Flashcards in 04 Meniscus Deck (41):
exam techniques are predicated on
- clusters of s/s
- critical pathways
- clinical decision making
- clinical practice guidelines
What is an indication of a meniscus tear on imaging?
if you see discoloration within the bowtie
What other injury occurs with a high index of suspicion of a meniscus problem as well?
Why do orthopedic surgeons need to use MR for meniscal tears?
- determine the exact type of tear to help guide the surgery
- location and type of tear will determine what's done
What is the most common procedure performed in orthopedic surgery? (broad category)
What is the most common procedure performed in orthopedic surgery (subtype)?
arthroscopic partial meniscectomy
What is the prevailing philosophy of meniscectomy procedures?
- protect the meniscus at all costs
- total meniscectomies are extremely problematic
Why is the amount of meniscus removed so important?
There's a direct correlation between the onset of DJD and the amount of meniscus removed
What are the types of meniscus procedures?
- Total meniscectomy
- Arthroscopic partial meniscectomy
- Arthroscopic meniscus repair
- Meniscus allograft
When would a total meniscectomy be indicated?
for a macerated, non-repairable meniscus
What idea is the arthroscopic partial meniscectomy based on?
based on the principle that the "white section" can be smoothed out or debrided
What is the success of a arthroscopic partial meniscectomy a result of?
reflection of the amount of meniscal tissue removed
Why are older people susceptible to torn menisci?
- older people have degenerative changes in the meniscus from wear and tear
- standing up could be a twisting injury due to normal arthrokinematics of the knee
What is done in a arthroscopic partial meniscectomy?
resect out the degenerated part and save as much as they can
arthroscopic partial meniscectomy outcomes
- initial reports were positive
- later reports indicate that the remaining tissue may not provide adequate joint protection
Why was the arthroscopic meniscus repair procedure developed?
to preserve damaged tissue
What are the surgical considerations for an arthroscopic meniscus repair?
- chronicity of injury
- tear type
- tear location
- tear length
- associated ligamentous injury
- related vascular supply (based on zones)
What are the 3 zones associated with arthroscopic meniscus repair?
What is the red-red zone?
- peripheral (10-30%) with blood supply on both sides
- fully vascular with excellent healing potential
- repairable within 3 mm of vascular periphery
What is the red-white zone?
- junction of vascular zone blood supply peripherally, not centrally
- border of vascular supply
- has generally good healing prognosis
What is another name for the area of the red-white zone?
When is the red-white zone repairable?
if vascularity is stimulated
How is the red-white zone vascularity able to be stimulated?
- fibrin clot injection
- vascular access channel creation
- synovial abrasion
How is fibrin clot injection performed?
A fibrin clot can be injected into the meniscal lesion to promote healing through hematoma chemotactic factors
another name for vascular access channel
How are vascular access channels created? Why?
- tunnels created from vascular portions of the peripheral meniscus (red zone) to the more central avascular area (white zone)
- enables fibrovascular scar proliferation in the damaged meniscal section
What is synovial abrasion?
- abrasion of the synovium with a surgical rasping device
- activates chemotactic factors that stimulate meniscal healing
What is the white-white zone?
- avascular zone
- poor prognosis for healing
How are surgical techniques for arthroscopic meniscus repair named?
named for the origin of suture delivery
What are the types of surgical techniques for arthroscopic meniscus repair?
- open repair or arthroscopically assisted
- inside-out repair
- outside-in repair
- all-inside repair
- meniscus arrows
Are open repairs common?
no, they are very rare now
Meniscus arrows: common?
- shouldn't see many of these
- mostly failed
What is rehab for arthroscopic meniscus repair dependent on?
- strength of the repair
- fixation used
- location of tear
- concomitant surgery
What is the controversy with regard to rehab of arthroscopic meniscus repair?
how to rehab
- traditional approach
- accelerated approach
All rehab protocols for arthroscopic meniscus repair will have
For arthroscopic meniscus repair, what is weigh bearing status predicated on?
soft tissue healing
Why would a patient who has had arthroscopic meniscus repair need to stay on crutches longer?
to control effusion in the joint
What is the traditional approach for rehab of arthroscopic meniscus repair?
approach rehab slowly
- first week or two, NWB to allow healing to occur
- progressive to FWB within 4-6 weeks
What is different about the accelerated rehab protocols for arthroscopic meniscus repair?
allows early WB within first few weeks
What is a meniscus allograft?
- take a graft of donor tissue and replace the damaged meniscus
- bone plugs used to keep in place