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Meniscus Injuries PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Meniscus Injuries" by Ian Rice MD.

This medical PowerPoint presentation is about meniscus injuries. The meniscus is a C-shaped piece of cartilage located in the knee joint. Its primary function is to act as a shock absorber between the thighbone (femur) and the shinbone (tibia). Meniscus injuries are common and can occur in anyone, but are most often seen in athletes and older adults.

There are two types of meniscus tears: traumatic and degenerative. Traumatic tears occur due to a sudden twisting or hyperextension of the knee joint, while degenerative tears occur due to wear and tear on the meniscus over time.

Symptoms of a meniscus tear include pain, swelling, stiffness, and difficulty moving the knee. Depending on the severity of the tear, surgery may be necessary to repair or remove the damaged portion of the meniscus. In less severe cases, rest, ice, compression, and elevation (RICE) may be sufficient to reduce pain and swelling.

Rehabilitation and physical therapy are important in the recovery process and can help improve range of motion and strengthen the surrounding muscles. It is also important to take steps to prevent future meniscus injuries, such as wearing proper footwear, maintaining a healthy weight, and properly warming up and stretching before exercise.

Tags : Meniscus Injuries, knee joint, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 23, 2023 | Views : 1979 | Downloads : 4

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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
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
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