ONE SECOND AND AN INCORRECT OR QUICK MOVEMENT WILL RUPTURE THE JOINT MENIS. WHICH SPORTS HAVE THE HIGHEST RISK OF MENSCULAR REAR AND IS AN ACTIVE LIFESTYLE STILL POSSIBLE AFTER THIS INJURY?
VISAMS RAFAELS, RAKUS Traumatologist-orthopedic at the Traumatology and Orthopedics Clinic
UNA KALNITE is a physiotherapist at the "Medsport" physiotherapy center
The rupture of the meniscus and cruciate ligaments of the knee joint in one second last year deprived the javelin thrower Lina Muse of the opportunity she deserved after long, hard work to participate in the Olympic Games in Rio de Janeiro. This is a typical sports injury not only for professionals, but also for those who follow an active lifestyle. How to avoid it, and how to properly treat the injury if it is experienced?
Meniscus - as thin as paper
Most often, injuries are diagnosed in the menisci of the knee joint, so many people do not know that menisci are also in other joints: wrists, between the collarbones and shoulder bones, collarbones and sternum, as well as jaws. But usually, when talking about "meniscus", it is mostly understood as the knee. It contains two crescent-shaped cartilages between the femur and shin bones that make up the knee joint. The job of the menisci is to equalize the weight acting on the knee joints and absorb shocks. While the menisci are healthy, they keep the bones of the lower leg and femur from rubbing against each other, wearing out, and deforming the joints, but because the menisci are paper thin, if they are torn, this cartilage does not grow back in the event of an injury.
Of course, there are meniscal implants, they can also be grown from one's own cells, but in Latvia, the state does not pay for the placement of such implants and the operation is expensive. For all the listed reasons, menisci are almost irreplaceable for some of us, therefore expensive and carefully preserved.
The trauma of young people
You don't always have to have a sports injury to experience a meniscus tear. A careless movement such as a deep squat is enough to cause an injury, but once the meniscus is damaged, it continues to gradually tear until the pain becomes unbearable. Seniors are at high risk of experiencing a meniscus tear, as cartilage wears down, becomes dry and brittle during life. Sometimes it is enough to twist or cut the knee joint to feel a sharp pain in it. However, 70-80% of patients with meniscal injuries are young people aged 20-30 years. The most risky sports are basketball, football, handball, also athletics: javelin, high jump, running. The more popular running becomes, the more often traumatology patients become people who, while preparing for a half-marathon or marathon, have recklessly increased the load quickly. If the muscles are not prepared for the impact of landing with each step, the joints will not be ready for the run and the menisci can tear.
It should also be taken into account that in about 80% of cases, after cruciate ligament rupture, a person immediately experiences a meniscus tear as well. A cruciate ligament tear most often occurs after an incorrect, rotating movement, which is also the cause of a meniscus tear.
Live or operate?
In medicine, meniscal tears are divided into mild, moderate and severe. In the case of a mild tear, a person feels only minor changes in the joint and pain, which is mostly tolerable. It is usually enough to put a cooling compress on the knee, use anti-inflammatory and painkillers for a couple of days, the body adapts to the changes and after a while no longer reports them with pain. Only with years, if the tear becomes bigger and bigger, the pain is felt more often, which makes it necessary to go to the doctor. A moderately severe tear is difficult to live with, as pain will be felt every time the knee is loaded.
Finally, if there is a severe or complete meniscal tear, the meniscus melts between the bones and blocks the joints. There is sharp pain and limitation of movement - difficulty in straightening or bending the leg.
If the meniscus is not completely torn, then the doctors prescribe treatment, which also means a ban on running, jumping, deep squatting for at least six weeks, as well as strengthening the thigh muscles with the help of physiotherapy. However, if there is a complete meniscus tear, surgery is most often the solution. It is true, even if there is a full tear of the meniscus, for seniors after 50 and 60 years, surgery is not recommended, because it has been proven that at a respectable age, the meniscus does not heal well after surgery, deteriorates, and develops arthritis. On the other hand, if the damaged part is removed outside, the cartilage is at an even greater risk of wear and tear, so there is also a greater chance of developing arthritis. On the other hand, if the patient is still young and full of strength, depending on where the meniscus is torn, the traumatologist decides to remove the damaged part of the meniscus or sew it up anyway. The meniscus is attached to the joint in only one place, and therefore the blood supply to the thin cartilage comes from only one side, that is, the outside of the joint. The meniscus is best supplied with blood on the outside of the joint, so if the tear occurs there, it can be sutured. On the other hand, if the tear happened in the worst-perfused place, where there is no blood tissue, it is not worth sewing the meniscus - the place of the tear will never heal and will not stop hurting. The only thing doctors can do is to remove the damaged area outside. The practice of traumatologist Wisam Rafael shows that it is possible to sew up the meniscus in only about half of all cases.
What to do to reduce the risk of a meniscus tear
1 From childhood, exercise and engage in physical activities throughout your life, which strengthen the muscles of both legs and the whole body equally well, as well as train the sense of balance and coordination.
2 Never avoid physical activities. Joints are made for us to move.
3 For free time, choose sports activities that do not have a high impact on the joints, such as swimming and/or cycling.
Suddenly trauma! Correct action if a meniscus tear is suspected
1 Relieves the painful leg! Sit or lie down and, supporting your leg, keep it higher than your body.
2 Put a cool compress on the knee and keep it on the injured area for 15-20 minutes every hour for the next 3-4 hours.
3 If the pain is not severe enough to rush to the trauma center, ask your family doctor for a referral to a traumatologist. Sign up for a visit!
1 It should be expected that the traumatologist will prescribe magnetic resonance for accurate diagnosis of the rupture site.
2 You have to prepare for the operation.
Physiotherapy
Physiotherapy after an operation in which a meniscal tear is sutured is an integral part of treatment. For all! If the leg is not loaded after the operation, the thigh muscles will become weak and soft. In order to avoid muscle weakness and the resulting feeling of instability, it is important to strengthen the thigh muscles, lower leg muscles and ligament joints. There are no universal exercises - everyone must perform different exercises during rehabilitation. The physiotherapist offers them taking into account the patient's age, height, weight and posture, as all this affects the condition of the meniscus and the load on it. You should come to physiotherapy classes three times a week. In the first month, the exercises are gentle, but in the following months, you should try more and more to strengthen the muscles of the legs. It is not easy for non-athletic people to put up with such a regimen worthy of army life for several months, but all exercises must be performed accurately and regularly. Only if the muscles are in good tone, the joint will not be overloaded.
Return to sport
After three months. The biggest challenge is figuring out how quickly you can get back into running shoes after meniscus surgery. About three months after surgery, a person usually feels well enough to gradually resume exercise. The load should be increased slowly and gradually. You can safely swim and ride a bike, but you should resume running gradually, choosing shoes with shock-absorbing material in the soles. Instead of urban asphalt and pavement, preference should be given to the soft surface of running tracks and forest paths.
Orthotics should be used during sports, if necessary. The orthosis helps relieve stress on the knee joint.
In middle age, more gentle activities should be preferred. If in young people the scar heals quickly and after proper treatment there are rarely complications, Una Kalnīte advises middle-aged people to consider the possibility of finding joy in life by walking, swimming, cross-country skiing, cycling.
Warm-up, cool-down, and stretching exercises should never be forgotten. After meniscus surgery, there is a 20-30% higher risk of tearing than if the meniscus were intact. However, don't be afraid either! Sports lovers manage to play football for years after meniscus tears, participate in adventure competitions and run not only marathons, but also the world's most difficult endurance races.
KNEE JOINT
A healthy meniscus
Cross-link
Meniscus damage
Pros and cons of surgery
If part of the meniscus is removed
+ The patient feels much better the next day. There is no pain. + After 10 days you can return to sports and an active lifestyle. -As the removed part of the meniscus no longer protects the bones from contact, their wear is faster. It takes 10-20 years for noticeable bone deformation.
If the meniscus is sutured
- An average of six months of rehabilitation should be expected.
+ Although there is a risk that the meniscal injury may recur, the bones will still be protected from friction and therefore premature wear.
Two stories about returning to sports after injury
Agris Samtsovs (38 years old), logistics specialist:
"I experienced a meniscus tear two and a half years ago. I walked to the river and climbed on the footbridge to wash the sand off my feet. I didn't sit down, but, leaning on one leg, squatted down to dip the other leg into the water. The joint could not withstand the load, and I limped away from the river. The pain and discomfort did not go away, so after a week I went to the traumatologist, who ordered an X-ray. Since it was not possible to see the injury in the X-ray image, an ultrasonography was ordered, in which nothing could be clearly seen either. Finally, a meniscal tear was clearly visible in the magnetic resonance examination. The doctor immediately said that an operation would be necessary. I had to wait a few months before that, but then I had the torn piece of the meniscus removed from my knee joint. After the operation, I performed exercises on my own for a couple of months, went swimming, but now I feel the effects of a meniscus tear only when I squat on the injured leg. Otherwise, nothing prevents either walking or running. I run more than 200 kilometers every month and now I am preparing for the "Lattelecom" Riga Marathon."
Alice Schultz (23 years old), photographer:
"I just turned 18 years old, I studied in the 12th grade, and the last sports lesson of the school year took place. Exercises in triple jump and long jump were to be performed. I jumped, kicked back, fell into a hole and realized that I had fallen on top of my leg the way I shouldn't have - my knee had turned. In the hospital, they said that the ligaments were strained and they put on a cast. The leg was in a cast for two weeks, but it didn't get better - the temperature rose, I felt bad, until my parents supported me, I decided to go to the Diagnostic Center in Riga, where the magnetic resonance revealed the cruciate ligament and meniscus tear, and now also the inflammation of the bone, which was caused by the unnecessarily applied plaster because of. Until then, I clung and moved carefully to protect myself from pain. After elective surgery to have my meniscus sutured and cruciate ligaments connected with implants, I walked on crutches for three weeks and then went to physical therapy three times a week for four months. For a long time I was psychologically afraid of falling, but last winter I finally overcame my fear and jumped over the trampolines with a snowboard."
Content created in collaboration with webelevate.
original article: Gundega Kārkliņa Veselība
