Meniscal tears, Osteoarthritis

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Meniscal tears, Osteoarthritis Osgood-
Schlatters Disease

• By Juliann Plimpton

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Meniscal Tears

• MOI/ Etiology
• Valgus force- adducts the knee- tears medial
  meniscus
• Varus Force- abducts the knee- tears lateral
  meniscus
• Weight- baring combined with rotary force while
  knee is flexed or extended
• Londitudinal tear- knee is forcefully extended
  from a flexed position while the femur is
  internally rotated
• Most tears happen as a combination of all these
  MOI
• Lateral rotation of the femur
• Knee partially flexed
• Foot firmly planted
• Three zones
• Red-Red zone- outer 1/3 rich blood supply. Tears
  can heal over time when in this area
• Red-White zone- middle 1/3 blood scares
• White-White zone- inner 1/3 no blood circulation
• Surgery is required when meniscal tears are in
  these zones.

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Signs Symptoms

• Joint line pain and loss of motion
• Intermittent locking. Giving way of the knee
• Pain when athlete squats
• Complaining of popping knee collapse
• Swelling
• Management
• MRI
• Arthroscopic surgery
• Special Test
• McMurrays Meniscal test (p. 621)
• Apley Compression test

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Arthroscopic Surgery

• The evaluation of a tear by inserting a blunt
  probe into the knee
• Once evaluated the effected area is removed
  (meniscectomy)
• Removed my cutting and sucking out tear

                                                           
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Techniques for Meniscal Tear Repair

• Inside Out- curved guide tubes are used to direct
  a pair of long needles into the meniscus and out
  through a small incision in the back of the knee
• Suture threads connected to the needles are then
  tied off out side of the knee
• This works well but take note that a 11/2 to 2
  incision needs to be made.

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Cont.

• Inside-In (T-Fix) includes meniscal staples and
  bioreabsorbable T- arrows.
• sutures have an anchor,
• Multiple sutures pairs are placed through long
  hollow needles
• knot pusher instrument that securely snugs the
  meniscus down and provides an excellent repair.

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Peripheral meniscal tear in the zone of blood supply                                                                                                 
Knots are pushed down after placing suture anchors               Close up of knot pusher  
                                                                   Arthroscopic view of a meniscus repaired with the T-Fix system                                                                                                            
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Management

• No weight baring for at least three weeks, with
  light-loading muscle exercises
• After this physical therapy, maximal weight
  training not allowed until 2-3 months
• Return to running and agility sports 3-4 months
• With just the removal of a meniscal tear one
  recovers a lot quicker.
• Back in play by 4-6 weeks.

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Osgood-Schlatter Larsen- Johansson Diseases

• MOI of Osgood-Schlatters Disease-
• Is an apophysitis characterized by pain at the
  attachment of the patellar tendon and tibial
  tubercle
• Repeated avulsion of the patellar tendon at the
  apophysis
• Common in adolescents
• MOI of Larsen-Johansson Disease-
• Occurs at the inferior pole of the patella
• Due to excessive strain on the patella tendon
• Signs and Symptoms
• Swelling
• Hemorrhages
• Gradual degeneration of the apophysis
• Athlete complains of severe pain when kneeling,
  jumping, and running
• PT over anterior proximal tibial tubercle

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CONT.

• Management-
• Decrease stressful activity (6 months to a year)
• Cylindrical cast
• Ice
• Isometric strengthening

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Osteoarthritis

• MOI- chronic degeneration of the articular or
  hyaline cartilage
• Wear and tear- to the pt. of exposing the bone
• Repeated trauma to the joint, tendons, ligaments
  (running, cycling)
• Signs and Symptoms
• Pain brought by friction when in use
• Stiffness
• Tenderness
• Creaking
• Grating
• Crepitus

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Treatment

• Hyalgan injections- purified Sodium hyaluronate
• 5 injection over 5 weeks- works for 12 months
• Glucosamine Sulfate- over the counter drug
• Derivative of glycosaminoglycans found in
  articular cartilage

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Looking beyond the Drugs

• Worse case Surgery.
• Three methods
• Arthroscopy
• Osteotomy
• Arthroplasty
• 
  http//www.edheads.org/activities/knee/
  

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Pictures
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References

• Avery, Lincoln. (2006). The Meniscus Shock
  Absorber for the Knee. http//www.orthoassociates
  .com/meniscus.htm.
• Grainger, Rebecca Cicuttini, Flavia. (2004).
  Medical management of osteoarthritis of the knee
  and hip joint. The Medical Journal of Australia.
  232. http//www.mja.com.au/public/issues/180_05_01
  0304/gra10763_fm.html.
• Prentice, E. William Musculoskeletal
  Conditions. Arnheims Principles of Athletic
  Training 12th ed. 585, 2005.
• Surgical Treatment of Osteoarthritis of the
  knee. (2003). http//orthoinfo.aaos.org/fact/thr_
  report.cfm?Thread.
• http//www.coachroblowe.com/injuries-lower-osgood-
  schlatters.jpg.
• http//www.radiology.vcu.edu/Peds20COTW/2006/03-3
  0-06/lat.jpg.gt