella (patella).
When the meniscus ruptures, the detached and dangling part of the meniscus begins to interfere with movements in the knee joint. Small tears can cause painful clicks or a feeling of difficulty moving. With large ruptures, blockade of the joint is possible due to the fact that the relatively large size of the torn and dangling fragment of the meniscus moves to the center of the joint and makes some movements impossible, i.e. the joint “wedges”.With ruptures of the posterior horn of the meniscus, flexion is more often limited, with ruptures of the body of the meniscus and its anterior horn, extension in the knee joint suffers.
The pain with a ruptured meniscus can be so severe that it is impossible to step on the leg, and sometimes a meniscus rupture manifests itself only as pain with certain movements, for example, when going downstairs. In this case, climbing stairs can be completely painless.
It should be noted that blockade of the knee joint can be caused not only by a rupture of the meniscus, but also by other causes, for example, a rupture of the anterior cruciate ligament, a free intra-articular body, including a detached fragment of cartilage in Koenig’s disease, plica syndrome of the knee joint, osteochondral fractures, fractures of the tibial condyles and many other reasons.
In case of an acute rupture in combination with damage to the anterior cruciate ligament, the swelling may develop faster and be more pronounced. Injuries to the anterior cruciate ligament are often accompanied by a rupture of the lateral meniscus. This is due to the fact that when the ligament is torn, the outer part of the tibia is dislocated forward and the lateral meniscus is pinched between the femur and tibia.
Chronic, or degenerative, tears are more likely to occur in people over 40; pain and swelling at the same time develop gradually, and it is not always possible to detect their sharp increase.Often, there is no indication of injury in the history, or only a very minor effect is found, for example, bending the leg, squatting, or even a tear may appear simply when getting up from the chair. In this case, joint blockade can also occur, however, degenerative ruptures often give only pain. It should be noted that with a degenerative rupture of the meniscus, the adjacent cartilage covering the femur or, more often, the tibia is often damaged.
Like acute tears of the meniscus, degenerative tears can give various severity of symptoms: sometimes from pain it is completely impossible to step on the foot or even slightly move it, and sometimes pain appears only when descending stairs, squatting.
The main symptom of a meniscus rupture is pain in the knee joint that occurs or worsens with a certain movement. The severity of pain depends on the place where the meniscus rupture occurred (body, posterior horn, anterior meniscus horn), the size of the rupture, and the time elapsed since the injury.
Once again, we note that meniscus rupture can occur suddenly, without any injury. For example, a degenerative rupture can occur at night while a person is asleep and present with pain in the morning when getting out of bed.Often, degenerative tears also occur when getting up from a low chair.
The intensity of pain is influenced by both individual sensitivity and the presence of concomitant diseases and injuries of the knee joint (arthrosis of the knee joint, ruptures of the anterior cruciate ligament, ruptures of the lateral ligaments of the knee joint, fractures of the condyles and other conditions that themselves can cause pain in the knee joint ).
So, the pain with a ruptured meniscus can be different: from weak, appearing only occasionally, to strong, making movements in the knee joint impossible.Sometimes it is even impossible to step on your foot because of the pain.
If pain occurs when descending a staircase, then there is most likely a rupture of the posterior meniscus horn. If there is a rupture of the body of the meniscus, then the pain increases with extension in the knee joint.
If the knee joint is “stuck”, i.e. there is a so-called blockade of the joint, then most likely there is a rupture of the meniscus, and the blockade is due to the fact that the torn off part of the meniscus just blocked the movement in the joint. However, the blockade happens not only when the meniscus ruptures.For example, the joint can “jam” and with ruptures of the anterior cruciate ligament, infringement of synovial folds (“plica” syndrome), exacerbation of arthrosis of the knee joint.
The diagnosis of a meniscus rupture cannot be made on your own – you need to contact an orthopedic traumatologist. It is advisable that you contact a specialist directly involved in the treatment of patients with injuries and diseases of the knee joint.
First, the doctor will ask you about how the pain started, about the possible causes of its appearance.Then proceeds to the inspection. The doctor carefully examines not only the knee joint, but also the entire leg. First, the amplitude and soreness of movements in the hip and knee joints are assessed, since part of the pain in the hip joint is given to the knee joint. The doctor then examines the thigh for muscle atrophy. Then the knee joint itself is examined: first of all, it is assessed whether there is an effusion in the knee joint, which may be synovitis or hemarthrosis.
As a rule, effusion, i.e. accumulation of fluid in the knee joint, manifested by visible swelling above the patella (patella).The fluid in the knee joint can be blood, in which case they speak of hemarthrosis of the knee joint , which literally means “blood in the joint” in Latin. Hemarthrosis occurs with fresh meniscus tears.
If the rupture occurred a long time ago, then an effusion is also possible in the joint, but this is no longer hemarthrosis, but synovitis, i.e. excess accumulation of synovial fluid, which lubricates the joint and nourishes the cartilage.
Swelling of the right knee joint.Note that the swelling is located above the patella (patella), i.e. fluid accumulates in the supra-patellar sac (upper torsion of the knee joint). Shown for comparison is the left, normal knee
Meniscus tear is often manifested by the inability to fully extend or bend the leg at the knee joint.
As we have already noted, the main symptom of a meniscus rupture is pain in the knee joint, arising or worsening with a certain movement.If the doctor suspects a meniscus rupture, then he is trying to just provoke this pain in a certain position and with a certain movement. As a rule, the doctor presses with his finger in the projection of the joint space of the knee joint, i.e. just below and to the side (outside and inside) of the patella and flexes and unbends the leg at the knee. If this causes pain, then most likely there is a meniscus rupture. There are other special tests that can help diagnose a meniscus tear.
Basic tests a doctor performs to diagnose a ruptured knee meniscus.
The doctor must perform not only these tests, but also others that allow suspecting and diagnosing problems with the cruciate ligaments, patella and a number of other situations.
In general, if the doctor assesses the knee joint by a combination of tests, and not by any one of the signs, then an internal meniscus rupture can be diagnosed in 95% of cases, and an external one – in 88% of cases. These indicators are very high, and in fact, often a competent traumatologist can quite accurately diagnose a meniscus rupture without any additional examination methods (X-ray, magnetic resonance imaging, ultrasound).However, it will be very unpleasant if the patient falls into those 5-12% of cases when the meniscus rupture is not diagnosed despite the fact that it is, or is diagnosed incorrectly, therefore in our practice we quite often try to resort to additional research methods that confirm or deny doctor’s guess.
Radiography. A knee X-ray can be considered mandatory for any knee pain. Sometimes there is a desire to immediately perform magnetic resonance imaging (MRI), which “will show more than X-rays.”But this is wrong: in some cases, X-rays make it easier, faster and cheaper to establish the correct diagnosis. Therefore, you should not independently assign yourself studies, which may turn out to be a waste of time and money.
Radiography is performed in the following projections: 1) in frontal projection in a standing position, including with 45 ° bending of the knees (according to Rosenberg), 2) in lateral projection and 3) in axial projection. The posterior surfaces of the femoral condyles in arthrosis of the knee joint usually wear out earlier, and when the legs are flexed 45 ° in the standing position, a corresponding narrowing of the joint space can be seen.In any other position, these changes will most likely be invisible, so other x-ray positions are not relevant for examination for knee pain. If a patient complaining of pain in the knee joint radiographically reveals a significant narrowing of the joint space, it is very likely that there is extensive damage to the meniscus and cartilage, in which arthroscopic resection of the meniscus (incomplete or partial meniscectomy) is useless, which we will discuss below. To exclude such a cause of pain as chondromalacia of the patella, radiography in a special axial projection (for the patella) is necessary.Plain radiography, which does not in any way facilitate the diagnosis of meniscus rupture, nevertheless allows to exclude such concomitant disorders as osteochondritis dissecans (Koenig’s disease), fracture, tilt or subluxation of the patella and articular mice (free intra-articular bodies).
MRI (magnetic resonance imaging) significantly increased the accuracy of diagnosing meniscus tears. Its advantages are the ability to obtain an image of the meniscus in several planes and the absence of ionizing radiation.In addition, MRI allows you to assess the condition of other articular and periarticular formations, which is especially important when the doctor has serious doubts about the diagnosis, as well as if there are concomitant injuries that make it difficult to perform diagnostic tests. The disadvantages of MRI include the high cost and the possibility of misinterpreting changes with the ensuing additional research. A normal meniscus for all pulse sequences gives a weak uniform signal. In children, the signal can be enhanced due to the more abundant blood supply to the meniscus.An increased signal in the elderly may be a sign of degeneration.
According to MRI, four degrees of changes in the meniscus are distinguished (classification according to Stoller). Grade 0 is a normal meniscus. Grade I is the appearance in the thickness of the meniscus of a focal signal of increased intensity (not reaching the surface of the meniscus). Grade II – the appearance in the thickness of the meniscus of a linear signal of increased intensity (not reaching the surface of the meniscus). Grade III is a signal of increased intensity reaching the surface of the meniscus.Only grade III changes are considered a true meniscus rupture.
0 degree (norm), meniscus unchanged.
I degree – a spherical increase in signal intensity, not associated with the surface of the meniscus.
II degree – a linear increase in signal intensity not associated with the surface of the meniscus.
III degree (rupture) – increased signal intensity in contact with the surface of the meniscus.
Magnetic resonance imaging.On the left is a normal, intact meniscus (blue arrow). Right – rupture of the posterior meniscus horn (two blue arrows)
The accuracy of MRI in diagnosing a meniscus rupture is approximately 90-95%, especially if a signal of increased intensity is recorded twice in a row (ie, on two adjacent sections), capturing the surface of the meniscus. To diagnose a rupture, you can also focus on the shape of the meniscus. Usually in pictures in the sagittal plane, the meniscus is shaped like a butterfly. Any other shape could be a sign of rupture.A symptom of a rupture is also the symptom “double posterior cruciate ligament” (or “third cruciate ligament”), when, as a result of displacement, the meniscus is in the intercondylar fossa of the femur and is adjacent to the posterior cruciate ligament.
A meniscus rupture can be detected on MRI and in the absence of complaints in the patient, and the frequency of such cases increases with age. This suggests how important it is to take into account all clinical and radiological data when examining. In a recent study, meniscus tears with no complaints or physical signs (i.e.That is, positive test results when examined by a doctor’s hands) were found on MRI in 5.6% of patients aged 18 to 39 years. According to another study, 13% of patients under 45 years old and 36% of patients over 45 years old showed signs of meniscus rupture on MRI in the absence of complaints and physical signs.
What are knee meniscus tears?
Meniscus tears can be classified according to the cause and nature of the changes found on examination (MRI) or during surgery (knee arthroscopy).
As we have already noted, ruptures can be traumatic (excessive load on the unchanged meniscus) and degenerative (normal load on the meniscus altered by degenerative processes).
At the place where the rupture occurred, the ruptures of the posterior horn, body and anterior horn of the meniscus are distinguished.
Since the meniscus is unevenly supplied with blood, three zones are distinguished in it: peripheral (red) – in the area of the joint of the meniscus with the capsule, intermediate (red-white) and central – white, or avascular, zone.The closer the rupture is to the inner edge of the meniscus, the fewer vessels pass near it and the lower the likelihood of its healing.
In terms of shape, the breaks are divided into longitudinal, horizontal, oblique and radial (transverse). There may also be gaps combined in shape. In addition, a special variant of the meniscus rupture form is distinguished: the “watering can handle” (“basket handle”).
Classification of meniscus tears according to H. Shahriaree: I – longitudinal rupture, II – horizontal rupture, III – oblique rupture, IV – radial rupture
Special variant of the meniscus tear shape: “watering can handle” (“basket handle”)
Acute traumatic ruptures occurring at a young age go vertically in the longitudinal or oblique direction; combined and degenerative tears are more likely to occur in older people.Vertical longitudinal breaks, or watering can handle breaks, are complete or incomplete, and usually begin at the posterior horn of the meniscus. With long ruptures, significant mobility of the severed part is possible, allowing it to move into the intercondylar fossa of the femur and block the knee joint. This is especially true for ruptures of the medial meniscus, possibly due to its lower mobility, which increases the shear force acting on the meniscus. Oblique tears usually occur at the border between the middle and posterior third of the meniscus.Most often these are small tears, but their free edge can fall between the articular surfaces and cause a rolling or clicking sensation. Combined tears occur in several planes at once, are often localized in or near the posterior horn, and usually occur in older people with degenerative changes in the menisci. Horizontal longitudinal tears are often associated with cystic degeneration of the menisci. These tears usually begin at the inner edge of the meniscus and are directed to the junction of the meniscus with the capsule.They are thought to arise from shear force and, when associated with cystic meniscus degeneration, form in the medial medial meniscus and cause local swelling (bulging) along the joint space.
How to treat a knee meniscus rupture?
Treatment of meniscus tears is conservative (i.e. non-surgical) and surgical (meniscectomy, i.e. removal of the meniscus, which can be complete or incomplete (partial)).
Special options for surgical treatment of meniscus ruptures are suture and meniscus transplantation, but these techniques are not always possible and sometimes give not very reliable results.
Conservative (non-surgical) treatment of knee meniscus ruptures. Conservative treatment is usually prescribed for small tears of the posterior meniscus horn or for small radial tears. These tears can be painful, but do not pinch the meniscus between the articular surfaces and do not cause clicks or rolling sensations.These tears usually occur in stable joints.
Treatment consists of a temporary reduction in stress. Unfortunately, it is often possible to meet a situation when in our country a plaster cast is applied due to a meniscus rupture, which completely excludes movements in the knee joint. If there are no other injuries in the knee joint (fractures, ligament ruptures), but there is only a meniscus rupture, then such treatment is fundamentally wrong and it can even be called crippling. The fact is that large meniscus tears will not heal anyway, despite the plaster cast and complete immobilization of the knee joint.And small meniscus tears can be treated in more gentle ways. Complete immobilization of the knee joint with a heavy plaster cast is not only painful for a person (after all, it is impossible to wash normally, bedsores may appear under the cast), but also has a detrimental effect on the knee joint itself. The fact is that complete immobilization can lead to joint contracture, i.e. persistent limitation of the amplitude of movements due to the fact that the nondisposing cartilaginous surfaces stick together, and, unfortunately, movements in the knee after such treatment cannot always be restored.It is doubly sad when treatment with a plaster cast is used in cases where the gap is large enough, and after several weeks of torment in a plaster cast, you still have to do an operation. Therefore, it is so important for a knee injury to immediately consult a specialist who is well familiar with the treatment of tears in the menisci and ligaments of the knee joint.
If the patient goes in for sports, then with conservative treatment it is necessary to exclude situations that can additionally injure the joint. For example, they temporarily stop practicing sports that require quick jerks, especially with turns and movements in which one leg remains in place – they can worsen the condition.
In addition, exercises are needed to strengthen the quadriceps and hamstrings. The fact is that strong muscles additionally stabilize the knee joint, which reduces the likelihood of such shifts of the femur and tibia relative to each other, which injure the meniscus.
Often, conservative treatment is more effective in the elderly, since the cause of the described symptoms is often arthrosis, rather than a meniscus rupture. Small (less than 10 mm) stable longitudinal tears, tears of the upper or lower surface that do not penetrate the entire thickness of the meniscus, as well as small (less than 3 mm) transverse tears may heal on their own or do not appear at all.
In cases where a meniscus rupture is combined with a rupture of the anterior cruciate ligament, conservative treatment is usually first resorted to.
Surgical treatment of knee meniscus tears. Indications for arthroscopic surgery are significant tears that cause mechanical symptoms (pain, clicks, blockages, restriction of movement), persistent joint effusion, and cases of unsuccessful conservative treatment.Once again, we note that the very fact of the existence of the possibility of conservative treatment does not mean that all meniscus ruptures should first be treated conservatively, but then, if it fails, then resort to “surgery, at least”. The fact is that quite often meniscus ruptures are of such a nature that it is safer and more effective to operate them immediately, and sequential treatment (“first conservative, and then, if it does not help, then the operation”) can significantly complicate recovery and worsen the results.Therefore, we emphasize once again that in case of a meniscus rupture, and indeed with any knee injury, it is important to consult a specialist.
In meniscus tears, friction and blockage, called mechanical or movement symptoms (because they occur during movement and disappear or are significantly weakened at rest), can be a hindrance both in everyday life and in sports. If symptoms occur in everyday life, then the doctor can easily detect signs of a rupture on examination.As a rule, there is an effusion in the joint cavity (synovitis) and soreness in the projection of the joint space. Limitation of movement in the joint and pain during provocative tests are also possible. Finally, other causes of knee pain should be ruled out based on history, physical examination, and X-ray. If these symptoms are present, then this means that the meniscus rupture is significant and the issue of surgery should be considered.
It is important to know that in case of meniscus rupture, it is not necessary to delay the operation for a long time and endure pain.As we noted, the dangling meniscus flap destroys the adjacent cartilage covering the femur and tibia. Cartilage from smooth and elastic becomes softened, loose, and in advanced cases, a dangling flap of a torn meniscus erases the cartilage completely to the bone. Such damage to the cartilage is called chondromalacia, which has four degrees: in the first degree, the cartilage is softened, in the second, the cartilage begins to loosen, in the third, there is a “dent” in the cartilage, and in the fourth degree, the cartilage is completely absent.
Photo taken during knee arthroscopy. This patient endured pain for almost a year, after which he turned to traumatologists for help. During this time, the dangling flap of the torn meniscus completely erased the cartilage to the bone (fourth degree chondromalacia)
Meniscus removal, or meniscectomy (arthrotomy through a large incision 5-7 centimeters long), was initially considered a harmless intervention and complete removal of the meniscus was performed very often.However, the long-term results were disappointing. Recovery or noticeable improvement was noted in 75% of men and less than 50% of women. Complaints disappeared in less than 50% of men and less than 10% of women. In young people, the results of the operation were worse than in the elderly. In addition, 75% of those operated on developed arthritis (versus 6% in the control group of the same age). Often, arthrosis appeared 15 years or more after surgery. Degenerative changes developed faster after lateral meniscectomy.When, finally, the role of the menisci became clear, the operational technique changed and new tools were created that made it possible to restore the integrity of the menisci or remove only a part of them. Since the late 1980s, arthrotomy complete removal of the meniscus has been recognized as an ineffective and harmful operation, which has been replaced by the possibility of arthroscopic surgery to preserve the intact part of the meniscus. Unfortunately, in our country, due to organizational reasons, arthroscopy is far from available everywhere, so there are still surgeons who offer their patients to completely remove a torn meniscus.
Nowadays, the meniscus is not completely removed, since its important role in the knee joint has become clear, but a partial (partial) meniscectomy is performed. This means that not the entire meniscus is removed, but only the torn off part, which has already ceased to perform its function. What is the principle of partial meniscectomy, i.e. partial removal of the meniscus? The video and illustration below will help you understand the answer to this question.
Principle of partial meniscectomy (i.e.e., incomplete removal of the meniscus) consists not only in removing the poisoned and dangling part of the meniscus, but also in making the inner edge of the meniscus even again.
Principle of partial meniscus removal. Various variants of meniscus ruptures are shown. A part of the meniscus is removed from its inner side so as not only to remove the dangling flap of the torn meniscus, but also to restore the even inner edge of the meniscus.
In the modern world, the operation of partial removal of a torn meniscus is performed arthroscopically, i.e.That is, through two small punctures. An arthroscope is inserted into one of the punctures, which transmits an image to a video camera. In essence, an arthroscope is an optical system. A saline solution (water) is injected through the arthroscope into the joint, which inflates the joint and allows it to be examined from the inside. Through the second puncture, various special instruments are inserted into the cavity of the knee joint, with which they remove the damaged parts of the menisci, “restore” the cartilage and perform other manipulations.
Knee arthroscopy. A – The patient lies on the operating table, the leg is in a special holder. Behind – the arthroscopic stand itself, which consists of a xenon light source (through a light guide with xenon to illuminate the joint), a video processor (to which a video camera is attached), a pump (pumps water into the joint), a monitor, a wiper (a device for ablation of cartilage, synovial membrane of the joint), shaver (a device that “shaves”). B – an arthroscope (left) and a working tool (nippers, right) were inserted into the knee joint through two punctures, one centimeter each. B – Appearance of arthroscopic nippers, clamps.
If cartilage damage (chondromalacia) is detected during arthroscopy, the doctor may recommend that you inject special drugs into the knee joint after the operation (Intraject, Fermatron, Hyalurom, etc.). You can find out more about which drugs can be injected into the knee joint and which cannot be injected on our website in a separate article.
In addition to meniscectomy, there are methods for restoring the meniscus.These include meniscus suture and meniscus transplant. Deciding when it is more expedient to remove part of the meniscus, and when it is better to restore the meniscus, is difficult. It is necessary to take into account many factors that affect the outcome of the operation. In general, it is believed that if the meniscus is damaged so extensively that almost the entire meniscus will have to be removed during arthroscopic surgery, then it is necessary to decide whether the meniscus can be restored.
Meniscus suture can be performed in cases where a little time has passed since the rupture.A prerequisite for successful fusion of the meniscus after stitching is a sufficient blood supply to the meniscus, i.e. the gap d must be located in the red zone, or at least at the border of the red and white zones. Otherwise, if you perform stitching of the meniscus, which has developed in the white zone, the seam will sooner or later become untenable again, a “re-rupture” will occur and an operation will be required again. The meniscus suture can be performed arthroscopically.
Inside-out arthroscopic meniscus suture principle.There are also methods “outside-inside” and meniscus stepping
Photo taken during arthroscopy. Meniscus seam stage
Meniscus transplant. Now there is a possibility of transplantation (transplantation) of the meniscus. Meniscus transplantation is possible and may be advisable when the knee joint meniscus is significantly damaged and completely ceases to perform its functions. Contraindications include severe degenerative changes in the articular cartilage, knee instability and curvature of the leg.
Both frozen (donor or cadaveric) and irradiated menisci are used for transplantation. The best results are reportedly to be expected from the use of donor (fresh frozen) menisci. There are also artificial meniscus endoprostheses.
However, operations on transplantation and endoprosthetics of the meniscus are associated with a number of organizational, ethical, practical and scientific difficulties and this method has no convincing evidence base. Moreover, among scientists and surgeons there is still no consensus on the expediency of
In general, it should be noted that transplantation and endoprosthetics of the meniscus are extremely rare.
Questions to discuss with your doctor
1. Do I have a meniscus tear?
2. What is my meniscus tear? Degenerative or Traumatic?
3. What are the dimensions of the meniscus gap and where is the gap located?
4. Are there any other injuries besides the meniscus rupture (is the anterior cruciate ligament, lateral ligaments intact, fractures, etc.)?
5. Is there damage to the cartilage covering the femur and tibia?
6.Do I have a significant meniscus tear? Do I need an MRI scan?
7. Can my meniscus tear be treated without surgery, or is it worth having an arthroscopy?
8. What is the probability of cartilage damage and the development of arthrosis if I delay the operation?
9. What is the likelihood of cartilage damage and arthrosis if I go for arthroscopic surgery?
10. If arthroscopy gives a better chance of success than the non-surgical method, and I agree to the operation, how long will recovery take?
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City Clinical Hospital No. 31 – Arthrosis – an insidious thing
According to the strict scientific definition, “arthrosis is a chronic joint disease characterized by degenerative changes in the articular cartilage.”This means that the disease develops gradually, year after year damaging the most important part of our joints – cartilage.
At first, a person may not notice anything, only with sudden movements the joint crunches, and when bending, unpleasant sensations arise. But is this a reason to run to the doctor, we naively think. And we don’t get treatment, we expect that everything will go away by itself. Unfortunately, it does not work. Years go by, and pain appears when moving. If arthrosis has affected the hip joint, the pain comes from the upper thigh and radiates to the knee, which is especially felt when walking.With arthrosis of the knee joint, it becomes painful to go down the stairs. With arthrosis of the shoulder joint, raise and lower the arm. It would seem that now it is certainly necessary to visit the doctor, but again we are in no hurry. All the time is running out. And only when any movement causes unbearable pain, and the joint loses mobility, we begin to lament: “Doctor, help.” But time is lost. At this stage of the disease, one can only remove the inflammation that has joined the arthrosis, remove the pain, but it is no longer possible to restore the cartilage damaged by arthrosis.
According to experts, the reasons for the destruction of articular cartilage can be: metabolic and hormonal disorders, deterioration of the blood supply to the joint, hereditary predisposition to diseases of the cartilage tissue, old age, injuries, as well as diseases such as rheumatoid arthritis and psoriasis. However, the most common cause of arthrosis is a mismatch between the stress on our joints and the ability of the articular cartilage to resist this stress.
What happens with arthrosis? The main components of cartilage are destroyed: collagen and proteoglycans.First, the cartilage becomes cloudy, rough, loses its firmness and elasticity. Then, razvlechenie occurs, the cartilage cracks and ulcerates, the bone is exposed. Fragments are separated, which form foreign bodies in the articular cavity. Now the cartilage can no longer absorb at all under load, so all the pressure falls on the bone under it, it is damaged, and bone growths appear at the site of defects in the cartilage tissue.
Despite the fact that arthrosis is rarely written in the popular literature, it is the most common disease affecting the joints.According to statistics, from 6.4 to 12% of the population suffer from it, and what is most sad, today arthrosis causes disability and leads to disability several times more often than a few decades ago. Women suffer from arthrosis twice as often as men, but after 65 years, this difference is almost not noticeable: signs of the disease are found in 68% of women and 58% of men.
Anyone can get arthrosis. The risk group includes not only the elderly, whose cartilage components are destroyed faster than synthesized, but also professional athletes (especially boxers, wrestlers, runners and football players), dancers, stuntmen, extreme sports enthusiasts and ordinary citizens, work or image whose lives are associated with increased stress on the joints.Curvature of the spine, which shifts the center of gravity when walking, high heels in fashionistas, excess weight and even the habit of sitting leg by leg, all this can eventually lead to joint problems.
Like any other disease, arthrosis is easier to prevent than to cure. Therefore, we just need to take good care of our joints. First, be careful about physical activity, try to avoid sudden movements and injuries. Secondly, if possible, engage in preventive gymnastics for the joints.In addition, forget that “a good person, the more the better.” Weight, twice as normal, must be corrected by diet.
If a person does get sick, then it is very important to recognize arthrosis at the earliest stage, when all the defects that have appeared in the articular cartilage can still be corrected. Not long ago, if there was suspicion of arthrosis, patients were sent for X-ray: the joint was shone through from different sides, and … nothing was found. The person was sent home, and ten years later they were prescribed disability due to arthrosis.As it turned out, X-ray diagnostics is good only for detecting the last stages of arthrosis, when the disorders have become irreversible. At the beginning of the disease, it is practically useless.
A real breakthrough in the diagnosis of arthrosis came with the advent of arthroscopy – a surgical manipulation that allows you to view a joint from the inside under a high magnification. It looks something like this: through a small puncture, the doctor inserts an arthroscope, a special optical device with illumination, into the patient’s joint cavity.The arthroscope is attached to a video camera, which allows not only to carefully examine all the structures of the joint, but also to display the resulting image on the monitor screen, as well as to save this image in the archive. The material accumulated by specialists allowed us to draw up criteria with the help of which even insignificant changes in the joints are detected with 100% probability. This method of diagnosing arthrosis has only one drawback: not every patient with crunching and mild joint pain voluntarily agrees to get on the table to the surgeon.First, he will have to convince him for a long time that arthroscopy is the most accurate way to diagnose terrible arthrosis, that the operation is very small, that he will be able to walk by the evening, and there will be no scars from punctures at all.
And only when the method of magnetic resonance imaging (MRI) appeared in the armament of rheumatologists-arthrologists, non-surgical diagnosis of arthrosis became possible. The method itself is based on the fact that we all consist of charged particles, which, once in the field of action of a huge magnet, can change their magnetic properties.By registering these changes, you can get an image of the internal organs of a person, including the joints. Scientists were faced with a difficult task – to figure out how the initial changes in cartilage in arthrosis look on MRI. There have been many studies comparing arthroscopy and magnetic resonance imaging data, and the long-awaited result has already been obtained. MRI criteria have been developed, with the help of which it is possible to detect arthrosis at the earliest stage with an accuracy of 95%. The huge advantage of this method is that you do not need to enter the patient’s joint to make a diagnosis, it is enough to enlighten them with a smart device.
It is not easy to cure arthrosis. In advanced cases, even a highly qualified specialist will not be able to fully restore the patient’s joint; he can only slightly slow down the development of the disease, relieve pain and dampen the inflammatory process. If arthrosis is detected on time, there is every chance to get rid of it completely. For this, there are modern drugs that restore cartilage tissue (chondroprotectors). In the treatment of the initial stage of arthrosis, hyaluronic acid preparations have proven themselves best.
A very special direction in the fight against arthrosis is irrigation (washing) of the joint. It looks like this: during arthroscopy, the articular cavity is washed with a large amount (3-4 liters) of normal saline solution. Such a complete cleansing of the joint from decay products has a good therapeutic effect in case of a disease of any severity.
For those who do not like to be sick for a long time, there is only one advice: if you suddenly feel pain in the hip, knee or shoulder joint (they are most often affected by arthrosis), and this pain does not go away for several weeks, or even months, urgently sign up an appointment with a rheumatologist.It is imperative to check the condition of suspicious cartilage, and if necessary, put them in order. Until it’s not too late.
Doctor of Medical Sciences, Professor, at Rach rheumatologist-arthrologist of the highest category City Clinical Hospital №31 – Luchikhina Liliya Vladimirovna .
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folk remedies ointments infusions from arthritis arthrosis Treatment of arthrosis of the knee joint: causes and symptoms of the disease.Effective treatment of the knee joint of the department includes a whole range of measures: drug treatment, physiotherapy, exercise therapy and proper diet. Arthrosis of the knee joint is a degenerative-dystrophic disease of the cartilage tissue, which leads to exposure of the bone heads and impaired mobility in the joint. The disease is non-inflammatory and slowly progresses – the transition from the initial stage to disability takes from several years to several decades. Knee osteoarthritis is one of the 5 most common causes of disability and disability worldwide.Folk remedies for the treatment of arthrosis of the knee joint are aimed (to a greater extent) at relieving symptoms. In order to influence the problem in a complex way, you need to apply other methods. When the situation is already associated with serious complications, it will not be possible to avoid surgical intervention. Here, during the operation, the damaged tissue is removed, and the joint itself is replaced with metal elements. After such a procedure, the patient will have to undergo a rehabilitation course for a long time, which will already be associated with taking medications, and then folk recipes can be used.Alternative methods of treatment can be supplemented with other procedures Treatment of deforming arthrosis of the knee joint 1, 2, 3 degrees. Treatment of gonarthrosis at home, in a sanatorium and medication. Arthrosis is a degenerative process, during which the tissues of the joint are destroyed, it loses its mobility, and if the course of arthrosis was long, then it also causes deformation of the joint. Injuries. Most often from falling, hitting the knee, or hitting the knee on a hard surface. Arthrosis of the knee joint is a chronic disease, as a result of the development of which there is a gradual destruction of the articular cartilage.Against the background of this pathological process, the function of the joint is impaired, severe pain and other symptoms occur. The degree and symptoms of arthrosis of the knee joint. In total, three stages of arthrosis of the knee joint are distinguished: At the first stage of the development of the disease, there are still no pronounced changes in the joint. Surgical treatment of arthrosis of the knee joints. If conservative therapy does not bring the desired result or the disease is in an advanced stage, doctors consider the expediency of surgical intervention.How to treat arthrosis of the knee, ankle, shoulder and other joints. Arthrosis is a disease of the joints of a degenerative-dystrophic nature with a gradual destruction of cartilaginous and proliferation of bone tissue. The process is accompanied by deformation, impaired articular function and pain. Recently, the term osteoarthritis (osteoarthritis of OA) has been used more often – a group of diseases based not on purely dystrophic, but on dystrophic-inflammatory processes leading to the gradual destruction of the joint.Preparations for the treatment of arthrosis. Folk methods. It is better to learn how to treat arthrosis with these methods in consultation with your doctor. Arthrosis of the knee joint (gonarthrosis) is a complex disease of a degenerative-dystrophic nature that affects the osteochondral part of the knee. Knee arthrosis: what it is, stages, symptoms and treatment myths. Content. Important about the disease. The causes of arthrosis. Stages of destruction. Symptoms and complaints. Conservative treatment. Knee arthrosis surgery. Treatment of grade 3 arthrosis.Treatment of arthrosis of the 2nd degree. Stem cells for knee treatment. Method according to Neumyvakin. Mud treatment. Description of symptoms, methods of diagnosis and treatment of arthrosis of the knee joint. Arthrosis of the knee joint (gonarthrosis) is a common disease in which there is a gradual destruction (degeneration) of the cartilage tissue, followed by involvement of the surrounding structures in the degeneration process. Without the timely help of a doctor, the disease becomes the cause of severe pain and restriction of mobility, and in advanced cases leads to disability.General information. When used uncontrollably, many drugs can worsen the condition of the joint, as well as cause unpleasant side effects. Physiotherapy. Arthrosis is a degenerative disease of the cartilage tissue, which is characterized by the gradual destruction of the cartilage structure, the development of inflammation around the joint and subsequently – a violation of its function. The main problem of arthrosis is not reduced to painful sensations accompanying the development of the disease, but to the fact that it is irreversible. That is, such a magic remedy has not yet been created that could restore the structure of the cartilage.According to medical data, every year the symptoms of arthrosis appear earlier, which is associated with poor ecology, unbalanced diet, and bad habits. In addition, other factors contribute to the appearance of the disease – the primary anatomy of the knee joint Pain in the knees after sports Pain in the knees and shoes Help with chronic pain in knees Why knee pain appears at a young age. Knees hurt at any age. Pain can appear in both sick and healthy people. Arthritis and arthrosis affects the joints, which causes knee pain.Common causes of arthritis are heredity, infection of the knee joint, insufficient physical activity, unbalanced diet, and excess weight. Treatment primarily involves limiting the stress on the joints. 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My elbows ached, especially at night, I drank pain pills.But the pain came back: again, and again until I bought the arthrofish capsules. After one month’s course, I felt lightness, the pain subsided. For the second month I have been using the drug for a complete recovery. The capsules are taken orally twice a day after meals. It is recommended to drink two capsules at a time and drink them with plenty of water. The instructions for use require the use of the medication in a course, the duration of which is 30 days. If necessary, the treatment can be repeated.In this case, it is recommended to take a monthly break. The capsules are taken orally twice a day after meals. It is recommended to drink two capsules at a time and drink them with plenty of water. The instructions for use require the use of the medication in a course, the duration of which is 30 days. If necessary, the treatment can be repeated. In this case, it is recommended to take a monthly break. Inflammatory disease of the joints of the foot has extremely negative consequences, since nature has assigned significant tasks to the foot of the leg: to ensure the vertical position of the body, to help maintain body balance, to perform spring and push functions.In addition, the foot is rich in reflexogenic areas. How to treat inflammation of the foot joint. The main stage of treatment is the use of non-steroidal anti-inflammatory drugs. As an additional therapy, analgesics, chondroprotectors, multivitamin complexes, physiotherapeutic procedures and other methods of treatment are used. In the network of CMRT clinics, treatment is prescribed based on an accurate diagnosis, the general condition of the patient. The following therapy methods are used: Everything. Ankle arthritis: causes, symptoms, stages of the disease.Classification of the disease: rheumatoid, reactive and other types of joint inflammation. Everything about effective treatment: drugs, non-drug methods. Along the way, arthritis is divided into acute and chronic. ICD-10 code M00 – M99. The ankle joint is a movable joint formed by three bone structures: the heads of the tibia and fibula of the lower leg and the talus of the foot. To the right and left of the talus are bony eminences – the ankles. The peculiarity of the joint is its resistance to external influences, in this it is much superior to the knee joint.Orthopedist traumatologist Moscow Shoulder pain treatment Elbow joint diseases Treatment of wrist and hand diseases Meniscus injuries and treatment Treatment of ankle joint diseases Treatment of hip joint diseases Foot diseases and their treatment. Than we treat. Orthopedic surgeon traumatologist Knee arthroscopy Bone on the foot PRP therapy in Moscow Hyaluronic acid injections in the knee Individual orthopedic insoles. Diseases of the feet and their treatment. 1. Plantar (plantar) fasciitis, heel spur.Disturbed by pain at the base of the foot, under the ankle. Hemorrhages are detected in the area of the inner ankle. The ability to lean on the foot has been lost. Fractures of other bones of the tarsus. Rarely diagnosed. Keller’s disease I is detected in boys 3-7 years old, accompanied by pain in the proximal part of the foot, closer to its inner edge. The pain intensifies when walking and feeling, forcing the child to lean not on the entire foot, but on its outer edge. Over time, the pain syndrome becomes permanent, it does not disappear even at rest.Lameness occurs. Edema and hyperemia are absent. Foot pain – treatment in Moscow. Procedures and operations. Price. The symptom of what diseases is pain in the foot, the causes and treatment of the ailment, the list of recommended tests and studies, which doctor to contact. The foot consists of 26 bones, which, when connected to each other, form several joints, held together by numerous elastic muscles and strong ligaments. The entire weight of the human body rests on it, so pain in the foot causes not only discomfort, but in many cases limits motor activity.Foot pain is a common symptom that can be caused by a variety of reasons. The joints of the feet can become inflamed for many different reasons. But the main one, of course, is most often arthritis. For what reasons can this disease occur? Arthritis includes several diseases that differ from each other by various etiologies. That is, we can conclude that this disease has several forms and each of them has its own causes. Different forms of arthritis proceed in different ways.If arthritis is in the initial stage, then the leg, the joints of which have been damaged, should be provided with complete rest and the maximum motor activity should be limited. Also, with arthritis, you can visit the manual therapy room. Arthritis and antibiotics. Arthrosis of the foot is a degenerative disease of the joints, which, along with damage to cartilage, is concentrated in muscle and bone fibers. Most often, the disease manifests itself in the metatarsophalangeal part of the thumb. In this case, deformation occurs, which is the cause of subsequent negative changes in the structure of the foot.The specificity of the disease lies in the special configuration of the foot, which consists of a significant number of small joints, the plexus of nerves and the vascular system. Typically, patients suffering from this disease are around 45 years old. Content. 8. Arthrosis of the foot: methods of treatment. 9. Feet hurt: what to do and how to treat the disease? How is foot bursitis treated? If a person has pain in the joints of the foot, but he does not consult a doctor for a long time, this is fraught with increased discomfort, up to the appearance of lameness when moving.In addition, cartilage and soft tissues are subjected to total destructive processes, and wounds appear near the joint. In the treatment of this disease, an integrated approach is used, as in the fight against other similar problems. Typically, the patient is referred for physiotherapy procedures that include magnetic resonance therapy, laser therapy, electrophoresis, mud therapy, and UHF. Diseases of the foot. Hallux valgus. Hyperkeratosis of the feet. Diabetic foot syndrome. Curvature of the toes.Bones on the legs. Corns in the forefoot. With this disease, an X-shaped curvature of the ankle joints and feet occurs with a change in the support of the heel to its inner edge. The presence of deformity is indicated by a significant distance between the heels in a pose with the legs brought together. Curvature of the toes is an abnormality in which the toes take on an unnatural shape. This is not only an aesthetic problem, but also the cause of pain, cramps, ulcers and chronic diseases of the joints of the feet.
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For the treatment of joints, Artrofish gel is used, which has a local effect. But this dosage form is not effective enough, therefore it is recommended to take capsules at the same time, which will provide a complex effect on the joints. The medicine Arthrofish is made on the basis of the cartilage tissue of marine fish. These are useful substances that provide adequate nutrition for the cartilage tissue.For their processing, a patented method of enzymatic hydrolysis is used, which ensures the full preservation of all the unique components of the cartilage. Knee meniscus surgery is indicated for the treatment of recent injuries – peripheral or longitudinal ruptures. If a cyst is diagnosed, meniscus resection and plastic are prescribed. The task of arthroscopy is to preserve the body of the meniscus in the maximum volume in order to prevent the development of arthrosis. The prognosis of surgery on a damaged meniscus depends on the age and location of the rupture.If the injury is acute in areas with good blood supply, the chances of healing are greater than with chronic ruptures. Transplantation. A radical operation with a rupture of the lateral and internal meniscus is resorted to for complete or partial replacement of tissues. We suggest that you familiarize yourself with the article Knee Meniscus Operation. Look for even more useful information on the website. Meniscus treatment – stages. Meniscus surgery is not an independent procedure. It is performed in the course of a complex of diagnostic and therapeutic measures, which include several stages: Diagnostics, during which the doctor finds out the cause of the integrity violation, draws attention to the main symptoms of the pathological process, and also prescribes methods of additional research with visualization of the knee structures (X-ray, ultrasound, computed or magnetic resonance imaging, arthroscopy).Cost of arthroscopic knee surgery in Germany. How to sign up for a meniscus tear operation for a foreign patient? Surgical treatment of an injured meniscus is carried out using two methods. Meniscectomy involves removing a portion of the damaged meniscus to flatten the articular surface. Surgical treatment of knee meniscus tears is performed using arthroscopy. This is a minimally invasive and currently effective method for diagnosing and treating such pathologies.It is less traumatic in relation to the surrounding tissues. After arthroscopy, the rehabilitation period proceeds quite easily and quickly, in contrast to open-access surgery, while there are no large scars on the patient’s body. The plan of rehabilitation measures is developed by the rehabilitation therapist individually, taking into account the peculiarities of the pathology, the treatment carried out, age characteristics, concomitant pathologies, and his lifestyle. Meniscus tear surgery. What is a meniscus tear? Meniscus tear is one of the most common intra-articular knee problems.In each knee joint there are 2 menisci, the medial (internal) and lateral (external) – these are C-shaped pads of dense connective tissue that ensure a snug fit of the rounded condyles of the femur to the flat condyles of the tibia. A tear in the meniscus causes pain, swelling, and limitation of the range of motion of the knee joint. Biology of knee osteoarthritis treatment. Introduction. Knee meniscus surgery involving complete / incomplete removal is called meniscectomy in orthopedics and traumatology.According to the method of creating access, the technique is classified into 2 types: open and closed resection of the knee meniscus. The first type of procedure involves opening the joint cavity (incision length up to 8 cm) and performing manipulations through a completely open surgical field. Postoperative treatment of a partially or totally removed meniscus is much easier than if its structures were sutured. The therapeutic program in each case is developed individually. Treatment of the knee joint meniscus: symptoms, signs, causes of the disease.Prompt diagnosis and effective treatment of the disease in the Health Workshop clinic. Make an appointment with a doctor in St. Petersburg on our website !. Knee Meniscus Treatment. Menisci are crescent-shaped cartilage layers inside the knee joint. They cushion and evenly distribute the load on the knee. Among the main diseases of the meniscus are injuries, tears, excessive mobility, degeneration. Surgical treatment of menisci. Small cartilage layers that are located in the knee joint play an important role in human life.They take part in the distribution of the optimal load on the joint, give the knee stability during its movement, and are sensitive shock absorbers. Before arthroscopy, you should shave off the hair in the area of the knee joint. After the operation, you will need crutches, so you need to purchase them in advance and take care of the method of transportation home (for some time the patient will not be able to operate the car). Anesthesia before surgery. Treatment of a ruptured knee meniscus. First aid for knee injury, which is accompanied by severe pain, is to immobilize it (using a splint or splint), as well as cooling (using an ice pack or sports cooler).Then the victim must be taken to a trauma doctor as soon as possible to receive adequate treatment. This approach significantly reduces the risk of complications from a ruptured knee meniscus. Meniscus tears are divided into: tearing at the site of attachment to the joint (damage can heal if bed rest is observed, limb immobilization with a splint) arthrosis of the knee joint symptoms treatment with folk remedies . buy arthrofish in Grozny.
How to correct the X-shaped deformity of the legs in a child
Most often, hallux valgus develops as a result of excessive stress on the baby’s legs during verticalization.The reason may be too early to start walking – in such cases, the muscles and ligaments are not yet sufficiently formed to keep the child’s legs in the correct position, and poor coordination exacerbates this problem, since while walking, the child spreads his legs too wide for stability.
The formation of an X-shaped legs can also be triggered by an overweight child. However, if there is no excess weight, pathology often develops in asthenics, and not in hypersthenics, which may be due to congenital weakness of the musculo-ligamentous apparatus, which is more characteristic of people with asthenic body type.Girls suffer from valgus curvature of the legs more often than boys due to the peculiarities of the pelvic structure associated with the sex of the child, while the wider the pelvis and the shorter the thigh bones, the more pronounced the X-shaped curvature of the legs can be.
Children get tired quickly and often complain of pain in the lower extremities. Their gait becomes awkward, unsure. An accurate assessment of the severity of pathology in a child will be determined by an orthopedic surgeon. If in a baby under 4 years old this distance exceeds 4-5 cm, further examination, conservative treatment is necessary, orthosis and dynamic observation 3-4 times a year are possible.
Prolonged absence of correction of hallux valgus entails anatomical changes in the knee joints, feet, and in some cases, the spine. The lack of positive dynamics after a course of physiotherapy exercises and massage implies joining the treatment of physiotherapeutic procedures, in advanced cases of orthosis with splints on the lower extremities.
Prolonged absence of correction of hallux valgus leads to the fact that the internal collateral ligaments of the knee joints are overstretched, the joint becomes unstable, its lateral hyperextension occurs.The feet of patients with X-shaped legs acquire a flat-valgus setting, flat feet are formed, which makes walking even more difficult, causes pain and increased fatigue after exercise.
If you start prevention in time, you will not have to resort to extreme measures.
A set of exercises for X-shaped leg deformity.
Therapeutic gymnastics plays a special role in the X-shaped deformity of the legs:
- it is useful to teach the child to walk like a “bear” on the outside of the legs;
- Teach your child to squat with a ball or soft toy clamped in the knees, perform 2-3 sets of 15 squats;
- Let the child sit on the floor on his knees, spread them as wide as possible and lean forward, stretching his arms as far as possible (you can offer to reach for the toy), perform 2-3 approaches 10 times;
- are useful exercises with raising a straight leg as high as possible from a lying position on the side, perform 2-3 sets of 10 lifts with each leg;
- Let the child stand with his legs crossed at the ankles and slowly sit on the floor in a Turkish fashion, if it does not work out, you can hold his hands, repeat the exercise 10 times.
Also effective are wall bars, cycling, swimming in the pool. Walking on toes and on heels along a narrow path or board, on the outer part of the feet, taking a sitting position “in Turkish”, squats with a ball clamped between the knees are very useful.
If the child is too young to complete these exercises, try to turn them into a game, do them yourself and have the child repeat after you.
To monitor the dynamics of the disease, you should visit an orthopedist every three months.
90,000 What causes coccidiosis and how to get rid of it?
Coccidinia is a pain felt in the coccyx of the spine. The tailbone is the last bone in the spine, and pain in this area can be caused by a fall, childbirth, sitting too long, or, in rare cases, a swelling.
In most cases the pain goes away after a few weeks or months, but sometimes it can be much longer and seriously affect the patient’s ability to carry out daily activities.
What is the cause of this pain? How is it diagnosed? How is it treated? And what are the ways to prevent this? You will find answers to all these questions in this article.
What is the role of the tailbone in the body?
The tailbone is located below and at the base of the spine. This triangular bone forms the lower portion of the spine below the sacrum.
Depending on individual growth, the tailbone can consist of three to five bones. This piece of bone is not fixed, and its bony parts have limited movements that are performed by the ligaments and joints attached to them.How about
The tailbone is attached to the sacrum through the sacrococcygeal joint. In this case, the pelvis and legs move slightly back and forth. When you are sitting and standing, all of the pelvic bones, of which the tail is a part, move back and forth for balance.
The tailbone is a junction of many pelvic floor muscles. These muscles support the anus and aid with bowel movements, support the vagina in women, and help walk, run, and move the legs.
Also read this post: Side Effect of Spinal Injection
What is coccidinia?
Pain in the tail bone is mild or severe, depending on the degree of injury.Acute pain usually comes on suddenly and goes away within a few days or weeks, but chronic pain caused by inflammation can last for more than three months.
Symptoms of coccidinia
Symptoms of coccidiosis can vary from person to person, sometimes even with other symptoms. But in general, its common symptoms are:
In this condition, pain is felt only in the coccyx, and not in the pelvis and other bones.This pain is sometimes mild and sometimes severe. Sometimes it persists continuously, and sometimes it is felt by the pressure and movement of the tail of the tail shoot.
Pain while sitting
In this case, the person feels pain when sitting or leaning back. Or sitting on a hard surface without a pillow. Or, for example, he feels pain while cycling.
Pain when moving from sitting to standing
In this case, rotation of the pelvic bones and muscle movements can cause pain in the tail.This pain can be so severe that it is difficult for the person to stand and sit, and needs to lean on something to make it easier to change position.
Pain during sex and bowel movements
Due to the proximity of the tail to the anus and genitals, in these cases the patient may feel mild to severe pain.
Most common causes of tail pain
The causes of coccidinia are various. But the most common ones are:
Blow to the buttocks
Direct injury to the coccyx is the most common cause of coccidinia and usually results in inflammation and pain around the coccyx.The ligaments become inflamed, and sometimes the front or back of the tailbone breaks and dislocates.
Continuous pressure on the coccyx
Certain activities, such as horse riding and cycling, will cause pressure and pain in the tail area for a long time. Of course, this pain is not permanent, but if left unchecked, it can develop into chronic pain and cause long-term irritation of the sacro-sacral joint.
During labor, the baby’s head passes over the coccyx and pressure on the coccyx can damage the coccyx structures (discs, ligaments and bones). Although very unusual, sometimes this pressure will damage and fracture the tail.
Tumors and infections
In very rare cases, a tumor near the coccyx or an infection in the lateral parts of this bone can spread to it and cause pain and inflammation of the coccyx.
Cancer is one of the rare causes of coccidiosis. This cancer may be bone cancer or cancer in other areas that has spread to that area. (Metastatic cancer)
Pain is transmitted from other parts to the tail
This is not uncommon, but pain can spread to other parts of the spine or pelvis, and even to the bladder.
Factors that have a greater impact on coccidiosis
Bone pain is generally more common in women than in men, but in general, certain factors increase the risk of developing it.
Obesity interferes with the movement of the pelvic bones. Sometimes this constant pressure causes pain in the tail. Studies have shown that if the body mass index (BMI) in women is above 27.4 and in men is more than 29.4, then the risk of coccidinia is higher.
Very low weight
Excessive weight loss is also one of the causes of coccidiosis. In this case, the tailbone will be more prone to injury due to insufficient fat in the buttocks.
Due to the greater angle of the pelvis, as well as trauma to the tail during childbirth, women are more prone to coccidiosis.
In old age, the small cartilaginous discs (elastic, flexible tissue) that help hold the tailbone in place wear out, and the bones that make up the tailbone become stronger. This can put more stress on the tailbone and lead to pain.
How is coccidinia diagnosed?
Usually, in cases where the pain is not mild and annoying, the patient will not seek the exact cause.But severe pain indicates a serious problem. This is why correct diagnosis is so important.
At the initial stage, a clinical examination and a review of the patient’s medical history are carried out. When necessary, diagnostic methods such as testing are used to accurately diagnose the disease; imaging, X-ray, computed tomography and MRI. Some conditions, such as sciatica, herpes zoster in the buttocks, sacroiliitis, or fractures, have similar symptoms to coccidinia.
What is the treatment for bone marrow pain?
Non-surgical treatments successfully treat coccidinia in about 90% of cases.
- The use of anti-inflammatory drugs such as non-steroidal anti-inflammatory drugs (ibuprofen, naproxen) or COX-2 inhibitors will reduce coccyx inflammation.
- Applying a cold compress and ice pack several times a day for the first few days after the onset of pain reduces inflammation and pain.
- Using a bag of hot water for the first few days of pain can relieve muscle tension that causes tailbone pain.
- Changes in the way you perform daily activities that cause more pressure and stimulation of the tailbone. For example, standing in front of a table instead of sitting for a long time, or using medical pillows to sit.
- Change your diet and eat foods high in fiber if you are constipated and need to sit on the toilet for a long time; This makes it easier to defecate and relieves pressure on the tail.
- Physiotherapy and special sports exercises that reduce pressure on the coccyx.
- Injections of anesthetics (lidocaine) and steroids (to reduce inflammation) around the tailbone may relieve pain. Of course, this injection is given up to three times a year.
- Massaging tense pelvic floor muscles that move towards the coccyx may reduce coccidinia.
- And in rare cases, non-surgical treatments do not work and your doctor may recommend surgery to correct the problem.
Prevention of coccidinia
Prevention The main key is to prevent relapse and relapse of tail pain.Prevention methods such as the following will prevent the development of coccidiosis.
1. Sit well, avoid prolonged sitting, stand well and move well
2. Regular stretching and strengthening exercises
3.Exercise with appropriate equipment and methods
4. Use your seat belt when traveling
5.Creating an ergonomic working environment
6.Good food, good weight
7.Reduce stress and don’t smoke
Also read this post: Exercises After Back Surgery
By following these tips, you can prevent tail pain.