Meniscal tears, Osteoarthritis & Osgood- Schlatters Disease By: Juliann Plimpton.
-
Upload
darleen-parker -
Category
Documents
-
view
225 -
download
0
Transcript of Meniscal tears, Osteoarthritis & Osgood- Schlatters Disease By: Juliann Plimpton.
Meniscal tears, Osteoarthritis & Osgood- Schlatters Disease
By: Juliann Plimpton
Meniscal TearsMOI/ 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.
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 McMurray’s Meniscal test (p. 621) Apley Compression test
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
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.
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.
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
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.
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
CONT…. Management-
Decrease stressful activity (6 months to a year) Cylindrical cast Ice Isometric strengthening
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
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
Looking beyond the Drugs… Worse case… Surgery. Three methods:
Arthroscopy Osteotomy Arthroplasty
http://www.edheads.org/activities/knee/
Pictures
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_010304/gra10763_fm.html.
Prentice, E. William: “Musculoskeletal Conditions. Arnheim’s 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/Peds%20COTW/2006/03-30-06/lat.jpg.>