Articular Cartilage Lesions Flashcards Preview

MS Test 3: Lower Quarter > Articular Cartilage Lesions > Flashcards

Flashcards in Articular Cartilage Lesions Deck (32):
1

What is the function of the articular cartilage?

Provides low friction weight bearing surface
 Low coefficient of friction – 15X less than ice on ice

2

What is important to remember about the vascularity and neural component of the cartilage?

Minimal ability to repair / regenerate and lacks inflammatory phase as it is avascular and aneural

3

What about the underlying bone?

Abundance of nerve
endings
– Well vascularized

4

What are two important anatomical features of articular cartilage?

 Chondrocytes
– Orchestrate matrix
balance

 Tidemark
– Junction of calcified articular cartilage with subchondral bone (critical part for healing or no healing)

5

What are the 4 types of lesion classification?

type 1- softening
type 2- fibrilation
type 3- fissuring to bone
type 4- full thickness

6

What is size classification for an articular cartilage damage?

small less then 2 cm
mod- 2-10 cm
large over 10 cm

7

What are non surgical options for cartilage lesions?

Nsaids, glucosamine/chondrotin injections, hyaluronic acid injections can provide 6-12 months of pain relief

8

Other then meds what is used for non surgical cartilage lesions?

bracing to unload joint, orthotic therapy, exercises to let muscles absorb more shock

9

What is a common procedure to attempt and repair cartilage lesions?

Microfracture- stimulates marrow stem cells

10

What is important to remember about micofracture procedure?

it replaces hyaline cartilage with fibrocartilage

11

What is major difference between hyaline and fibrocartilage?

hyaline- organized collagen fiber formation

fibrocartilage- unorganized collagen which makes it not as strong and not as resistant to load

12

What are advantages of a micro fracture procedure?

relatively simple procedure, high long term success rate, doesn't burn any bridges for other procedures

13

What are criteria for a likely successful micro fracture procedure?

small area, acute injury (3 months), weight bearing surface, young patient (under 40)

14

What is key for micro fracture rehab?

is to create a healing environment without overloading healing tissue

15

What is typical WB status following a MF procedure?

small- NWB-TDWB- 4-6 weeks

large- NWB-TDWB 6-8 weeks

16

What are usual PT guidelines for rehab?

Weight shifts week 4
Squats week 6
Lunges & Step-ups week 8 Walking program week 10 Moderate sports week 12-16 High impact athletics week 18-26

17

What is an OATS procedure?

osteochondral graft transfer, transferring healthy cartilage from minor load bearing surface to area of lesion so replacing hyaline with hyaline

18

Why would an allograft be used in an OATS vs an autograft?

allograft- larger area, but slower bone incorporation and higher non union rates

19

What is typical weight bearing status after an OATS procedure?

 Week 0-2 NWB brace locked @ 0°  Week 3-4 TDWB brace locked @ 0°  Week 5-6 PWB
 Week 6-8 FWB

too much load early on will disrupt healing

20

What is typical rehab after an OATS procedure?

Weight shifts week 4
Squats week 6
Lunges & Step-ups week 8 Walking program week 10 Moderate sports week 12-16 High impact athletics week 18-26

21

What is an ACI procedure?

autologous chondrocyte implantation, two stages

1. arthroplasty- determine area
2. open- execute procedure

22

What is premise behind ACI?

harvest cells from healthy cartilage and then inject cultured cells into unhealthy cartilage

23

What is most crucial part of ACI rehab?

PT education about procedure and why it is important to follow guidelines to protect healing

24

What are goals during protection phase post ACI?

 Protect healing tissue from load and shear forces  Decrease pain and effusion
 Restore full passive knee extension
 Improve knee flexion
 Improve quadriceps control

25

What is weight bearing status 0-6 weeks post ACI?

 NWB 1-2 weeks
 TTWB 2-3 weeks  PWB 4-5 weeks

26

What are rehab goals in the transitional phase of post ACI?

 Gradually increase ROM
 Gradually improve quadriceps strength/endurance  Gradual increase in functional activities

27

When should a brace be discharged post ACI?

week 6

28

What is WB status in weeks 6-12 post ACI?

Progress to WBAT
 FWB at week 8-9
 D/C crutches at week 8-9

29

What is ROM goals weeks 6-12 post ACI?

 Maintain full passive knee extension  Increase knee flexion to 125°-135°

30

What are goals weeks 12-26 post ACI?

– Goals:
 Improve muscular strength and endurance Increase functional activities
– ROM:
 Patient should exhibit full ROM in flexion and extension

31

What are goals weeks 26-52 post ACI?

Gradual return to full functional activities Begin sport-specific programs

32

What is the future of articular cartilage repair?

use of hydrogels, similar water content to cartilage has low coefficient of friction and can withstand a lot of load

however having trouble integrating to bone