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Year 2 > Cartilage injuries and arthritis > Flashcards

Cartilage injuries and arthritis Flashcards

1
Q

Where is hyaline cartilage found?

A

Covering the surface of bones at synovial joints

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2
Q

What are the functions of hyaline cartilage?

A

Decrease friction

Distribute load

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3
Q

Describe the structure of hyaline cartilage

A

Water
Collage type II
Proteoglycans
Chondrocytes

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4
Q

What do chondocytes do?

A

Produce collagen (type II), proteoglycans and enzymes which help maintain the extracellular matrix

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5
Q

How does hyaline cartilage receive it’s nutrition?

A

Synovial fluid

Subchondral bone

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6
Q

What is the function of proteoglycans?

A

Highly hydrophilic molecules which “inflate like balloons” to provide compressive strength

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7
Q

What is the function of collagen?

A

Tensile strength

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8
Q

What are proteoglycans made of?

A

Hyaluronic acid

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9
Q

Hyaline cartilage defects can be traumatic or atraumatic. Give some examples of both

A 
Traumatic 
 - Ligament injury
 - Dislocation
Atraumatic 
 - Osteochondritis dissecans 
 - Osteoarthritis 
 - Inflammatory arthritis
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10
Q

Which type of cartilage injuries heal? What is different about healed cartilage as compared to normal cartilage?

A

Full thickness

Not hyaline but fibrocartilage which is less wear resistant with greater friction

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11
Q

What is osteochondritis dissecans?

A

Area of the knee loses its blood supply and cartilage +/- bone fragment detachment

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12
Q

In what age group is osteochondritis dissecans most common?

A

Adolescents

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13
Q

How is osteochondritis dissecans managed?

A

May heal/resolve spontaneously
Can pin in place if detaching on MRI
Can fix or remove if detached
Cartilage regeneration in severe cases

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14
Q

Is cartilage regeneration more effective on big or small defects?

A

Small

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15
Q

Which joint can cartilage regeneration techniques NOT be performed on? Why?

A

Patellofemoral joint

There is too much sheer stress at this joint for it to be effective

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16
Q

What are the techniques used for cartilage regeneration?

A

Drilling/microfracture
Mosaicoplasty
MACI
Osteochondral auto/allograft

17
Q

What does MACI stand for?

A

Membrane induced autologous chondrocyte implantation

18
Q

What are the contra-indications to cartilage regeneration?

A

Radiographic signs of osteoarthritis
Joint instability
Inflammatory arthritis

19
Q

Why are open procedures not great with respect to cartilage regeneration?

A

Air is toxic to hyaline cartilage

20
Q

What techniques of cartilage regeneration are used in tayside and why?

A

Microfracture - cheap and easy

Allograft - larger defects +/- bone damage

21
Q

What is osteoarthritis?

A

Pathology of the joints resulting from imbalance of cartilage breakdown and regeneration

22
Q

What predisposes to osteoarthritis?

A 
Injury
Malalignment
Degenerate meniscal tear
Infection
Genetic
23
Q

How is osteoarthritis initially managed?

A

Weight loss
Analgesia
Activity modification, aids, etc

24
Q

When are steroid injections indicated in osteoarthritis?

A

Acute flare ups

25
Q

What are the risks of steroid injection with respect to osteoarthritis?

A

Too many injections can accelerate OA

Infection risk

26
Q

When is osteotomy indicated in osteoarthritis?

A

Early medial compartment OA in a varus leg

27
Q

When is debridement and washout indicated in osteoarthritis?

A

Never because it doesn’t work

28
Q

Which compartment of the knee will be under the most stress in a varus and valgus knee respectively?

A

Varus - medial

Valgus - lateral

29
Q

How can the directions of the legs in genu varum and valgus be remembered?

A

VaRum - feet Return

VaLgus - feet Leave

30
Q

When is knee replacement indicated for osteoarthritis? Which type of knee replacement is most effective?

A

Elderly patients with end stage disease.

Total replacement has better results than partial replacement

31
Q

What are the risks of knee replacement?

A

Deep infection
Stiffness
Pain
DVT +/- PE

Year 2 (72 decks)

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