Issues related to the damage or removal of the meniscus or its different parts, I get a lot. Most often these are questions about pain in the knee joint, as well as whether exercises on the MTB simulator (or some other exercises) will help to avoid surgery to replace the joint with an implant (endoprosthesis) or simply surgery to remove the meniscus (meniscectomy).

I already wrote that any surgical penetration into the knee joint threatens the development of arthrosis — sooner or later it will happen. Arthrosis is inevitable after arthroscopic “examination of the insides” of the joint. And it’s not even a surgical impact on the joint, after which there are scars and adhesions. This effect can be quite correct. But it is important to know that the structure of the knee joint is perhaps the most complex joint in the human body, and the violation of any component of this joint can have dire consequences.

Negative consequences after any penetration into the knee joint (surgical or arthroscopic) most often arise from the patient’s lack of understanding of what is happening to his joint, that is, from a lack of understanding of the correct behavior in relation to the damaged or operated joint before and after surgery. I mean proper rehabilitation. Sometimes, after surgery or injury, it takes ten or even twenty years before the “play out” deforming arthrosis, but it is sure to “take place” if the patient will operate the damaged joint without proper physical prevention. In most cases, patients place too much hope on the “surgical miracle”, but we must not forget that a person does not have unnecessary parts of the body!

So I want to remind the reader what a meniscus is.

To begin, I want to note some anatomical features of the knee joint:

1) the Knee joint is an intermediate joint of the lower limb and a connecting link between the femur and tibia — the levers of the knee joint. They are connected to each other with the help of condyles, which are a kind of block that allows for the main movements in the joint — flexion and extension. Biconvex condyles of the femur form the sides of the block and correspond to the design of the wheels of the aircraft. The articular surface of the tibia has corresponding bends and forms two concave parallel grooves separated by an elevation. From the point of view of flexion and extension of the knee joint can be primarily considered as a block-shaped surface, sliding in concave grooves. (Such kinds of movement as rotation of (rotation) or circular movement I view not d, so as they are too specific and are used rather in acrobatics, than in normal life. Rotation is possible only when the knee joint is bent.)

2) Since the articular surfaces of the knee joint do not have congruence, that is, the line of contact is uneven, broken, it is the meniscus that compensates for this feature of the joint, acting as a kind of spacers-springs. Therefore, meniscus play an important role as elastic parts that transmit the force of compression (pressure) from the femur to the tibia. Another “spring” in the knee joint is the fat pad in the anterior part of the knee joint.

Why do I focus on these features? Unfortunately, in complaints of pain in the knee joint is often completely removed and meniscus (this operation is called meniscectomy), and fat pad, thereby surgically destroying the spring function in the knee joint. This is an unreasonable action and leads to fairly early deforming arthrosis (gonarthrosis), because the end of the femur begins to wear off about the end of the tibia…

With the advent of arthroscopy, it became possible to remove only the affected segment of the meniscus (such surgery is called partial meniscectomy). This operation is performed when this segment (horn) is a mechanical obstacle to movement (flexion-extension) and injures articular cartilage. After rupture of the meniscus, its damaged part can not follow the normal movement in the knee joint and wedges between the condyles of the femur. As a result, the joint is blocked in the flexion position, and complete extension, even passive, becomes impossible. In this case, such an operation is necessary.

How can a knee injury occur?

With a sharp flexion (or impact), the knee joint is unstable, and its ligaments and menisci are most prone to injury. For example, if you fall on a bent leg, there may be arbitrary damage or even a complete separation of the meniscus from the capsule. With a sharp extension (for example, when hitting a soccer ball), the knee injury most often leads to intra-articular fractures and rupture of ligaments, detachment of the anterior horn of the meniscus. But the most interesting (and it is necessary to understand!) is that with a knee injury, meniscus damage is only part of the diagnosis!!!

In fact, the basis of such damage is often ligament injury (!). Let me explain what this means.

The fact that the meniscus is very tightly attached to the knee joint, its capsule and patella ligaments, cords and fibers of tendons and muscles in the knee joint.

That is, the knee joint is a complex multi-component mechanism in which each detail affects the other and depends on it.

The knee joint is a complex multi-component mechanism in which every detail affects and depends on another.

For this reason, it would be unwise to simply surgically remove part of the meniscus (not to mention its complete removal) without taking any further measures to prevent the destruction of the knee joint. It is important to understand that in this case, the joint becomes not the same as it was before the injury or surgery, because part of its spring (cushioning) function between the two bones — the femoral condyles and the tibia has disappeared.

A new spring in the joint is not inserted! But when the joint wears out, it is changed to an endoprosthesis! That’s all that is invented at the moment! And in this case, no knee pads, as well as the reception of chondroprotectors, which allegedly contribute to the restoration of cartilage, can not help.

Chondroprotectors are just garbage that enters the body orally (through the mouth as food). Also trying to enter into the joint of different substances — oblasti supposedly replaces joint fluid and cartilage. But all this is expensive and meaningless at least because the meniscus damage occurs, as mentioned above, through damage to the ligaments of the joint, which fix the joint from careless movements.

Attempts to consider the meniscus separately from the entire mechanism of the joint are ridiculous! Such actions are not aimed at the restoration of the joint, and the seizure of money from the purse (or account) of the patient!

If the injury of the meniscus it does not close the articular surface and the movement of “flexion-extension” can be carried out, then I do not consider it a mandatory procedure to remove this meniscus or part of it, as the meniscus is very poorly supplied with blood, as well as the intervertebral disc. And although the meniscus has no way to recover from damage, proper activation of muscles, ligaments and tendons, which occurs when performing special exercises, allow you to activate the blood flow, and at the same time to relieve inflammation (swelling), which occurs when a meniscus injury. This process involves special cells of the immune system — phagocytes (phagocytes — a common name of the immune system cells responsible for phagocytosis — the mechanism of leasing, resorption and excretion of diseased tissues). As a result, the remains of the meniscus gradually dissolve (that is, lysis occurs) and are removed from the joint bag.

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