Scribd Logo
Upload

Welcome to Scribd!

  • 65 views

    Knee Patho

    Uploaded by

    Ailee Gliezl Milanie Montemayor
    The knee is a hinge joint composed of the femur, tibia, fibula, and patella. It contains cruciate ligaments that control anterior-posterior movement and collateral ligaments that control lateral movement. The menisci distribute weight and convert the tibial surface into a shallow socket. Common knee injuries include patellar dislocation, meniscal tears, and injuries to the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Diagnosis involves examination, imaging like x-rays and MRI, and treatment ranges from rehabilitation to surgery depending on the severity of the injury. Future advances aim to improve reconstruction through tissue engineering and gene therapy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Knee Patho

    Uploaded by

    Ailee Gliezl Milanie Montemayor
    65 views32 pages
    The knee is a hinge joint composed of the femur, tibia, fibula, and patella. It contains cruciate ligaments that control anterior-posterior movement and collateral ligaments that control lateral movement. The menisci distribute weight and convert the tibial surface into a shallow socket. Common knee injuries include patellar dislocation, meniscal tears, and injuries to the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Diagnosis involves examination, imaging like x-rays and MRI, and treatment ranges from rehabilitation to surgery depending on the severity of the injury. Future advances aim to improve reconstruction through tissue engineering and gene therapy.

    Original Description:

    Knee Patho

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The knee is a hinge joint composed of the femur, tibia, fibula, and patella. It contains cruciate ligaments that control anterior-posterior movement and collateral ligaments that control lateral movement. The menisci distribute weight and convert the tibial surface into a shallow socket. Common knee injuries include patellar dislocation, meniscal tears, and injuries to the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Diagnosis involves examination, imaging like x-rays and MRI, and treatment ranges from rehabilitation to surgery depending on the severity of the injury. Future advances aim to improve reconstruction through tissue engineering and gene therapy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    65 views32 pages

    Knee Patho

    Uploaded by

    Ailee Gliezl Milanie Montemayor
    The knee is a hinge joint composed of the femur, tibia, fibula, and patella. It contains cruciate ligaments that control anterior-posterior movement and collateral ligaments that control lateral movement. The menisci distribute weight and convert the tibial surface into a shallow socket. Common knee injuries include patellar dislocation, meniscal tears, and injuries to the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, and posterior cruciate ligament. Diagnosis involves examination, imaging like x-rays and MRI, and treatment ranges from rehabilitation to surgery depending on the severity of the injury. Future advances aim to improve reconstruction through tissue engineering and gene therapy.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 32

    KNEE

    PATHOLOGY
    Basic Anatomy of the Knee
    • Large Hinge Joint
    • Femur
    • Tibia
    • Fibula
    • Patella

    2
    Cruciate ligaments
    • Control anterior and
    posterior movements
    • Fit inside the
    intercondylar fossa
    Collateral ligaments
    • Control lateral movement
    • Exposed to valgus (MCL) and varus (LCL) forces
    Menisci
    • Weight distribution
    • Without menisci the weight of
    the femur would be
    concentrated to one point on
    the tibia
    • Converts the tibial surface into
    a shallow socket
    Patello-femoral Joint
    • articulation of the
    patella and femur

    • the patella is a true


    sesamoid bone

    • posterior surface of the


    patella is covered with
    thick hyaline cartilage

    • the patella slides


    within the trochlear
    groove
    Ligaments
    • Provide most of the support
    to the knees
    • Little structure or support
    from the bones
    Gross Anatomy: Muscles
    Thigh
    Quadriceps femoris
    Sartorius
    Gracilis
    Hamstrings
    IT band
    Leg
    Gastrocnemius
    Plantaris
    Popliteus
    Patellar Dislocation
    Predisposition
    Genu valgum
    Overweight
    Weak quadriceps
    Mechanism
    Direct contact to
    medial side
    External tibial rotation
    with forceful
    quadriceps contraction
    Patellar Dislocation: Diagnosis
    Obvious if not yet
    reduced
    Patellar hypermobility/
    apprehension test
    X-ray/MRI only
    necessary to rule out
    osteochondral
    fractures, other
    associated injuries
    Patellar Dislocation:
    Treatment
    Knee extension
    Aspiration to relieve
    discomfort and check for
    fat in blood
    Surgery unnecessary
    unless osteochondral
    fracture
    Crutches, PRICE
    Rehabilitation focusing
    on vastus medialis
    Meniscal Tears
    Shear force from femur
    Acute or degenerative
    Athletes, elderly,
    overweight
    Horizontal
    Within substance
    Longitudinal
    Bucket handle –ACL risk
    Radial or vertical
    Parrots beak
    Medial Meniscus Tear
    Tears easier than lateral
    due to certain traits
    Squatting
    Internal rotation of tibia
    with knee flexed
    Member of “unhappy triad”
    Medial meniscus
    MCL
    ACL
    Medial Meniscus: Diagnosis
    Examination
    McMurray’s test
    Apley’s compression test
    MRI
    Low-signal intensity
    (black triangle ) =
    normal
    White interruption =
    lesion
    Arthroscopy as last
    resort
    Medial Meniscus: Treatment
    PRICE for isolated and minimal tear
    Partial arthroscopic meniscectomy most common
    Lateral Meniscus Tear
    Lower incidence
    Often more
    painful
    More likely to incur
    radial or parrots beak
    Not rare for anterior
    horn
    Discoid meniscus
    Lateral Meniscus: Diagnosis/Treatment
    Same techniques as for
    medial meniscus
    McMurray’s test and
    Apley’s test performed
    with internal tibial
    rotation
    MRI slightly less
    accurate than with MM
    Treatment similar
    Medial Collateral Ligament
    Attached to fibrous
    capsule and MM
    Injury rarely isolated –
    “unhappy triad”
    Can tear with external
    rotation (skiing), but
    more commonly from
    valgus or abduction force
    (football)
    Pain localized to medial
    joint line, but can subside
    following Grade III tear
    MCL: Diagnosis: Examination
    Abduction stress test
    First at 30
    Again at full extension
    Rule out PCL tear
    Anterior drawer test
    with external rotation of
    tibia
    Hip flexed 45
    Knee flexed 90
    Tibia rotated 30ext.
    Anterior rotation of
    medial tibial condyle
    MCL: Diagnosis: Imaging
    X-ray
    Only useful for young
    patients to differentiate
    from epiphyseal fracture
    Taken at 20-30flexion
    Enlarged joint space = tear

    MRI
    Coronal scan
    Normal MCL looks thin,
    taut, low-signal
    MCL: Treatment
    Surgery
    Surgery necessary for Open incision
    compound injury Midsubstance ruptures
    Crutches + PRICES + rehab sutured
    for Grade I, II only if isolated
    Tear from bone repaired
    Grade III tears may require
    surgical repair, but with suture anchors
    immobilization can be
    effective if isolated (rare)
    • 3-4 months recovery
    Lateral Collateral Ligament
    Courses slightly posterior
    Sprained least frequently
    Flexed knee = isolated tear
    Anteromedial blow 
    hyperextension/ postero-
    lateral corner injury
    Risk to common peroneal
    nerve
    Foot drop, sensation loss
    LCL: Diagnosis:Examination
    Adduction stress test
    At 30, then fullextension

    Posterolateral drawer test


    Tibia externally rotated,
    posterior forceapplied

    Reverse pivot shift test


    Knee 90, tibia ext. rotated
    With valgus, slowlyextended
    Temporary posterior
    subluxation of lateral tibial
    condyle around 30
    Forcibly reduces with extension
    LCL: Imaging andTreatment
    MRI
    Coronal oblique scan
    Sagittal scan to rule
    out fibular fracture,
    avulsion
    Tear looks less taut or
    discontinuous – no
    thickening
    Treatment
    Similar to MCL
    Grade III usually
    requires surgery
    Anterior Cruciate Ligament
    Most common knee injury
    among athletes

    Hyperextension, internal
    rotation – rarely isolated
    injury from contact force

    “unhappy triad”

    May tear from tibia (3-10%),


    from femur (7-20%), or in
    midportion (70%)
    Proximal end receivesbranch
    from middle genicular a.
    ACL: Diagnosis: Examination
    History, large hemarthrosis
    Autonomic symptoms
    Anterior drawer test
    Tibia neutral, pull ant.
    NOT RELIABLE BYITSELF
    Lachman test
    Knee only flexed 15-20
    Pivot shift
    Start in extension, tibia
    internally rotated, valgus
    Slowly flex, lateral tibial
    condyle temporarily
    subluxates anteriorly ~30
    ACL: Diagnosis: Imaging
    X-ray
    Segond fracture of
    lateral tibial condyle
    ACL tear with it 75-
    100%
    Tibial spine avulsion
    in young patients
    MRI – 95% accuracy
    All 3 planes in full
    extension
    Edema/hemorrhage
    often obscuresACL
    Normal ACL Torn ACL
    ACL: Treatment
    Extrasynovial, heals
    poorly
    Partial, isolated tears
    may be treated with
    PRICE, rehab, bracing
    of slightly flexed knee
    Most tears, athletes
    will require
    reconstruction
    Posterior Cruciate Ligament
    Broader, longer, stronger
    The PCL, is not injured as frequently as the ACL

    Tears much less frequently


    Only in isolation when
    “dashboard knee” injury
    Hyperextension in sports,
    especially with side force
    Falling to ground with
    foot plantar flexed
    PCL: Diagnosis
    Posterior Drawer Test
    Gravity or sag test
    Hips at 45 or 90,
    compare tibial
    tuberosities forsag
    Abduction/adduction stress
    test at full extension
    X-ray to confirm sag test negative positive
    MRI shows lower-signal
    intensity for intact PCL
    compared to ACL due to its
    fiber organization
    Take on all 3 axes, but best
    is sagittal oblique
    PCL:Treatment
    Controversial
    PRICE, rehab, bracing for most isolated tears
    Rehab focused on quadriceps muscles for
    compensatory anterior drawer
    Surgery avoided when possible because PCLnot
    easy to access without additional risk factors
    Prognosis good because better blood supply =
    revascularization
    Future of Reconstruction
    Goals:
    Improve recovery time
    Improve remodeling of insertion sites
    Improve nervous and vascular restoration
    With biological manufacture of:
    Growth factors, cytokines
    Antibiotics
    Techniques:
    Gene therapy – viral/non-viral vector delivers specific gene
    Tissue engineering – mesenchymal stem cells

    You might also like