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PTH9111 Test 2 > Lecture 29 - Cartilage > Flashcards

Lecture 29 - Cartilage Flashcards

1
Q

3 types of cartilage

A
  1. Fibrocartilage
  2. Elastic cartilage
  3. Hyaline Cartilage
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2
Q

fibrocartilage is found where

A
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3
Q

Elastic cartilage is found where

A
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4
Q

Hyaline cartilage is found where

A
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5
Q

What are the 4 features of a synovial joint

A
  1. Hyaline Cartilage: Articular surfaces of the bone
  2. Joint Capsule: Connective tissue sleeve surrounding the joint
  3. Synovial Membrane: Lining of joint capsule
  4. Synovial Fluid: Viscous fluid that lubricates articular surfaces
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6
Q

Joint capsule

A

Important for function of synovial joint

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7
Q

Joint capsule is innervated by

A

Nerves from those supplying the muscle acting on the joint

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8
Q

What 2 sensations occur at the joint capsule

A

1) Proprioception
2) Pain

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9
Q

T or F: The joint capsule can be stretched or contracted which affects joint function

A

T

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10
Q

Function of a continuous passive motion machine

A

Passive motion performed by mechanical device that moves joint slowly and continuously through controlled ROM

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11
Q

2 functions of hyaline cartilage

A

1) Resist compression/loading of joints
2) Smooth surface to allow joint ROM

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12
Q

4 characteristics of hyaline cartilage

A
  1. Smooth
  2. Avascular (diffusion for nutrients)
  3. No innervation
  4. Low friction
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13
Q

2 components of hyaline cartilage and what makes up each component

A
  1. Cells -> Chondrocytes
  2. ECM:
    ->Fibrillar Component: Type II collage and elastin
    ->Interfibrillar component: Water and proteoglycans
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14
Q

Proteoglycans affect

A

Hydration of tissue

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15
Q

Where are proteoglycans found

A

Connective tissue

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16
Q

Proteoglycans consist of a core protein which are attached to

A

Glycosaminoglycan chains

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17
Q

Hyaline cartilage are avascular so how do they receive nutrition and eliminate wastes

A

Diffusion through synovial fluid with assistance by joint movements (aid diffusion)

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18
Q

What are the 4 layers of hyaline cartilage

A
  1. Superficial/Tangential Zone (Zone 1): Functions against shear forces with collagen orientated parallel to joint surface
  2. Intermediate/Transitional Zone (Zone 2): Withstand shearing and compressive forces with collagen organized in meshwork
  3. Deep/Radiate Zone (Zone 3): Highest proteoglycan content to resist compressive forces
  4. Calcified Cartilage Zone (Zone 4): Anchors cartilage to underlying bone
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19
Q

List the 5 grades of hyaline cartilage injury

A
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20
Q

4 characteristics of hyaline cartilage injury

A
  1. No vascular response
  2. Chondrocytes increase proteoglycan synthesis but regeneration will be slow if at all (mainly at peripheries)
  3. If injury does NOT penetrate subchondral bone, the articular cartilage does not heal and cartilage degeneration takes place
  4. If injury penetrates subchondral bone, damaged hyaline cartilage is replaced by fibrocartilage and biomechanical properties will be mismatched
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21
Q

What are 3 goals of surgical management for chondral and osteochondral defects (hyaline cartilage)

A
  1. Reduce symptoms
  2. Improve joint congruence by restoring joint surface with best possible tissue
  3. Prevent additional cartilage deterioration
22
Q

What 2 arthroscopic options promote healing for cartilage tear

A
  1. Lavage and debridement
  2. Microfracture
23
Q

What is lavage

A

Removes loose intraarticular tissue debris and inflammatory mediators that are generated by synovial lining which could allow chondrocytes to increase biosynthetic activity but results are temporarily short-lived

24
Q

What is microfracture

A

Disruption of subchondral bone to induce bleeding which could result in fibrocartilaginous tissue repair

25
Q

What are 2 structural changes in articular cartilage due to osteoarthritis

A
  1. Macroscopic: Softening and erosion
  2. Microscopic: Loss of cartilage layers and clefts found through cartilage
26
Q

How does osteoarthritis change the ECM of articular cartilage

A

Loss of PG content leading to a more permeable solid matrix which decreases the tissues ability to withstand compression.
Also observe softening and disturbed organization of collagen

27
Q

What 3 affects happen to the subchondral bone as a result of
degeneration from osteoarthritis

A
  1. Increased subchondral plate thickness (increased stiffness decreasing shock-absorbance)
  2. Formation of new bone at joint margins (osteophytes)
  3. Development of subchondral bone cysts
28
Q

What 2 structural changes in articular cartilage and peri-articular bone occur due to osteoarthritis

A
  1. Loss of cartilage thickness causing joint laxity
  2. Alteration in stresses at joint surface enhancing disease progression
29
Q

T or F: Radiographic findings are strongly related to symptom and pain severity of osteoarthritis

A

F, it is not

30
Q

How would you describe the pain of osteoarthritis

A

Episodic/intermittent initially that is triggered by specific activities

31
Q

What are 4 secondary effects of osteoarthritis

A

1) Muscle weakness
2) Altered gait and balance
3. Decreased activity
4) Loss of ROM

32
Q

Fibrocartilage

A

Articulating structures between vertebrae (intervertebral disc)

33
Q

What 3 adjacent structures is intervertebral disc connected to

A
  1. vertebrae at rim
  2. anterior and posterior longitudinal ligaments
  3. Hyaline cartilage end plates superiorly and inferiorly
34
Q

What are 2 distinct components of intervertebral discs and function

A

1) Annulus fibrosis (outer) Made of type 1 collagen that retains the nucleus and takes up and distributes the forces exerted by the nucleus during activities
2) Nucleus pulposis (inner): Gelatinous and acts as a shock absorber (made up of proteoglycans)

35
Q

Describe the intervertebral disc blood supply

A

Does not have its own direct blood supply.
Limited with only the outer mm of annulus fibrosis containing capillaries from surround soft tissue

36
Q

Describe the intervertebral disc nerve supply

A

Limited with only the outer mm of annulus fibrosis containing free nerve endings (pain) and mechanoreceptors (GTO, Ruffini, Pacinian)

37
Q

What happens to the intervertebral discs as we age

A
  1. Degeneration begins as early as 1st decade and prominent by end of 2nd decade where spondylosis (Degenerative disc disease) can occur
  2. Peripheral annulus widens and nucleus pulposis loses proteoglycan content
  3. Decreased ability to withstand forces with most adults have some level of degenerative disc disease
38
Q

Disc Herniation

A

Nucleus pushes through a tear in the annulus

39
Q

Meniscus and where it can be found

A

Type of fibrocartilage found in the knee

40
Q

Describe knee meniscus blood supply

A

Anterior and posterior horns are well vascularized

41
Q

Describe knee meniscus nerve supply

A

Anterior and posterior horns along with outer 1/3 of meniscus contain mechanoreceptors and proprioceptors, but the inner 2/3 of meniscus lack nerve supply

42
Q

Image of meniscus tears

A
43
Q

What are 2 characteristics of tissue healing for knee meniscus

A
  1. Injury in peripheral zone results in hematoma at tear site
  2. Tear site heals with fibrovascular scar that is continuous with normal meniscal fibrocartilage but does not achieve strength of normal meniscus fibrocartilage
44
Q

Where is the labrum found

A

Shoulder and hip

45
Q

3 function of the labrum

A
  1. Deepens socket joint
  2. Increases contact between joint surfaces
  3. Evens load distribution across joint surfaces
46
Q

Describe labrum of shoulder blood supply

A

Does not have its own blood supply but does receive vascularization from neighbouring tissues

47
Q

Describe the nerve supply of labrum in the shoulder

A

Contains free nerve endings in its periphery and may be responsible for proprioceptive feedback

48
Q

Describe labrum blood supply in the hip

A

Supplied to outer 1/3 of labrum by obturator, superior gluteal, and inferior gluteal arteries

49
Q

Describe labrum nerve supply of the hip

A

Superior and inferior portion are innervated by free nerve endings and nerve sensory end organs to detect pain, pressure, and deep sensation

50
Q

What are 4 factors of aging that affect cartilage

A
  1. Size of proteoglycans decrease with age
  2. Decrease in chondroitin
  3. Decreased water content (less efficient with mechanical loads)
  4. Loss of thickness of cartilage (alter joint laxity and therefore mechanical loading
51
Q

What are 7 factors of immobility that affect cartilage

A
  1. Increased fatty connective tissue in joint space
  2. Increased adhesion between folds of synovium
  3. Increased atrophy of cartilage
  4. Weakened ligaments at insertion sites
  5. Regional osteopenia
  6. Decreased proteoglycans
  7. Increased water content in cartilage

PTH9111 Test 2 (16 decks)

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