Articular cartilage and meniscal injuries

Question 1

meniscus anatomy

Answer 1

Comprised of wedge shaped fibrocartilage

Lateral meniscus is more circular and mobile
Medial meniscus is more crescent shaped

Question 2

mechanism and symptoms for meniscus injury

Answer 2

Twisting
pain worse with movement and better with rest
May complain of locking
Joint line tenderness
Acute effusion within two hours
Acute sudden onset and less than 40 years age
Chronic no specific and greater than 50

Question 3

Longitudinal lesion

Answer 3

typical of third decade
Most frequent meniscal tear

Question 4

Bucket handle lesions are frequent in

Answer 4

In medial meniscus

Question 5

oblique tears

Answer 5

Generally, in the region between 1/3 back and 1/3 medium of the meniscus

Question 6

complex lesions

Answer 6

Produced by repeated knee trauma

Question 7

Radial lesions originate from

Answer 7

Free side to periphery

Question 8

Horizontal tears are

Answer 8

Degenerative lesions involving meniscus intramural portion

Question 9

good prognosis for meniscus tear

Answer 9

Age less than 35
Peripheral damage
Short tear
Longitudinal tear
Acute injury, bloody effusion
Stable knee

Question 10

Poor prognosis for meniscal healing

Answer 10

Older patient
Central damage
Complete tear
Bucket handled tear
Chronic injury
Unstable knee

Question 11

Hallmark objective findings for meniscus

Answer 11

Joint line tenderness

Effusion- mild moderate over one to two days

Positive entrapment test - McMurrays, apleys, squat

Quad inhibition - atrophy over first week or two following injury

Question 12

indications for meniscus repair

Answer 12

Traumatic lesion within vascular zone
Intact peripheral circumferential fiber
Minimal damage to meniscal body
Longer than 8 mm

Question 13

meniscus rehab principles

Answer 13

Control effusion
do not push ROM
Restore normal gait
Restore strength and proprioception

Question 14

Semimembranosus attaches to

Answer 14

Medial meniscus

Question 15

articular cartilage is what type of cartilage

Answer 15

hyaline

Question 16

traumatic onset of articular cartilage

Answer 16

Often associated with concomitant ligament damage
Often missed acutely

Question 17

not traumatic articular cartilage injuries

Answer 17

Repetitive micro trauma
Many lesions are nonprogressive and remain asymptomatic
Grade one and two lesions are typically asymptomatic

Question 18

articular cartilage examination

Answer 18

Thorough history and palpation
Malalignment
Painful crepitus
Mechanical symptoms
Quad atrophy
Sensitivity to weather changes
deep, dull ache
Pain and effusion after use

Question 19

Debridement and lavage

Answer 19

remove particles of cartilage and inflammatory cells
Short term pain relief of symptoms

Question 20

Debridement and lavage outcomes

Answer 20

probably does not improve pain or ability to function compared to placebo

probably Leads to little or no difference in pain or ability to function

May improve pain compared to washout

May not lead to any difference in pain or ability to function compared to closed needle joint levage

Question 21

Micro fracture

Answer 21

pick holes through the tide mark
Encourage blood flow
Replaced with fibrocartilage ( less resilient to transverse plane)
Weight-bearing has to be controlled

Question 22

Micro fracture outcomes

Answer 22

Use of micro fracture for the treatment of small lesions and patients with low postoperative demands was observed to result in good clinical outcomes at a short term follow up

Beyond five years postoperatively treatment failure after micro fracture could be expected regardless of lesion size

younger patient showed better clinical outcomes

Question 23

ACI autologous chondrocyte implantation

Answer 23

Small biopsy of autologous articular cartilage

Cartilage is enzymatically digested in lab to release chondrocytes

Chondrocytes cultured and implanted at second surgery

periosteal flap placed as patch

Question 24

Osteochondral autograft transplantation system

Answer 24

Full thickness defects
Remove plug from nonweightbearing surface
Press fit plugs implanted into lesion

Question 25

Articular cartilage, rehab principles

Answer 25

Control weight-bearing status
PROM is key
Slow and progressive rehab
Rarely return to sports emphasize on ADLs without pain
Constant communication with MD