Meniscus/Articular Cartilage CPG

Question 1

What is commonly injured with a meniscus tear?

Answer 1

ACL

Question 2

What type of meniscus tears are traumatic?

Answer 2

Longitudinal

Radial

Question 3

What type of meniscus tears are degenerative?

Answer 3

Horizontal cleavages
Flaps
Complex tears

Question 4

What age is considered cut off for repair of the meniscus versus menisectomy?

Answer 4

< 35 may repair

>45 most likely menisectomy

Question 5

What is the time frame for quad recovery after menisectomy?

Answer 5

2 years

Question 6

What are two prognostic factors with slower rate of recovery for menisectomy?

Answer 6

Female gender

Severe deg of OA

Question 7

What is a huge factor in outcomes for articular cartilage procedures?

Answer 7

Age - younger persons have better outcomes than older persons

Question 8

Of the three cartilage procedures, which has best results according to research?
OATs, ACI, Microfracture

Answer 8

OATs - osteochondral autograft transplantation

Question 9

Of the three cartilage procedures, which has the highest failure rates?
OATs, ACI, microfracture

Answer 9

ACI - autologous chondrocyte implantation

Question 10

Of the three cartilage procedures, which is most appropriate for small lesions, low demand sports?
OATs, ACI, microfracture

Answer 10

Microfracture - higher demand sports tend to have high failure rates

Question 11

What are four risk factors for tearing meniscus, specifically the medial meniscus?

Answer 11

Age, female gender, high BMI, lower physical activity level

Question 12

What are six risk factors for failure rates with articular cartilage repairs?

Answer 12

Age, female gender, BMI, longer sx duration, previous procedures, lower knee function

Question 13

What are the factors to derive a Meniscal Pathology Composite score?

Answer 13

1) pain with hyperextension
2) pain with maximum passive flexion
3) pain or click with McMurrays
4) hx of ‘catch’ or ‘locking’
5) joint line tenderness
3 findings = high score and can classify with meniscal tear

Question 14

Both meniscal tears and articular cartilage tears ahve a hx of catching/locking, effusion and joint line tenderness. How can you differentiate between the two injuries?

Answer 14

Positive Thessaly test for meniscus with hx of twisting injury
Insidious onset aggravated by repetitive impact for articular cartilage

Question 15

What are the Ottawa knee rules?

Answer 15

1) age > 55
2) isolated tenderness of the patella
3) tenderness of fibular head
4) unable to flex > 90 deg
5) cannot bear 4 WB steps - limping counts as WB steps

Question 16

What is one of the most sensitive aspects of the examination for meniscal tears?

Answer 16

Joint line tenderness (0.77)

Question 17

In outcomes for ACI, is there better, worse or no change in results with an accelerated WB program? (6 weeks to FWB vs. progressive and FWB at 8 weeks)

Answer 17

Better results with accelerated at 6 weeks FWB