The document discusses the anatomy and function of the menisci in the knee joint. It provides details on the history of meniscal repair surgery and classifications of meniscal tears. The menisci are C-shaped structures that deepen the tibial surfaces and absorb shock in the knee. They are composed primarily of collagen and decrease contact stress between the tibia and femur. Common injuries include longitudinal tears, especially in the posterior horn, which can occur during twisting motions of the knee.
The document discusses meniscal injuries and pathology. It provides information on the anatomy and function of the menisci, as well as types of meniscal tears. The diagnosis of meniscal tears involves taking a history of the injury and examining for symptoms like joint line tenderness, effusion, and a locking sensation. Investigations may include x-rays, MRI, arthrography and arthroscopy. Treatment options discussed include non-surgical management for minor tears and surgical repair or resection for larger tears.
The document discusses floor reaction orthoses (FRO). It defines an FRO as a custom plastic device that supports the ankle and foot from below the knee to the foot. An FRO works by holding the ankle in plantar flexion, which shifts the line of force from the ground reaction force behind the ankle and in front of the knee, generating extension at the knee. This allows patients with weak leg muscles to walk without knee buckling. FROs are indicated for patients with conditions like polio, cerebral palsy, or spinal cord injury that cause lower leg weakness. They provide knee stability during walking in a lightweight design.
Meniscal tears can occur from traumatic injuries or degeneration. The menisci are C-shaped fibrocartilaginous structures that act as shock absorbers and provide stability in the knee. MRI is the gold standard for diagnosing meniscal tears, which are classified based on their location and orientation. Treatment depends on the type and location of the tear but may involve conservative management, arthroscopic repair, or partial meniscectomy. Repair is preferred for young patients with peripheral, longitudinal tears while meniscectomy is used for complex, degenerative tears. The goal of treatment is to preserve as much meniscal tissue as possible to prevent osteoarthritis.
This document provides an overview of hallux valgus, including its anatomy, causes, symptoms, diagnosis, and treatment options. Key points include:
- Hallux valgus is a lateral deviation of the great toe and medial deviation of the first metatarsal. It can cause pain over the bunion.
- Risk factors include heredity, footwear, ligament laxity, and pes planus. Diagnosis involves examining range of motion, deformity, and taking x-rays to measure angles.
- Treatment progresses from footwear modifications and stretching to various surgical procedures depending on severity, including distal soft tissue procedures, osteotomies, and joint fusion or replacement in severe cases.
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
The document provides information on recurrent patellar dislocation, including:
- Anatomy of the patella and its attachments
- Static and dynamic stabilizers of the patella
- Causes of patellar instability such as trochlear dysplasia, patella alta, increased Q angle
- Mechanisms of injury for acute vs recurrent dislocations
- Evaluation methods like the apprehension test, patellar glide test, and imaging views
The document discusses meniscal injuries and pathology. It provides information on the anatomy and function of the menisci, as well as types of meniscal tears. The diagnosis of meniscal tears involves taking a history of the injury and examining for symptoms like joint line tenderness, effusion, and a locking sensation. Investigations may include x-rays, MRI, arthrography and arthroscopy. Treatment options discussed include non-surgical management for minor tears and surgical repair or resection for larger tears.
The document discusses floor reaction orthoses (FRO). It defines an FRO as a custom plastic device that supports the ankle and foot from below the knee to the foot. An FRO works by holding the ankle in plantar flexion, which shifts the line of force from the ground reaction force behind the ankle and in front of the knee, generating extension at the knee. This allows patients with weak leg muscles to walk without knee buckling. FROs are indicated for patients with conditions like polio, cerebral palsy, or spinal cord injury that cause lower leg weakness. They provide knee stability during walking in a lightweight design.
Meniscal tears can occur from traumatic injuries or degeneration. The menisci are C-shaped fibrocartilaginous structures that act as shock absorbers and provide stability in the knee. MRI is the gold standard for diagnosing meniscal tears, which are classified based on their location and orientation. Treatment depends on the type and location of the tear but may involve conservative management, arthroscopic repair, or partial meniscectomy. Repair is preferred for young patients with peripheral, longitudinal tears while meniscectomy is used for complex, degenerative tears. The goal of treatment is to preserve as much meniscal tissue as possible to prevent osteoarthritis.
This document provides an overview of hallux valgus, including its anatomy, causes, symptoms, diagnosis, and treatment options. Key points include:
- Hallux valgus is a lateral deviation of the great toe and medial deviation of the first metatarsal. It can cause pain over the bunion.
- Risk factors include heredity, footwear, ligament laxity, and pes planus. Diagnosis involves examining range of motion, deformity, and taking x-rays to measure angles.
- Treatment progresses from footwear modifications and stretching to various surgical procedures depending on severity, including distal soft tissue procedures, osteotomies, and joint fusion or replacement in severe cases.
Osteotomies around the hip are surgical procedures used to correct biomechanical alignment and load transmission across the hip joint. They involve removing a portion of bone. The goals are to improve femoral head coverage, containment, motion, relieve pain, and correct leg length discrepancies. Different types of osteotomies target the proximal femur or pelvis. Proximal femoral osteotomies are classified based on anatomical location and degree of displacement. Pelvic osteotomies aim to redirect the acetabulum and include Salter, Sutherland, Steel/Tonnis, and Ganz/Bernese procedures. Key considerations for each procedure include indications, approach, osteotomy cuts made, advantages/disadv
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
The document provides information on recurrent patellar dislocation, including:
- Anatomy of the patella and its attachments
- Static and dynamic stabilizers of the patella
- Causes of patellar instability such as trochlear dysplasia, patella alta, increased Q angle
- Mechanisms of injury for acute vs recurrent dislocations
- Evaluation methods like the apprehension test, patellar glide test, and imaging views
The hip joint is a ball and socket synovial joint that connects the femur to the acetabulum. It is the largest and most stable joint in the body. The hip joint allows for flexion, extension, abduction, adduction, and rotation. Several strong ligaments reinforce the hip joint capsule to provide stability, including the iliofemoral, ischiofemoral, and pubofemoral ligaments. The main muscles that act on the hip joint are the gluteal muscles, iliopsoas, quadriceps femoris, hamstrings, and adductors.
Recurrent Dislocation of patella -PAWANPawan Yadav
This document discusses recurrent patellar dislocation. It begins by defining recurrent patellar dislocation as the patella shifting laterally with minimal stress on knee flexion. It then discusses the anatomy and Q angle as well as predisposing causes such as increased Q angle, weak medial quads, and tight lateral structures. The document outlines clinical features, tests, x-ray findings, and treatment options including conservative immobilization and surgical procedures like realignment and patellectomy.
Dr. Ankur Mittal presented on diagnostic tests and imaging for Achilles tendon injuries. [1] Ultrasound is often used to determine tendon thickness and gap size for complete ruptures and is inexpensive and fast. [2] MRI is better for detecting incomplete tears and planning surgery for chronic tears but is more expensive. [3] Imaging is rarely needed for acute cases but can help with chronic cases for diagnosis and surgical planning.
Flat foot, also known as pes planus, is a condition where the arch of the foot collapses, causing the entire sole of the foot to touch the ground. It can be congenital or acquired later in life. Flexible flat foot can be corrected by dorsiflexing the toes while rigid flat foot cannot. Treatment depends on the type and severity, ranging from exercises and orthotics to reconstructive surgery like triple arthrodesis for rigid flat foot. The goal is to relieve pain by restoring the arch alignment and motion of the foot.
The document discusses various aspects of arthrodesis or surgical fusion of joints. It describes the indications for arthrodesis including pain, instability, and failed joint replacement. It provides details on techniques for hip, knee, ankle, and shoulder arthrodesis including positioning, surgical approaches, fixation methods, rehabilitation, and complications. Arthrodesis is described as a way to relieve pain by permanently immobilizing the joint, though it results in stiffness. Various internal and external fixation devices and grafts are discussed for fusing the bones and achieving stability during healing.
This document discusses meniscus injuries of the knee. It describes the anatomy and functions of the medial and lateral meniscus. Common types of meniscal tears are described based on location and pattern. Physical exam maneuvers for diagnosing meniscal tears include Thessaly test, McMurray's test, and Apley's grinding test. MRI is the most sensitive imaging method. Treatment involves initial rest, ice, and NSAIDs for minor tears. Surgery options include partial meniscectomy, meniscal repair, or meniscal transplantation for more severe tears. The goal of treatment is to relieve symptoms and prevent further joint damage.
Collapse of medial longitudinal arch, with the entire sole of the foot coming into complete or near-complete contact with the ground.
Books Refered :
Text Book Of ANATOMY - Vishram Singh
Joint Structure And Function – Cynthia Norkin
Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
The document discusses graft fixation options in ACL reconstruction. It notes that fixation is the weakest link in the early postoperative period and that tibial fixation carries a greater risk of failure. Interference screws provide the gold standard for fixation but tunnel widening remains a concern. The ideal fixation is strong, stiff, and secure to avoid graft slippage and interference with healing while allowing revision. Aperture fixation and hybrid techniques may improve outcomes over suspensory fixation alone. Rehabilitation must also account for the biomechanical strengths and weaknesses of the fixation method used.
This document provides information on meniscal tears of the knee. It begins with an introduction stating that meniscal tears are common injuries responsible for many arthroscopies annually. It then covers anatomy of the medial and lateral menisci, blood supply, classification of tears, mechanisms of injury, clinical features, investigations like MRI and arthroscopy, and treatment options including non-operative care, meniscectomy, and meniscal repair. The focus is on providing detailed information on meniscal anatomy, tears, and surgical and non-surgical management.
This document discusses meniscal tears, including types of tears, anatomy, function, biomechanics, diagnosis, and treatment options. It provides an overview of the meniscus, noting its crescent shape, fibers, and vascularity. Types of tears include longitudinal, radial, horizontal, complex, and bucket handle tears. Diagnosis involves physical exam maneuvers like McMurray's test and imaging like MRI. Treatment options discussed include arthroscopic partial meniscectomy, open or arthroscopic repair, and all-inside repair techniques. Outcomes and complications of procedures are also summarized.
Poller screws, also known as blocking screws, are non-interlocking screws placed outside an intramedullary nail to improve fracture reduction and fixation. They provide a more rigid construct by serving as a surrogate cortex where nail-cortex contact is insufficient. Their placement helps centralize the guidewire in the medullary canal and maintains reduction through a blocking effect. While there is no consensus on their exact placement, they are generally inserted on the concave side of expected deformities to prevent malalignment during nailing.
Medial patellofemoral ligament reconstruction ---- an update on techniques used. This lecture was taken by me at Trinity Arthroscopy Course, Chandigarh.
Shoulder injuries and instability can have various causes. There are three main types of shoulder instability: 1) traumatic structural instability due to major trauma or microtrauma, 2) atraumatic structural instability from repetitive overuse, and 3) atraumatic non-structural instability resulting from abnormal muscle recruitment. Common injuries include anterior dislocation, which can cause Bankart lesions and Hill-Sachs defects. Treatment depends on the type and severity but may involve immobilization, physical therapy to strengthen muscles, or surgery such as Bankart repair to reconstruct damaged tissues.
The document discusses injuries to the patella and extensor mechanism. It describes the anatomy and biomechanics of the patella. Common injury mechanisms are direct trauma from a fall or dashboard injury, or indirect trauma from forceful knee flexion against a contracted quadriceps. Injuries can include fractures or ruptures of the patella or tendons. Treatment depends on the specific injury but may involve nonoperative management with immobilization or operative fixation or reconstruction of bony or soft tissue injuries.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...Sitanshu Barik
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
The Krukenberg surgery converts the forearm into a forceps-like structure by separating the radius and ulna into opposing rays that can act against each other like chopsticks. This allows amputees, especially in areas without modern prosthetics, to regain some hand function. The procedure involves longitudinally splitting the flexor and extensor muscles of the forearm into radial and ulnar groups and severing the interosseous membrane to separate the radius and ulna at their tips while maintaining motion at their proximal ends. Reconstructing the forearm in this way provides a more useful alternative to amputees than a mechanical prosthesis.
This document discusses various foot and ankle deformities and their treatments. It covers deformities including claw toes, cavus deformity, dorsal bunions, talipes equinus, talipes equino varus, and talipes equino valgus. It describes classifications of deformities and discusses tendon transfers, osteotomies, and arthrodesis procedures to correct different types of deformities based on the underlying muscle imbalances. Key considerations for surgical timing and approach are also outlined.
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
This document provides information about pes planus (flat foot), including its components, classification, examination, and treatment. Pes planus is characterized by a lowered or absent medial longitudinal arch. It can be flexible or rigid depending on joint mobility. Flexible flat foot is more common and usually asymptomatic, especially in children. Treatment focuses on orthotics, exercises, or surgery if conservative measures fail. Surgical options include tendon lengthening, arthrodesis, and osteotomies to realign the foot structure.
This document discusses the sequelae and management of septic arthritis. Septic arthritis results in inflammation and destruction of the joint space. This can lead to several orthopedic sequelae including joint destruction, bony or fibrous ankylosis, fractures, limb length discrepancy, and persistent infection. The management depends on factors like the patient's age, delay in treatment, and extent of joint involvement. Treatment may include conservative measures, surgical stabilization, deformity correction, lengthening procedures, or arthrodesis to achieve a stable, mobile joint without pain. Classification systems help guide treatment, with the goal of optimizing long term function and quality of life.
The document discusses meniscal injuries of the knee. It describes the anatomy and function of the menisci, types of meniscal tears, symptoms and diagnosis of tears. Treatment options include nonsurgical care, partial meniscectomy to remove torn parts, and meniscal repair surgery which is best for peripheral, vertical tears. While removal addresses pain, it increases risk for osteoarthritis long term. The goal of repair is to preserve as much viable meniscal tissue as possible for cartilage protection.
The Stone Clinic is a sports medicine clinic in San Francisco, California, offering orthopaedic surgery and medical care, physical therapy and rehabilitation, and radiology imaging services. The Stone Clinic was founded by Kevin R. Stone, M.D., an orthopaedic surgeon, combining himself with a team of nurses, physical therapists, imaging specialists, and patient coordinators, in 1988 to focus on caring for injured athletes and people experiencing arthritis pain.
The Stone Clinic is founded on the goal of rehabilitating all patients to an operating level higher than before they were injured. The Stone Clinic specializes in sports medicine and injury treatment of knee, shoulder, and ankle joints. Stone has lectured and is recognized internationally as an authority on cartilage and meniscal growth, replacement, and repair. Stone and the Stone Clinic are known for the development of the paste grafting surgical technique in 1991, combined with meniscus replacement, which are biologic joint replacement procedures for the regeneration of the knee joint. Surgical procedures were subjected to rigorous outcomes analysis with the results reported in peer reviewed journals. The surgical techniques have been taught to surgeons in the US and worldwide, through lectures and videos.
Nursing students, medical students, residents, fellows, and other physicians from various institutions around the world, rotate through The Stone Clinic and mentor with Stone. The Stone Clinic hosts the annual Meniscus Transplantation Study Group Meeting as well as the annual Professional Women Athlete's Career Conference.
The hip joint is a ball and socket synovial joint that connects the femur to the acetabulum. It is the largest and most stable joint in the body. The hip joint allows for flexion, extension, abduction, adduction, and rotation. Several strong ligaments reinforce the hip joint capsule to provide stability, including the iliofemoral, ischiofemoral, and pubofemoral ligaments. The main muscles that act on the hip joint are the gluteal muscles, iliopsoas, quadriceps femoris, hamstrings, and adductors.
Recurrent Dislocation of patella -PAWANPawan Yadav
This document discusses recurrent patellar dislocation. It begins by defining recurrent patellar dislocation as the patella shifting laterally with minimal stress on knee flexion. It then discusses the anatomy and Q angle as well as predisposing causes such as increased Q angle, weak medial quads, and tight lateral structures. The document outlines clinical features, tests, x-ray findings, and treatment options including conservative immobilization and surgical procedures like realignment and patellectomy.
Dr. Ankur Mittal presented on diagnostic tests and imaging for Achilles tendon injuries. [1] Ultrasound is often used to determine tendon thickness and gap size for complete ruptures and is inexpensive and fast. [2] MRI is better for detecting incomplete tears and planning surgery for chronic tears but is more expensive. [3] Imaging is rarely needed for acute cases but can help with chronic cases for diagnosis and surgical planning.
Flat foot, also known as pes planus, is a condition where the arch of the foot collapses, causing the entire sole of the foot to touch the ground. It can be congenital or acquired later in life. Flexible flat foot can be corrected by dorsiflexing the toes while rigid flat foot cannot. Treatment depends on the type and severity, ranging from exercises and orthotics to reconstructive surgery like triple arthrodesis for rigid flat foot. The goal is to relieve pain by restoring the arch alignment and motion of the foot.
The document discusses various aspects of arthrodesis or surgical fusion of joints. It describes the indications for arthrodesis including pain, instability, and failed joint replacement. It provides details on techniques for hip, knee, ankle, and shoulder arthrodesis including positioning, surgical approaches, fixation methods, rehabilitation, and complications. Arthrodesis is described as a way to relieve pain by permanently immobilizing the joint, though it results in stiffness. Various internal and external fixation devices and grafts are discussed for fusing the bones and achieving stability during healing.
This document discusses meniscus injuries of the knee. It describes the anatomy and functions of the medial and lateral meniscus. Common types of meniscal tears are described based on location and pattern. Physical exam maneuvers for diagnosing meniscal tears include Thessaly test, McMurray's test, and Apley's grinding test. MRI is the most sensitive imaging method. Treatment involves initial rest, ice, and NSAIDs for minor tears. Surgery options include partial meniscectomy, meniscal repair, or meniscal transplantation for more severe tears. The goal of treatment is to relieve symptoms and prevent further joint damage.
Collapse of medial longitudinal arch, with the entire sole of the foot coming into complete or near-complete contact with the ground.
Books Refered :
Text Book Of ANATOMY - Vishram Singh
Joint Structure And Function – Cynthia Norkin
Therapeutic Exrercise – Carolyn Kisner
Orthopaedic Physical Assessment – Magee
Orthopaedic Medicine – L. Ombregt
Campbell’s Operative Orthopaedics
The document discusses graft fixation options in ACL reconstruction. It notes that fixation is the weakest link in the early postoperative period and that tibial fixation carries a greater risk of failure. Interference screws provide the gold standard for fixation but tunnel widening remains a concern. The ideal fixation is strong, stiff, and secure to avoid graft slippage and interference with healing while allowing revision. Aperture fixation and hybrid techniques may improve outcomes over suspensory fixation alone. Rehabilitation must also account for the biomechanical strengths and weaknesses of the fixation method used.
This document provides information on meniscal tears of the knee. It begins with an introduction stating that meniscal tears are common injuries responsible for many arthroscopies annually. It then covers anatomy of the medial and lateral menisci, blood supply, classification of tears, mechanisms of injury, clinical features, investigations like MRI and arthroscopy, and treatment options including non-operative care, meniscectomy, and meniscal repair. The focus is on providing detailed information on meniscal anatomy, tears, and surgical and non-surgical management.
This document discusses meniscal tears, including types of tears, anatomy, function, biomechanics, diagnosis, and treatment options. It provides an overview of the meniscus, noting its crescent shape, fibers, and vascularity. Types of tears include longitudinal, radial, horizontal, complex, and bucket handle tears. Diagnosis involves physical exam maneuvers like McMurray's test and imaging like MRI. Treatment options discussed include arthroscopic partial meniscectomy, open or arthroscopic repair, and all-inside repair techniques. Outcomes and complications of procedures are also summarized.
Poller screws, also known as blocking screws, are non-interlocking screws placed outside an intramedullary nail to improve fracture reduction and fixation. They provide a more rigid construct by serving as a surrogate cortex where nail-cortex contact is insufficient. Their placement helps centralize the guidewire in the medullary canal and maintains reduction through a blocking effect. While there is no consensus on their exact placement, they are generally inserted on the concave side of expected deformities to prevent malalignment during nailing.
Medial patellofemoral ligament reconstruction ---- an update on techniques used. This lecture was taken by me at Trinity Arthroscopy Course, Chandigarh.
Shoulder injuries and instability can have various causes. There are three main types of shoulder instability: 1) traumatic structural instability due to major trauma or microtrauma, 2) atraumatic structural instability from repetitive overuse, and 3) atraumatic non-structural instability resulting from abnormal muscle recruitment. Common injuries include anterior dislocation, which can cause Bankart lesions and Hill-Sachs defects. Treatment depends on the type and severity but may involve immobilization, physical therapy to strengthen muscles, or surgery such as Bankart repair to reconstruct damaged tissues.
The document discusses injuries to the patella and extensor mechanism. It describes the anatomy and biomechanics of the patella. Common injury mechanisms are direct trauma from a fall or dashboard injury, or indirect trauma from forceful knee flexion against a contracted quadriceps. Injuries can include fractures or ruptures of the patella or tendons. Treatment depends on the specific injury but may involve nonoperative management with immobilization or operative fixation or reconstruction of bony or soft tissue injuries.
Ligamentotaxis principle in the treatment of intra articular fractures of dis...Sitanshu Barik
This study assessed the correlation between radiological outcomes and functional outcomes in 45 patients treated with external fixation for intra-articular fractures of the distal radius. Good or acceptable restoration of radial length and palmar slope on radiographs post-operatively was found to produce good to excellent functional results regardless of fracture type. While poor radiological outcomes did not always lead to poor function, maintenance of radial length and correction of palmar tilt were important for functional outcomes. The study concluded that achieving good function is more important than surgical precision on radiographs alone.
The Krukenberg surgery converts the forearm into a forceps-like structure by separating the radius and ulna into opposing rays that can act against each other like chopsticks. This allows amputees, especially in areas without modern prosthetics, to regain some hand function. The procedure involves longitudinally splitting the flexor and extensor muscles of the forearm into radial and ulnar groups and severing the interosseous membrane to separate the radius and ulna at their tips while maintaining motion at their proximal ends. Reconstructing the forearm in this way provides a more useful alternative to amputees than a mechanical prosthesis.
This document discusses various foot and ankle deformities and their treatments. It covers deformities including claw toes, cavus deformity, dorsal bunions, talipes equinus, talipes equino varus, and talipes equino valgus. It describes classifications of deformities and discusses tendon transfers, osteotomies, and arthrodesis procedures to correct different types of deformities based on the underlying muscle imbalances. Key considerations for surgical timing and approach are also outlined.
This document provides an overview of the anatomy of the ankle joint and ankle arthrodesis (fusion). It describes the bones and ligaments that make up the ankle joint, including the tibia, fibula, and talus. It discusses the indications, contraindications, surgical technique, and postoperative care of ankle arthrodesis, which is performed to treat ankle arthritis and pain. The optimal position for fusion is slight dorsiflexion with mild hindfoot valgus and external rotation. Preoperative planning involves assessing bone quality, alignment, and arthritis in other joints like the subtalar.
This document provides information about pes planus (flat foot), including its components, classification, examination, and treatment. Pes planus is characterized by a lowered or absent medial longitudinal arch. It can be flexible or rigid depending on joint mobility. Flexible flat foot is more common and usually asymptomatic, especially in children. Treatment focuses on orthotics, exercises, or surgery if conservative measures fail. Surgical options include tendon lengthening, arthrodesis, and osteotomies to realign the foot structure.
This document discusses the sequelae and management of septic arthritis. Septic arthritis results in inflammation and destruction of the joint space. This can lead to several orthopedic sequelae including joint destruction, bony or fibrous ankylosis, fractures, limb length discrepancy, and persistent infection. The management depends on factors like the patient's age, delay in treatment, and extent of joint involvement. Treatment may include conservative measures, surgical stabilization, deformity correction, lengthening procedures, or arthrodesis to achieve a stable, mobile joint without pain. Classification systems help guide treatment, with the goal of optimizing long term function and quality of life.
The document discusses meniscal injuries of the knee. It describes the anatomy and function of the menisci, types of meniscal tears, symptoms and diagnosis of tears. Treatment options include nonsurgical care, partial meniscectomy to remove torn parts, and meniscal repair surgery which is best for peripheral, vertical tears. While removal addresses pain, it increases risk for osteoarthritis long term. The goal of repair is to preserve as much viable meniscal tissue as possible for cartilage protection.
The Stone Clinic is a sports medicine clinic in San Francisco, California, offering orthopaedic surgery and medical care, physical therapy and rehabilitation, and radiology imaging services. The Stone Clinic was founded by Kevin R. Stone, M.D., an orthopaedic surgeon, combining himself with a team of nurses, physical therapists, imaging specialists, and patient coordinators, in 1988 to focus on caring for injured athletes and people experiencing arthritis pain.
The Stone Clinic is founded on the goal of rehabilitating all patients to an operating level higher than before they were injured. The Stone Clinic specializes in sports medicine and injury treatment of knee, shoulder, and ankle joints. Stone has lectured and is recognized internationally as an authority on cartilage and meniscal growth, replacement, and repair. Stone and the Stone Clinic are known for the development of the paste grafting surgical technique in 1991, combined with meniscus replacement, which are biologic joint replacement procedures for the regeneration of the knee joint. Surgical procedures were subjected to rigorous outcomes analysis with the results reported in peer reviewed journals. The surgical techniques have been taught to surgeons in the US and worldwide, through lectures and videos.
Nursing students, medical students, residents, fellows, and other physicians from various institutions around the world, rotate through The Stone Clinic and mentor with Stone. The Stone Clinic hosts the annual Meniscus Transplantation Study Group Meeting as well as the annual Professional Women Athlete's Career Conference.
Meniscus injuries are common in young adults, often caused by twisting or heavy lifting. Symptoms include knee pain, swelling, stiffness, tenderness, pain with squatting, popping or clicking in the knee, and limited motion. Meniscus tears are classified as longitudinal, horizontal, radial, or flap tears. Exams like McMurray's test and Apley's test are used to diagnose tears. Treatment involves medications, surgery if the meniscus cannot be repaired, physiotherapy including exercises and bracing, and rehabilitation protocols after arthroscopic surgery or meniscal repair surgery. Isokinetic training after arthroscopy can help improve knee function and muscle strength recovery.
The document discusses meniscal tears in the knee. It describes the two menisci, their functions, and common mechanisms of injury like twisting motions or rising from a squat. The most common types of tears are outlined. Surgery is usually recommended for tears in the avascular zone that cannot heal or for larger tears causing pain. Rehabilitation after surgery or non-surgically involves restoring range of motion, strengthening the muscles, and gradually returning to activities over several months.
MENISCUS REPAIR I Dr.RAJAT JANGIR JAIPUR
#aclsurgeryjaipur #aclsurgeryhindia #aclsurgerytaekwondo
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#allinsideacl #internalbrace #drrajatjangir #bestaclsurgeon #aclexpert #bestkneesurgeon
To Know more about ACL Injury, Click the links below:
1. ACL surgery 7 different Techniques we do at our center - "Not single technique best for all"
https://youtu.be/oWkIr8IXvr8
2. Everything about ACL Injury tear surgery in Hindi I
https://youtu.be/bqpjkAkwZ14
3. Best Screw for ACL tear surgery in Hindi
https://youtu.be/1LGpU1NHiIs
4. ACL Injury Tear Surgery Recovery : All your questions & queries solved by Dr.Rajat Jangir
https://youtu.be/SIAPWiMbOqs
5. Partial ACL Tear Surgery or not ! ACL आधा टूटा हो तो क्या करें ?
https://youtu.be/NEJRPKskJTI
6. 5 Symptoms of ACL Injury tear इंजरी के पांच लक्षण ?
https://youtu.be/EXpgy19Jxzw
7. PRP injection therapy in Partial ACL TEARs
https://youtu.be/qyG1EYgS87E
Dr.RAJAT JANGIR(Asso Prof.)
Senior Consultant Arthroscopy and Joint Replacement
(Specialist in Shoulder Knee Hip Surgery)
Ligament and Joints Clinic
67/34 Mansarovar Jaipur
Whatsapp: shorturl.at/gnAEP
Appointment: +91 8104855900
Email: ligamentsurgeon@gmail.com
Google Page: https://g.page/KNEE-Shoulder-SURGERY?...
Facebook: https://www.facebook.com/Ligamentandj...
* Vast experience and specialisation in the field of Arthroscopy and sports surgery.
* M.S. orthopaedics from BJ Medical College, Civil hospital, Ahmedabad
* Fellowship in Arthroscopy and Sports injury with Prof Joon Ho Wang at Samsung Medical Center, South Korea
* Diploma in Sports Medicine from InternationaI Olympic Committee
* Invited as Athlete Medical Doctor at Rio Olympic 2016
* Done Rajasthan's first "All Inside Physeal Preserving ACL reconstruction" in 13 year old Athlete
Dr.Rajat is rated as one of the best orthopedic surgeon with with excellence in Knee Shoulder Arthroscopy surgeries as replacements'
The document discusses meniscal tears in the knee. It provides information on:
1. The anatomy and functions of the menisci in the knee joint.
2. Common causes and types of meniscal injuries, which most often occur from twisting motions in sports.
3. Evaluation, treatment options including surgery and rehabilitation for meniscal tears.
4. The rehabilitation process focuses on reducing pain and inflammation, regaining range of motion and strength through stretching and strengthening exercises.
The medial and lateral menisci are C-shaped pieces of fibrocartilage in the knee that help distribute weight and improve joint congruity. The medial meniscus is less mobile and more commonly injured, usually via a twisting motion. Injuries are evaluated clinically and via imaging like MRI, with arthroscopy used to confirm tears. Treatment involves rest, bracing, and exercises for minor tears, while surgery like partial or total meniscectomy or repair is used for more severe tears. Complications are rare but include infection, nerve injury, and arthrofibrosis. Recovery focuses on regaining motion and strength.
The document discusses meniscal tears in the knee, including their structure, function, causes, diagnosis, and treatment options. It notes that meniscal tears are commonly sports-related or due to motor vehicle accidents. While meniscal repair or conservative treatment are preferred to preserve meniscal tissue, partial meniscectomy is still a common option that allows for quicker return to activity compared to repair or no surgery. However, meniscectomy is associated with increased risk of osteoarthritis over the long-term. MRI is an important diagnostic tool but clinical exam also provides value in diagnosis.
This document discusses meniscus repair, including indications for repair such as longitudinal tears less than 3 cm within the vascular zone of the meniscus. It describes techniques for meniscus repair including inside-out, outside-in, all-inside, and hybrid techniques. Postoperative rehabilitation involves immobilization and restricted weight bearing followed by progressive range of motion and strengthening exercises.
This document provides an overview of the anatomy and common injuries of the knee joint. It describes the bones, ligaments, menisci, vasculature and nerves of the knee. Common injuries discussed include patellar dislocation, meniscal tears, injuries to the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Diagnosis and treatment approaches for each type of injury are summarized. The document concludes with an overview of ligament reconstruction procedures and potential future advances.
This document discusses lesions of the menisci, specifically tears. It describes the different types of meniscal tears including vertical/longitudinal, horizontal, and radial tears. It outlines the mechanisms of injury including twisting motions. The clinical features of a meniscal tear are also summarized, including symptoms like pain and locking of the knee. Tests to diagnose a tear are explained, such as McMurray's test and Thessaly test. Treatment options including conservative treatment with immobilization and physical therapy or surgical treatment like arthroscopy are mentioned.
This document provides a rehabilitation protocol for meniscal repairs, outlining 3 phases. Phase 1 (weeks 1-6) focuses on maximum protection with limited weight bearing, range of motion up to 90 degrees, and isolated strengthening exercises. Phase 2 (weeks 6-10) allows for increased range of motion, weight bearing, and addition of balance and coordination exercises. Phase 3 (weeks 11-15) emphasizes return to sport activities with power and endurance exercises if criteria are met, with return to full activity permitted once fully recovered. An accelerated protocol is also described, progressing patients more quickly by advancing to full weight bearing and range of motion by 2 weeks.
This document discusses the anatomy, biomechanics, and pathology of the meniscus in the knee. It begins by describing the structure and functions of the meniscus, including its role in load distribution, shock absorption, and joint stability. It then covers the different types of meniscal tears, categorized by their orientation (horizontal, longitudinal, radial). Imaging techniques for identifying meniscal tears are discussed, along with clinical exams. Finally, the document outlines treatment approaches, including non-surgical management and surgical options like meniscectomy, repair, and transplantation.
The document discusses potential complications from ACL reconstruction surgery, noting that surgical technical errors during graft harvest, tunnel preparation, or fixation are most common causes of failure. Five possible causes of reconstruction failure are identified as graft discontinuity, inappropriate tunnel positioning, hardware failure, infection, or arthrofibrosis. Proper surgical technique and avoidance of tunnel malpositioning are emphasized to prevent complications.
Evolution of tunnel placement in ACL reconstructionDhananjaya Sabat
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The knee joint is complex and vulnerable to injury due to high stress. Common acute injuries include patellar dislocation, meniscal tears, and ligament sprains. Patellar dislocation occurs when the patella is displaced from its normal position, often due to direct impact or forceful quadriceps contraction. Meniscal tears are caused by the menisci receiving poor blood supply in their centers, making tears difficult to heal. Ligament sprains range in severity from minor fiber tears to complete ruptures. Understanding the knee's anatomy is important for diagnosing and treating these injuries.
This document discusses the anatomy and kinematics of the knee joint. It begins by describing the three bones that make up the knee - the femur, tibia, and patella. It then discusses the anatomy of the femoral and tibial surfaces, as well as the patella. Next, it covers the ligaments that provide stability to the knee, including the medial and lateral collateral ligaments, anterior and posterior cruciate ligaments, and menisci. The document then discusses the blood supply and innervation of the knee. It concludes by explaining the different theories of knee kinematics, including rolling back of the femur, the four-bar linkage model, and screw home motion.
This document provides an overview of MRI techniques and protocols for musculoskeletal imaging. It discusses common musculoskeletal injuries and conditions that can be identified on MRI, including meniscal tears, ligament tears, tendon injuries, osteochondral lesions, and bone marrow abnormalities. For each condition, it describes the MRI appearance and features that help characterize the severity and chronicity of the problem. Images are included to demonstrate the MRI findings for many common orthopedic pathologies.
This document discusses MR imaging of the knee. It describes common knee pathologies like meniscal tears, ligament injuries, and cartilage lesions. It provides details on MR imaging techniques and protocols for the knee. Specific meniscal anatomy and grading of meniscal signal are reviewed. Various types of meniscal tears, ligament injuries like ACL and PCL tears are demonstrated with images. Other findings like cartilage lesions, bony lesions, tendon injuries are also described. Potential pitfalls in interpreting MR images of the knee like pseudo meniscal tears are discussed to improve diagnostic accuracy.
This document discusses meniscal injuries of the knee. It begins by describing the anatomy of the menisci, including their location, structure, and attachments in the knee. It then discusses the different types of meniscal tears, including longitudinal, horizontal, radial, and complex tears. The mechanisms of injury and symptoms of meniscal tears are explained. Physical exam maneuvers for diagnosing tears like McMurray's test are outlined. MRI is described as the preferred imaging method to evaluate tears. Finally, treatment options for meniscal tears including non-operative rest and rehabilitation versus surgical repair or removal are presented.
Meniscal pathologies and cartilage injuries sivavarigonda
This document discusses the anatomy, function, injuries, and treatment of the medial and lateral menisci of the knee. It begins by describing the anatomy of each meniscus, noting their shapes, attachments, and roles in load bearing. It then covers the microstructure of meniscal tissue. Common types of meniscal injuries are outlined, including longitudinal, horizontal, oblique, and radial tears. Clinical evaluation and MRI are discussed for diagnosing tears. Treatment options are summarized, including non-operative management, partial or total meniscectomy, and arthroscopic repair. Post-operative rehabilitation is also briefly mentioned.
The knee joint is a complex synovial joint that allows flexion and extension. It is formed between the femur and tibia. The articular surfaces include the femoral and tibial condyles covered in hyaline cartilage. Stability is provided by muscles, collateral ligaments, and cruciate ligaments. The medial and lateral menisci act as shock absorbers on the tibial plateaus. Blood supply enters through the femoral, popliteal, and genicular arteries. Flexion and extension are the primary movements allowed.
The knee joint is made up of bones, ligaments, tendons, cartilages, and a joint capsule. It contains two joints - the tibiofemoral and patellofemoral joints. The bones that make up the knee are the femur, tibia, and patella. Ligaments such as the ACL and PCL provide stability while tendons like the quadriceps and patellar tendon connect muscles to bones. Cartilage cushions the bones and allows for smooth movement. Common knee injuries and conditions include ACL/PCL tears, meniscus tears, osteoarthritis, and bursitis.
The knee joint is formed by the femur, tibia, and patella. It allows for flexion and extension as well as some rotation. The knee joint is supported by several ligaments including the cruciate ligaments, menisci, and collateral ligaments. Injuries commonly involve tears to the medial meniscus or collateral ligaments from blows or twists to the flexed knee. Osteoarthritis is also a frequent cause of knee problems treated by knee replacement surgery.
knee joint
Functionally, the knee joint is a condylar & modified hinge joint.
Transverse axis of movement is not fixed, & moves forward during extension & translates backward in flexion;
Along with extension & flexion, there is a conjunct rotation of femur on tibia(or vice versa) around a more or less vertical axis.
1. Capsular ligament
2. Synovial membrane
3. Ligamentum patellae
4. Tibial collateral ligament
5. Fibular collateral ligament
6. Oblique popliteal ligament
Arcuate popliteal ligament
Medial & lateral menisci
TIBIAL COLLATERAL LIGAMENT
The ligament consist of superficial & deep part . Both part are attached above to the medial epicondyle of femur. The superficial part extends downward & forward as a flattened band & is attached to the medial condyle & upper part of medial border of shaft of tibia along a rough strip of bone.
The knee joint is composed of three joints within a synovial cavity. It allows for both hinge-like flexion and extension as well as some rotational movement. The knee joint is supported by ligaments such as the ACL, PCL, and collateral ligaments as well as menisci that act as shock absorbers. Common knee joint issues include osteoarthritis, which involves the destruction of cartilage over time, and various injuries to structures like the menisci and ligaments that can compromise stability.
The knee joint is composed of three joints within a synovial cavity. It includes the medial and lateral condylar joints between the femur and tibia, and the patellofemoral joint between the femur and patella. The knee joint is supported by ligaments including the ACL, PCL, medial collateral ligament, lateral collateral ligament, and menisci. The knee allows for flexion and extension through the actions of various muscles and is an important weight-bearing joint that can be subject to injuries and osteoarthritis.
The temporomandibular joint (TMJ) is a synovial joint that connects the mandible to the temporal bone. It is a compound joint composed of the head of the mandible, mandibular fossa, articular disc, articular eminence, and surrounding ligaments. The TMJ allows hinge-like opening and closing of the jaw as well as gliding movements. It is innervated by the trigeminal nerve and irrigated by blood vessels including the middle meningeal artery.
Meniscal injuries are common soft tissue injuries of the knee joint. The menisci help with load distribution, joint stability, and shock absorption in the knee. Traumatic meniscal tears often occur in young, active individuals during twisting sports and can be diagnosed using physical examination maneuvers like the McMurray test. Arthroscopic surgery is a common treatment for meniscal tears.
The document discusses disorders of the upper limb, including the shoulder, elbow, wrist, and hand. It provides details on anatomy, common conditions such as frozen shoulder, lateral epicondylitis, carpal tunnel syndrome, and treatments including injections, physical therapy, and surgery. It comprehensively covers the assessment and management of various musculoskeletal issues in the upper extremity.
The cubital fossa is a triangular depression on the anterior surface of the elbow joint. It is bounded laterally by the brachioradialis muscle, medially by the pronator teres muscle, and superiorly by the epicondyles of the humerus. The brachial artery bifurcates in the cubital fossa into the radial and ulnar arteries. The median nerve also passes through the cubital fossa. Injuries like supracondylar fractures can damage the neurovascular structures within the fossa.
The document provides an overview of the biomechanics of the knee joint, including its structural components and functional movements. It describes the tibiofemoral and patellofemoral joints, the bones that make up the knee (femur and tibia), supporting ligaments (ACL, PCL, MCL, LCL), menisci, and the range of motions involved in flexion/extension, rotation, and abduction/adduction. It also discusses how the cruciate ligaments and "screw home mechanism" aid in locking the knee during full extension and unlocking it to allow flexion.
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Examination of tmj &muscles of mastication (2)rachitajainr
The temporomandibular joint (TMJ) connects the mandible to the temporal bone. It is a synovial joint that allows hinge-like and gliding motions. The articular disc separates the joint into upper and lower compartments. Ligaments such as the collateral, temporomandibular, and sphenomandibular ligaments stabilize and limit movements of the joint. Examination of the TMJ involves history taking, inspection, palpation of the joint and muscles, and assessing maximum mouth opening.
The wrist joint is a complex biaxial joint between the carpal bones and the distal end of the radius. It allows for flexion/extension and abduction/adduction motions. Key structures include the articular surfaces of the radius, triangular articular disc, and proximal carpal bones. The joint is surrounded by ligaments including the radial and ulnar collateral ligaments. Common injuries include fractures of the scaphoid bone and Colles' fracture of the radius. Ganglions also sometimes develop as cysts near the joint.
TMJ surgical anatomy and applied aspectsJoel D'silva
The temporomandibular joint (TMJ) allows for hinge and gliding motions that facilitate functions like chewing and speech. It is a synovial joint containing features like bone, fibrocartilage discs, fluid-filled cavities, and ligaments. The TMJ is unique in that its surfaces are covered by fibrocartilage instead of hyaline cartilage and it is the only joint with a rigid closure point provided by tooth occlusion. Development of the TMJ occurs relatively late in utero, beginning with the formation of cartilaginous condyles that later ossify and fuse to the mandible.
The document summarizes key anatomical structures of the knee, lower leg, and ankle. It describes the tibia, fibula, patella, knee joint, tibiofibular joints, ligaments, muscles, and bony landmarks. The knee joint is a complex joint formed by the femur, tibia, and patella. It contains cruciate and collateral ligaments that stabilize the joint. Muscles of the leg are divided into anterior, posterior, and lateral compartments that plantarflex, dorsiflex, invert and evert the foot. The tibia and fibula articulate proximally and distally to form the tibiofibular joints.
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Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Tests for analysis of different pharmaceutical.pptx
Meniscal tears
1.
2. Meniscal function is essential to normal
function of the knee joint
When the menisci is removed the joint
contact area is reduced by 40% the
contact area is 2.5 times greater when the
menisci are present.
In 1948 Fairbank first reported the
roentenographic changes after
meniscectomy
3. In 1970 DeHaven began to perform the open
meniscal repair through posterior arthrotomy,
usually in conjunction with ligament
reconstruction.
Ikeuchi performed the first meniscectomy in
Tokyo n 1979.
In 1980 Hening performed the first
meniscectomy in the United States.
O’Connor is the Pioneer of arthroscopic repair.
4. Menisci are two fibrocartilagenous
crescents
They try to deepen the articular surfaces of
the condyles of the tibia, partially divide
the joint cavity into upper and lower
compartments.
5. Each menisci has
Two ends- attached to the tibia.
Two borders- the outer border is thick,
convex and fixed
to the fibrous band; the inner
border is thin concave and
free
6. Two surfaces- the
upper surface is
concave for femur;
the lower surface is
flat for peripheral two
thirds of the tibial
condyles.
7. It is a C shaped structure forming 3/5 of the
ring asymmetrically larger posteriorly than
anteriorly.
The anterior horn is attached to the tibia
anterior to the intercondylar eminence and to
the anterior cruciate ligament.
The posterior horn is anchored immediately in
front of the attachment of posterior cruciate
ligament posterior to the intercondylar
eminence.
8. Its entire peripheral border is attached to
the medial capsule and through the
coronary ligament to the upper border of
tibia.
Most of the weight is borne on the
posterior portion of the meniscus.
9. It is circular forming 4/5 the of the ring
with symmetrical anterior and posterior
horn.
The anterior horn is attached to the tibia
in front of the intercondylar eminence.
The posterior horn is attached to
posterior aspect of the intercondylar
eminence in front of posterior attachment
of the medial meniscus.
10. The posterior horn receives anchorage to
the femur via the ligament of Wrisberg
and ligament of Humphrey and from
fascia covering the popliteus muscle.
The tendon of the popliteus separates the
posteriolateral periphery of the lateral
meniscus from the joint capsule and
fibular collateral ligament.
11. The lateral meniscus is smaller in diameter,
thick in periphery, wide in body and more
mobile.
In contrast the medial meniscus is
much larger in diameter is thinner in the
periphery, narrower in body and less mobile.
The menisci follow the tibial condyles during
flexion and extension, but during rotation they
follow the femur and move on the tibia.
12.
13. Menisci are composed of dense, tightly woven
Type-I collagen with some Type-III)
and elastin to create a compressible structure.
The major orientation of collagen fibres in the
menisci is circumferential; radial and
perforating are also present.
The circumferential fibres function in hoops to
accept stress without gross deformation or
extrusion of the joint.
14. Radial fibres stabilizes the meniscus,
preventing circumferential splits as wells
resisting excessive compressive loads.
15. The medial meniscus is semicircular and
attached to the medial collateral ligament
(medial collateral ligament) of the knee
joint.
It only moves 2-5 mm within the joint and
is hence more prone to tears than the
lateral meniscus which is more circular in
shape and moves 9-11mm.
16. The menisci of the knee are present
developmentally at eight weeks as a
collection of fibroblasts.
At birth, the menisci are vascularised
through their substance; with ageing
through early adulthood, there is
eventual peripheralization of the
vascularity to the outer third of meniscus.
17. Vascular supply is from the lateral and medial
geniculate vessels ( inferior and superior).
The branches from the vessels give rise to
perimeniscal capillary plexus within the
Synovial and capsular tissue and supply the
peripheral border of meniscus.
The depth of the vascular penetration is 10% to
30% of the width of the medial meniscus and
0% to 25% of width of lateral meniscus.
18. Acts as joint filler compensating for the
gross incongruity between tibial and
femoral articulating surfaces.
Prevent capsular and Synovial
impingement during flexion-extension
movements.
Joint lubrication help to distribute
Synovial fluid through the joint and
aiding the nutrition of articular cartilage.
19. Contribute to stability in all planes but
are important rotatory stabilizers.
Shock absorption; the larger area
provided by the meniscus reduces the
average contact stress between the
bones.
20. Traumatic lesions of the menisci are most
commonly produced as the flexed knee
moves toward an extended position.
The most common location of injury is
the posterior horn of the meniscus, and
longitudinal tears are the most common
type of injury.
21. Menisci with peripheral cyst formation.
Menisci that have been rendered less
mobile from previous injury or disease.
Congenital anomalies-discoid lateral
meniscus.
Areas of degeneration that develop as a
result of aging.
Abnormal mechanics in the joint
incongruities or ligamentus disruptions.
22. Congenitally relaxed joints.
Inadequate musculature especially quadriceps.
Certain sports are commonly associated with
meniscal injuries. Soccer players are
particularly liable, especially when pivoting
with the weight on one leg with the knee
flexed. Other sports such as hockey, tennis,
badminton, squash, and skiing are liable to
meniscal injury.
23. Turning or twisting of the loaded joint
may trap the menisci between the joint
and tear the meniscus.
MEDIAL MENISCUS
Internal rotation of femur over tibia with
knee in flexion forces the posterior
segment of medial meniscus towards the
centre of the joint.
24. The posterior horn may be trapped in
this position by sudden extension of
knee.This excessive force results in tear
of the meniscus from its peripheral
attachment and causes a longitudinal
splitting of its substance.
25. Vigorous external rotation of femur while
the knee is flexed will displace the
posterior half of the lateral meniscus
toward the centre of the joint.
During sudden extension of the knee, an
anterioposterior distracting force tends
to straighten the cartilage and imposes a
strain on the medial concave rim, which
tears transversely and obliquely.
26. Smillie’s classification
Peripheral detachments(10%)
Complete(23%)
Segmental-either anterior or
posterior(2%)
Horizontal tears-Posterior, middle or
anterior(48%)
Cystic degeneration(12%)
28. Based on the location
of the tear in the three
zones of vascularity.
a. Red-Red-fully within
vascular area
b. Red-White-at the
border of vascular
area
c.White-White within
the avascular area
29. Based on the type of tear found at
surgery
a. Longitudinal tear.
b. Horizontal
c. Oblique
d. Radial tears
e.Variations which include flap tears,
complex tears and degenerative tears.
30. Most commonly occur as a result of trauma to a
reasonably normal meniscus.
The tear is vertically oriented and may extend
completely through the thickness of the
meniscus or may extend only partially or
incompletely through it.
31. Medial side is 3 times
more commonly
involved than lateral.
If the tear is near the
meniscocapsular
attachment of the
meniscus, it is
referred to as
peripheral tear.
32. Complete tear is
associated with ACL
injury.
Long tears that extend at
least two third of the
circumference of the
meniscus produce an
unstable fragment that
displaces into the
intercondylar notch,
referred to as bucket
handle tear.
33. Most common in older
patients in the posterior
horn of the medial
meniscus or in the mid
portion of lateral
meniscus.
The horizontal cleavage
divides the meniscus
into superior and
inferior leaves
resembling a fish
mouth.
34. Full thickness tears running obliquely
from the inner edge of the meniscus out
into the body.
If the base of the tear is posterior, it is
referred to as posterior oblique tear; the
base of an anterior oblique tear is in the
anterior horn of the meniscus.
35. Common in lateral
meniscus and middle
third is commonly
involved.
Three varieties are
encountered,
1.Incomplete
2.Complete
3.Parrot beak
In incomplete type, tear
extends all the way from
the inner edge of
meniscus out towards
periphery.
36. In the complete type,
tear extends all the
way from the inner
edge to
meniscosynovial
rim.
In parrot beak variety,
longitudinal or oblique
tears are added to
incomplete or
complete radial tears.
37. It begins as horizontal
cleavage tears in the
degenerative tissue of
an older patient.
It is superior or
inferior flap
depending on the
location of the base of
the flap.
38. It may contain elements of all the above
types of tears.
More common in chronic meniscal
lesions or in older degenerative menisci.
39. Most often seen in older patients.
Present with marked irregularity and
complex tearing within the meniscus.
40. An accurate detailed history is essential
and its importance is frequently greater
than that of the clinical examination.
Patient gives history of a twisting injury
to the knee while the joint was flexed.
41. Locking: Locking means inability to extend the
knee fully.This results as displaced segment
interpose between the tibial and femoral
condyle preventing full extension.
Sensation of giving away:The patient notices
this on turning around suddenly, walking on
uneven ground or on stepping on a mall stone
and often associates it with a feeling of
subluxtion or “the joint jumping out of place”.
42. Effusion: Indicates that something is
irritating the synovium and has limited
specific diagnostic value. Sudden onset
after an injury denotes a hemarthrosis.
Repeated displacement of torn portion of
a meniscus can produce chronic synovitis
with an effusion of a nonbloody nature.
43. Tenderness: Most important physical
finding in localized tenderness along the
medial or lateral joint line or over the
periphery of meniscus.This is most often
located posteromedially or
posterolaterally
44. Atrophy of the quadriceps suggest
recurring disability of the knee.
Clicks, snaps, or catches, either audible
or detected by palpation can be valuable
diagnostically. If the noises are localized
to the joint line, the meniscus most likely
contains a tear.
45. Often it is difficult to diagnose the cause
of knee symptoms on history and clinical
examination.
Such non specific symptom complex is
termed as internal derangement of the
knee.
46. Position: Supine
Examiner stands on
the affected side;
grasps the foot firmly
with one hand and
the knee with other
hand
The joint is slowly
extended slowly
keeping the foot in
externally rotated
and abducted.
47. As the femur passes over the tear in the
meniscus, patient complains of pain.
At the same time click will be felt by the hand
at the knee.
On the similar exercise with the foot in internal
rotation and knee adducted if elicits click and
pain indicates tear in lateral meniscus.
48. Position: prone
With the knee flexed
to 90 degree and the
thigh fixed to the
examination table
clinician applies
compression and
lateral rotation to the
leg from foot.
49. If the patient experiences pain it
indicates M.M. tear.
If patient experiences pain on internal
rotation of leg, a tear in lateral meniscus
is suspected.
50. Consists of several repetitions of full
squat with the feet and leg alternately
rotated as the squat is performed.
Pain in the internally rotated position
suggests injury to the lateral meniscus.
Pain in the external rotation suggests
injury to the medial meniscus.
51. Position: Sitting
Patient sits with the
leg bent over the
table about 90
degree.
To assess the M.M.
tear, the foot is
externally rotated
which produces some
discomfort.
52. Position: Supine
The examiner grasps the leg near the
ankle with one hand while flexing the
knee to 30 degree with the other hand.
The patient is asked to relax and the
knee is forcible and quickly extended in
one moment or jerk.
53. As the patient passes from flexion to
recurvatum the patient experiences a
sharp pain on the side with the damaged
meniscus which may radiate up and
down the limb.
54. Radiological Examination:
AP, Lateral and intercondylar notch view
with a tangential view of inferior surface
of patella.
It is essential to exclude loose bodies,
osteochondritis and other derangements
of the knee.
55. Arthrography of the knee has proved to be a
valuable supplement to analysis of knee
disorders.
It is an invasive procedure.
Air and an opaque contrast material such as
Iothalamate meglumine or diatrizoates sodium
and megleomine are injected into the joint
under sterile condition.
56. Multiple roentgenographic views are
then made by rotating the joint and
bringing all portions of medial and
lateral menisci into profile.
57. Accuracy in diagnosis
Medial menisci-95%
Lateral menisci-
85%
It is contraindicated in pyoarthrosis,
bleeding disorder and allergic to
contrast material.
With the improvement in CT scan and
MRI arthrography is rarely used.
58. Is the diagnostic procedure to detect the
meniscal injuries.
It has an accuracy of 98% for medial
meniscus injury.
It has an accuracy of 90% for lateral
meniscus injury.
59. Ultrasound
Scintigraphy
CT
MRI:
Is currently of great value in the
diagnostic evaluation of meniscal tears.
The accuracy of meniscal tears exceeds
90%.They are graded as
60. Grade I Tear of the meniscus has increased
signal in the meniscal substance.
Grade II Involves a more pronounced and
frequently linear signal that does not break the
surface of the meniscus.
Grade III Signal that traverses through the
meniscal surface
Grade IV There is extension of tear through
both tibial and femoral surfaces of the
meniscus.
61. Grade I and Grade II changes appear
normal on arthroscopic evaluation.
62. Injury to the alar pad of fat.
Rupture of the medial ligament.
Rupture of the cruciate ligament.
Fracture of the tibial spine.
Loose bodies.
Osteo arthritis.
Recurrent dislocation.
Chondromalacia patella.
63. The damage to the menisci is often but
one component of a complex injury to
knee.The plan of treatment should be
modified to accommodate for associated
lesions.
Non Surgical management
Surgical Management
64. Indication:
1. Incomplete meniscal tear or small
(5mm) stable peripheral tear with no
pathological condition.
2.Tears associated with ligamentous
instabilities can be treated non-
surgically if patient defers ligament
reconstruction or if
reconstruction is contraindicated.
65. 1. Chronic tears with superimposed acute
injury.
2. In a locked knee with bucket handle
tear of meniscus.
66. Initial treatment of a meniscal tear follows
the basic RICE formula: rest, ice,
compression and elevation, combined
with nonsteroidal anti-inflammatory
medications for pain.
67. 1. An acute episode without locking but
with an acute synovitis with effusion
requires immediate abstinence from
weight bearing, rest with knee flexion,
application of ice packs and
compression dressing.
2. Traction with 5 to 7 pounds of weight.
3. Fluid should be aspirated.
68. 5. A single intra-articular steroid injection
should be permissible.
6. Squatting, flexion, external rotation and
valgus stress to the knee to be avoided
in the first week.
7. Groin to ankle cylindrical cast to be
worn for 4 to 6 weeks.
8. Isometric exercise program during the
time the leg is in cast.
69. 9. At 4 to 6 weeks cast is removed and
rehabilitative program is intensified.
10.If symptoms recur after a period of NST,
surgical repair or removal of damaged
meniscus may be necessary.
70. 1. Meniscectomy
By arthrotomy
By arthroscopy
2. Meniscal repair
By arthrotomy
By arthroscopy
3. Meniscal transplantation
With autografts, allograft, prosthetic
scaffolds.
71. Treatment of proven meniscal tear is
usually either through arthrotomy or
arthroscopy.
Arthroscopic techniques are preferred to
arthrotomy unless associated injuries,
such as ligament disruption or
osteochondral fracture, require open
techniques.
72. Types of meniscal excisions:
Depending upon the amount of meniscal
tissue to be removed O Connor classified:
i) Partial meniscectomy: Only the loose,
unstable fragments are excised; e.g.
Displaceable inner fragment in bucket
handle tear , the flap in flap tears or flap in
oblique tears.
ii) In this stable and balanced peripheral rim is
preserved.
73. ii) Subtotal meniscectomy:This requires
excision of portion of peripheral rim of
meniscus.
Most of the anterior horn and a
portion of middle 3 rd of the meniscus
are not resected.
74. iii) Total meniscectomy: Done when
meniscus is detached from its peripheral
menisco-synovial attachment and
intrameniscal damage and tears are
extensive.
75. 1. Using single anteromedial incision:
Begin the incision just medial to the
patella, continue it approximately 5 cm
distally, parallel to the patella and the
patellar tendon and end it at the level of
upper tibia. Incise the fascia and capsule
0.5 cm medial to the edge of patella and
patella tendon.
76. Using two incision: HENDERSON
An additional posteromedial incision is
used.
Permits easier and complete
detachment of posterior horn.
Posterior incision is made 5 cm parallel
and slightly posterior to the tibial
collateral ligament.
77. An anterolateral incision is made.
Begin the incision at the level of mid
portion of the patella and extend it
distally parallel to the patella and
patellar tendon to the upper tibial
surface.
If the posterior horn is not visible a
second incision (HENDERSON) can be
used.
78. A compression bandage is applied to the
knee.
Knee is immobilized in extension with
posterior plaster splint or with a knee
immobilizer for 5-7 days.
Ice is applied over the knee and limb is
elevated for 24-48 hours postoperatively.
79. Quadriceps exercises are started 2 nd
day onwards, isometric quadriceps
exercises are carried out on every hour
when the patient is awake.
When the good muscular control is
achieved, patient is allowed to walk with
crutches and with partial weight bearing.
80. The sutures are removed 2 weeks and
gentle resistive exercises are begun.
81. It is carried out as an diagnostic and an
therapeutic procedure.
The objective of the treatment is to
remove the torn mobile meniscal
fragment and contour the peripheral rim
leaving a balance , stable rim of meniscal
tissue.
82. Longitudinal displaced complete intra
meniscal tears (Bucket handle tear)
Technique: AM and AL portal’s is used to
do partial meniscectomy.
83. It is used in the excision of large
complete, intrameniscal tears of
posterior horn.
Arthroscope, grasping instruments,
cutting instruments are used through the
three portals.
Arthroscope placed through the AL
portal. Probe the posterior limits of
displaced bucket handle through AM
portal.
84. Through AM portal anterior horn
attachment of the meniscus is released.
Grasping clamp is placed through the
AM portal to grasp the anterior horn and
it is removed.
Now probe is used through AM portal to
check the stability of the remaining rim
and look for any tears.
85. Motorized shaver are introduced through
AM portal to smoothen the remaining
rim.
86. 30 degree viewing Arthroscope is
inserted through an AL portal.
Probe is placed through the AM portal.
Objective is to perform partial
meniscectomy.
Complete the contouring and balancing
of the meniscal rim with the motorized
shaver.
87. 30 degree oblique
viewing Arthroscope
is used through AL
portal.
Superior and inferior
leaves of the tear is
removed with the
basket forceps.
Peripheral rim is
trimmed and
contoured.
88. Three portal technique is adopted, small
posteriorly based oblique tears are
usually removed by morcellation of flaps
with basket forceps or motorized cutter,
trimmer instruments.
Large posterior or oblique tears are
removed enbloc.
Anterior oblique tears are removed by
triangulation.
89. 1. Post operative haemarthrosis.
2. Chronic synovitis.
3. Synovial fistulae.
4. Painful neuromas of the branches of the
infrapatellar portion of saphanous nerve.
5. Thrombophlebitis- suggested by
postoperative pain and swelling in the calf
and distal extremity with low-grade fever.
90. 6. Postoperative infection-Increasing
effusion, pain and fever beginning 2 to
3 days after surgery indicate the onset
of pyarthrosis.
7. Reflex sympathetic dystrophy.
8. Retained meniscal fragment.
9.Late changes: Degenerative changes
within the joint.
91. Fairbank described three changes
i) Narrowing of joint space.
ii) Flattening of the peripheral half of the
articular surface of condyle.
iii) Development of anteroposterior ridge
that projected distally from the margin of
femoral condyle.
92. Vertically oriented sutures are easy to do
by open arthrotomy. It is more secure
than more horizontally oriented suturing
by arthroscopic techniques.
In repair of posterior horn peripheral
tears by open arthrotomy technique,
posteromedial or posterolateral capsular
reconstruction can be done concurrently.
93. Since open incision is required to expose
the capsule with arthroscopic techniques
have no advantage over open technique.
Immobilization required is the same for
both open and arthroscopic technique.
94. Certain tears are easier to suture by
arthroscopic technique- posterolateral
tears and tears central to menicosynovial
junction.
95. Knee is placed in a hinged brace and
immediate range of motion from 0 to 90
degree is permitted.
Touch down weight bearing is permitted
immediately, and full weight bearing in 6
weeks after the brace and crutches are
discarded.
No sports are allowed for 3 months.
96. If tear is large crutches are discarded at 8
weeks.
No sports are allowed for 6 months.
97. Tears that are definitely reparable
include ,single vertical tear in the
peripheral vascular portion of menisci,
red-red zone, red-white zone within 3 mm
of the junction.
98. Inside to outside
Outside to inside
All inside technique
99. Diagnostic arthroscopy
Repair of M.M. tear place 30 degree of
Arthroscope through AL or central portal
Anterior limit of tear is seen with strong
valgus strain with the knee flexed to 10-
20 degree.
100. To approach anterior and middle third of
medial meniscus tear straight cannula
technique is used from lateral portal
crossing under the arthroscope which is
central or AM portal.
To approach posterior third of M.M. tear
through AM portal with arthroscope
located central or AL.
101. If the peripheral tear extends beyond PM
corner of the knee an incision of 5-7 cm
is made to preserve the popliteal vessels.
Long needles with swaged 2-0 ethaband
are used.
102. Posterior tear of the lateral meniscus.
30 degree arthroscope view with an AM
portal and the probe in anterolateral
portal.
Place the leg in figure of four position
and advance 30 viewing arthroscope
from AM portal to AL compartment.
Tear is sutured in 90 degree flexion.
103. The suture is introduced through a spinal
needle that is inserted from outside to
inside.
Safe technique for posterior horns.
Large peripheral tears (bucket handle
tear) a combination of inside to outside
and outside to inside methods are used.
104. Morgan described all inside technique.
Posterior horn peripheral meniscal tears
within 3 mm of the menisco-synovial
junction.
Advantages It allows the placement of
vertical sutures thus securing the
circumferentially oriented meniscal
collagen fibres.
105. Smaller incision can be used.
Disadvantages Need for special
instrumentation.
Difficulty in tying the knot in a confined
space.
106. It acts as a chemo tactic and mitogenic
stimulus for reparative cells and provide
scaffolding for reparative process.
Arnocky and Warren reported the
injection of exogenous fibrin clot
obtained from the patients coagulated
blood to improve meniscal healing.
107. Exogenous fibrin clot is injected with a
blunt needle in the stem of the tear.
1-2 ml of clot was sufficient to fill an
average defect.
When gaps are large facial sheath was
used and fibrin clot is injected under the
cover of the sheath.
Repairs of tears less than 2 months show
higher healing rates.
108. Attempts at meniscal
replacement with
allograft menisci, auto
graft fascial material
and synthetic menisci
scaffold are in various
stages of study.