Knee- Meniscus and OA Flashcards
What is the meniscus made of?
fibrocartilage = stabilizer
What is the prevalence of meniscus injuries?
- 2nd MOST common knee injury
- Medial > lateral meniscus
- posterior > anterior horn
What are risk factors for an acute meniscus injury?
all WBing sports
What are risk factors for a degenerative meniscus injury?
- greater the age, esp > 60 yrs. of age
- biological male > female
- work related kneeling/swatting/stair climbing
What is a risk factor for both acute and degenerative meniscus injuries?
- greater time elapsed from any knee injury
What is a menisci?
nearly circular wedge-shaped fibrocartilage disk(s) on tibial plateau
What is the meniscus attached to the tibia by?
coronary ligaments
What are the functions of the menisci?
- stability > shock absorption
- deepen the joint surface for stability
- outer 1/3 is mostly type I collagen, inner 1/3 is mostly type II collagen
What is the unique about the medial meniscus?
- more O shaped
- torn more frequently
- attachment to MCL
What is unique about the lateral meniscus?
- more C shape
- greater mobility without ligamentous attachment
What are symptoms of a meniscus tear?
- joint space/line pain with possible leg referral
- limited and painful motion
- WBing limitations with possible catching or locking
What is the onset of a mensicus tear if acute?chronic?
- if acute = trauma reported
- if chronic = then gradual and unknown, typically in an older individual without or with a prior injury
What will we observe with a meniscus tear?
- possible swelling
- potential asymmetrical and antalgic gait
What will we find with ROM with a meniscus tear?
limited and painful motion
What will we find with resisted testing/MMT with a meniscal tear?
- potentially weak and painful
What will we find with stress tests with a meniscus tear?
possibly painful with compression
What are some special tests for meniscus tears?
- meniscal CPR
- McMurray’s
- Ege’s
- Thessaly’s
- Apley’s
What are signs of meniscus tears in muscle activity and palpation?
- m. activity/MMT = inhibited quads
- palpation - joint line tenderness (min to no support)
What percentage of those 20-68 yo had a meniscal abnormality on a MRI?
98%
What is the PT rx for meniscus tears?
- POLICED
- AD to minimize/avoid limping
- JM
- MET
What are JMs for with meniscal tears?
- pain modulation via descending pathways
- meniscal integrity
What is MET for with meniscal tears?
- primarily for stabilization and meniscal integrity
What has mod support for strength with meniscal tears?
NMES
What can MET do for degenerative tears of the meniscus?
- equally effective as sx for improved pain
- less anxiety and depression vs sx
What is a partial meniscectomy?
- removal of tear
What are post-op aspects of a partial meniscectomy?
- no immobilization
- earlier WBing
- return to play within 2-6 weeks
What is a meniscal repair?
- sutured
What are the post-op aspects of a meniscal repair?
- primarily with tears in outer 1/3 due to blood supply
- immobilization and/or limited ROM initially
- TTWB for 4-6 weeks
- return to play in ~ 12 weeks
What should we know about surgery for degenerative tears vs sham sx?
- sx no better at 2, 6, or 12 months vs sham sx without ARJC
Should those with with degenerative tears of the meniscus and age related joint changes have surgery?
- STRONG RECOMMENDATION AGAINST SX
What is the etiology of Baker’s Cyst?
- often age-related joint changes
What are the pathomechanics of a baker’s cyst?
- fluid filled cyst due to persistent and excessive inflammation
- subsequent weakening of capsule and herniation of fluid
Baker’s cysts are asymptomatic until what?
significant effusion
What can a baker’s cyst mimic?
degenerative meniscus tear
What will ROM be with a baker’s cyst?
limited and painful
What should we know about resisted/MMT into flexion with a baker’s cyst?
PAINFUL
Where can we palpate for a baker’s cyst?
popliteal protrusion just near the medial gastroc head
What is the PT rx for a Baker’s cyst?
- like degenerative meniscal tear
What is a precaution with baker’s cyst PT?
forceful activity, like all herniations
What is the prognosis of a baker’s cyst?
- difficult to manage in active individuals