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Knee Meniscus & Cartilage
Repairs new update questions
and answers
which meniscus is c-shaped - answer medial meniscus which meniscus is circular - answer lateral meniscus how do the menisci shift w/ ROM - answer move outward & posteriorly which meniscus is more mobile - answer lateral which fibers of the menisci distribute the majority of hoop stresses - answer the circumferential fibers where do menisci receive their nutrients from - answer -their root attachments -have three zones of vascularity what are the three zones of meniscal vascularity - answer -red-red -red-white -white-white have implications for healing/repair
what is the function of the menisci - answer -chondral protection -shock absorption/lubrication -knee stabilization how much articular surface does the medial meniscus cover - answer 50-60% how much articular surface does the lateral meniscus cover - answer 70-80% what role do the menisci play in knee stabilization - answer -secondary stabilizer w/ intact ACL -primary stabilizer w/ deficient ACL does knee flexion put more or less compressive load on the knee than extension - answer flexion (85%) places a greater compressive load on menisci than extension (50%) what are the consequences of a meniscectomy on general health - answer -adolescents have 90% chance of developing OA over next 40 yrs -132x the risk of knee replacement -20-50% of pts never RTS what are the consequences of a meniscectomy on knee anatomy - answer -dec contact area by 45-70% -inc contact stressed by 200-300% -risk of OA progression directly porportional to amt of meniscus removed what are the types of meniscal tears - answer -root tears -ramp lesions -radial tears -bucket handle tears
what are components of radial meniscus tears - answer -up to 28% of all tears of posterior horn -posterior horn tears compose up to 50% of all radial tears what are different types of meniscal repairs - answer -inside-out (gold standard) -outside-in -all-inside what are pros of inside-out meniscus repair - answer -gold standard -small footprint -multiple fixation points -cheaper what are cons of inside-out meniscus repair - answer -NV injury (medial saphenous, lateral peroneal) -needs skilled assistant -technically difficult what are pros of outside-in meniscus repair - answer -good for anterior tears -small footprint -cheap what are cons of outside-in meniscus repair - answer -limited anatomy -potential articular cartilage injury what are pros for all-inside meniscus repair - answer -fast -no assistant needed -no incision needed
-faster OR timing what are cons for all-inside meniscus repair - answer -cost -NV injury -implant breakage -potential chondral damage what are results of a meniscal repair - answer -best done w/ ACL reconstruction but isolated repairs can be done successfully -requires stability (70% fail rate w/ ACL deficiency) what composes articular cartilage - answer -chondrocytes -water -type II collagen -proteoglycans what are ways articular cartilage can be injured - answer -trauma -ligamentous injury -patellar dislocation -repetitive load -iatrogenic -osteochondritis dissecans what are components of articular cartilage diagnosis - answer -gold standard = arthroscopy -NOT ALL DEFECTS ARE SYMPTOMATIC
what are components of treatment for osteochondritis dissecans (OCD) - answer -protected WB -healing may take several months -50-90% healing rate how is surgery for OCD chosen - answer -symptomatic -unstable -juvenile v athlete v adult -bone involvement v pure cartilage what is RTS criteria for OCD - answer -ability to meaningfully contribute to the team -no catching or locking -full ROM -no effusion or trace what are stable lesions for OCD surgical treatment - answer -anterograde v retrograde drilling -stimulates vascular channels -leads to fibrocartilage repair (not hyaline) -works best in juvenile cases what are components of cartilage repair which have PT implications - answer -location of defect -size -pt age -sport participation -fixation method -is there another surgery planned?
what are options for cartilage restoration - answer -microfracture -ACI -OATS -OCA what are considerations for cartilage restoration - answer NOT ALL CARTILAGE IS SALVAGEABLE
