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Meniscus Injuries PowerPoint Presentation

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Description : Check out this medical presentation on Orthopedic Surgery, which is titled "Meniscus Injuries", to know about Meniscus Injuries.

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Published on : Jul 20, 2021 | Views : 386 | Downloads : 5

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Slide 1-

Ian Rice MD Meniscus Injuries
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How far we haven’t come “…It is, however, a clinical fact that one of the semilunar cartilage, usually the internal one, does occasionally become loosened from its attachments; and, in consequence, this body is liable to be displaced either forwards or backwards, and so to interfere with the proper movements of the knee-joint…” 1838 - 1907
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Among most common injuries seen in orthopedic practice 61 cases per 100,000 per year Arthroscopic partial menisectomy one of the most common orthopedic procedures Epidemiology
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Pathoanatomy Overview Crescent shaped and have triangular cross section Fibers have circumferential orientation Anterior and posterior root attachments prevent extrusion Lateral covers 84% of the condylar surface, 12mm wide, 3-5mm thick Medial covers 64%, 10mm wide, 3-5mm thick
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Vascularity Genicular arteries 50% vascularized at birth 10-25% in adults Makes healing very difficult 3 vascular zones Red-red Red-white White-white Pathoanatomy
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Collagen Organization Circumferential fibers Radial Fibers Fine superficial layer around outside Pathoanatomy
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Load Sharing Increases contact area between femur and tibia Decreases contact stress on articular cartilage Increases congruity Provides stability Aids in lubrication Meniscal function
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In extension, 50% of the load is absorbed At 90 flexion, 90% load-sharing Beyond 90, forces predominate through posterior horns Biomechanics
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Meniscal excursion with knee flexion 11.2 mm excursion of lateral meniscus 5.1 mm excursion of medial meniscus Capsule Deep MCL Coronary ligament Meniscal Excursion
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Complete removal of meniscus results in 2-3X increase in contact stress Removal of inner 1/3 = 10% reduction in contact area and 65% increase in stress Increase loss of meniscal tissue = increase contact stress Medial meniscal root tears have pressures similar to complete meniscectomy Biomechanics
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History Twisting injury with change in direction in younger patients Squatting or falling in older patients Acute tear usually has insidious swelling Joint line location Mechanical complaints Evaluation
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Small effusion Joint Line Tenderness McMurray Apley Thessaly ROM generally normal Bucket handle block Tight due to effusion Physical Exam
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McMurray
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McMurray
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Apley’s Compression Test
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Thessaly Test
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Plain films to assess for bony injury and OA MRI is the gold standard of diagnosis Imaging
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Typically seen in younger patients High association with ACL tears 90% of LVT in MM and 83% in LM are associated with ACL tears Longitudinal Vertical Tears
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This is a LVT with central margination Most frequent type of displaced tear Double PCL Double Anterior Horn Absent Bow Bucket Handle Tears
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Involves the free edge and propagates peripherally Usually degenerative Older patients Horizontal Tears
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Also involve free edge, but path is perpendicular to long axis Drastically affect ability to resist hoop stresses Deeper the tear, the more drastic the biomechanical consequences Radial Tears
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Radial Tears
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Radial Tear
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AKA vertical flap tear Starts as a radial tear Propagates as a longitudinal Parrot Beak Tears
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Parrot Beak Tear
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Root Tears
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Non-surgical Stable, longitudinal <10mm with <3-5mm displacement Degenerative tears with concomitant OA <3mm radial tears Stable partial tears Treatment
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Indications Radial Flap Horizontal Complex White-white tears Meniscectomy
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Goal is to debride tear and leave stable rim Preservation is ideal 80% satisfactory function at 5 yrs Lateral debridement = faster degeneration Meniscectomy
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Predictors of Positive Result < 40yo Normal alignment Minimal arthritis at initial scope Single fragment tear Meniscectomy
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Relative Contraindications Advanced OA Complex tears Poor tissue quality ACL deficiency Surgical Repair
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Open Repair Rarely used Numerous studies have proven reduced surgical morbidity with arthroscopic repair Reserved for peripheral tears in the posterior horn
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Inside-out Repair Suture passed on either side of tear with needle cannula Suture is brought out of capsule A small skin incision is made Suture is tied down to capsule Posterior Horn Repairs
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Sutures passed through the meniscus from the outside Eliminates need for larger incision Generally suited for anterior repair Studies have shown similar results with both techniques Outside-In Repair
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All-inside repair devices were developed to reduce surgical time, prevent complications resulting from external approaches, and allow access to tears of the posterior horn Fourth-generation repair devices allow placement of sutures in the meniscus without the aid of an external incision or a suture fixator system All Inside
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Self-adjusting, with the anchor located behind the capsule and with a sliding knot that can be tensioned appropriately by the surgeon Mechanical studies show comparable strength to outside-in sutures All Inside
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Outcomes Success rates for all techniques reported 70-95% Second-look scopes show lower success rates of 45-91% Ligamentous laxity decreases success rate to 30-70% 90% success reported in conjunction with ACL repair
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Failure to heal Stiffness Articular surface damage NV structure damage Complications
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Transplantation Indications: Recurrent pain after partial or total debridement symptomatic with ADLs <50yo Contraindications: Malalignment Laxity Inflammatory arthritis Advanced OA
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Outcomes Widely varying reports of success (Country differences) Subjective improvement in tibiofemoral pain No clear long-term benefit in preventing OA has been established Grafts seem to do better when placed with a bone block Preserving some peripheral rim helps to avoid extrusion Variety of meniscal scaffold options being investigated in animals
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