Orthopedic Procedures- Knee Flashcards
Commandments of Osteroarthritis Evaluation
- Dull Ache
- Worse with activity/start up pain
- Mechanical symptoms
- Increased water/Decreased proteoglycans in ECM
- Insidious onset
- Crepitus
- Joint line tenderness
- Effusion
- Deformity
- ROM difficulty
Radiographs in Osteoarthritis- what to order (4) and what you see (4)
Weight bearing* AP and lateral views, 45 degree flexion, sunrise
- Joint space narrowing
- Ostephyte formation
- Subchondral sclerosis
- Subchondral cysts
Osteoarthritis treatment options- nonoperative
Activity modification (reduce impact loading, reduce weight- for every 1 lb, 7lb of reactive force through knee)
Medications- NSAIDS (COX-1 or 2), acetaminophen (analgesic), narcotics
Injections- corticosteroids, Hyaluronate (backbone of proteoglycan), blood products
Osteoarthritis surgical options
Arthroscopy- debridement, chondroplasty: used for specific ROM pain that be be fixed by removing specific cartilage flap (NOT generalized knee pain)
Osteotomy- isolated arthritis, cutting bone and realigning
Arthroplasty- partial or full reconstruction of joint
Arthroscope prognostic factors- good
Increased pain with acute onset, mechanical symptoms
Recent effusion
Loose bodies; normal mechanical alignment
Isolated disease, Chandra like flap, meniscus tear
Arthroscope poor prognosis
Chronic symptoms
Malalignment, ligamentous instability
Complete loss of joint space
Diffuse disease, severe chondromalacia
Arthroplasty- indications, goals
Debilitating pain, failure of conservative care, end stage osteoarthritis (bone on bone- total knee)
Partial knee- isolated disease in one compartment
Total knee If insult to bone, cartilage, meniscus, and synovium* (if just have synovitis, just give steroid shot)
Resurface joint
Restore alignment
Restore joint height
Balance ligaments
What will cause immediate swelling of knee?
Delayed swelling?
Fracture, knee cap dislocation, ACL tear: only things vascular enough to cause immediate swelling
Cartilage, meniscus, arthritis
Meniscus function/vascularity
75% water, Collagen type I (ECM): Stability, shock absorption (load distribution, increase contact area, increase with flexion), decrease contact stress, lubrication, congruity
Medial posterior- anterior translation protection of tibia on femur
Lateral menisci- rotatory translation of tibia on femur
Both protect ACL
Vascularity- medial/lateral geniculate, inner portion is avascular/outer portion is vascular
Meniscus evaluation commandments
- Joint line pain with activity
- Mechanical complaints
- Acute- delayed effusion
- Twisting injury
- Small effusion
- Joint line tenderness*
- McMurray test
- Apley Compression test
- X-ray to rule out osteoarthritis
- MRI is gold standard
Meniscus treatment options
Nonsurgical- NSAIDs, PT, injections to control inflammation
Surgery- debridement, repair, replace (*once torn, function is lost) only gets rid of mechanical symptoms
Depends on different tear morphologies- radial tear splits white zone (avascular center)
Primary function of ACL is to prevent:
Anterior translation of tibia
Internal rotation of tibia on femur
Helps pivot shift
ACL- made up of, vascularity, healing potential
90% collagen 1
Middle geniculate a.
Intra-articular, extra synovial
NO healing potential
ACL tear evaluation commandments
- Pop sound in 70%
- Instability
- Immediate swelling
- Effusion
- Lachman
- Segond Sign- avulsion injury of lateral tibial plateau
- Anterior drawer
- Associated injuries in 75%- lateral meniscus, mcl, ACL
- MRI gold standard
- Bone bruises= pathognomonic
ACL treatment goals
Prevent instability
Pivot shift= cartilage damage= OA
