Flashcards in Lecture 5 Deck (86)
What is the MC knee injury in service members?
Meniscal tears are 10x more common
Which meniscus is most commonly torn?
Medial meniscus shape and what is it attached to?
It is semilunar and adherent to MCL
Shape and location of the lateral meniscus?
Covers more of the tibia
What is the purpose of a meniscus?
Distributes the load of the joint via circumferential or hoop stress
How much does lateral meniscus decrease compartment loads by>?
Medial meniscus decreases compartment loads by___?
Common tears of meniscus?
Vertical longitudinal (moon in the middle)
Vertical radial (a cut)
Horizontal (wear on the inside of the c)
Oblique (oblique cut)
Complex/degenerative (shit show)
What is the effect of a meniscal tear?
It disrupts the mechanics of the knee, leading to degenerative arthritis
Blood supply in meniscuses?
The more peripheral the higher the blood supply
The higher the blood supply the higher the chance of of healing
MOA for meniscus tear?
Usually pivot or twist
Meniscus warning signs
Joint line tenderness of medial or lateral side of knee
Pains worsens w twisting or squatting
Mechanical symptoms (locking, catching and popping)
Effusion >12hrs (slow leak)
PE for meniscal tear?
Joint line tenderness
Decreased ROM (esp w locked knee)
Special tests for meniscus tear?
Pt has a displaced “bucket handle” meniscal tear?
What do radiographs show?
Eval for loose bodies/bone fragments
What grades of meniscus tear are visible on arthroscopy?
III and IV
You’re getting surgery
You get a meniscus tear and it gets fixed (or doesnt) what do you win?
Osteoarthritis will develop
Who should not get surgery?
Conservitavie management for:
- 40+ w pain but no mechanical symptoms
- degenerative tears and/or middle 1/3 (avascular)
Who should get surgery?
Tears between 1 and 4cm
Meniscal root tear
Failure of nonopp
Bucket handle/locked knee
We decide not to get surgery how do we treat your meniscal tear?
The same as any other musculoskeletal inj
Back to life
96% of the time what are the surgeons doing for meniscus tears?
Only 4% repair
How does the military handle surgery for meniscal tears?
The military does many more repairs than the civilian sector does
What meniscus tears get referred?
Trauma, mechanical symptoms or instability
All bucket handle tears
What is an OCD?
Osteochondritis dissecans : osteonecrosis of subchondral bone
Usually occurs in the knee but not always
MC location for OCD?
Posterolateral side of the medial femoral condyle
What causes OCD?
Repetitive small stress to the subchondral bone that disrupts the blood supply to an area of bone
Osteonecrotic bone separates
Shear forces fracture the articular surface
What happens to the osteonecrotic fragment once it breaks free?
It can become a loose body in the joint
Clinical presentation of OCD?
Gradual onset of knee pain
Knee effusion and catching or locking symptoms