Cartilage injuries Flashcards
What is hyaline cartilage?
Covers the surface of bones in synovial joints and decreases friction and distributes load
What is hyaline cartilage composed of?
Water,collagen,proteoglycans and chondrocytes
(chondrocytes produce collagen,PGs and enzymes and enzymes to regulate the extracellular matrix)
What is the hyaline cartilage nutrition from?
Synovial fluid and subchondral bone
What type of strength do collagen fibres give?
tensile strength
proteoglycans are highly hydrophilic- they catlike balloons to give ______ ____
compressive strength
Articular cartilage defects can be ______ or _______
traumatic
atraumatic
What is included under atraumatic articular cartilage defects
Osteochondritis dissecans
osteoarthritis
inflammatory arthritis
Only ___ thickness injuries can heal
full
Healing is with _____ which has greater friction and is less wear resistant
fibrocartilage
What is osteochondritis dissecans
an area of the surface of the knee loses its blood supply and cartilage +- bone can fragment off
It is most common in adolescents
What is the treatment for osteochondritis dissecans
can heal or resolve spontaneously
if detaching on MRI can pin in place- If detached can fix or remove
May benefit from cartilage regeneration in more severe cases
Cartilage regeneration techniques
All heal with fibrocartilage
- has higher friction and is less water resistant
Better for smaller defects, unsuccessful in patellofemoral joint.
What are the options for cartilage regeneration techniques?
Drilling/microfracture
Osteochondral autograft/allograft
Mosaicplasty
MACI-membane induced autologous chondrocyte implantation
What is the cheapest and simplest technique for cartilage regeneration?
Microfracture
What technique is used for larger defect or bone loss
Osteochondral allograft
how many years benefit does a cartilage regeneration tend to provide
5
What disease process can be described as a “imbalance of cartilage breakdown and repair”
OA
What may OA be predisposed by?
Injury-articular cartilage injury, fracture,joitn instability
Malalignment-Genu vacuum or valgum,fracture malunion
Degenerate meniscal tear
Infection
also familial/genetic influences
What are the non operative treatments for early OA
WT loss stick exercise analgesics activity modification
In OA when are steroid injections used?
only for acute flare ups
What is useful in various knee with isolated early medial compartment OA
Osteotomy
Who is eligible for knee replacement?
only for older patients with end stage arthritis
-disappointing results in early OA
If younger then poorer outcomes and higher failure
-partial knee replacements have poorer results than total knee replacement
How long does a TKR last
15-20 y
What are the risks of knee replacement
Deep infection- occurs in 1%
pain.stiffness,DVT/PE,medical complications
