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Orthopaedic Sports Medicine- Orthobullets > Meniscal Injury > Flashcards

Meniscal Injury Flashcards

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1
Q

Epidemiology

A
  • MC indication for knee surgery

- higher risk in ACL deficient knees

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2
Q

Medial Tears- Intro

A
  • More common than lateral tears

- Exception is in the setting of an acute ACL tear where lateral tears are more common

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3
Q

where do degenerative medial tears in older patients tend to occur?

A

posterior horn medial meniscus

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4
Q

Lateral Tears- More common when

A

acute ACL tears

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5
Q

Descriptive Classification

A
  • location
  • size
  • pattern
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6
Q

Descriptive Classification- Location

A
  1. red zone
  2. red-white zone
  3. white zone
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7
Q

Red zone

A

outer third, vascularized

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8
Q

Red-white zone

A

middle third

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9
Q

white zone

A

inner third, avascular

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10
Q

Descriptive Classification- Pattern

A
  1. vertical/longitudinal
  2. Bucket handle
  3. oblique/flap/parrot beak
  4. radial
  5. horizontal
  6. complex
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11
Q

vertical/longitudinal tear

A
  • common, esp with ACL tear

- repair when periph

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12
Q

bucket handle tear

A

-vertical tear which may displace into the notch

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13
Q

oblique/flap/parrot beak tear

A

-may cause mechanical locking symptoms

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14
Q

horizontal tear

A
  • more common in older population

- may be a/w meniscal cysyts

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15
Q

Symptoms

A
  • pain localizing to medial or lateral side
  • mechanical symptoms (locking and clicking)
  • delayed or intermittent swelling
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16
Q

Exam

A
  • joint line tenderness
  • effusion
  • provocative tests (Apley, Thessaly and McMurray)
17
Q

Apley Compression Test

A
  • Prone
  • bend affected knee to 90 p
  • axial force and rotate tibia
  • distraction force and rotate tibia
18
Q

Thessaly Test

A
  • standing at 20 degrees of knee flexion on the affected limb, the patient twists with knee external and internal rotation
  • positive test = discomfort or clicking
19
Q

McMurray’s Test

A
  • flex the knee and place a hand on the medial side of the knee, externally rotate the leg and bring the knee into extension
  • palpable pop/click + pain is a positive test and can correlate with medical meniscus tear
20
Q

Treatment- Nonop

A

rest, nsaids rehab

21
Q

rest, nsaids rehab

A

indications

- first line tx degenerative tears

22
Q

Treatment- operative

A
  1. Partial Meniscectomy
  2. Meniscal Repair
    3, Meniscal transplantation
  3. total meniscectomy
23
Q

Partial Meniscectomy- Indications

A

-tears not amenable to repair (complex, degenerative and radial)

24
Q

Partial Meniscectomy- Outcomes

A
  • > 80% satisfactory fxn at minimum f/u

- 50% have Fairbanks radiographic changes (osteophytes, flattening, joint space narrowing)

25
Q

What are Fairbanks radiographic changes?

A

osteophytes, flattening, joint space narrowing

26
Q

Partial Meniscectomy- predictors of success

A
  • <40
  • normal alignment
  • minimal or no arthritis
  • single tear
27
Q

Meniscal Repair- Indications

A

best candidate for repair…

  • peripheral in the red-red zone (vascularized region)
  • rim width is distance from the tear to peripheral meniscocapsular junction (blood supply)
  • rim width correlated with the ability of meniscal repair to heal (lower rim width has better blood supply)
  • vertical and longitudinal tear (rather than radial, horizontal or degenerative)
  • 1-4cm in length
  • acute repair combined with ACL recon
  • traditional literature report higher healing rates with concurrent ACL recon
  • current literature shows no difference in healing for 2nd generation all-inside repairs with/w/o concomitant ACL recon
28
Q

Meniscal Repair- Outcomes

A
  • 70-95% successful
  • highest success when done with concomitant ACL recon
  • porr results with untreated ACL- deficiency
29
Q

Meniscal Transplantation- Indication

A

young patient with near total meniscectomy, especially lateral

30
Q

Meniscal Transplantation- Contraindications

A
  • inflammatory arthritis
  • instability
  • marked obesity
  • grade 4 chondrosis
  • malalignment
  • diffuse arthritis
31
Q

Meniscal Transplantation- Outcomes

A
  • requires 8-12 months for graft to fully heal
  • return to sports 6-9 months
  • 10 year f/u showed..
  • persistent improvement in subjective pain and function scores
  • most had radiographic progression of degenerative changes
  • re-teats or extrusions are common
32
Q

Total Menisectomy

A
  • historical ONLY
  • Outcomes
  • 20% significant arthritic changes 3 years after surgery
  • 100 have arthritis at 20 years
  • severity of degenerative changes is proportional to % of the meniscus that was removed

Orthopaedic Sports Medicine- Orthobullets (3 decks)

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