30. Cartilage injuries of the knee joint (including meniscus injuries). Principles of arthroscopy

Question 1

What is the anatomy of the knee joint cartilages?

Answer 1

Each knee joint has two crescent shaped menisci

Question 1

What is the cartilage that is most likely to be injured in the knee?

Answer 1

Medial meniscus

Question 2

What is the mechanism of injury to the meniscus?

Answer 2

Twisting movement while the knee is bent:
* Transverse Tears
* Bucket- Handle Tears: This is an exaggerated form of a longitudinal tear.
OR
Wear and teat → Degenerative Changes (flap): This may lead to edges of the menisci becoming frayed and jagged.

Question 3

How can you diagnose a menisceal injury?

Answer 3

• The knee is examined for swelling.
• The McMurray test: involves pressing on the joint line while stressing the meniscus (using flexion-extension movements and varus or valgus stress).
• Appley test: patient lies prone, the knee is bent and the ankle is twisted right and left
• The cooper’s sign: pain when turning over in bed at night
• MRI
• Knee arthroscopy

Question 4

How can you treat a menisceal injury?

Answer 4

Conservative (physiotherapy, NSAID)

Surgery:
Success depends on:
* Age (younger better)
* If done on central portion of cartilage (where blood supply is worse) higher chance of failure
* compliant with post operative rehabilitation.

Question 5

What are the principles of arthroscopy?

Answer 5

Two holes are made:
In first hole Camera, fluid in, fluid out In second hole manipulation tool