Transcript Meniscal tears, Osteoarthritis & Osgood

Meniscal tears, Osteoarthritis &
Osgood- Schlatters Disease
By: Juliann Plimpton
Meniscal Tears
MOI/ Etiology
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Valgus force- adducts the knee- tears medial meniscus
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Varus Force- abducts the knee- tears lateral meniscus
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Weight- baring combined with rotary force while knee is flexed or
extended
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Londitudinal tear- knee is forcefully extended from a flexed position
while the femur is internally rotated
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Most tears happen as a combination of all these MOI:
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Lateral rotation of the femur
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Knee partially flexed
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Foot firmly planted
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Three zones:
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Red-Red zone- outer 1/3 rich blood supply. Tears can heal over
time when in this area
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Red-White zone- middle 1/3 blood scares
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White-White zone- inner 1/3 no blood circulation
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Surgery is required when meniscal tears are in these zones.
Signs & Symptoms
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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
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McMurray’s Meniscal test (p. 621)
Apley Compression test
Arthroscopic Surgery
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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
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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.
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Inside-In (T-Fix): includes meniscal staples and bioreabsorbable Tarrows.
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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Management
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No weight baring for at least three weeks, with light-loading muscle
exercises
After this physical therapy, maximal weight training not allowed until 23 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
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MOI of Osgood-Schlatters Disease
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MOI of Larsen-Johansson Disease
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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
Occurs at the inferior pole of the patella
Due to excessive strain on the patella tendon
Signs and Symptoms
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Swelling
Hemorrhages
Gradual degeneration of the apophysis
Athlete complains of severe pain when kneeling, jumping, and running
PT over anterior proximal tibial tubercle
CONT….
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Management
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Decrease stressful activity (6 months to a year)
Cylindrical cast
Ice
Isometric strengthening
Osteoarthritis
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MOI- chronic degeneration of the articular or hyaline cartilage
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Wear and tear- to the pt. of exposing the bone
Repeated trauma to the joint, tendons, ligaments (running, cycling)
Signs and Symptoms
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Pain brought by friction when in use
Stiffness
Tenderness
Creaking
Grating
Crepitus
Treatment
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Hyalgan injections- purified Sodium hyaluronate
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5 injection over 5 weeks- works for 12 months
Glucosamine Sulfate- over the counter drug
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Derivative of glycosaminoglycans found in articular cartilage
Looking beyond the Drugs…
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Worse case… Surgery.
Three methods:
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Arthroscopy
Osteotomy
Arthroplasty
http://www.edheads.org/activities/knee/
Pictures
References
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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.>