Knee pain and mobility impairments: meniscal and articular cartilage lesions

Question 1

What outcome measures should be used for knee- specific outcomes?

Answer 1

KOOS (B)
Tegner/ Marx (C) 
IKDC 2000 (B) 
EQ-5D (C)
KQol- 26 (C)

Question 2

What physical performance measures can be used for assessing global knee function for those with meniscus/ articular cartilage lesions?

Answer 2

Early rehab- stair climb test, TUG, 6M walk test, 30 sec chair/ stand test
Return to activity/ sports- Single leg hop tests (C)

Question 3

What physical impairment measures should you administer for patients with meniscus tears?

Answer 3

B evidence 
Modified Stroke test 
Knee AROM 
Isometric/ isokinetic quad strength 
forced hyperextension 
Max passive knee flexion 
McMurrays 
Palpation for joint line tenderness

Question 4

What recommendations can be made about progressive knee motion after meniscus/ articular cartilage surgery?

Answer 4

Early progressive active and passive knee motion (B)

Question 5

What weight bearing recommendations would you consider after meniscus repair? After MACI procedure?

Answer 5

Early progressive WB (C)- meniscus

Stepwise progression to full weight bearing 6-8 weeks (B)- MACI

Question 6

What recommendations can you make about return to activity post meniscus repair surgery?

Answer 6

early progressive return to activity (C)

Question 7

What are the exercise recommendations for meniscus tears, articular cartilage lesions, or after surgery for either pathology?

Answer 7

Progressive ROM
Progressive strength of knee AND hip
Neuromuscular training
(B evidence)

Question 8

What is the recommendations for NMES post meniscus procedures?

Answer 8

B evidence for NMES to increase quad strength, functional performance, and knee function

Question 9

What is the incidence of meniscus tears?

Answer 9

12-14%- second most common injury to the knee

high incidence occurs with ACL tear

Question 10

Where is the most frequent cartilage injury noted?

Answer 10

medial femoral condyle and patella articular surface

Question 11

How can meniscus tears be classified and what populations are these post commonly seen in?

Answer 11

Traumatic versus degenerative
Younger with traumatic (longitudinal/ radial)
Older with degenerative (horizontal cleavages, flap, complex tears, maceration/ destruction)

Question 12

In the athletic population, younger versus older people are more likely to sustain a meniscus lesion to which compartment?

Answer 12

III evidence
Younger than 30- lateral
Older than 30- medial

Question 13

Are males/ females more likely to sustain a meniscus tear?

Answer 13

Females

Question 14

Based on age, what type of meniscus surgery are you more likely to receive? What is the primary surgical procedure performed?

Answer 14

> 45 meniscectomy
< 35 repair
Partial meniscectomy

Question 15

The incidence of articular cartilage lesions is high after what procedure/ injury?

Answer 15

partial meniscectomy or 2nd ACL injury

Question 16

Describe the pathoanatomical features of the meniscus

Answer 16

fibrocartilage and wedge shaped
Lateral- more circular and more mobile
Medial- crescent shaped

Question 17

What is the function of the meniscus?

Answer 17

Distribute stress across knee during weight bearing
Provide shock absorption
secondary joint stabilizer
articular cartilage nutrition and lubrication
Facilitate joint gliding
Prevent hyperextension
Protect the joint margins

Question 18

What is a strong risk factor for future medial meniscus tears? What are other risk factors for a degenerative versus acute meniscus tear?

Answer 18

Delaying ACL reconstruction
Older, male, Work related kneeling/ squatting, climbing stairs- degenerative
Soccor/ rugby- acute

Question 19

What are the pathoanatomical features of articular cartilage?

Answer 19

Hyaline in nature- decreases friction between gliding surfaces, withstands compression by acting as shock absorber

Question 20

What are the 4 methods of operation for articular cartilage?

Answer 20

Arthroscopic lavage and debridement
microfracture
autologous chondrocyte implantation (ACI)
Osteochondral autograft transplantation (OAT)

Question 21

Comparing procedures for articular cartilage lesions- which had higher rate of self reported knee function, return to sports, and maintenance activity

Answer 21

OAT versus
ACI (failure rate/complications are high)
or microfracture (best for small lesions and low- demand activity/ sport)

Question 22

In terms of strength and function, do non- op or operative patients with partial meniscectomy report better outcomes?

Answer 22

in short and intermediate term- non operative patients

Question 23

What are some predictive factors of the severity of chondral lesions?

Answer 23

Greater the patients age

Longer time from ACL injury

Question 24

What are some of the factors associated with higher failure rates with articular cartilage repair?

Answer 24

Female sex
Older age 
higher BMI 
longer symptom duration 
previous procedure/ surgery 
Low self- reported knee function

Question 25

What can be said in patients post partial meniscectomy regarding incidence of other knee patholgy?

Answer 25

60% incidence of knee OA

Higher with degenerative meniscus tears compared to traumatic tears

Question 26

What clinical findings are associated with meniscus tear?

Answer 26

Twisting injury
Tearing sensation at time of injury
delated effusion
H/o catching/ locking
pain with forced hyperextension
pain with max knee flexion
Pain/ audible click with McMurrays (most specific for lateral)
Joint line tenderness (most specific for lateral)
Discomfort/ sense of locking with Thessaly’s in 20 deg flexion (sensitive and specific)

Question 27

What is the Meniscus Pathology Composite Score?

Answer 27

If you have 3-5 of which findings its highly specific

1. Catching/ locking
2. pain with forced hyperextension
3. Pain with max passive knee flexion
4. joint line tenderness
5. Pain/ click with mcmurrays

Question 28

What are the clinical findings for articular cartilage defect?

Answer 28

Acute trauma with hemarthrosis 
Insidious onset aggravated by repetitive impact 
intermittent pain/ swelling 
h/o catching/ locking 
joint line tenderness

Question 29

What is the ottawa knee rule for determining when to order radiograph for the knee?

Answer 29

High sensitivity

1. 55/ older
2. Isolated patella tenderness
3. Tenderness to head of fibula
4. Inability to flex the knee to 90 deg
5. Inability to bear weight immediately and in ED for 4 steps regardless of limping