Meniscal tears, Osteoarthritis & Osgood- Schlatters Disease By: Juliann Plimpton

Meniscal Tears MOI/ Etiology Valgus force- adducts the knee- tears medial meniscus Varus Force- abducts the knee- tears lateral meniscus Weight- baring combined with rotary force while knee is flexed or extended Londitudinal tear- knee is forcefully extended from a flexed position while the femur is internally rotated Most tears happen as a combination of all these MOI: Lateral rotation of the femur Knee partially flexed Foot firmly planted Three zones: Red-Red zone- outer 1/3 rich blood supply. Tears can heal over time when in this area Red-White zone- middle 1/3 blood scares White-White zone- inner 1/3 no blood circulation Surgery is required when meniscal tears are in these zones.

Signs & Symptoms Joint line pain and loss of motion Intermittent locking. Giving way of the knee Pain when athlete squats Complaining of popping knee collapse Swelling Management MRI Arthroscopic surgery Special Test McMurray’s Meniscal test (p. 621) Apley Compression test

Arthroscopic Surgery The evaluation of a tear by inserting a blunt probe into the knee Once evaluated the effected area is removed (meniscectomy) Removed my cutting and sucking out tear

Techniques for Meniscal Tear Repair Inside Out- curved guide tubes are used to direct a pair of long needles into the meniscus and out through a small incision in the back of the knee Suture threads connected to the needles are then tied off out side of the knee This works well but take note that a 11/2 to 2’’ incision needs to be made.

Cont. Inside-In (T-Fix): includes meniscal staples and bioreabsorbable T- arrows. sutures have an anchor, Multiple sutures pairs are placed through long hollow needles knot pusher instrument that securely snugs the meniscus down and provides an excellent repair.

Peripheral meniscal tear in the zone of blood supply Peripheral meniscal tear in the zone of blood supply Knots are pushed down after placing suture anchors Close up of knot pusher Knots are pushed down after placing suture anchors Close up of knot pusher Arthroscopic view of a meniscus repaired with the T-Fix® system Arthroscopic view of a meniscus repaired with the T-Fix® system

Management No weight baring for at least three weeks, with light-loading muscle exercises After this physical therapy, maximal weight training not allowed until 2- 3 months Return to running and agility sports 3-4 months With just the removal of a meniscal tear one recovers a lot quicker. Back in play by 4-6 weeks.

Osgood-Schlatter & Larsen- Johansson Diseases MOI of Osgood-Schlatters Disease- Is an apophysitis characterized by pain at the attachment of the patellar tendon and tibial tubercle Repeated avulsion of the patellar tendon at the apophysis Common in adolescents MOI of Larsen-Johansson Disease- Occurs at the inferior pole of the patella Due to excessive strain on the patella tendon Signs and Symptoms Swelling Hemorrhages Gradual degeneration of the apophysis Athlete complains of severe pain when kneeling, jumping, and running PT over anterior proximal tibial tubercle

CONT…. Management- Decrease stressful activity (6 months to a year) Cylindrical cast Ice Isometric strengthening

Osteoarthritis MOI- chronic degeneration of the articular or hyaline cartilage Wear and tear- to the pt. of exposing the bone Repeated trauma to the joint, tendons, ligaments (running, cycling) Signs and Symptoms Pain brought by friction when in use Stiffness Tenderness Creaking Grating Crepitus

Treatment Hyalgan injections- purified Sodium hyaluronate 5 injection over 5 weeks- works for 12 months Glucosamine Sulfate- over the counter drug Derivative of glycosaminoglycans found in articular cartilage

Looking beyond the Drugs… Worse case… Surgery. Three methods: Arthroscopy Osteotomy Arthroplasty

Pictures

References Avery, Lincoln. (2006). “The Meniscus: Shock Absorber for the Knee”. Grainger, Rebecca; Cicuttini, Flavia. (2004). “Medical management of osteoarthritis of the knee and hip joint”. The Medical Journal of Australia Prentice, E. William: “Musculoskeletal Conditions. Arnheim’s Principles of Athletic Training 12 th ed.: 585, “Surgical Treatment of Osteoarthritis of the knee”. (2003)