An Evidence Based Medicine Understanding of Meniscus Injuries and How to Treat Them
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Physio Med Self Help for Achilles Tendinopathy
Physio Med Self Help 0113 229 1300 for Achilles Tendinopathy Achilles tendon injuries are common, often evident in middle aged runners to non-sporting individuals. They are often characterised by pain in the tendon, usually at the beginning and end of exercise, pain and stiffness first thing in the morning or after sitting for long periods. There is much that can be done to both speed up the healing and prevent re-occurrence. Anatomy of the Area The muscles of your calf (the gastrocnemius and soleus) are the muscles which create the force needed to push your foot off the floor when walking, running and jumping, or stand up on your toes. The Achilles tendon is the fibrous band that connects these muscles to your heel. You may recognise the term ‘Achilles Tendonitis’ which was the previous name used for Achilles Tendinopathy. However the name has changed as it is no longer thought to be a totally inflammatory condition, but rather an overuse injury causing pain, some localised inflammation and degeneration of the thick Achilles tendon at the back of the ankle. Potential causes of Achilles Tendinopathy and advice on how to prevent it • Poor footwear or sudden change in training surface e.g. sand makes the calf work harder » Wear suitable shoes for the activity (type, fit and condition of footwear). » Take account of the surface you are exercising on and if soft and unstructured like sand or loose soil reduce the intensity / duration or take a short break or reduce any load you are carrying into smaller loads until you become conditioned to it. -
Meniscus Tear
291 North Fireweed Soldotna, AK 99669 907-262-6454 www.kenaipeninsulaortho.com ______________________________________________________________________________________ Orthopaedic Surgeon: Hand and Wrist Specialist: Henry G. Krull, M.D. Edwin D. Vyhmeister, M.D. Meniscus Tear The meniscus is the rubbery, soft cartilage cushion in the knee. There are two of the C-shaped cushions in each knee, a medial (inner) and lateral (outer) meniscus. They sit between the two bones that form the knee joint, and function to cushion and support the knee. The meniscus can tear with injury or degeneration, or a combination of both. The medial meniscus is torn about 10X more frequently than the lateral meniscus. In young people, the meniscus usually tears with an injury. In older people, the cartilage can degenerate (weaken) with age, and can tear with or without an injury; spontaneous tears can occur. Meniscal tears can occur in association with other injuries to the knee. Symptoms: Pain is the usual symptom of complaint with a meniscus tear. There is often a noticeable “pop.” Swelling and stiffness can also occur. Mechanical symptoms are common—clicking, popping, and locking. Sometimes there is just a feeling that something is wrong inside the knee. Pain can be sharp, or can be dull and aching. Meniscus tears do not heal, but sometimes the symptoms dissipate. Chronic, intermittent symptoms is very common. Meniscal tears can cause a feeling of instability, or can cause the knee to buckle or give way. Cause: Injuries, particularly with sports, are a common cause of meniscal tears in young people. As people age, the meniscus tissue weakens through the normal degenerative process, and tears can occur spontaneously, or with simple activities, such as getting up from a chair, and changing direction while walking. -
About Your Knee
OrthoInfo Basics About Your Knee What are the parts of the knee? Your knee is Your knee is made up of four main things: bones, cartilage, ligaments, the largest joint and tendons. in your body Bones. Three bones meet to form your knee joint: your thighbone and one of the (femur), shinbone (tibia), and kneecap (patella). Your patella sits in most complex. front of the joint and provides some protection. It is also vital Articular cartilage. The ends of your thighbone and shinbone are covered with articular cartilage. This slippery substance to movement. helps your knee bones glide smoothly across each other as you bend or straighten your leg. Because you use it so Two wedge-shaped pieces of meniscal cartilage act as much, it is vulnerable to Meniscus. “shock absorbers” between your thighbone and shinbone. Different injury. Because it is made from articular cartilage, the meniscus is tough and rubbery to help up of so many parts, cushion and stabilize the joint. When people talk about torn cartilage many different things in the knee, they are usually referring to torn meniscus. can go wrong. Knee pain or injury Femur is one of the most (thighbone) common reasons people Patella (kneecap) see their doctors. Most knee problems can be prevented or treated with simple measures, such as exercise or Articular cartilage training programs. Other problems require surgery Meniscus to correct. Tibia (shinbone) 1 OrthoInfo Basics — About Your Knee What are ligaments and tendons? Ligaments and tendons connect your thighbone Collateral ligaments. These are found on to the bones in your lower leg. -
Arthroscopic Partial Meniscectomy 1
Chris Lena MD, James Alvarez PAC Arthroscopic and Reconstructive Surgery of the Shoulder and Knee Sports Medicine MEA’s Karen Smith, Jackie Zuidema, Annmarie Fiore Tel: (860) 549-8249 - FAX: (860) 244-8813 www.oahct.com Arthroscopic Partial Meniscectomy 1. ACTIVITIES: No harm is done in putting full weight on your knee immediately. You are encouraged to try to walk as smoothly as possible. Do not do any strenuous activity such as running and jumping until I clear you for this. You may experience some mild discomfort as you walk. You may use crutches, but generally they are not necessary. You may start bending your knee as tolerated, the sooner the better. 2. BANDAGES: Your bandage may be removed 2 days following surgery. The knee should then be re-wrapped with only the elastic bandage for about 3-4 days or until swelling is gone. DO NOT wrap the elastic bandage too tightly, or it will act like a tourniquet and cause ankle swelling. 3. MEDICATIONS: : A prescription will be provided to help relieve pain. Please use this medication as directed. This medication is strong, and should not be taken with alcohol or other pain medications, and may cause drowsiness. Exercise good judgment in its use. You may also try over the counter pain medications such as Aleve (naprosyn) or Advil (Ibuprofen). Take as directed unless there are contraindications. Take 1 Aspirin (325 mg) daily in addition to the pain medication. 4. SHOWER: You may shower after 48 hours. Do not take a bath or submerge the knee under water for 7 days. -
Meniscus FAQ Robert T. Bents, MD
Meniscus FAQ Robert T. Bents, MD Q. What is a “meniscus”? A. The meniscus is a “C” shaped shock absorber in your knee joint. The meniscus is made of cartilage similar to your earlobe. The meniscus has several different functions‐shock absorption, joint stabilization, and joint instability. A healthy meniscus is important to protect against arthritis. Q. What does it mean to “tear” a meniscus? A. You can tear a meniscus in many different ways. As we get older the water content of the meniscus decreases and becomes more brittle. With twisting, squatting, or sporting activities the meniscus can be pinched between the femur and tibia causing it to fray, tear, or split. The tear may occur with injury or simply fray with aging. The most severe tears involve the attachment to the bone called the root. Q. What are some of the symptoms of a torn meniscus? A. Patients may have pain associated with twisting activities. The pain is usually localized along the inside (medial) or outside (lateral) part of the knee. Swelling of the joint is another common complaint. Sometimes patients will feel like something is catching or pinching in the joint. Occasionally the knee will “lock” in a certain position. Most of these symptoms are reproducible by the doctor’s examination. Q. Will an X‐ray detect a meniscal tear? A. No. The purpose of the X‐ray is to make certain that you do not have any underlying arthritis in your knee. Also a loose bone chips or “loose body” may mimic a meniscal tear. The X‐ray gives your doctor information about the “bony” anatomy of a joint. -
Understanding the Stiff-To-Compliant Transition of the Meniscal
Research Article Cite This: ACS Appl. Mater. Interfaces 2019, 11, 26559−26570 www.acsami.org Understanding the Stiff-to-Compliant Transition of the Meniscal Attachments by Spatial Correlation of Composition, Structure, and Mechanics Alexander J. Boys,† Jennie A. M. R. Kunitake,† Corinne R. Henak,‡ Itai Cohen,§ Lara A. Estroff,†,∥ and Lawrence J. Bonassar*,‡,⊥ † ‡ § ∥ Department of Materials Science & Engineering, Meinig School of Biomedical Engineering, Department of Physics, Kavli ⊥ Institute at Cornell for Nanoscale Science, and Sibley School of Mechanical Engineering, Cornell University, Ithaca, New York 14853, United States *S Supporting Information ABSTRACT: Recently, the scientific community has shown considerable interest in engineering tissues with organized compositional and structural gradients to mimic hard-to-soft tissue interfaces. This effort is hindered by an incomplete understanding of the construction of native tissue interfaces. In this work, we combined Raman microscopy and confocal elastography to map compositional, structural, and mechanical features across the stiff-to-compliant interface of the attach- ments of the meniscus in the knee. This study provides new insight into the methods by which biology mediates multiple orders of magnitude changes in stiffness over tens of microns. We identified how the nano- to mesoscale architecture mediates complex microscale transitional regions across the interface: two regions defined by chemical composition, five distinguished by structural features, and three mechanically distinct regions. We identified three major components that lead to a robust interface between a soft tissue and bone: mobile collagen fiber units, a continuous interfacial region, and a local stiffness gradient. This tissue architecture allows for large displacements of collagen fibers in the attachments, enabling meniscal movement without localizing strains to the soft tissue-to-bone interface. -
Postoperative Instructions for Knee Arthroscopy, Torn Meniscus Dr
Postoperative Instructions For Knee Arthroscopy, Torn Meniscus Dr. Jeffrey J. Mair, DO PAIN: You will be sent home from the surgery center with prescriptions for pain medication. Take the pain medication as prescribed. After the first few days, as the pain lessens, you may decrease the frequency with which you take the medication and taper off as you feel comfortable, but keep in mind that many people have an increase in pain around day 3 or 4 after surgery. Remember, the medications are not necessarily meant to completely eliminate your pain, only to make it more bearable. It is also helpful to use ice, as well as to elevate your leg to decrease pain and swelling. Elevation should be achieved by placing pillows under the heel or calf—not under the knee—in order to keep your leg straight. If these measures are not adequately controlling your pain, please call our office. MEDICATIONS: Most pain medications need a handwritten prescription for refills and cannot be obtained after hours or on the weekends. Please plan accordingly. Narcotic pain medications can cause constipation; you may wish to use an over-the- counter stool softener to help prevent this. DRESSINGS: You will have a soft dressing applied over your incisions. It is meant to absorb any leaking blood or fluid from the joint, and to protect from infection. Leakage immediately after surgery is normal and actually helps to drain some of the fluid that accumulates in the joint during surgery. The dressings may become moist or blood-stained; this is normal and usually not a cause for alarm. -
Medial Meniscus Anatomy
Quantitative and Qualitative Assessment of the Posterior Medial Meniscus Anatomy Defining Meniscal Ramp Lesions Nicholas N. DePhillipo,*y MS, ATC, OTC, Gilbert Moatshe,yz§ MD, PhD, Jorge Chahla,z MD, PhD, Zach S. Aman,z BA, Hunter W. Storaci,z MSc, Elizabeth R. Morris,z BA, Colin M. Robbins,z BA, Lars Engebretsen,§ MD, PhD, and Robert F. LaPrade,*k MD, PhD Investigation performed at Steadman Philippon Research Institute, Vail, Colorado, USA Background: Meniscal ramp lesions have been defined as a tear of the peripheral attachment of the posterior horn of the medial meniscus (PHMM) at the meniscocapsular junction or an injury to the meniscotibial attachment. Precise anatomic descriptions of these structures are limited in the current literature. Purpose: To quantitatively and qualitatively describe the PHMM and posteromedial capsule anatomy pertaining to the location of a meniscal ramp lesion with reference to surgically relevant landmarks. Study Design: Descriptive laboratory study. Methods: Fourteen male nonpaired fresh-frozen cadavers were used. The locations of the posteromedial meniscocapsular and meniscotibial attachments were identified. Measurements to surgically relevant landmarks were performed with a coordinate measuring system. To further analyze the posteromedial meniscocapsular and meniscotibial attachments, hematoxylin and eosin and alcian blue staining were conducted on a separate sample of 10 nonpaired specimens. Results: The posterior meniscocapsular attachment had a mean 6 SD length of 20.2 6 6.0 mm and attached posteroinferiorly to the PHMM at a mean depth of 36.4% of the total posterior meniscal height. The posterior meniscotibial ligament attached on the PHMM 16.5 mm posterior and 7.7 mm medial to the center of the posterior medial meniscal root attachment. -
Ministry of Health of Ukraine Ukrainian Medical Dental Academy
Ministry of Health of Ukraine Ukrainian Medical Dental Academy Methodical instructions for independent work for students during training to practical (seminar) classes and in class Academic discipline Surgical dentistry Module № 5 Lesson topic № 1 Anatomy of the temporomandibular joint (TMJ). Modern methods of diagnosing TMJ diseases. Arthroscopy, its possibilities in the diagnosis and treatment of TMJ diseases. Dislocations of the mandible: etiology, clinic, diagnosis, treatment. Curation of the patient in the clinic of maxillofacial surgery. Writing an academic medical history. Course V Faculty Stomatological Poltava 2020 1. Relevance of the topic. Knowledge of the anatomical structure of the temporomandibular joint (TMJ) and the characteristics of modern diagnostic methods for assessing their pathologies. The etiology, clinical diagnosis and treatment of mandibular dislocations allows you to choose a timely and effective way to treat this pathology, avoid mistakes and complications, allows the dentist to diagnose TMJ and prescribe optimal treatment. Academic history in which the student is able to use knowledge , obtained in the study of basic and applied sciences, obtained demonstrate practical skills. 2. Specific target: 2 .1.Analyze to know statistics, diseases TMJ.; 2.2. Explain the methods of diagnosing diseases TMJ; 2.3. To offer to examine patients with diseases of TMJ; 2.4. Classify diseases TMJ; 2.5. Interpret theoretical and clinical studies of diseases TMJ; 2.6. Draw diagrams, graphs 2.7. Analyze the treatment plan for patients with diseases TMJ; 2.8. Make a plan for the treatment of patients with diseases TMJ; 3. Basic knowledge, skills, abilities necessary for studying the topic (interdisciplinary integration). Names of previous Acquired skills disciplines Anatomy To study the anatomical and topographic structure of the temporomandibular joint. -
ANKLE LIGAMENT STRAIN DURING SUPINATION SPRAIN INJURY – a Alt, W., Lohrer, H., & Gollhofer, A
Vilas-Boas, Machado, Kim, Veloso (eds.) Portuguese Journal of Sport Sciences Biomechanics in Sports 29 11 (Suppl. 2), 2011 REFERENCES: ANKLE LIGAMENT STRAIN DURING SUPINATION SPRAIN INJURY – A Alt, W., Lohrer, H., & Gollhofer, A. (1999). FunctionalProperties of Adhesive Ankle Taping: COMPUTATIONAL BIOMECHANICS STUDY Neuromuscular and Mechanical Effects Before and After Exercise. Foot & Ankle International , 20(4), 238-45. Daniel Tik-Pui Fong1,2, Feng Wei3, Youlian Hong4,5, Tron Krosshaug6, Benesch, S., Putz, W., Rosenbaum, D., & Becker, H.-P. (2000). Reliability of Peroneal Reaction Time Roger C. Haut3 and Kai-Ming Chan1,2 Measurements. Clin Biomech , 15. Cordova, M. L., Bernard, L. W., Au, K. K., Demchak, T. J., Stone, M. B., & Sefton, J. M. (2010). Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Cryotherapy and ankle bracing effects on peroneus longus response during sudden inversion. J 1 Electromyogr Kinesiol , 20, 248-53. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China The Hong Kong Jockey Club Sports Medicine and Health Sciences Centre, Delahunt, E. (2007). Peroneal reflex contribution to the development of functional instability of the 2 ankle joint. Phys Ther Sport , 8, 98-104. Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China 3 Docherty, C. L., & Arnold, B. L. (2008). Force sence deficits in functionally unstable ankles. J Orthop Orthopaedic Biomechanics Laboratories, Michigan State University, USA Res , 26(11), 1489-93. Department of Sports Science and Physical Education, Faculty of Education, 4 Eechaute, C., Vaes, P., Duquet, W., & Gheluwe, B. v. (2009). Reliability ans discriminative validity of The Chinese University of Hong Kong, Hong Kong, China sudden ankle inversion measurements in patients with chronic ankle instability. -
Acute Anterior Cruciate Ligament Injury with Medial and Lateral Bucket-Handle Meniscus Tears
THIEME Case Report 21 Acute Anterior Cruciate Ligament Injury with Medial and Lateral Bucket-Handle Meniscus Tears Joseph J. Fazalare, MD1,2,3 Jason Payne, MD4 Stephanie L. Stradley, PA3 Thomas M. Best, MD, PhD1,5 Joseph Yu, MD4 David C. Flanigan, MD1,2,3 1 OSU Sports Medicine, The Ohio State University, Columbus, Ohio Address for correspondence David C. Flanigan, MD, OSU Sports 2 The Sports Health and Performance Institute, The Ohio State Medicine Center, 2050 Kenny Road, Suite 3100, Columbus, OH 43221- University, Columbus, Ohio 3502 (e-mail: david.fl[email protected]). 3 Department of Orthopaedics, The Ohio State University Medical Center, Columbus, Ohio 4 Department of Radiology, The Ohio State University Medical Center, Columbus, Ohio 5 Department of Family Medicine, The Ohio State University Medical Center, Columbus, Ohio J Knee Surg Rep 2015;1:21–24. Abstract We report the case of a healthy 31-year-old female professional billiard player presented with a 5-day history of severe left knee pain after a fall. A magnetic resonance imaging of the left knee showed that she had suffered an anterior cruciate ligament (ACL) rupture along with buckle-handle tears of both the medial and lateral meniscus. Both of these menisci had flipped anterior and centrally to the femoral condyles and were lodged in the notch. The patient had also suffered a mild injury to the medial collateral ligament. Keywords Repair of both menisci was performed using an inside-out technique. Following this, an ► meniscus ACL reconstruction was done using a quadrupled hamstring autograft. Endobutton ► ACL rupture fixation (Smith & Nephew, Andover, MA) was used on the femur with a screw and sheath ► bucket-handle used for tibial fixation. -
The Anatomy of the Medial Part of the Knee
LaPrade.fm Page 2000 Thursday, August 16, 2007 12:24 PM COPYRIGHT © 2007 BY THE JOURNAL OF BONE AND JOINT SURGERY, INCORPORATED The Anatomy of the Medial Part of the Knee By Robert F. LaPrade, MD, PhD, Anders Hauge Engebretsen, Medical Student, Thuan V. Ly, MD, Steinar Johansen, MD, Fred A. Wentorf, MS, and Lars Engebretsen, MD, PhD Investigation performed at the University of Minnesota, Minneapolis, Minnesota Background: While the anatomy of the medial part of the knee has been described qualitatively, quantitative de- scriptions of the attachment sites of the main medial knee structures have not been reported. The purpose of the present study was to verify the qualitative anatomy of medial knee structures and to perform a quantitative evaluation of their anatomic attachment sites as well as their relationships to pertinent osseous landmarks. Methods: Dissections were performed and measurements were made for eight nonpaired fresh-frozen cadaveric knees with use of an electromagnetic three-dimensional tracking sensor system. Results: In addition to the medial epicondyle and the adductor tubercle, a third osseous prominence, the gastrocne- mius tubercle, which corresponded to the attachment site of the medial gastrocnemius tendon, was identified. The average length of the superficial medial (tibial) collateral ligament was 94.8 mm. The superficial medial collateral lig- ament femoral attachment was 3.2 mm proximal and 4.8 mm posterior to the medial epicondyle. The superficial me- dial collateral ligament had two separate attachments on the tibia. The distal attachment of the superficial medial collateral ligament on the tibia was 61.2 mm distal to the knee joint.