ONE SECOND, AND THE JOINT MENISCUS WILL RUPTURE DUE TO AN INCORRECT OR RAPID MOVEMENT. WHICH SPORTS HAVE THE GREATEST RISK OF A MENISCUS RUPTURE, AND IS AN ACTIVE LIFESTYLE STILL POSSIBLE AFTER THIS INJURY?
VISAMS RAFAELS, traumatologist-orthopedist of the RAKUS Traumatology and Orthopedics Clinic
UNA KALNĪTE physiotherapist at the physiotherapy center "Medsport"
A torn meniscus and cruciate ligament in the knee joint last year deprived javelin thrower Lina Muse of the opportunity she had earned through long, hard work to participate in the Rio de Janeiro Olympic Games in one second. This is a typical sports injury not only for professionals, but also for those who lead an active lifestyle. How to avoid it, and how to properly treat the injury if it has occurred?
Meniscus - as thin as paper
Most often, injuries are diagnosed to the meniscus of the knee joint, so many people are not even aware that menisci are also found in other joints: the wrist, between the collarbone and shoulder bones, the collarbone and sternum, as well as the jaws. However, usually, when talking about "meniscus", it is mostly understood as the knee. In it, the meniscus is two crescent-shaped cartilages between the femur and shinbone, which form the knee joint. The task of the meniscus is to equalize the weight that acts on the knee joints and absorb shocks. As long as the meniscus is healthy, they ensure that the shinbone and thighbone do not rub against each other, do not wear out, and do not deform the joints. However, since the meniscus is as thin as paper, in the event of an injury, when they are torn, this cartilage no longer grows back.
Of course, there are meniscus implants, they can also be grown from a person's own cells, but in Latvia the state does not pay for the placement of such implants and the surgery is expensive. For all the reasons listed, for some of us, menisci are almost irreplaceable, therefore expensive and need to be carefully preserved.
Trauma in 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, because cartilage wears down, becomes dry and brittle over time. Sometimes it's enough to twist or cut the knee joint to feel sharp pain in it. However, 70-80% of patients with meniscus injuries are young people aged 20 to 30. The riskiest sports are basketball, football, handball, and also athletics: javelin throw, high jump, running. The more popular running becomes, the more often people who, while preparing for a half marathon or marathon, have recklessly increased their load quickly become traumatologists' patients. If your muscles are not prepared for the impact of landing with each step, your joints will not be ready for running and your meniscus may tear.
It should also be noted that in approximately 80% of cases, after a cruciate ligament tear, a person also experiences a meniscus tear immediately. A cruciate ligament tear most often occurs after an incorrect, rotating movement, which is also the cause of a meniscus tear.
To live or to operate?
In medicine, mild, moderate and severe meniscus tears are distinguished. In the case of a mild tear, a person feels only minor changes in the joint and pain, which is mostly tolerable. Usually, a cooling compress on the knee is enough, anti-inflammatory and analgesic drugs are taken for a couple of days, the body adapts to the changes that have occurred and after a while no longer reports them with pain. Only with age, if the tear becomes larger, pain is also felt more often, which requires a visit to the doctor. A moderate tear is difficult to live with, because every time there is a load on the knee, pain will be felt.
Finally, if there is a severe or complete meniscus tear, the meniscus gets stuck between the bones and blocks the joint. There is sharp pain and limitation of movement - difficulty straightening or bending the leg.
If the meniscus is not completely torn, then 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. True, surgery is not recommended for seniors over the age of 50 and 60, even if there is a complete meniscus tear, because it has been proven that at a respectable age the meniscus heals poorly after surgery anyway, deteriorates, and arthritis develops. On the other hand, if the damaged part is removed, the cartilage is at even greater risk of wear, and therefore a greater chance of developing arthritis. On the other hand, if the patient is still young and strong, depending on where the meniscus is torn, the traumatologist decides whether to remove the damaged part of the meniscus or to sew it back together. The meniscus is attached to the joint in only one place, and therefore the blood supply to the thin cartilage comes only from one side, that is, from the outside of the joint. The meniscus is best supplied with blood on the outside of the joint, so if the tear occurs in this place, it can be sewn up. On the other hand, if the tear occurs in the worst bloodied area, where there is no blood tissue, sewing the meniscus is not worth it - the tear site will never heal and will not stop hurting. The only thing doctors can do is remove the damaged area. The practice of traumatologist Wissam Rafael shows that sewing the meniscus is possible only in about half of all cases.
What to do to reduce the risk of a meniscus tear
1 From childhood onwards, exercise and engage in physical activities throughout your life that strengthen the muscles of both legs and the entire body, as well as train your sense of balance and coordination.
2 Never avoid physical activity. Joints are designed to keep us moving.
3 For your free time, choose sports activities that do not put a lot of pressure on your joints, such as swimming and/or cycling.
Sudden trauma! Correct action if a meniscus tear is suspected
1 Relieve the pressure on your painful leg! Sit or lie down and support your leg, keeping it higher than your body.
2 Apply a cool compress to your knee and hold it over the injured area for 15-20 minutes every hour for the next 3-4 hours.
3 If the pain is not severe enough to immediately go to the trauma center, ask your family doctor for a referral to a traumatologist. Make an appointment!
1 It should be expected that the traumatologist will order magnetic resonance imaging to accurately diagnose the rupture site.
2 Prepare for surgery.
Physiotherapy
Physiotherapy after surgery to repair a torn meniscus is an integral part of treatment. For everyone! If the leg is not loaded after surgery, the thigh muscles will become weak and soft. In order to prevent muscle weakness and the resulting feeling of instability, it is important to strengthen the thigh muscles, lower leg muscles and ligamentous 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, because all this affects the condition of the meniscus and the load placed on it. You should come to physiotherapy sessions three times a week. The exercises are gentle in the first month, but in the following months you should increasingly try to strengthen the leg muscles. It is not easy for unsportsmanlike people to put up with such a regime worthy of army life for several months, but all exercises must be performed accurately and regularly. Only if the muscles are in good tone will the joint not be overloaded.
Return to sports
After three months. The biggest challenge is figuring out how soon you can wear sneakers again after meniscus surgery. About three months after surgery, a person usually feels well enough to gradually resume playing sports. The load should be increased slowly and gradually. Swimming and cycling are safe, but running should be resumed 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 sports fields, treadmills and forest trails.
When exercising, you should use an orthosis if necessary. The orthosis helps relieve the pressure on the knee joint.
In middle age, more gentle activities should be preferred. While in young people the scar heals quickly and complications are rare after proper treatment, Una Kalnīte recommends that middle-aged people consider seeking the joy of life by Nordic walking, going for long walks, swimming, cross-country skiing, or cycling.
You should never forget about warm-up, cool-down, and stretching exercises. After meniscus surgery, the risk of rupture is 20-30% higher than if the meniscus was healthy. However, there is no need to be afraid! Sports enthusiasts 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.
JOINT
Healthy meniscus
Crucifix - 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. -Since the bones are no longer protected from contact by the removed meniscus, their wear is faster. It takes 10-20 years for the bones to become noticeably deformed.
If the meniscus is sutured
- Expect an average of six months of rehabilitation.
+ Although there is a risk that the meniscus injury may recur, the bones will still be protected from friction, and therefore premature wear.
Two stories about returning to sports after injury
Agris Samcovs (38 years old), logistics specialist:
"I tore my meniscus two and a half years ago. I went to the river and climbed onto the footbridge to wash the sand off my feet. I didn't sit down, but instead, leaning on one leg, squatted down to dip my other leg into the water. The joint couldn't handle the load, and I was already limping away from the river. The pain and discomfort didn't go away, so a week later I went to a traumatologist, who ordered an X-ray. Since the X-ray couldn't show the injury, they ordered an ultrasound, which also couldn't see anything clearly. Finally, the MRI clearly showed a torn meniscus. The doctor immediately said that I would need surgery. I had to wait a few months for that, but then they removed the torn piece of meniscus from my knee joint. After the surgery, I did exercises on my own for a couple of months, went swimming, but now I only feel the effects of the torn meniscus when I squat on the injured leg. Otherwise, nothing prevents me from walking or running. I run more than 200 kilometers every month and am now preparing for the Lattelecom Riga Marathon."
Alise Schulz (23 years old), photographer:
"I just turned 18, I was in 12th grade, and it was the last gym class of the school year. I had to do triple jump and long jump exercises. I jumped, bounced back, fell into a hole and realized that I had landed on my leg the wrong way - my knee had turned. At the hospital, they said that I had sprained my ligaments and put a cast on it. My leg was in a cast for two weeks, but it didn't get any better - my temperature rose, I felt unwell, until, with the support of my parents, I decided to go to the Diagnostic Center in Riga, where an MRI revealed a torn cruciate ligament and meniscus, and now also bone inflammation, which had occurred due to the unnecessarily applied cast. Until then, I limped and moved carefully to protect myself from pain. "After an elective surgery, in which my meniscus was stitched and my cruciate ligaments were connected with implants, I walked with crutches for three weeks, and then went to physiotherapy 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 ski jumps with a snowboard."
Original article: Gundega Kārkliņa Health
