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MSK 1 > 11/8 - Articular Cartilage Lesions > Flashcards

11/8 - Articular Cartilage Lesions Flashcards

(60 cards)

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1
Q

OA vs articular cartilage lesions

A

OA - larger, broader scale of damage

articular cartilage lesions more localized

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2
Q

what are 2 functions of articular cartilage

A
  1. provides low friction wt bearing surface (low coefficient of friction)
  2. absorbs shock
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3
Q

what does it mean that articular cartilage is aneural and avascular

A

lacks inflammatory phase
minimal ability to repair/regen

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4
Q

role of chondrocytes

A

orchestrate matrix balance

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5
Q

what is the tidemark in cartilage

A

junction of calcified articular cartilage w subchondral bone
- aka transition from cartilage to bone

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6
Q

describe lesion classification of articular cartilage

A

type 1 = softening
type 2 = fibrillation
- superficial damage
type 3 = fissuring to bone
type 4 = full thickness

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7
Q

how to dx a type 1 articular cartilage lesion

A

via arthroscopy and probe surface to detect softening

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8
Q

MOI of articular cartilage defects is similar to what other injuries

A

meniscal tears
ligamentous injuries

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9
Q

why are XRs used as diagnostic imaging in articular cartilage lesions

A

can’t appreciate cartilage damage

looking to see where bone is taking more load than should be (whiter area = bony edema)

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10
Q

what is an important view to take XR from for articular cartilage damage

A

in a WBing view
- look at space b/w femur and tib -> can estimate amt of cartilage between

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11
Q

what diagnostic imaging can appreciate the cartilage defect

A

CT scan

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12
Q

size classification of articular cartilage lesions

A

small <2cm
mod 2-10cm
large >10cm

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13
Q

what relationship does the size of the defect have w the surgical procedure

A

bigger it is = worse it is = more challenging the procedure

depending on size makes surgeries more or less appropriate

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14
Q

what is a consideration when measuring the size of the lesion

A

lesions are larger than they seem
- once you debride all unhealthy tissue there is a greater area underneath

could see this on an MRI

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15
Q

what are 7 non-surgical options for articular cartilage lesions

A

NSAIDs
glucosamine/chondroitin sulfate
cosamin DS
viscosupplementation
bracing
orthotic therapy
exercise

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16
Q

what is the purpose of taking glucosamine / chondroitin sulfate

A

building blocks of articular cartilage

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17
Q

what is the purpose of taking cosamin DS / osteobioflex

A

components of articular cartilage
- does NOT form NEW cartilage

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18
Q

what is viscosupplementation and what is the duration

A

hyaluronic acid injections
6-12mo pain relief

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19
Q

what cases are unloader braces helpful in

A

isolated lesions on one side

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20
Q

what is the purpose of bracing in articular cartilage lesions

A

change mechanical stresses at impacted knee compartment

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21
Q

what is the purpose of orthotic therapy in articular cartilage lesions

A

change axis of stress at joint
- ex: wedge in shoe

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22
Q

with articular cartilage lesions what is the goal of exercises

A

ms that act to absorb shock
provide normal environment around knee

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23
Q

what are 4 surgical options for articular cartilage lesions

A

bone marrow stim
osteochondral transplantation
cellular therapy
matrices/scaffolds

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24
Q

what is bone marrow stimulation

A

abrasion, drilling, micro fx
- create bleeding environment to facilitate fibrocartilage growth

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25
what are osteochondral transplantation options for articular cartilage lesions
autologous: - OATS - mosaicplasty allograft
26
what is cellular therapy in articular cartilage lesions
autologous - MACI
27
what is the purpose of matrices and scaffolds in articular cartilage lesions
preserve cartilage and protect it
28
what can dictate healing potential from an articular cartilage lesion and what is the significance of someone's healing potential
declines w age depends on comorbidities: - DM, smoke, drink all this factors into if they are a better or worse candidate for surgery
29
why does the location of the articular cartilage lesion matter
plays a role in degree of motion that engages with the lesion and creates sx
30
what is arthroscopic debridement / chondroplasty
remove loose fragments to dec irritation and dec pain
31
incidence of chondroplasty procedures
not done often any more
32
what pt is chondroplasty optimal in
if low demands on knee
33
fibrocartilage replacement of hyaline cartilage defects?
fibrocartilage isn't as strong or desirable - but better than no cartilage
34
how does microfracture work as a surgical procedure
stim marrow stem cells - create fibrin clot -> fibrocartilage growth
35
collagen consistency in hyaline vs fibrocartilage
hyaline: types II, IX, XI - organized fiber orientation - organization allows to be stronger and more resilient to compressive and shear forces fibro: type I - unorganized fiber orientation
36
is hyaline or fibrous cartilage stiffer
hyaline 2x stiffer than fibrous
37
what are 4 advantages of microfracture
1. single stage procedure 2. ease of procedure 3. cost effective 4. doesn't "burn any bridges" - if fails, though that could go back in and do another procedure but not necessarily the case
38
what are 2 disadvantages of microfracture
final product is fibrocartilage - limited durability inferior results in lesions >4cm (size matters lol)
39
what are 4 success criteria in microfracture
1. young patient (<35-40) 2. small area - <2cm, contained 3. less WBing surface 4. BMI <25
40
articular cartilage lesion that is contained vs shouldering
contained - smaller - not a tone of load at subchondral bone shouldering - margins further away - load directly onto bone
41
ant vs post location of articular cartilage lesion and WBing
post - less WB surface - only when in deep flex ant - loading when standing up straight
42
what is a consideration of the rehab process for microfracture when thinking ab pt goals
not a short process - esp if have someone trying to get back to sports
43
after microfracture when does cartilage reach full maturation
6-12mo
44
what does WBing precautions after microfracture depend on
location and size of lesion fem condyle (ant) - FWB delayed to ~8wks patellar/trochlear (post) - WBAT in hinged brace w 10deg flex stop
45
return to high impact activity after microfracture
up to 8mo for large lesions 4-6mo in small lesions
46
what is the key to rehabing a microfracture
create healing environment without overloading healing tissue
47
goals for proliferation phase of microfracture rehab (3)
promote healing environment control pain and swelling work on PROM
48
what are the goals of the transition/remodelling phase of microfracture rehab (2)
1. good ROM, work on strengthening (quads) 2. inc functional activity - weaning away from AD and bracing to more WBing
49
what is the goal of maturation phase of microfracture rehab
deliberate return to sport
50
what is the criteria for progression to gradually return to sport after microfracture (4)
full pain free ROM 80-90% strength 80% balance no pain, swelling
51
what is the criteria to start working on strengthening after microfracture (4)
full passive ext 125deg knee flex min pain/swelling voluntary quad contraction
52
what happens during an OATS procedure
transfer healthy cartilage from minor load bearing surface to lesion
53
what is the primary advantage to an OATS procedure
better quality of tissue than fibrocartilage bc transferring hyaline cartilage
54
what is a limiting factor as to whether OATS procedure is appropriate
size of lesion - only so many places to harvest from that won't be WBing
55
what is an advantage to an autograft OATS
faster incorporation bc pt's own tissue
56
what is advantage to allograft OATS
slower bone incorporation bc not your own bone - can be non-union
57
when is allograft vs autograft OATS more appropriate
allograft = larger defect autograft = smaller
58
what is the success criteria for an OATS
optimal size of lesion <2cm
59
what is the usual harvest site for OATS
superior edges of trochlea
60
what dictates the WBing timeline after OATS
if lesion/graft on femoral condyle (more load bearing) or patellar/trochlear (bears less load)

MSK 1 (31 decks)

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