Knee Flashcards
Which meniscus is more mobile?
The lateral meniscus
What kind of cartilage makes of the menisci?
Fibrocartilage
Which section of the meniscus is the least likely to heal?
The white-white or innermost
What history or MOI makes you think meniscus?
-Twisting
-Worse with movement, better with rest
-“locking”
-Joint line tenderness
-Effusion within 2 hours
-Sudden onset in those <40 years old, no specific MOI in those >50
Will all meniscal tears have “locking?”
No, some can just “shake it out” and keep going
What are the types of meniscal tear?
-Longitudinal
-Bucket-Handle (progressed longitudinal)
-Radial (perpindicular to curve)
-Root
-Oblique/flap
-Horizontal
Who has a good meniscal healing prognosis?
-Age <35
-Peripheral damage
-Longitudinal tear
-Short tear
-Acute injury with bloody effusion
-Stable knee
What are hallmark meniscal objective findings?
-Joint line tenderness
-Effusion
-Postive entrapment test (McMurray’s, Apley’s, Squat)
-Quad Inhibition (atrophy over first 1-2 weeks post injury)
What is joint line tenderness good for regarding meniscal injury?
Good Sensitivity (ruling out if negative)
What is the timeline for return to activity with meniscal debridement/meniscectomy?
1-2 weeks for ADLs, longer for athletic endeavors
At what length of meniscal tear is a meniscal repair indicated?
Longer than 8 mm
What are the indications for a meniscal repair?
-Traumatic lesion in the vascular zone
-Intact peripheral circumferential fibers
-Minimal damage to the meniscal body
-Longer than 8 mm
Arthroscopic partial meniscectomy and physical therapy are both..what?
likely to result in considerable improvement in functional status and knee pain over a 6-12 month period
Why avoid early hamstring strengthening after meniscal repair?
The semimembranosus connects to the medial meniscus
What kind of cartilage does articular cartilage consist of?
Hyaline cartilage - to reduce friction between the ends of bones
What type of articular cartilage lesions are symptomatic?
Grade III, IV; Grade I and II are typically asymptomatic
What can be said about image findings and articular cartilcage pathophysiology?
There is a poor correlation
What are some signs of articular cartilage damage?
-Resting genu varus
-Painful crepitus
-Catching, locking, grinding
-Sensitivity to weather changes
-Too little and too much activity is painful
-Quad atrophy
-Deep, dull ache
What are the options for surgical management of knee issues from more palliative to restorative?
-Debridement and lavage
-Microfracture
-Autologous Chondrocyte Implantation
-Osteochondral Grafting (OATS)
What is being done with articular catilcage debridement and lavage?
Removal of cartilage particles and inflammatory cells for short term pain relief of symptoms
What does the research say regarding debridement and lavage for articular cartilage lesions?
-No improvement compared to sham
-Little or no difference in pain or ability to function
-Maybe better than washout
Describe microfracture as a treatment for articular cartilage lesions.
Making pick holes through tidemark to encourage blood flow; replaces cartilage with fibrocartilage
What does the research say regarding medium to long-term outcomes with microfracture for articular cartilage lesions?
Poor regaring getting back to sport, better with sedentary or low post operative demand individuals. Treatment failure after 5 years is expected
Describe the Autologous Chondrocyte Implantation (ACI) procedure
Small biopsy of autologous articular cartilage harvested, enzymatically digested in a lab to release chondrocytes, which are cultured and then implanted at a second surgery with a periosteal flap placed as a patch
