Knee operations are usually not difficult for either specialists or patients. But it also happens that the consequences of removing the meniscus of the knee joint bother the operated person for a long time. It is necessary to consider what explains these unpleasant phenomena.
One of the main consequences of the operation is knee pain. Its manifestations are largely explained by the type of surgical intervention that was used to treat the joint. Today, there are 2 types of meniscus removal operations. These are arthroscopy and arthrotomy.
The first is a minimally invasive procedure in which surgical instruments and an arthroscope are inserted into the knee joint through several punctures in the skin and tissue.
The second operation is open and requires complete tissue dissection. At the end of the manipulation, surgeons apply sutures, which contributes to swelling of the affected area. Arthrotomy is characterized by a long rehabilitation period, during which the patient may experience intense pain. With arthroscopy, unpleasant symptoms are less pronounced.
What to do if your knee hurts after meniscus surgery? First of all, you need to inform your doctor about the deterioration of your condition. Unpleasant sensations can be relieved with the help of antibiotics and painkillers. Each drug must be selected strictly by a specialist, taking into account the severity of the patient’s injury and his body’s individual tolerance of the constituent medications. Possible side effects and contraindications of medications must be taken into account.
There is a simple and affordable method that will help reduce leg pain after meniscus removal. You need to freeze a bag of water in the refrigerator and apply ice to the raised limb. Other cold objects can be used for the same purpose. If the pain does not go away for a long time, you should see a doctor: this condition may be a symptom of developing postoperative complications.
One of them is post-traumatic arthrosis. It is uncommon, but still occurs after meniscal arthroscopy. The cause of the pathology is scars that appear on the dissected tissues. They interfere with blood circulation in the operated joint, which over time leads to a violation of the congruence (compliance) of the surface of the bone elements.
Often the cause of pain is an inflammatory process caused by some irritant. These are divided into 3 types:
In the first case, the condition develops due to the presence of foreign bodies remaining in the knee where the meniscus was removed. These are parts of cartilage, bones, etc. The other two involve the body's immune system and the penetration of infectious agents into the wound.
The purulent-inflammatory process is recognized as the most dangerous postoperative condition. It can occur either immediately after the intervention or after 2–2.5 months of the rehabilitation period. The main symptoms of inflammation are increased body temperature (more than 38°C), severe pain, and redness of the injured area. Swelling develops, which prevents the person from using the limb.
Treatment is prescribed by a doctor after diagnostic procedures and determination of the condition.
A symptom of complications after meniscus removal is the accumulation of synovial fluid in the knee. Normally, this substance serves to lubricate cartilage and bone elements. But under the influence of injury during surgery or inflammation, too much of it is produced, which leads to negative consequences.
The following signs indicate that excess fluid is accumulating in the joint:
The nature of the pain that occurs with synovitis depends on the form of the pathology. In acute cases, the pain is throbbing and prevents the person from moving. The disease in its chronic form is almost not accompanied by pain; discomfort can occur occasionally and be moderate.
If synovitis is characterized by suppuration, then the person is accompanied by a feeling that the knee is bursting from the inside. It occurs not only during movement, but also at rest.
Synovitis is divided into 2 types and can be serous or purulent. After tissue resection, as a rule, the second one develops. It is characterized by the presence in the bursa (synovial bursa) of a large amount of exudate with inclusions of blood and pus.
If left untreated, such a postoperative complication can lead to rupture of the joint capsule and subsequent infection of the bone and cartilaginous elements. And this, in turn, leads to knee deformation and sepsis.
The doctor determines treatment methods after conducting a number of diagnostic procedures, including:
In some cases, aspiration is prescribed - pumping out exudate from the sore knee - to carry out analysis and determine the composition of the fluid.
The complication is mainly treated with drug therapy, but in particularly serious situations the patient again has to lie down on the operating table. Under local anesthesia, the exudate is pumped out and antibiotics or corticosteroids are administered, the purpose of which is to relieve inflammation in the knee joint.
Removal of the meniscus rarely leads to the development of serious complications, but despite this, the person operated on must strictly follow the doctor’s recommendations and not put too much strain on the diseased joint during the rehabilitation period.
Knee replacement is an effective method of restoring the functionality of a damaged part of the musculoskeletal system. Proper operation minimizes complications and ensures restoration of joint mobility by 96–98%. Even 15 years after surgery, the functionality of the limb is preserved by 85–90%.
Before installing an artificial joint, an in-depth examination of the patient is required, identification of contraindications, and study of possible risks. Information about knee replacement and the stage of rehabilitation after surgery will be useful to many categories of patients.
The operation to implant an endoprosthesis is carried out in cases of severe damage to the cartilage tissue and articular heads. For each type of pathology, there are certain stages at which therapeutic effects are ineffective and surgical methods of treatment are required.
Endoprosthetics will help the patient in the following cases:
There are not many restrictions on the operation, but some problems and conditions completely exclude surgical treatment for lesions of the knee joint. The sooner the patient applies for examination and treatment, the lower the risk of destruction of cartilage tissue, the less likely it is to undergo surgical intervention.
Find out what the meniscus of the knee joint is, its structural features and its physiological functions.
Read the instructions for using Movalis injections for joint pathologies on this page.
It is important to know the absolute contraindications:
The patient must follow all the doctor's instructions. Surgery on the knee joint is carried out after a complete examination, tests, clarification of the clinical picture, and identification of indications for implantation of an artificial joint.
The speed of recovery largely depends on the exact implementation of the doctor’s recommendations and the prevention of traumatic situations. On average, restoration of mobility and return to a full life takes up to four months, sometimes more. Complications often disrupt the rehabilitation schedule.
The main elements of rehabilitation after knee replacement:
The main task is to strengthen the muscles, restore normal range of motion, and completely restore the functionality of the knee joint. The doctor will describe the actions for the patient during different periods of rehabilitation.
Find out more about the causes of inflammation of the joints of the fingers and how to treat the pathology.
Treatment options for grade 3 coxarthrosis of the hip joint with folk remedies are described on this page.
Go to http://vseosustavah.com/travmy/rastyazheniya/svyazok-golenostopa.html and read about the signs and symptoms of an ankle sprain.
The rehabilitation period after knee replacement is not only exercise therapy, training on exercise machines, and measured load on the joint. A prerequisite for healing a wound and preventing inflammation is taking certain medications.
An integrated approach is important: the doctor prescribes antibiotics, non-steroidal anti-inflammatory compounds, and vitamin complexes. B vitamins help restore neurohumoral regulation, and muscle relaxants help ease muscle spasms. Angioprotectors improve blood circulation and supply tissues with useful substances. Chondroprotectors are indispensable when restoring areas of remaining cartilage.
Examining the patient, studying contraindications, identifying chronic pathologies, taking tests and samples reduces risks. No doctor can give a 100% guarantee that the operation will be perfect.
Sometimes complications arise in a later rehabilitation period if the patient systematically violates the rules of conduct, skips classes, or lifts weights. Some people start smoking again, drinking alcohol, do not follow the rules of getting up and down, and are on their feet for a long time.
Overload and poor lifestyle over time lead to complications that are difficult to cope with even for experienced rehabilitators. Patient discipline is a prerequisite for recovery.
Immediately after and during surgery, problems sometimes arise:
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The menisci in the knee joint are two additional layers of cartilage between the areas of the femur and the head of the tibia pressed against each other. They are necessary to absorb shocks and reduce contact stress. With their help, the loads falling on the joint elements are distributed, protecting them from damage.
The menisci limit the range of motion and stabilize the knee joint. Therefore, after a rupture, repair of the meniscus helps stop the destruction of cartilage, prevent arthrosis and maintain knee function.
The choice of treatment methods is influenced by:
Less than ten years ago, recovery from surgery and conservative therapy were carried out with the application of a plaster cast. As a result of complete immobilization, processes arose in the cartilage that led to the rapid development of arthrosis. The strength of the muscle that supported the joint was also lost. Because of this, when movement is restored, and even more so training, meniscal tears may again occur in the joint.
In order for the cartilage to heal on its own, it is necessary to reduce the load for several weeks.
For this purpose, it is sufficient to wear an elastic habit or wear an orthosis that does not allow excessive flexion or hyperextension. It is advisable to avoid relying on the affected joint in the first week. Sports training should be canceled for several weeks This is required to maintain joint stability. Use various techniques: magnetic and laser therapy, heat therapy, electrical myostimulation, the use of medications that accelerate healing and improve nutrition of joint structures.
Complete removal of the damaged cartilage through a large incision was considered the main method of treatment at the dawn of the development of orthopedics and traumatology. Thus, the blockade of movements and pain syndrome were eliminated. But many years later, analysis showed that in most patients the operation did not lead to recovery. Complaints of limited movements and pain persisted, and arthrosis and arthritis developed. Therefore, today menisci are removed extremely rarely.
Meniscectomy has been replaced by arthroscopy, that is, partial surgical intervention:
This technique allows to minimize surgical complications and maintain joint mobility in most patients. Recovery after knee arthroscopy:
After knee surgery, various complications are possible. But the frequency of their occurrence is low. Thrombosis, infections, and thromboembolism occur more often when veins and arteries become clogged. In such cases, you should immediately seek medical help:
Purpose: Complications during knee replacement - study and analysis.
Materials and methods: the results of treatment of 885 patients who underwent knee replacement between 2003 and 2013 were analyzed. There were 684 (77.29%) women, 201 (22.71%) men. The age range is from 19 to 82 years, with an average age of 61.68 years.
Results: in the immediate and late postoperative period, complications were recorded in 10 patients (1.13%): 1 (0.11%) - persistent contracture, 3 (0.34%) deep suppuration, 1 (0.11%) - aseptic instability, 2 (0.23%) - persistent arthralgia, 3 (0.34%) non-fatal PE. Venous thromboembolic complications were recorded in 87 (9.83%) patients, hemorrhagic complications - in 18 (2.03%) patients.
Conclusions: during the treatment of patients, it was possible to obtain good anatomical, radiological and functional results in 96.38% of patients during the first year.
Alabut Anna Vladimirovna
Alabut Anna Vladimirovna Head of the Department of Traumatology and Orthopedics of the Rostov State Medical University Clinic, Candidate of Medical Sciences, Associate Professor of the Department of Traumatology and Orthopedics
Sikilinda Vladimir Danilovich
Sikilinda Vladimir Danilovich, Professor , Doctor of Medical Sciences, Head of the Department of Traumatology and Orthopedics, Rostov State Medical University, Vice-President of the All-Russian Association of Traumatologists and Orthopedists of the Southern Federal District
Despite the introduction of new technologies, complications during knee replacement and unsatisfactory results are quite common and amount to 3.3–13.2%. The incidence of surgical site infection during primary knee arthroplasty ranges from 0.5 to 3.5%, and during repeated operations reaches 3.2% and 5.6% [1, 2]. The incidence of complications such as periarticular pain, aseptic instability, and contracture can reach 3-12% [3]. The incidence of deep vein thrombosis after knee replacement ranges from 41 to 88%, proximal thrombosis is recorded in 5-22% of patients, pulmonary embolism without thromboprophylaxis occurs in 1.5-10% of patients, fatal cases of pulmonary embolism are recorded in 0.1-1 .7% of patients [4, 5].
In 1982, McElwaine JP first reported 7 cases of stress fractures of the proximal femur 3-16 months after total knee arthroplasty in a group of 500 operated patients. Subsequently, publications on stress fractures began to appear regularly [6, 7, 8]. According to the authors, stress fractures have multiple etiologies. Local and systemic osteoporosis diagnosed in patients, steroid therapy, increased muscle activity and pressure on the femoral neck in patients who limit mobility before surgery due to severe pain are important. The surgical technique is important when, when installing the femoral component, impact forces are transferred to the neck and lead to microfractures. With the expansion of motor activity, the fractures become complete.
The purpose of the study was to analyze complications of total knee replacement.
Materials and methods for analyzing complications.
The results of treatment of 885 patients who underwent knee replacement were analyzed in the Department of Traumatology and Orthopedics of the Yugoslav Medical Center, the Traumatology and Orthopedic Department of the Rostov State Medical University clinic and the bases of the Department of Traumatology and Orthopedics of the Rostov State Medical University in the period from 2003 to 2013. There were 684 (77.29%) women, 201 (22.71%) men. The age range is from 19 to 82 years, with an average age of 61.68 years.
The structure of patients was dominated by patients with primary - 665 (75.14%) and post-traumatic 160 (18.08%) arthrosis of stage III-IV (according to Kellgren I., Lawrence I., 1957), in second place were patients with rheumatoid arthritis - 48 (5.43%) people, less often endoprosthesis replacement was required for chronic osteomyelitis - 4 (0.45%), benign and malignant tumors - 8 (0.90%) patients.
In order to prevent and identify venous thromboembolic complications, 7-10 days after surgery, patients underwent a triplex study of the veins of the lower extremities. Diagnosis of osteoporosis was carried out on the basis of an assessment of risk factors for osteoporosis and an osteodensitometric study.
X-ray assessment of the results of knee replacement was performed according to the EC Ewald scale (1989) as modified by O.A. Kudinov et al (2005). X-rays were taken in direct and lateral projections from the hip to the ankle joint, centered on the knee joint.
In the immediate and long-term postoperative period, the following complications during knee replacement were recorded in 10 patients (1.13%), table. 1.
The nature of complications after knee replacement
One patient developed persistent contracture of the right knee joint in the postoperative period.
Clinical example. Patient G., 57 years old, medical history No. 5587, was hospitalized in the department due to post-traumatic gonarthrosis of the right knee joint of clinical and radiological stage 3 according to Kosinskaya, a healed fracture of the external condyle of the right tibia in conditions of cortical metal osteosynthesis with two screws, aseptic necrosis of the external condyle, a stand mixed contracture of the right knee joint. The patient underwent removal of the metal structure and total arthroplasty of the right knee joint. The range of motion after surgery is 90°, flexion 90°, extension 180°. 4 months after the operation, the patient complained of limited movement in the right knee joint: flexion 100°, extension 165°, amplitude 65°. The patient underwent redressing of the right knee joint, and the range of motion was restored to 90°. Due to non-compliance with recommendations during the rehabilitation period, the patient was unable to maintain an optimal range of motion. At a follow-up examination after 7 years, the patient showed no signs of instability of the endoprosthesis. Range of motion in the knee joint is 70°, extension 170°, flexion 100°. The patient assesses her range of motion as sufficient and refused the proposed surgical treatment. Figure 1 shows radiographs of the patient after surgery. 7 years after knee replacement, pronounced ossification of the periarticular tissues is detected.
Rice. 1. Radiographs of patient a – 4 months after surgery
Rice. 1. Radiographs of patient b – 7 years after surgery
Three patients had deep infection. One patient developed a paraendoprosthetic acute postoperative infection according to Coventry-Fitzgerald. The second patient has an exogenous acute postoperative infection. The third patient has late chronic infection. In all patients, debridement of the postoperative wound and attempts to preserve the endoprosthesis were unsuccessful; the metal structure was removed.
Clinical example. Patient K., 68 years old, medical history No. 001792, No. 008995, No. 010533, No. 012564, No. 013448, No. 014097, No. 018967, No. 023756, No. 038616, No. 039490 was operated on for bilateral gonarthrosis of the 3rd clinical-radiological stage according to Kosinskaya. The patient underwent total arthroplasty of the left knee joint. 2 months after the operation, while getting out of the car, the patient hit the operated knee joint against the door. After the impact, a hematoma formed. As a result of a late visit to a medical facility, 3 weeks after the injury, a hematoma suppurated. The patient underwent active drainage of a festering hematoma using supply and flushing systems. S. aureus was isolated from wound culture. Due to the ineffectiveness of antibacterial therapy and sanitation measures, 6 months after endoprosthetics, the endoprosthesis was removed and arthrodesis of the left knee joint was performed using an external fixation device. The supply and flushing system operated for 3 weeks. After three times negative culture of rinsing water from the wound, the supply-irrigating system was removed. After 6 months, the external fixation device was removed. There were no relapses of inflammation within 2 years after the infection was stopped. In this regard, in November 2012, the patient underwent revision arthroplasty of the left knee joint using a Mati endoprosthesis. 4.5 months after revision knee arthroplasty, the patient still has an active extension deficit of 10 degrees due to weakness of the quadriceps femoris muscle; passive extension is complete. Active flexion 95 degrees, passive flexion 85 degrees. The patient continues rehabilitation treatment.
In one 72-year-old patient, bone lysis around the tibial component occurred due to progression of osteoporosis, resulting in aseptic instability of the endoprosthesis. The patient underwent revision arthroplasty.
Two patients had persistent arthralgia of the knee joint without signs of aseptic loosening and conflict of the patella. Both patients underwent revision of the knee joint cavity with tissue release, in one case through arthrotomy, in the second - arthroscopically.
In 1 patient, 68 years old, 10 months after knee replacement due to postmenopausal osteoporosis, a fracture of the proximal femur on the side of the operation occurred.
Venous thromboembolic complications. In 12 (1.36%) patients, floating thrombi were detected in the tibiopopliteal segment, in 7 (0.79%) there was thrombosis of the femoral vein. All patients required emergency surgery. Thrombectomy and plication of the superficial femoral vein were performed. Thromboembolism of small branches of the pulmonary artery developed in three (0.34%) patients in the first six days after surgery. Timely intensive therapy avoided fatal complications. In 24 (2.71%) patients, clinically significant deep vein thrombosis developed during the first month after surgery and required hospitalization. Non-embolic asymptomatic deep vein thrombosis of the leg was diagnosed in 41 (4.63%) patients as an accidental finding during a control ultrasound examination 2.5-3 months after surgery.
All patients received anticoagulation therapy according to industry standard. During anticoagulant therapy, 18 (2.03%) patients developed hemorrhagic complications. Three patients (0.34%) were diagnosed with major bleeding from the gastrointestinal tract.
In the preoperative period, when performing videogastroduodenoscopy, no ulcers and erosions of the stomach and duodenum were detected in patients. In the postoperative period, on days 4-5, against the background of anticoagulant therapy, patients developed an acute stress ulcer of the antrum of the stomach with massive gastrointestinal bleeding, melena, “coffee ground” vomiting. A decrease in the hemoglobin level in patients occurred below 75 g/l, which required transfusion of donor blood products.
15 (1.69%) patients developed minor bleeding: one (0.11%) - from hemorrhoids, 4 (0.45%) - uterine bleeding, 7 (0.79%) - nosebleeds, three (0.34%) patients developed hemarthrosis. In 1 patient, during long-term anticoagulant therapy after endoprosthetics and for chronic heart failure, recurrent hemarthrosis developed, requiring arthroscopic ablation (Fig. 2).
Rice. 2. Hematoma and hemarthrosis in a patient after knee replacement during long-term anticoagulant therapy
Complications during knee replacement require careful adjustment.
Forecasting, drug and non-drug prevention of infectious complications in the area of surgical intervention allowed us to obtain a minimum number of 3 (0.34%) purulent-septic complications.
Comprehensive diagnostics, drug prevention of decreased bone mineral density and treatment of osteoporosis made it possible to reduce the risks of early instability of the endoprosthesis in patients undergoing arthroplasty.
Specific and nonspecific prevention of venous thromboembolic complications, adequate in dose and duration, and the use of modern tableted anticoagulants have reduced the risk of developing thrombosis. Performing a control ultrasound examination of the veins of the lower extremities in patients 5-7 days after endoprosthetics surgery helped to avoid fatal pulmonary embolism.
Thoughtful complex therapy of the patient’s comorbid conditions made it possible to reduce the number of complications associated with exacerbation of concomitant diseases. The choice of surgical tactics made it possible to reduce the trauma of surgical intervention and obtain good anatomical, radiological and functional results in 96.38% of patients.
For meniscal injuries, various treatments are prescribed, which depend on the stage of development of the disease. In case of severe injuries, or due to the lack of results of traditional treatment, removal of the meniscus of the knee joint is prescribed, and the presence of consequences after surgery depends on the rehabilitation period.
To understand the possible consequences of a torn meniscus in the knee, you need to know the purpose of this inner part of the knee.
The meniscus is a cartilage plate that performs special functions:
Each knee is equipped with two menisci (internal and external). The outer (lateral) meniscus is fixed more freely in relation to the articular parts, and therefore is rarely subject to injury.
Damage occurs mainly to the medial (inner) knee shock absorber, due to the rigid fixation to the tibia.
Not all meniscus injuries result in surgical procedures. Damage can occur independently, or it can be caused by certain provoking factors.
Meniscus injuries include:
The most dangerous injury to the meniscus of the knee joint is considered to be its tear, and the consequences of late seeking medical help can be the most serious:
The following methods of knee meniscus surgery are distinguished:
Arthroscopy is considered the most effective method of surgical intervention, and at the same time the least traumatic.
Surgery to remove the meniscus of the knee joint can be complicated by consequences. This happens due to a sharp increase in joint load, and the subsequent course of arthrosis or arthritis of the knee joint.
Complete resection of a damaged meniscus is rarely performed. If the meniscus is removed, the consequences may overshadow the entire effect of surgical manipulations.
When an operation is performed with sutures, a postoperative consequence such as re-rupture of the meniscus is possible.
The sooner treatment begins, the greater the opportunity to avoid surgery and further unwanted complications.
Next, we will tell you in more detail about the possible consequences during the recovery process.
The rehabilitation period after meniscus surgery depends on the severity of the injury, the type of surgical intervention, and will be individual for each patient.
The following complications are possible after surgical procedures:
The listed complications are possible, but they do not happen often.
To restore motor activity, it is necessary to adhere to medical prescriptions in the postoperative period on the meniscus of the knee joint. When the cartilage plate is removed, you need to take care of the limb for a week, avoiding stress. To move around, it is recommended to use crutches to reduce the load and because a splint is placed on the limb.
Performing special gymnastics to recover from a meniscus injury begins on the second day after surgery. Specific classes are selected for each patient.
Regardless of the method of surgery on the meniscus of the knee joint, traditional treatment is necessarily prescribed in the postoperative period. To exclude postoperative pathologies, anti-inflammatory medications are prescribed, which simultaneously eliminate swelling and normalize blood flow. In the first days after the operation, painkillers are prescribed.
It is necessary to follow the following basic rules for the rehabilitation and restoration of the meniscus after a rupture and surgery:
If resection of the meniscus of the knee joint is performed, recovery after surgery lasts longer compared to arthroscopy. It happens that the body does not accept the implant and rejects the foreign body. To exclude such a serious complication, the patient’s well-being is monitored by a doctor. Light exercise is allowed no earlier than 6 weeks after surgery.
For professional athletes who have suffered a knee injury and subsequently undergone surgery, a special recovery technique has been developed. Rehabilitation activities are aimed at developing individual muscle groups. Specially designed exercises are used for this purpose.
The operation using arthroscopy is a modern and gentle method of partial resection of the meniscus. The essence of the manipulation lies in the following surgical points:
During the recovery time after arthroscopy, you must adhere to the following rules:
During the entire rehabilitation period, it is necessary to follow medical prescriptions. Usually massage sessions, physiotherapy courses, and special physical education are prescribed. To restore joint tissue, a course of medications is prescribed.
In the first postoperative days, any movement is carried out only with crutches. Small, partial loads are allowed after a month.
Normal, everyday exercise is allowed at week 5.
Anyone can get injured in the knee. But, if you take basic care and take preventive measures, you can avoid injuries.
If you engage in professional sports, you must definitely use special fixing knee pads that protect the knee from impact and prevent injuries when falling.
In normal, everyday life, it is recommended to wear comfortable shoes to keep your feet comfortable.
Moderate physical activity is required. Among sports activities, it is better to give preference to such as cycling, race walking, jogging. With such sports activities, the knee joint will be strengthened, and the likelihood of injury will be minimal.
With increased physical activity, there is always a possibility of damage to the knee joint.
Have you ever experienced unbearable joint pain or constant back pain? Judging by the fact that you are reading this article, you are already familiar with them personally. And, of course, you know firsthand what it is:
Now answer the question: are you satisfied with this? Can such pain be tolerated? How much money have you already spent on ineffective treatment? That's right - it's time to end this! Do you agree? That is why we decided to publish an exclusive interview in which the secrets of getting rid of joint and back pain are revealed. Read more.
Becker's hernia of the knee joint has several names - grumbling of the knee fossa, Becker's cyst. It manifests itself in the form of a painful protrusion in the area of the popliteal fossa, and the main reasons for its appearance are the inflammatory process in the knee joint (arthritis), degenerative-dystrophic or traumatic changes. This pathology received its name from the name of Dr. W. Baker, who described this disease back in the 19th century.
The diameter of a knee joint hernia can vary from a few millimeters to 3 centimeters. In this case, the cyst manifests itself clinically in cases when it begins to put pressure on the surrounding tissues and the neurovascular bundle in the popliteal fossa. Most often, this pathology occurs in preschool children and adults over 35 years of age.
Becker's cyst is a unilateral disease, but there have been cases where this pathology affected both knees.
The anatomy of a Becker cyst is determined by the structural features of the knee joint. In half of people, there is an intertendinous bursa between the gastrocnemius and semimembranosus tendons (on the back of the joint). Its presence is considered a variant of the norm. When an inflammatory process occurs in a joint or when it is traumatically damaged, synovial (intra-articular) fluid can enter the intertendon bursa, stretching it. This creates a rounded formation (hernia), which, increasing in size, compresses the surrounding soft tissue, causing pain and discomfort.
A small cyst in some cases can be completely asymptomatic. It is also difficult to detect upon careful examination. Clinically, a popliteal hernia appears only when it reaches a significant diameter. In this case, there is pain or discomfort in the knee area, which intensifies when bending the leg. Visually and palpation can identify a round, sometimes painful tumor-like formation in the popliteal fossa.
Sometimes a knee joint cyst develops against the background of an existing pathology, for example, with osteoarthritis, rheumatoid arthritis, or a meniscus tear. In such cases we are talking about a secondary Becker cyst.
The rate of progression of this disease may vary. Sometimes it does not increase in size for several months or even years, and in some cases it is generally prone to healing on its own.
The diagnosis of Becker's hernia can only be made by an orthopedist or traumatologist, assessing the patient's complaints, as well as based on the results of the examination. Instrumental diagnostic methods include ultrasound and MRI of the knee joint, which allow visualization of pathological formations in it.
When planning surgical intervention, as well as in the most difficult cases, diagnostic arthroscopy of the knee joint can be performed. This is a minimally invasive diagnostic method, which is performed using a thin probe and camera, which allows you to examine the condition of the articular surfaces and soft tissues, and evaluate the anatomy of the joint.
The choice of treatment method for Becker cyst depends on the size of the formation, symptom complex, as well as the presence and severity of concomitant diseases. Nonsteroidal anti-inflammatory drugs are used as conservative therapy to reduce pain and tissue swelling. An important step is the treatment of the underlying joint disease - rheumatoid arthritis or osteoarthritis.
In some cases, puncture is used to treat a cyst. During this manipulation, the hernia is pierced with a needle, after which all the fluid from the pathological formation is aspirated. Then a corticosteroid drug is injected into the cavity of the cyst, which promotes gluing of the walls of the bag. Puncture is usually used for large hernias, the presence of which is accompanied by significant pain.
If it is not possible to achieve an analgesic effect with the help of non-steroidal anti-inflammatory drugs, the cyst is injected with prednisolone drugs. However, the results of such treatment may be short-lived.
Physiotherapeutic methods have also gained wide popularity in the treatment of knee hernias, the regular use of which can lead to significant relief of the patient’s condition and long-term remission. Pulsed electromagnetic radiation, bioresonance therapy, and electrophoresis are used.
As part of conservative therapy, patients with a hernia of the knee joint are often prescribed therapeutic exercises. Exercises are selected in such a way as to strengthen the muscles and the knee joint itself. They are especially effective if the cause of the development of the cyst is arthritis of the knee joint.
Folk remedies are also used to treat Becker cysts. Tinctures and compresses made from celandine, burdock or golden mustache can reduce pain and relieve tissue swelling.
Surgical treatment of Becker's hernia is used in cases where the cause of the disease is injury (for example, a torn meniscus). Since in this case the popliteal fossa cyst is secondary, it will not be possible to eliminate it using conservative methods. Surgical methods are also used in situations where the hernia is significant, pain is severe, or conservative treatment methods have proven ineffective.
The operation is performed under local anesthesia. A small incision is made above the cyst, through which a tumor-like formation is isolated, and the junction of the tendon bursa and the knee joint is sutured, bandaged, after which the cyst is cut off. The modern method of hernia removal is arthroscopic. It is performed using special optical surgical instruments, does not require wide access and is a minimally invasive technique, allowing to significantly reduce the trauma of surgical intervention.
The most common complication of a Becker cyst is the leakage of joint fluid into the surrounding soft tissue. Accumulating on the back of the lower leg, it can cause swelling, irritation and pain. This symptom complex often imitates thrombophlebitis, and sometimes is combined with it. In such cases, it is important to carry out a differential diagnosis of these conditions.
A hernia of significant size, squeezing large deep veins, can lead to stagnation of blood, the appearance of phlebitis and the formation of blood clots. Can also be given to the right hand. The most dangerous consequence of this condition is PE (pulmonary embolism), when a blood clot, forming in a vein of the lower limb, breaks away from the vessel wall and is carried through the bloodstream into the pulmonary artery, blocking its lumen.
If the cyst compresses large vessels, muscles and nerves (which happens extremely rarely), a violation of the metabolic processes of soft tissues (trophic ulcers, necrosis or osteomyelitis) may be observed in the lower limb.