DNB - PMR , ORTHOPAEDICS
MD - PMR
MS - ORTHOPAEDICS
FINAL EXAM …!!!
Q 3 DESCRIBE VARIOUS GRADES AND MANAGEMENT OF MEDIAL MENISCUS TEAR ?
A 3 INTRODUCTION
1 Is also kn as torn meniscus - is a damage to the cartilage that is positioned on the top of tibia to allows the femur to glide when the knee joint moves
2 Meniscal tears are the most common pathology of the knee with a mean annual incidence of 66 per 100000
3 has the bimodal peak of occurrence - young active adults and elderly people
4 has many risk factors such as advanced age , male gender , work related kneeling , squatting , climbing stairs ( 30 flights )
ANATOMY
1 The menisci are wedge shaped fibrocartilaginous structures located between the femoral condyles and tibial plateau
2 Medial meniscus is U shaped and it covers around 60 % of medial compartment
3 it consists of mainly type I collagen fibers and water
4 These fibers run circumferentially from the anterior horn insertional ligament to posterior horn insertional ligament
5 These fibers helps to absorb the energy by converting axial loading forces across the joints into hoop stresses within the tissues
6 It’s blood supply is mainly from the periphery via the medial and lateral geniculate arteries - there are 2 zones ( red vascular zone in the periphery and white avascular zone centrally
PATHOPHYSIOLOGY
The most common cause being trauma related
CLASSIFICATION
A ) Are classified according to orientation -
1 vertical longitudinal ( bucket handle )
2vertical radial
3 horizontal
4 oblique
B ) Out of these longitudinal tears are more common medially whereas radial tears are frequently seen laterally
C ) vertical longitudinal tear occurs between the circumferential collagen fibers
D ) complete vertical tear can twist leading to bucket handle type variant - are highly unstable and can leads to locking of knee
E ) vertical tear disrupts the circumferential collagen fibers and affects the ability of meniscus to absorb tibiofemoral load
F ) Horizontal tears split the meniscus into an upper and lower part and these are usually asymptomatic
MANAGEMENT
Depends on patient age , expectations , activity level , lifestyle , general health status and lesions ( location , type , ETIOLOGY , general health status )
A ) CONSERVATIVE OR NON OPERATIVE
1 Quadriceps strengthening exercises using static cycling for 25 minutes 3 times a week for 10 weeks
IF PAIN / SWELLING
1 Rest and elevation with compression and ice ( PRICE )
2 use of analgesic and anti inflammatory medications
B ) OPERATIVE OR SURGICAL
1 Menisectomy -
A ) partial is indicated as total may leads to osteoarthritis in long run
B ) medial is more recommended than lateral as it can leads to osteoarthritis secondary to increased convexity of lateral tibial plateau and also medial tibial plateau is concave
C ) Also lateral side menisectomy is not preferred as it covers a greater area nearly 70 % of the area
2 Meniscal repair -
A ) Blood supply is fundamental to success of a Meniscal repair - only tears in the red - red or red - white regions are expected to heal
B ) Exogenous fibrin clots are used in this case to encourage healing of avascular zones if it is less
C ) Terphination of vascular channels on free Meniscal edges
D ) a combination of ACL repair with Meniscal repair as during drilling it can deliver various growth factors
3 Meniscal reconstruction -
A ) It includes Meniscal scaffolds , Meniscal allograft transfer ( MAT )
Meniscal scaffolds - are highly porous , cell free and biodegradable are used to fill the defect in previously partially resected menisectomy by allowing migration and vascularisation of growth channels
A ) are of 2 main types - collagen meniscus implant and polyurethane based
MAT
A ) are of foll types - fresh viable , fresh frozen , cryopreserved and lyophilised - out of these fresh frozen and fresh viable are indicated
B ) has the following indications -
1 unicompartmental pain in presence or absence of total or partial menisectomy
2 a concomitant procedure in ACL reconstruction to aid joint stability
3 a concomitant procedure with previously failed Meniscal repair