The Knee: Common Problems and Current Treatment

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Meniscal tears are among the most common knee injuries. Find out the symptoms, why it tears and why you have pain

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The Knee: Common Problems and Current Treatment

  1. 1. The Knee: Common Problems and Current Treatments David D Bullek, M.D. Orthopedic Surgery Surgery of the Knee and Shoulder Summit Medical Group Orthopedic Office of Westfield-
  2. 2. Knee Anatomy Summit Medical Group Orthopedic Office of Westfield
  3. 3. Knee Anatomy Summit Medical Group Orthopedic Office of Westfield
  4. 4. Knee Anatomy Summit Medical Group Orthopedic Office of Westfield
  5. 5. Anatomy of the Meniscus Lateral meniscus Medial meniscus Summit Medical Group Orthopedic Office of Westfield
  6. 6. What does the meniscus do? • Shock absorber of the knee • Meniscus absorbs 50% of load when standing Forces Redirected by Meniscus Summit Medical Group Orthopedic Office of Westfield
  7. 7. Meniscus Function • Enhance articular conformity femur tibia Summit Medical Group Orthopedic Office of Westfield meniscus
  8. 8. Meniscus Tears Why do they happen? Mostly circumferential fibers, few radial “ties” Tears like a cheap shirt!!! Summit Medical Group Orthopedic Office of Westfield
  9. 9. Meniscal Tears Most common source of mechanical knee pain Meniscal fragment is “abnormally mobile” Hang nail of the knee!!
  10. 10. Meniscus Tear = Cartilage Tear Summit Medical Group Orthopedic Office of Westfield
  11. 11. Clinical History of Meniscal Tears Younger patients usually are injured with a significant TRAUMA Summit Medical Group Orthopedic Office of Westfield
  12. 12. Clinical History of Meniscal Tears Older Patients- do not need significant trauma Kneeling, squatting or simple twist Many do not recall any traumatic event Summit Medical Group Orthopedic Office of Westfield
  13. 13. Symptoms Clicking Knee Swelling Locking Giving Way Increased pain with twisting, squatting or change of direction Summit Medical Group Orthopedic Office of Westfield
  14. 14. Examination  Joint line tenderness  Positive Apley’s or McMurray’s sign Summit Medical Group Orthopedic Office of Westfield
  15. 15. Radiographic Evaluation • Xrays- Standing AP, 45 degree PA, lateral and Merchant view Summit Medical Group Orthopedic Office of Westfield
  16. 16. MRI MRI is 93% accurate in diagnosis of medial meniscus tears Accuracy in diagnosis of lateral meniscus tears is 90% Summit Medical Group Orthopedic Office of Westfield
  17. 17. Treatment Options • Resect or Repair Summit Medical Group Orthopedic Office of Westfield
  18. 18. Meniscal Repair Red-red tear Indications     Tears in the vascular zone Intact body of the meniscus > than 1cm in size or unstable Stable knee or in conjunction with an anterior cruciate reconstruction Summit Medical Group Orthopedic Office of Westfield
  19. 19. Meniscal Repair Techniques Sutures arrows Summit Medical Group Orthopedic Office of Westfield
  20. 20. Results of Meniscal Repair • 70% success in isolated tears • 90 % success in tears repaired in conjunction with ACL reconstructions Summit Medical Group Orthopedic Office of Westfield
  21. 21. Meniscal Resection • Indicated in the symptomatic mobile meniscus tear not amenable to repair (the majority of tears in adults) Knee arthroscopy Summit Medical Group Orthopedic Office of Westfield
  22. 22. Technique of Meniscal Resection  Remove all of mobile fragment  Contour the rim  Preserve the rim (barrel hoops)  Avoid excessive resection Summit Medical Group Orthopedic Office of Westfield
  23. 23. Results of Partial Menisectomy Summit Medical Group Orthopedic Office of Westfield
  24. 24. Causes of Failure in Arthroscopic Partial Menisectomy Summit Medical Group Orthopedic Office of Westfield
  25. 25. Arthritis and Meniscal Tears Results directly related to degree of arthritis No arthritis -95% satisfactory results @ 3years Ahlback I(50% jt space narrowing) 65% satisfactory results @ 3 years Ahlback II and III- poor results Summit Medical Group Orthopedic Office of Westfield
  26. 26. Recommendations Standing xrays of knee determine preexisting OA and need for surgery! • MRI alone is not sufficient • Summit Medical Group Orthopedic Office of Westfield
  27. 27. The End Thank You Summit Medical Group Orthopedic Office of Westfield

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