Articular cartilage and meniscal injuries Flashcards
meniscus anatomy
Comprised of wedge shaped fibrocartilage
Lateral meniscus is more circular and mobile
Medial meniscus is more crescent shaped
mechanism and symptoms for meniscus injury
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
Longitudinal lesion
typical of third decade
Most frequent meniscal tear
Bucket handle lesions are frequent in
In medial meniscus
oblique tears
Generally, in the region between 1/3 back and 1/3 medium of the meniscus
complex lesions
Produced by repeated knee trauma
Radial lesions originate from
Free side to periphery
Horizontal tears are
Degenerative lesions involving meniscus intramural portion
good prognosis for meniscus tear
Age less than 35
Peripheral damage
Short tear
Longitudinal tear
Acute injury, bloody effusion
Stable knee
Poor prognosis for meniscal healing
Older patient
Central damage
Complete tear
Bucket handled tear
Chronic injury
Unstable knee
Hallmark objective findings for meniscus
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
indications for meniscus repair
Traumatic lesion within vascular zone
Intact peripheral circumferential fiber
Minimal damage to meniscal body
Longer than 8 mm
meniscus rehab principles
Control effusion
do not push ROM
Restore normal gait
Restore strength and proprioception
Semimembranosus attaches to
Medial meniscus
articular cartilage is what type of cartilage
hyaline
traumatic onset of articular cartilage
Often associated with concomitant ligament damage
Often missed acutely
not traumatic articular cartilage injuries
Repetitive micro trauma
Many lesions are nonprogressive and remain asymptomatic
Grade one and two lesions are typically asymptomatic
articular cartilage examination
Thorough history and palpation
Malalignment
Painful crepitus
Mechanical symptoms
Quad atrophy
Sensitivity to weather changes
deep, dull ache
Pain and effusion after use
Debridement and lavage
remove particles of cartilage and inflammatory cells
Short term pain relief of symptoms
Debridement and lavage outcomes
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
Micro fracture
pick holes through the tide mark
Encourage blood flow
Replaced with fibrocartilage ( less resilient to transverse plane)
Weight-bearing has to be controlled
Micro fracture outcomes
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
ACI autologous chondrocyte implantation
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
Osteochondral autograft transplantation system
Full thickness defects
Remove plug from nonweightbearing surface
Press fit plugs implanted into lesion
Articular cartilage, rehab principles
Control weight-bearing status
PROM is key
Slow and progressive rehab
Rarely return to sports emphasize on ADLs without pain
Constant communication with MD
