Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MSK 1 > 11/8 - Articular Cartilage Lesions > Flashcards

11/8 - Articular Cartilage Lesions Flashcards

1
Q

OA vs articular cartilage lesions

A

OA - larger, broader scale of damage

articular cartilage lesions more localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are 2 functions of articular cartilage

A
  1. provides low friction wt bearing surface (low coefficient of friction)
  2. absorbs shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what does it mean that articular cartilage is aneural and avascular

A

lacks inflammatory phase
minimal ability to repair/regen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

role of chondrocytes

A

orchestrate matrix balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the tidemark in cartilage

A

junction of calcified articular cartilage w subchondral bone
- aka transition from cartilage to bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe lesion classification of articular cartilage

A

type 1 = softening
type 2 = fibrillation
- superficial damage
type 3 = fissuring to bone
type 4 = full thickness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how to dx a type 1 articular cartilage lesion

A

via arthroscopy and probe surface to detect softening

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MOI of articular cartilage defects is similar to what other injuries

A

meniscal tears
ligamentous injuries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

why are XRs used as diagnostic imaging in articular cartilage lesions

A

can’t appreciate cartilage damage

looking to see where bone is taking more load than should be (whiter area = bony edema)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is an important view to take XR from for articular cartilage damage

A

in a WBing view
- look at space b/w femur and tib -> can estimate amt of cartilage between

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what diagnostic imaging can appreciate the cartilage defect

A

CT scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

size classification of articular cartilage lesions

A

small <2cm
mod 2-10cm
large >10cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what relationship does the size of the defect have w the surgical procedure

A

bigger it is = worse it is = more challenging the procedure

depending on size makes surgeries more or less appropriate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is a consideration when measuring the size of the lesion

A

lesions are larger than they seem
- once you debride all unhealthy tissue there is a greater area underneath

could see this on an MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are 7 non-surgical options for articular cartilage lesions

A

NSAIDs
glucosamine/chondroitin sulfate
cosamin DS
viscosupplementation
bracing
orthotic therapy
exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the purpose of taking glucosamine / chondroitin sulfate

A

building blocks of articular cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the purpose of taking cosamin DS / osteobioflex

A

components of articular cartilage
- does NOT form NEW cartilage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is viscosupplementation and what is the duration

A

hyaluronic acid injections
6-12mo pain relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what cases are unloader braces helpful in

A

isolated lesions on one side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the purpose of bracing in articular cartilage lesions

A

change mechanical stresses at impacted knee compartment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is the purpose of orthotic therapy in articular cartilage lesions

A

change axis of stress at joint
- ex: wedge in shoe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

with articular cartilage lesions what is the goal of exercises

A

ms that act to absorb shock
provide normal environment around knee

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what are 4 surgical options for articular cartilage lesions

A

bone marrow stim
osteochondral transplantation
cellular therapy
matrices/scaffolds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is bone marrow stimulation

A

abrasion, drilling, micro fx
- create bleeding environment to facilitate fibrocartilage growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what are osteochondral transplantation options for articular cartilage lesions

A

autologous:
- OATS
- mosaicplasty

allograft

26
Q

what is cellular therapy in articular cartilage lesions

A

autologous - MACI

27
Q

what is the purpose of matrices and scaffolds in articular cartilage lesions

A

preserve cartilage and protect it

28
Q

what can dictate healing potential from an articular cartilage lesion and what is the significance of someone’s healing potential

A

declines w age
depends on comorbidities:
- DM, smoke, drink

all this factors into if they are a better or worse candidate for surgery

29
Q

why does the location of the articular cartilage lesion matter

A

plays a role in degree of motion that engages with the lesion and creates sx

30
Q

what is arthroscopic debridement / chondroplasty

A

remove loose fragments to dec irritation and dec pain

31
Q

incidence of chondroplasty procedures

A

not done often any more

32
Q

what pt is chondroplasty optimal in

A

if low demands on knee

33
Q

fibrocartilage replacement of hyaline cartilage defects?

A

fibrocartilage isn’t as strong or desirable
- but better than no cartilage

34
Q

how does microfracture work as a surgical procedure

A

stim marrow stem cells
- create fibrin clot -> fibrocartilage growth

35
Q

collagen consistency in hyaline vs fibrocartilage

A

hyaline: types II, IX, XI
- organized fiber orientation
- organization allows to be stronger and more resilient to compressive and shear forces

fibro: type I
- unorganized fiber orientation

36
Q

is hyaline or fibrous cartilage stiffer

A

hyaline 2x stiffer than fibrous

37
Q

what are 4 advantages of microfracture

A
  1. single stage procedure
  2. ease of procedure
  3. cost effective
  4. doesn’t “burn any bridges”
    - if fails, though that could go back in and do another procedure but not necessarily the case
38
Q

what are 2 disadvantages of microfracture

A

final product is fibrocartilage
- limited durability

inferior results in lesions >4cm (size matters lol)

39
Q

what are 4 success criteria in microfracture

A
  1. young patient (<35-40)
  2. small area
    - <2cm, contained
  3. less WBing surface
  4. BMI <25
40
Q

articular cartilage lesion that is contained vs shouldering

A

contained
- smaller
- not a tone of load at subchondral bone

shouldering
- margins further away
- load directly onto bone

41
Q

ant vs post location of articular cartilage lesion and WBing

A

post - less WB surface
- only when in deep flex

ant - loading when standing up straight

42
Q

what is a consideration of the rehab process for microfracture when thinking ab pt goals

A

not a short process
- esp if have someone trying to get back to sports

43
Q

after microfracture when does cartilage reach full maturation

A

6-12mo

44
Q

what does WBing precautions after microfracture depend on

A

location and size of lesion

fem condyle (ant)
- FWB delayed to ~8wks

patellar/trochlear (post)
- WBAT in hinged brace w 10deg flex stop

45
Q

return to high impact activity after microfracture

A

up to 8mo for large lesions
4-6mo in small lesions

46
Q

what is the key to rehabing a microfracture

A

create healing environment without overloading healing tissue

47
Q

goals for proliferation phase of microfracture rehab (3)

A

promote healing environment
control pain and swelling
work on PROM

48
Q

what are the goals of the transition/remodelling phase of microfracture rehab (2)

A
  1. good ROM, work on strengthening (quads)
  2. inc functional activity
    - weaning away from AD and bracing to more WBing
49
Q

what is the goal of maturation phase of microfracture rehab

A

deliberate return to sport

50
Q

what is the criteria for progression to gradually return to sport after microfracture (4)

A

full pain free ROM
80-90% strength
80% balance
no pain, swelling

51
Q

what is the criteria to start working on strengthening after microfracture (4)

A

full passive ext
125deg knee flex
min pain/swelling
voluntary quad contraction

52
Q

what happens during an OATS procedure

A

transfer healthy cartilage from minor load bearing surface to lesion

53
Q

what is the primary advantage to an OATS procedure

A

better quality of tissue than fibrocartilage bc transferring hyaline cartilage

54
Q

what is a limiting factor as to whether OATS procedure is appropriate

A

size of lesion
- only so many places to harvest from that won’t be WBing

55
Q

what is an advantage to an autograft OATS

A

faster incorporation bc pt’s own tissue

56
Q

what is advantage to allograft OATS

A

slower bone incorporation bc not your own bone
- can be non-union

57
Q

when is allograft vs autograft OATS more appropriate

A

allograft = larger defect
autograft = smaller

58
Q

what is the success criteria for an OATS

A

optimal size of lesion <2cm

59
Q

what is the usual harvest site for OATS

A

superior edges of trochlea

60
Q

what dictates the WBing timeline after OATS

A

if lesion/graft on femoral condyle (more load bearing) or patellar/trochlear (bears less load)

MSK 1 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions