An articular cartilage injury, or chondral injury, may occur as a result of a pivot or twist on a bent knee, similar to the motion that can cause a meniscus tear. Knee meniscus and articular cartilage / chondral tears are among the most common injuries I see in my Orange county Orthopedic surgery practice. Chondral osteochondral Injury, knee. Subchondral low signal crescent surrounded by edema; associated with meniscal tear/meniscectomy. The symptoms of a chondral injury resulting from articular cartilage damage will not present themselves as prominently as a torn acl or meniscus tear. Chester Knee clinic Knee problems Articular. Flap tear: the carilage is avulsed from the subchondral bone; - crater: full thickness, in which of the knee ; - w/ this evidence, it may not be necessary to drill the chondral defect, since the. Cabrera, md; Kurt Spindler,.
he specializes in addressing chondral defects and other problems with the knee. Wiregrass/Wesley chapel, tampa, zephyrhills, and, brandon,.
Arthroscopic examinations, in which a doctor looks into the knee using a small camera, remain the best way to identify these defects. When diagnosed, chondral defects are often treated using nonsurgical methods, which provide many patients with relief. These treatments include special types of exercise, shock-absorbing shoe inserts, changes in physical activity, hyaluronic acid injections and prescription pain medications. The most common surgical techniques for treating chondral defects are: Shaving or debridement, this procedure has been used for decades and involves smoothing shredded or frayed cartilage in the knee. Microfracture or abrasion, a surgeon scrapes the damaged area within the knee, causing blood to accumulate there. Blood and bone marrow cells will come into contact with the defect, encouraging scar tissue to grow there and replace the damaged cartilage. Cartilage is taken from another part bandgevoel of the body and planted where theres a defect. Autologous chondrocyte implantation, cartilage cells are removed from a patients own injured knee and developed in a tissue culture outside the body for several weeks. It is then implanted in the defect to promote the growth of new cartilage there. Osteochondral allograft resurfacing, this procedure is used if theres damage to bone, as well as cartilage. A transplant will be used from a recently deceased donor.
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Chondral defects are damage to the cartilage that covers the ends of the bones in the knee joint. This damage is common and can be caused by sudden injury or the routine wear and tear that comes with aging. Some people may not experience any symptoms related to these defects for many years. The first symptom may be intermittent swelling, which occurs due to loose pieces of cartilage floating around in the knee. Other symptoms include pain in the knee during walking and other activities, the knee buckling when theres weight placed urine on it, and noises coming from the knee when its being moved. Diagnosing chondral defects can be difficult. Swelling may be present during a physical exam but not in every case. X-rays can provide some indication of cartilage loss, and mri scans may be used to detect later stages of chondral defects.
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Mechanism of injury Trauma is the most common mechanism; however, the repetitive stress associated with osteochondritis dissecans and with chondromalacia patellae is also the cause of symptomatic lesions. Rotational force in direct trauma is the most common cause of injury to the articular cartilage. In most cases injury is in weight-bearing regions of articular cartilage and is usually in the medial compartment (four times more common that lateral injuries). Osteochondral lesions are most common in adolescents. Articular cartilage has little capacity to repair itself or regenerate. Therefore, cartilage defects repair by forming scar tissue from the subchondral bone. This scar tissue is deficient in type ii collagen and has lower load-bearing capacity. This later surface deterioration may progress to give chronic pain and poor function and may, in some cases, lead to early-onset osteoarthritis.
A double-blind sham-controlled trial involving patients aged 35-65 years with symptoms of a degenerative medial meniscus tear (but without knee osteoarthritis) demonstrated no better outcomes after arthroscopic partial meniscectomy than after a sham surgical procedure. The authors suggest that a degenerative meniscal tear may be an early sign of osteoarthritis of the knee rather than a separate clinical entity and noted that osteoarthritis may progress more quickly in people undergoing arthroscopy. A systematic review and meta-analysis concluded that there is moderate evidence to spieren suggest that there is no additional benefit of arthroscopic meniscal debridement for degenerative meniscal tears compared to exercise, and no benefit in comparison with sham surgery or injection therapy 12,. A further systematic review and meta-analysis showed that the small inconsequential benefits were absent by one and two years. Despite this emerging evidence, rates of arthroscopic meniscectomy are stable or continue to increase.
Knee arthroscopy is associated with deep vein thrombosis, pulmonary embolism, infection and death. Prognosis Following partial or total meniscectomy, functional activities may be commenced on day 7-8 and running commenced from days 10-14, depending on the the underlying knee condition and health of the patient. Rehabilitation protocols following meniscal repair vary. The articular surfaces of the femur and tibia are covered with hyaline cartilage. Damage to this hyaline cartilage is known as a chondral injury or, if the underlying bone is also fractured, an osteochondral injury. Articular chondral and osteochondral injuries of the knee are much less common than meniscal injuries. They generally occur in people aged under 35 years, usually in combination with other ligamentous or meniscal injuries to the knee.
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Refer to physiotherapy if there are mild-to-moderate symptoms. A physiotherapy regime will involve daily progressive exercises at home plus attendance at a physiotherapist. Refer routinely to an orthopaedic surgeon if a meniscal injury is suspected, and symptoms interfere with the ability to work or persist, despite 6-8 weeks of rehabilitation by a physiotherapist. Surgical options include repair (there are various techniques) or partial meniscectomy. Repair operations have better long-term outcomes, better activity levels and lower failure rates than meniscectomy (partial or total).
Total meniscectomy - this is no longer a common procedure, as long-term results are unfavourable. Meniscal transplantation is an option for selected symptomatic patients with previous complete or near-complete meniscectomy. A novel treatment is the partial replacement of the meniscus using a biodegradable scaffold but it is uncertain whether this offers any long-term advantages over other options. Several recent studies have questioned the efficacy of surgery, particularly when the meniscal tear is degenerate: Patients with a meniscal tear and evidence of mild-to-moderate osteoarthritis were randomly assigned to either arthroscopic partial meniscectomy with postoperative physical therapy or a standardised physical-therapy regimen alone. There was no significant difference in functional status and pain at six months. However, 30 of patients assigned to the physical-therapy group crossed over to surgery in the first six months.
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Knee ligament Injuries article. Management, advise pricer: P rotect from further injury. R est (crutches for kapağı the initial 24-48 hours). I ce (application of ice on the injured region for 20 minutes of each waking hour spinal during the initial 48 hours after injury). C ompression (with a knee brace or splint, if necessary). E levation (above the level of the heart). R ehabilitation An urgent referral to an orthopaedic surgeon is advised if the person has locking of the knee and a meniscal injury is suspected.
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Mechanism of injury, the mechanism of injury is typically twisting or pivoting. Acute meniscal tears occur in young, active people. No or minimal force can be sufficient to cause a degenerative meniscal tear in middle-aged and bandscheibenvorfall older people. Presentation, there may be acute pain, especially following obvious trauma or if a fragment of meniscus becomes trapped. Often patients cannot remember the exact nature of an injury but complain of popping, catching, locking (usually in flexion) or buckling, along with joint line pain. There may be slow onset of swelling (over 2-36 hours) due to an effusion. Effusions can be recurrent. If swelling is rapid in onset (0-2 hours) this may be due to a haemarthrosis or a large tense effusion when the tear is associated with a significant ligament injury. Associated diseases, meniscal tears are often associated with anterior cruciate ligament (ACL) injury (especially in younger patients) which should be identified.
Delayed, gadolinium-enhanced mri of cartilage (dgemric) is useful for assessing cartilage health. The two menisci in each knee are crescent-shaped coloana pads of cartilage tissue. The main functions of the menisci are tibiofemoral load transmission, shock absorption, lubrication of the knee joint and to improve the stability of the knee joint. Epidemiology 5, the mean annual incidence of meniscal tears is about 60-70 per 100,000. Male-to-female ratio is from.5:1 to 4:1. Meniscal tears in younger people are usually due to acute trauma, most commonly affecting men aged 21-30 years and girls and young women aged 11-20 years. Degenerative changes are the more likely the cause at an older age, most commonly in men aged 40-60 years.
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For guidance on examination of the knee, see also separate. Magnetic resonance imaging (MRI) is the technique of choice for evaluating internal derangement of the knee since even serious internal derangements of the knee may not be demonstrated on X-rays. The Ottawa Knee rules can be used to decide whether an X-ray is indicated. An X-ray should be performed if any of the following are present: Age over 55 years (because of the risk of osteoporosis). Tenderness over the fibular head. Discomfort confined to the patella upon palpation. Inability to flex the knee. Inability to bear weight, immediately and in the emergency lumbar department, for at least four steps. Incidental meniscal findings on mri scan of the knee are common in the general population and increase with increasing age: in one study of almost 1,000 people, 61 had meniscal tears on mri but had no knee symptoms in the previous month.