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Details

Knee Pathology
Meniscal and Chondral Injuries and Exam
40
Anatomy
Graduate
11/08/2010

Additional Anatomy Flashcards

 


 

Cards

Term

 

True or False

 

Menisci are primarily avascular

Definition

 

True

 

The inner 2/3 of menisci are avascular

Term

 

 

What are menisci?

 

Structurally not functionally

Definition

 

 

Fibrocartilagenous discs that are 74% water

Term

 

 

Are adolescents more or less prone to meniscal

injuries compared to adults

Definition

 

 

Less

 

*Tissue degenerates with aging

Term

 

 

When are menisci subject to injury/what

puts them at risk of injury?

Definition

 

 

Repetitive cyclic loading, cutting, pivoting, jumping

 

*Most often as a result of sudden rotation of femur on fixed tibia w/ knee in flexion

Term

 

 

Which meniscus is more subject to injury

Medial or Lateral?

Definition

 

Medial

Term

 

 

Key words with meniscal injuries

Definition

 

 

Locking

 

Catching

 

Clicking

Term

 

 

Typical Subjective Report

Meniscal Injuries

Definition
  • Medial or lateral compartment pain, often posteriorly
  • Pain w/ deep knee bending, walking, twisting
  • Sensation of giving way
  • Catching, locking, clicking (mechanical symptoms)
  • Continuous or recurrent effusions
Term

 

 

Hemarthrosis

Definition

 

  • 1-2 hour onset
  • Probable cause: ligament tear, osteochondral fx, peripheral meniscal tear
  • S&S: taut skin, doughy/hard feeling, warm surface
Term

 

Swelling

Purulent or Pus

Definition

 

  • warm/hot to touch
  • occassionally red
  • pt has signs of infection/fever
Term

 

 

Swelling

Synovial Fluid

Definition

 

  • 8-24 hour onset
  • S&S: boggy feeling to the joint
  • warm and tender surface
  • occurs with activity and disappears after a few days of inactivity
Term

 

 

Rehab after Meniscectomy

In General

Definition

 

  • No anatomic structure needs protection
  • Proceed aggressively
  • Goals are as for meniscal repairs
Term

 

Rehab after Meniscectomy

Acute Phase

*Brotzman

Definition
  • Diminish inflammation
  • Restore ROM
  • Re-establish quad activity
  • Days 1-10
Term

 

 

Rehab after Meniscectomy

Internal Phase

 

 

 

*Brotzman

Definition

 

  • Restore and Improve muscular strength and endurance
  • Re-establish full non-painful ROM
  • Gradual return to functional activities
  • Day 10 - Week 4
Term

 

Rehab after Meniscectomy

Advanced Activity Phase

 

 

 

*Brotzman

Definition

 

  • Enhance muscular strength and endurance
  • Maintain full ROM
  • Return to sport/functional activities
  • Weeks 4-7
Term

 

Rehab after Meniscectomy

Criteria for progression to Phase 3

 

 

 

*Brotzman

Definition

 

  • Full, non-painful ROM
  • No pain or tenderness
  • Satisfactory isokinetic test
  • Satisfactory clinical exam (minimal effusion)
Term

 

 

Zones of Cartilage

Definition
[image]
Term

 

 

Type 1 Cartilage Injury

Definition

 

  • Superficial
  • Microscopic damage to chondrocytes and ECM
  • Cell Injury
Term

 

 

Type II Cartilage Injury

Definition

 

  • Partial thickkness (microscopic disruption of surface)
  • Chondral fx or fissure
  • Does not provoke inflammatory response b/c it doesn't penetrate subchondral bone
Term

 

 

Type III Cartilage Injuries

Definition

 

  • Full thickness
  • Disruption of cartilage
  • Penetration into subchondral bone
  • Significant inflammatory response
Term

 

 

Tidemark Zone

Definition

 

 

weak link between overlying cartilage and subchondral bone

Term

 

 

Rotational force in direct trauma is

 most common cause of ___________

Definition

 

 

Chondral Injuries

Term

 

 

Osteochondritis Dissecans

(OCD)

Definition

 

 

Fragment of bone or cartilage comes loose and floats  within the knee joint

 

*AKA chondral fx or loose body

Term

 

 

Distribution of OCD

Definition
[image]
Term

 

 

OCD Treatment

Definition
  • Cartilage need WB and ROM to maintain integrity
  • Follow surgeon's ROM restrictions to avoid engaging lesion during exercise
  • Generally P/AAROM exercise ok
  • Goal of full ext in 1 wk and full flex 3-5 wks
  • Closed chain avoided for first 4-6 weeks
Term

 

 

8th leading cause of disability in the world

Definition

 

 

OA

Term

 

 

What's OA?

Definition
  • Fissures, cracks, and thinning of cartilage
  • Bone damage
  • Synovial inflammation
  • Hypertrophy of cartilage
  • Prograssive erosion
  • RESULT: pain and stiffness
Term

 

 

OA Rist Factors

Definition
  • Previous traumatic joint injury
  • obesity (knee > hip)
  • Heredity
  • Malalignment
  • Instability
  • Quad weakness
  • Occupation
Term

 

 

 

Priamy OA

Definition

 

  • No known cause
  • Eventual degredation of cartilage until bone is exposed
  • appears related to aging and heredity
  • believed to be result of excess load or normal loading of previously injured joint
Term

 

 

Secondary OA

Definition

 

Occurs as a result of articular injury

 

-Fx, repetitive joint stress, obesity, metabolic disease (osteoporosis, osteomalacia)

Term

 

 

When pt has OA, will stiffness increase, decrease, or stay the same with activity?

Definition

 

 

Decrease

Term

 

 

Mild OA Treatment

Definition
  • Education
  • AROM hip, knee and ankle
  • Modalities prn
  • knee sleeve
  • quad sets
  • isometrics PREs for quads, hamstrings, hip ADd/ABd
  • Low impact conditioning, aquatics
Term

 

 

Moderate-SEvere OA Treatment

Definition
  • AAROM hip, knee, and ankle
  • Stretching (hamstrings, quads, hip add, gastroc)
  • Unloaded aerobic conditioning
  • strength exs (isometric, progress to hip add/abd, SLR)
Term

 

 

Total Knee Arthroplasty

(TKA)

Definition

 

  • Most common indication is disabling arthritic knee pain that does not respond to conservative measures
Term

 

 

TKA Contraindications

Definition

 

 

Peripheral vascular disease

history of infection

morbid obesity

Term

 

 

Early Goals after TKA

Definition

 

  • Restore motion and strength
  • Reduce pain
  • Prevent DVT
Term

 

 

TKA goals during rehab

Definition

 

  • Obtain and maintain knee ROM
  • Develop knee and hip muscle strength
  • Functional independence
Term

 

 

TKA Complications

Definition
  • DVT
  • Wound issues
  • Infection
  • Nerve Palsy
  • Femoral Fracture
  • Patellofemoral instability
  • Knee stiffness
Term

 

 

Is infection after TKA more common with RA or OA?

Definition

 

 

2-3 times more likely in RA over OA

Term

 

 

TKA implant longevity

Definition

 

 

10-15 years

Term

 

 

Chondromalacia Patella (CMP)

Definition

 

 

  • Softening of cartilage
  • Referes to changes on lateral facet of patella
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