DOCSLIB.ORG

Hip and Knee Pain Module

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Hip and Knee Pain Module Hip and Knee Pain 2017 Summary Page © Jason E. Liebowitz, MD, John Flynn MD/Ambulatory Curriculum Section 1: Hip Pain Location of symptoms by history DDX (All include articular hip disease) Deep groin Renal colic, psoas abscess, pelvic inflammatory disease, osteitis pubis Anterior/inguinal Inguinal hernia, iliopsoas bursitis, renal colic, vascular insufficiency Trochanteric bursitis, tendonitis of hip abductors, lumbosacral spine disease, Lateral meralgia paresthetica (anterolateral thigh) Buttock Lumbosacral spine disease, ischial bursitis, vascular insufficiency • Assess bony landmarks, bursae, inguinal contents, buttocks, and hip range of motion. o Internal rotation and abduction typically the first affected with articular hip disease • Patrick’s test: flex hip and knee on symptomatic side, place lateral malleolus of ankle on contralateral knee. Patient should be able to lower examined leg to level of unexamined leg; failure to do so suggests articular hip disease. Pressure on flexed knee and contralateral anterior superior iliac spine can elicit arthritis of sacroiliac joint. • Trendelenburg test: patient stands on leg of affected side. Contralateral pelvis should be at or above horizontal. Drooping of pelvis below horizontal suggests hip abductor (gluteus medius) weakness Diseases of the hip • Osteoarthritis: The most common cause of hip pain; prevalence increases with increasing age o Patients describe pain deep in hip worse walking up stairs, flexing hip to tie shoes or trim toenails o Symptoms exacerbated by walking, relieved by rest, worst at the end of the day o Treatment includes weight loss, NSAIDs. Joint replacement if unresponsive • Inflammatory causes include gout, pseudogout, and septic arthritis, all of which are uncommon. Pain radiating to buttock/groin is typical. • Trochanteric bursitis: Seen in women more than men, esp. those in fourth-sixth decades o Risk factors include local trauma, leg length inequalities, jogging o Pain described as deep ache laterally, worse with walking, squatting, climbing stairs; patients avoid sleeping on affected side o Exam demonstrated tenderness over greater trochanter; treatment is rest/NSAIDS and steroid injection • Ischiogluteal bursitis (Ischial bursitis): Seen in people who sit on hard surfaces for prolonged periods o Exam shows exquisite tenderness over ischial bursa o Treatment includes seat cushions, NSAIDs, steroid injection • Meralgia paresthetica: Dysesthesia of anterolateral thigh due to irritation of lateral femoral cutaneous nerve o Risk factors include obesity, pregnancy, ascites, restrictive clothing, surgical trauma o Lateral thigh burning, dysesthesias, or anesthesia described; no motor symptoms seen o Treatment directed at underlying cause Section 2: Knee Pain • Degenerative changes much more common as age increases • Overuse, injury, Reiter’s syndrome, Ankylosing spondylitis, disseminated gonococcal infection, Lyme disease more common in young • Rheumatoid arthritis, gout more common causes ages 30-50 • On physical exam, knee should be cooler than extremities and have a negative bulge sign • Lachman test: tests ACL. Supine patient, flex knee 20-30 degrees with heel on table. Pull calf forward relative to thigh. Normal test results in definitive stop when pulling. • Anterior drawer test: tests ACL. Similar to Lachman, but knee flexed 90 degrees. • Posterior drawer test: tests PCL. Reverse of anterior drawer test. • McMurray test: tests torn meniscus. Patient supine, elevate leg and flex knee. Examiner extends knee, rotating internally and then externally. Torn meniscus will give popping sensation or inability to straighten knee. Diseases of the knee • Osteoarthritis: prior injury, obesity, heavy work are major risk factors o Symptoms worse with use and better at end of day; acute flares may be seen, and small effusions common o Treatment is acetaminophen, followed by NSAIDs and physical therapy if ineffective. Glucosamine/chondroitin controversial • Inflammatory causes include gout, pseudogout (less common), septic arthritis (the knee is the most commonly infected joint), SLE (symmetric presentation), or Lyme. All may present with pain, erythema, effusion (which are less impressive in SLE and Lyme). • Ligament injury: typically associated with prior injury. Treatment usually surgical. o Menisci (esp. medial meniscus) injured with twisting forces, although in elderly trauma may be minor . Patients describe knee as locking up on them o Cruciate ligaments occur with anterior or posterior force on the knee, often with popping sound . Patients describe lack of confidence in joint or instability. • Tendonitis: typically occurs with overuse or repetitive injury. Treatment typically NSAIDs, rest. o Patellar tendonitis: aka jumper’s knee; seen in athletes who run/jump. Anterior knee pain worsened with walking, squatting, jumping. Exam shows tenderness over inferior pole of patella o Iliotibial band syndrome: aka runner’s knee; seen in bicyclists, runners. Lateral knee pain worse with running. Exam shows tenderness over lateral epicondyle. • Bursitis o Prepatellar bursitis: seen in carpet layers and those who spend time on knees. Painful anterior knee swelling noted on exam. Aspiration, protective pads, NSAIDs mainstay of treatment o Anserine bursitis: seen in swimmers/runners. Pain and tenderness over medial aspect of upper tibia, often difficult to distinguish from medial collateral ligament injury. NSAIDS and rest for treatment. .
Load more

Recommended publications
  • An Evidence Based Medicine Understanding of Meniscus Injuries and How to Treat Them
    An Evidence Based Medicine Understanding of Meniscus Injuries and How to Treat Them Patrick S. Buckley, MD University Orthopaedic Associates June 1, 2019 Disclosures • None www.UOANJ.com Anatomy of the Meniscus • Act as functional extensions of the tibial plateaus to increase depth of tibial articular surface • The meniscotibial attachment contributes to knee stability • Triangular in cross-section Gross Anatomy of the Meniscus • Ultrastructural Anatomy – Primarily Type I collagen (90%) – 70% water – Fiber orientation is circumferential (hoop stressing) Meniscal Vascularity • Relatively avascular • Vascular penetration – 10 - 30% medial – 10 - 25% lateral • Non-vascularized portions gain nutrients from mechanical loading and joint motion Medial Meniscus • Semilunar shape • Thin anterior horn • Broader posterior horn • More stable & less motion than the lateral = tears more often Lateral Meniscus • Almost circular in shape • Intimately associated with the ACL tibial insertion • Posterior horn attachments – Ligament of Humphrey – Ligament of Wrisberg • Lateral meniscus is a more dynamic structure with more motion Main Importance of Menisci • Load transmission • Joint stability Load Bearing / Shock Absorption • MM 50% and 70% LM of load transmitted through mensicus in extension • 85 % at 90° of flexion • Meniscectomy – 50 % decrease in contact area – 20 % less shock absorption www.UOANJ.com Meniscal effect on joint stability • Secondary restraints to anterior tibial translation in normal knees • In an ACL-deficient knee: the posterior horn of the medial meniscus is more important than the lateral meniscus Interaction of ACL and PHMM • Lack of MM in ACLD knees significantly ↑ anterior tibial translation at all knee flexion angles • Think about with high grade pivot! (Levy, JBJS,1982) (Allen, JOR,2000) C9ristiani, AJSM, 2017) Meniscus Function -Now known to be important structure for load distribution and secondary stabilizer to the knee.
    [Show full text]
  • 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.
    [Show full text]
  • Bilateral Calcified Ischiogluteal Bursitis and Shoulder Tendinopathy
    Bilateral Calcified Ischiogluteal Bursitis and Conflict of Interest: None Shoulder Tendinopathy: A Case Report declared Seyyed-Mohsen Hosseininejad1,2, Saman Shakeri1, Hossein Mohebbi1, Mehdi Aarabi2, Shiva Momen3 This article has been peer reviewed. 1Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 Golestan University of Medical Sciences, Gorgan, Iran Article Submitted on: 21st 3Mazandaran University of Medical Sciences, Sari, Iran January 2019 Article Accepted on: 1st ABSTRACT June 2020 The ischiogluteal bursitis which is a rare the buttock. Ischiogluteal bursitis Aspiration Funding Sources: None disorder is irregularly found between the showed calcareous deposits; local injection declared gluteus maximus and ischial tuberosity. A of corticosteroid helped the patient to get 41-year-old female with bilateral calcifying free of symptoms. Calcified ischiogluteal Correspondence to: Dr ischiogluteal bursitis and her right shoulder bursitis is a rare condition but simply Seyyed-Mohsen Hosseininejad tendinopathy were presented. She had no diagnosed on x-ray. Local steroid injection related past medical history nor trauma to could provide symptom relief. Address: Shahid Beheshti University of Medical Sciences, Tehran, Iran Keywords: Calcifying Ischiogluteal Bursitis; Aspiration; Treatment; Shoulder pain; Tendinopathy E-mail: Hosseininejad.s.mohsen INTRODUCTION painful swelling in her both buttocks. The patient @gmail.com Ischiogluteal bursitis is a rare condition in which had no related past medical history nor recent Cite this Article: bursa between the gluteus maximus muscle and major trauma. Ischial tuberosities had swelling Hosseininejad SM, ischial tuberosity, which physiologically and tenderness in. Right shoulder had positive Shakeri S, Mohebbi H, decreases the frictional force, develops impingement tests but full range of motion. Aarabi M, Momen S.
    [Show full text]
  • Endoscopic Hamstring Repair
    Lorem Ipsum Endoscopic Hamstring Repair Carlos A. Guanche, MD Southern California Orthopedic Institute 12 Lorem Ipsum 2 Endoscopic Hamstring Repair With the expansion of knowledge regarding hip pathologies as a result of the increased treatment of hip problems arthroscopically has come an expanded treatment of many injuries that were previously treated through open methods. The treatment of symptomatic ischial bursitis and hamstring injuries is one such area. In this paper, the author describes the surgical procedure and discusses the findings and preliminary outcomes in a group of the first 15 patients undergoing the procedure. The clinical rationale associated with the treatment algorithm is also discussed. Hamstring injuries have been effectively addressed in the past with a variety of open methods.(1,2) However, the endoscopic management of much pathology previously treated with more invasive, open approaches has evolved. The technique described in this chapter is another such evolution. Hamstring injuries are common and can affect all levels of The hamstrings originate from the ischial tuberosity and athletes. (3-7) There is a continuum of hamstring injuries insert distally below the knee on the proximal tibia, with the that can range from musculotendinous strains to avulsion exception of the short head of the biceps femoris. The tibial injuries. (3,4) Most hamstring strains do not require surgical branch of the sciatic nerve innervates the semitendinosus, intervention and resolve with a variety of modalities and semimembranosus, and the peroneal branch of the sciatic rest. (3-7) In some patients, chronic pain can occur at the nerve innervates the long head of the biceps femoris.(5) hamstring origin from either partial or complete tears as well as from chronic ischial bursitis.
    [Show full text]
  • Orthopaedics Instructions: to Best Navigate the List, First Download This PDF File to Your Computer
    Orthopaedics Instructions: To best navigate the list, first download this PDF file to your computer. Then navigate the document using the bookmarks feature in the left column. The bookmarks expand and collapse. Finally, ensure that you look at the top of each category and work down to review notes or specific instructions. Bookmarks: Bookmarks: notes or specific with expandable instructions and collapsible topics As you start using the codes, it is recommended that you also check in Index and Tabular lists to ensure there is not a code with more specificity or a different code that may be more appropriate for your patient. Copyright APTA 2016, ALL RIGHTS RESERVED. Last Updated: 09/14/16 Contact: [email protected] Orthopaedics Disorder by site: Ankle Achilles tendinopathy ** Achilles tendinopathy is not listed in ICD10 M76.6 Achilles tendinitis Achilles bursitis M76.61 Achilles tendinitis, right leg M76.62 Achilles tendinitis, left leg ** Tendinosis is not listed in ICD10 M76.89 Other specified enthesopathies of lower limb, excluding foot M76.891 Other specified enthesopathies of right lower limb, excluding foot M76.892 Other specified enthesopathies of left lower limb, excluding foot Posterior tibialis dysfunction **Posterior Tibial Tendon Dysfunction (PTTD) is not listed in ICD10 M76.82 Posterior tibial tendinitis M76.821 Posterior tibial tendinitis, right leg M76.822 Posterior tibial tendinitis, left leg M76.89 Other specified enthesopathies of lower limb, excluding foot M76.891 Other specified enthesopathies of right lower limb,
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • 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.
    [Show full text]
  • Evaluation of the Hip Adam Lewno, DO PCSM Fellow, University of Michigan Primary Care Sports Update 2017 DEPARTMENT of FAMILY MEDICINE
    DEPARTMENT OF FAMILY MEDICINE Evaluation of the Hip Adam Lewno, DO PCSM Fellow, University of Michigan Primary Care Sports Update 2017 DEPARTMENT OF FAMILY MEDICINE Disclosures • Financial: None • Images: I would like to acknowledge the work of the original owners and artists of the pictures used today DEPARTMENT OF FAMILY MEDICINE Objectives • Identify the main anatomic components of the hip • Perform basic Hip examination along with associated special tests • Use a group educational model to correlate Hip examination with hip anatomy DEPARTMENT OF FAMILY MEDICINE Why do we care about the Hip? • The hip distributes weight between the appendicular and axial skeleton but it is also the joint from which motion is initiated and executed for the lower extremity • Forces through the hip joint can reach 3-5 times the body weight during running and jumping • 10-24% of athletic injuries in children are hip related • 5-6% adult athletic injuries in adults are hip and pelvis DEPARTMENT OF FAMILY MEDICINE Why is the Hip difficult to diagnosis? The hip is difficult to diagnosis secondary to parallel presenting symptoms of back pain which can exist concomitantly or independently of hip pathology DEPARTMENT OF FAMILY MEDICINE Hip Anatomy • Bone • Ligament • Muscle • Nerve • Vessels DEPARTMENT OF FAMILY MEDICINE DEPARTMENT OF FAMILY MEDICINE Bones DEPARTMENT OF FAMILY MEDICINE Ligaments DEPARTMENT OF FAMILY MEDICINE Everything is Connected DEPARTMENT OF FAMILY MEDICINE Muscles DEPARTMENT OF FAMILY MEDICINE Important Movers DEPARTMENT OF FAMILY MEDICINE
    [Show full text]
  • Nonspinal Musculoskeletal Disorders That Mimic Spinal Conditions
    REVIEW DHRUV B. PATEDER, MD JOHN BREMS, MD ISADOR LIEBERMAN, MD, FRCS(C)* CME Attending Spine Surgeon, Steadman Cleveland Clinic Spine Institute, Cleveland Clinic Spine Institute, and Department CREDIT Hawkins Clinic Spine Surgery, Cleveland Clinic of Orthopaedic Surgery, Cleveland Clinic; Professor Frisco/Vail, CO of Surgery, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University GORDON R. BELL, MD ROBERT F. McLAIN, MD Associate Director, Center for Spine Cleveland Clinic Spine Institute, Health, The Neurological Institute, Cleveland Clinic Cleveland Clinic Masquerade: Nonspinal musculoskeletal disorders that mimic spinal conditions ■ ABSTRACT OT ALL PAIN in the neck or back actual- N ly originates from the spine. Sometimes Nonspinal musculoskeletal disorders frequently cause pain in the neck or back is caused by a prob- neck and back pain and thus can mimic conditions of the lem in the shoulder or hip or from peripheral spine. Common mimics are rotator cuff tears, bursitis in nerve compression in the arms or legs. the hip, peripheral nerve compression, and arthritis in the This article focuses on the diagnostic fea- shoulder and hip. A thorough history and physical tures of common—and uncommon—non- examination, imaging studies, and ancillary testing can spinal musculoskeletal problems that can mas- usually help determine the source of pain. querade as disorders of the spine. A myriad of nonmusculoskeletal disorders can also cause ■ KEY POINTS neck or back pain, but they are beyond the scope of this article. Medical disorders that Neck pain is commonly caused by shoulder problems can present as possible spinal problems have such as rotator cuff disease, glenohumeral arthritis, and been reviewed in the December 2007 issue of humeral head osteonecrosis.
    [Show full text]
  • Prolo Your Pain Away: Curing Chronic Pain with Prolotherapy
    PROLO YOUR PAIN AWAY®, 4TH EDITION CUR NG CHRONICWITH PAIN PROLOTHERAPY Ross A. Hauser, MD & Marion A. Boomer Hauser, MS, RD PROLO YOUR PAIN AWAY! Curing Chronic Pain with Prolotherapy 4TH EDITION Ross A. Hauser, MD & Marion A. Boomer Hauser, MS, RD Sorridi Business Consulting Library of Congress Cataloging-in-Publication Data Hauser, Ross A., author. Prolo your pain away! : curing chronic pain with prolotherapy / Ross A. Hauser & Marion Boomer Hauser. — Updated, fourth edition. pages cm Includes bibliographical references and index. ISBN 978-0-9903012-0-2 1. Intractable pain—Treatment. 2. Chronic pain— Treatment. 3. Sclerotherapy. 4. Musculoskeletal system —Diseases—Chemotherapy. 5. Regenerative medicine. I. Hauser, Marion A., author. II. Title. RB127.H388 2016 616’.0472 QBI16-900065 Text, illustrations, cover and page design copyright © 2017, Sorridi Business Consulting Published by Sorridi Business Consulting 9738 Commerce Center Ct., Fort Myers, FL 33908 Printed in the United States of America All rights reserved. International copyright secured. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form by any means— electronic, mechanical, photocopying, recording, or otherwise—without the prior written permission of the publisher. The only exception is in brief quotations in printed reviews. Scripture quotations are from: Holy Bible, New International Version®, NIV® Copyrights © 1973, 1978, 1984, International Bible Society. Used by permission of Zondervan Publishing House. All rights reserved.
    [Show full text]
  • Rehabilitation Guidelines for Meniscal Repair of Root and Complex Tears
    UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Meniscal Repair of Root and Complex Tears There are two types of cartilage in the knee; articular cartilage and meniscus cartilage. Articular cartilage is made up of collagen, proteoglycans and water which lines the end of the bones that meet to form a joint. The primary function of the articular cartilage is to provide a smooth gliding surface for joint motion. Rubbing articular cartilage on articular cartilage is approximately Lateral Medial 5 times more smooth, or with less meniscus meniscus friction, than rubbing ice on ice. Figure 1 Meniscus cartilage (shown here from The meniscus cartilage in the knee above the knee, without the femur) Femur Tibia Medial includes a medial (inside) meniscus Image property of Primal Pictures, Ltd., primalpictures.com. Use of this meniscus and a lateral (outside) meniscus. image without authorization from Primal Pictures, Ltd. is prohibited. Together they are referred to as Figure 3 Normal MRI (saggital view) of the knee, lateral (outside) view menisci. The menisci are wedge shaped, being thinner toward the center of the knee and thicker toward the outside of the knee joint (Figures 1–3). This shape is very important to its function. The primary function of the menisci is to improve load transmission. A without with relatively round femur sitting on a meniscus meniscus relatively flat tibia forms the knee joint. Without the menisci the area of contact force between these two bones would be relatively small, increasing the contact stress by 235- 335% (Figure 4). The menisci also provide some shock absorption, Tibia Medial Femur lubrication and joint stability.
    [Show full text]