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DPT 516 > Articular Cartilage Pathophysiology and Treatment > Flashcards

Articular Cartilage Pathophysiology and Treatment Flashcards

1
Q

what is the fluid portion of articular cartilage?

A

water and ions

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2
Q

what is the solid portion of articular cartilage?

A

collagen and proteoglycans

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3
Q

t/f: adult cartilage is separated from subchondral vascular spaces by the subchondral plate

A

true

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4
Q

what does cartilage being avascular mean for the tissue?

A

it has low metabolic activity and poor regenerative capabilities

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5
Q

what are some characteristics of articular cartilage?

A

biphasic material

avascular

viscoelastic

time dependent behavior when subjected to deformation

low permeability

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6
Q

solid phase has ____ resistance to flow, causing _____interstitial pressure

A

high, high

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7
Q

what is the role of proteoglycans and fluid in articular cartilage?

A

they help provide compressive resistance

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8
Q

what allows fluid and waste to leave articular cartilage?

A

loading

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9
Q

what allows fluid and nutrients to enter the articular cartilage?

A

unloading

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10
Q

what are the zones of articular cartilage?

A

superficial tangential zone

middle (transitional) zone

deep zone (radiate stratum)

tidemark

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11
Q

what is the superficial tangential zone of articular cartilage?

A

densely packed type 2 collagen fibers arranged parallel to the surface that make up 10-20% of total thickness

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12
Q

what is the middle (transitional) zone of articular cartilage?

A

random orientation of fibers that are further apart create an open meshwork of cartilage that gives it the ability to absorb compressive forces

30% total thickness

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13
Q

what is the deep zone (radiate stratum) of articular cartilage?

A

fibers that form larger, radially-oriented fiber bundles perpendicular to the surface

40-60% total thickness

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14
Q

what is the tidemark of articular cartilage?

A

interface b/w articular cartilage and calcified cartilage beneath it that anchors cartilage to bone

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15
Q

what is the articular cartilage response to compression?

A

fluid gets pushed out to get rid of waste and fluid is recovered post stress-removal

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16
Q

what is the articular cartilage response to tension?

A

anisotropic response: stiffer in parallel
innomogenous response: stiffer in superficial region

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17
Q

what is the articular cartilage response to shear?

A

no volume changes and no interstitial fluid flow

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18
Q

how does articular cartilage receive its nutrition?

A

efflux and influx with loading and unloading

cartilage needs proper loading

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19
Q

what are the factors that contribute articular cartilage degeneration?

A

magnitude of stresses

of sustained stress peaks

structural changes

mechanical changes

4 Fs of cartilage degeneration

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20
Q

what are the 4 Fs of cartilage degeneration?

A

fissures result in fibrillation, flaking, and focal cysts

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21
Q

what are fissures?

A

cracking in the cartilage

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22
Q

what are fibrillations?

A

crack in the bone leaving flakey pieces hanging off the bone surface

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23
Q

what are flakes?

A

detached fibrillation

24
Q

what is endochondral ossification?

A

replacement of calcified layer of articular cartilage

25
Q

what happens to articular cartilage in aging?

A

deeper layers of cartilage gradually replaced with bone and superficial cartilage becomes thinner

w/micro-fracture there is possible formation of new ossification center that extends into the calcified layer of cartilage advancing into tidemark and thinning the non-calcified layer

26
Q

what is interfacial wear?

A

bearing surfaces in direct contact

defects in cartilage increase permeability and less lubricating fluid is available

27
Q

what is fatigue wear?

A

microscopic damage w/in bearing material under repetitive stressing

low load long time

28
Q

what is impact loading?

A

rapid application, high load

insufficient time for internal fluid redistribution to relieve compacted region

29
Q

what is type 1 cartilage injury?

A

superficial

microscopic damage to chondrocytes and ECM

30
Q

what is type 2 cartilage injury?

A

partial thickness

microscopic disruption of articular cartilage surface

chondral fractures and fissures

poor prognosis bc of no inflammatory response due to not penetrating the subchondral bone

31
Q

what is type 3 cartilage injury?

A

full thickness

disruption of articular cartilage and penetration of subchondral bone produces significant inflammatory process (OA)

32
Q

the onset of OA increases with _____ and typically affects _____ _____ joints

A

age, weight bearing

33
Q

what are the clinical signs of cartilage injuries?

A

impaired mobility, muscles performance, and balance

activity limitations

participation restrictions

34
Q

incapacity depends on what 2 things?

A

extent of damage and comorbidities

35
Q

where are the most common meniscal injuries?

A

TMJ and knee

36
Q

is an outer knee tear repairable?

A

no!

37
Q

tear tears in the midsection of the knee repairable?

A

possibly is vascularity is stimualted

38
Q

when does cartilage not heal?

A

when it doesn’t penetrate the subchondral bone

39
Q

when the subchondral bone is penetrated, is there repair?

A

yes!

40
Q

what is hoop stress of cartilage?

A

the way it handles stresses

direct pressure causes a resistance in the form of hoop stress

41
Q

is repaired articular cartilage the same as the original cartilage?

A

no, it is different biochemically and biomechanically

42
Q

how many months does it take for 1/2 full thickness tears to degrade into fibrillation, fissuring, and extensive degeneration?

A

6 months

43
Q

what is the main treatment for cartilage injuries?

A

pharmacological management with NSAIDS, opioid analgesics, and intraarticular corticoid injections

44
Q

how is a medial unicompartmental knee injury usually treated?

A

unloading braces that offloads the medial compartment

45
Q

what are common cartilage injury treatments?

A

pharmacological management

unloading

intraarticular viscosupplementation injections (chicken shots)

surgical management

PT

46
Q

what does PT do to treat cartilage injuries?

A

decrease joint pain

improve ROM

improve function

modalities

patient education

impact aerobic exercise

strengthening

47
Q

what is osteochondritis dissecans?

A

a rare anterior knee and ankle pain (can be other joints as well)

48
Q

how is knee osteochondritis dissecans characterized?

A

WB medial and lateral femoral condyles

pain and catching sensation with knee flexion

extensor weakness

maltracking of tibiofemoral joint

painful arc in smaller lesions where it passes over articular surface

49
Q

how is ankle osteochondritis dissecans characterized?

A

the dome of the talus

pain in anterolateral and posteromedial ankle

50
Q

how is osteochondritis dissecans diagnosed?

A

MRI, bone scan, or CT

51
Q

when would conservative treatment of osteochondritis dissecans be used?

A

if the lesion remains intact

52
Q

when would there be surgical intervention for osteochondritis dissecans?

A

if there is a need to reattach loose fragments to bone

53
Q

what is micro-fracture surgery?

A

when a surgeon uses a pick or drill to make small holes into the subchondral bone of areas of breakdown to create bleeding, trigger inflammation, and therefore fibrocartilage growth

54
Q

what kind of cartilage is created by microfracture surgery?

A

fibril cartilage which isn’t ideal but may help relieve some symptoms

55
Q

is microfracture surgery better in WB or reduced WB surfaces?

A

reduced WB surfaces

56
Q

when is osteochondral autograft transplant indicated?

A

in symptomatic, unipolar lesions of the distal femoral condyles (as well as other joints)

non degenerative joints

joints with ligamentous stability and meniscus competence

DPT 516 (14 decks)

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