Download Free Medical Meniscus Injuries PowerPoint Presentation

Meniscus Injuries PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

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

Tags : Orthopedic Surgery, Meniscus Injuries

Published on : Jul 20, 2021 | Views : 1794 | Downloads : 16

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Ian Rice MD Meniscus Injuries
Slide 2-

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
Slide 3-

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
Slide 4-

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
Slide 5-

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
Slide 6-

Collagen Organization Circumferential fibers Radial Fibers Fine superficial layer around outside Pathoanatomy
Slide 7-

Load Sharing Increases contact area between femur and tibia Decreases contact stress on articular cartilage Increases congruity Provides stability Aids in lubrication Meniscal function
Slide 8-

In extension, 50% of the load is absorbed At 90 flexion, 90% load-sharing Beyond 90, forces predominate through posterior horns Biomechanics
Slide 9-

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
Slide 10-

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
Slide 11-

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
Slide 12-

Small effusion Joint Line Tenderness McMurray Apley Thessaly ROM generally normal Bucket handle block Tight due to effusion Physical Exam
Slide 13-

McMurray
Slide 14-

McMurray
Slide 15-

Apley’s Compression Test
Slide 16-

Thessaly Test
Slide 17-

Plain films to assess for bony injury and OA MRI is the gold standard of diagnosis Imaging
Slide 18-

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
Slide 19-

ppt slide no 19 content not found
Slide 20-

ppt slide no 20 content not found
Slide 21-

This is a LVT with central margination Most frequent type of displaced tear Double PCL Double Anterior Horn Absent Bow Bucket Handle Tears
Slide 22-

ppt slide no 22 content not found
Slide 23-

Involves the free edge and propagates peripherally Usually degenerative Older patients Horizontal Tears
Slide 24-

ppt slide no 24 content not found
Slide 25-

ppt slide no 25 content not found
Slide 26-

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
Slide 27-

Radial Tears
Slide 28-

Radial Tear
Slide 29-

AKA vertical flap tear Starts as a radial tear Propagates as a longitudinal Parrot Beak Tears
Slide 30-

Parrot Beak Tear
Slide 31-

Root Tears
Slide 32-

Non-surgical Stable, longitudinal <10mm with <3-5mm displacement Degenerative tears with concomitant OA <3mm radial tears Stable partial tears Treatment
Slide 33-

Indications Radial Flap Horizontal Complex White-white tears Meniscectomy
Slide 34-

Goal is to debride tear and leave stable rim Preservation is ideal 80% satisfactory function at 5 yrs Lateral debridement = faster degeneration Meniscectomy
Slide 35-

Predictors of Positive Result < 40yo Normal alignment Minimal arthritis at initial scope Single fragment tear Meniscectomy
Slide 36-

Relative Contraindications Advanced OA Complex tears Poor tissue quality ACL deficiency Surgical Repair
Slide 37-

Open Repair Rarely used Numerous studies have proven reduced surgical morbidity with arthroscopic repair Reserved for peripheral tears in the posterior horn
Slide 38-

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
Slide 39-

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
Slide 40-

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
Slide 41-

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
Slide 42-

ppt slide no 42 content not found
Slide 43-

ppt slide no 43 content not found
Slide 44-

ppt slide no 44 content not found
Slide 45-

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
Slide 46-

Failure to heal Stiffness Articular surface damage NV structure damage Complications
Slide 47-

Transplantation Indications: Recurrent pain after partial or total debridement symptomatic with ADLs <50yo Contraindications: Malalignment Laxity Inflammatory arthritis Advanced OA
Slide 48-

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
Slide 49-

OITE
Slide 50-

OITE
Slide 51-

OITE
Slide 52-

OITE
Slide 53-

OITE
Slide 54-

OITE
Slide 55-

OITE
Slide 56-

OITE