04 Meniscus Flashcards Preview

7212 Pathophysiology > 04 Meniscus > Flashcards

Flashcards in 04 Meniscus Deck (41):
1

exam techniques are predicated on

- clusters of s/s
- critical pathways
- clinical decision making
- clinical practice guidelines

2

What is an indication of a meniscus tear on imaging?

if you see discoloration within the bowtie

3

What other injury occurs with a high index of suspicion of a meniscus problem as well?

MCL injury

4

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

5

What is the most common procedure performed in orthopedic surgery? (broad category)

meniscectomy

6

What is the most common procedure performed in orthopedic surgery (subtype)?

arthroscopic partial meniscectomy

7

What is the prevailing philosophy of meniscectomy procedures?

- protect the meniscus at all costs
- total meniscectomies are extremely problematic

8

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

9

What are the types of meniscus procedures?

- Total meniscectomy
- Arthroscopic partial meniscectomy
- Arthroscopic meniscus repair
- Meniscus allograft

10

When would a total meniscectomy be indicated?

for a macerated, non-repairable meniscus

11

What idea is the arthroscopic partial meniscectomy based on?

based on the principle that the "white section" can be smoothed out or debrided

12

What is the success of a arthroscopic partial meniscectomy a result of?

reflection of the amount of meniscal tissue removed

13

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

14

What is done in a arthroscopic partial meniscectomy?

resect out the degenerated part and save as much as they can

15

arthroscopic partial meniscectomy outcomes

- initial reports were positive
- later reports indicate that the remaining tissue may not provide adequate joint protection

16

Why was the arthroscopic meniscus repair procedure developed?

to preserve damaged tissue

17

What are the surgical considerations for an arthroscopic meniscus repair?

- age
- chronicity of injury
- tear type
- tear location
- tear length
- associated ligamentous injury
- related vascular supply (based on zones)

18

What are the 3 zones associated with arthroscopic meniscus repair?

- red-red
- red-white
- white-white

19

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

20

What is the red-white zone?

- junction of vascular zone blood supply peripherally, not centrally
- border of vascular supply
- has generally good healing prognosis

21

What is another name for the area of the red-white zone?

avascular midsubstance

22

When is the red-white zone repairable?

if vascularity is stimulated

23

How is the red-white zone vascularity able to be stimulated?

- fibrin clot injection
- vascular access channel creation
- synovial abrasion

24

How is fibrin clot injection performed?

A fibrin clot can be injected into the meniscal lesion to promote healing through hematoma chemotactic factors

25

another name for vascular access channel

trephination

26

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

27

What is synovial abrasion?

- abrasion of the synovium with a surgical rasping device
- activates chemotactic factors that stimulate meniscal healing

28

What is the white-white zone?

- avascular zone
- poor prognosis for healing

29

How are surgical techniques for arthroscopic meniscus repair named?

named for the origin of suture delivery

30

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

31

Are open repairs common?

no, they are very rare now

32

Meniscus arrows: common?

- shouldn't see many of these
- mostly failed

33

What is rehab for arthroscopic meniscus repair dependent on?

- strength of the repair
- fixation used
- location of tear
- concomitant surgery

34

What is the controversy with regard to rehab of arthroscopic meniscus repair?

how to rehab
- traditional approach
- accelerated approach

35

All rehab protocols for arthroscopic meniscus repair will have

ROM limitations

36

For arthroscopic meniscus repair, what is weigh bearing status predicated on?

soft tissue healing

37

Why would a patient who has had arthroscopic meniscus repair need to stay on crutches longer?

to control effusion in the joint

38

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

39

What is different about the accelerated rehab protocols for arthroscopic meniscus repair?

allows early WB within first few weeks

40

What is a meniscus allograft?

- take a graft of donor tissue and replace the damaged meniscus
- bone plugs used to keep in place

41

What is now being used in animal trials for meniscus allograft?

gel material