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Acute Cartilage Injuries Of the Knee

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History

■ Work or recreational injury

■ Mechanism

➣ Landing impact injury with isolated chondral defect

➣ Noncontact injury with sudden deceleration or cutting, associated meniscal or ligamentous injury

➣ Contact injury with varus or valgus force, associated meniscal or ligamentous injury
■ Painful

Symptoms of knee cartilage problems
■ May have mechanical symptoms (e.g., locking, catching) from chondral flap

Acute Cartilage Injuries Of the Knee
Acute Cartilage Injuries Of the Knee

Physical exam

■ Moderate effusion
■ May have hemarthrosis on aspiration if osteochondral fracture
■ Tender over affected condyle, plateau, or patellofemoral joint ± joint line tenderness

Studies

■ Radiographs
➣ AP, lateral sunrise (three or four views)
➣ Normal
■ MRI
➣ Will show signal changes at articular surface and possibly subchondral bone bruise
➣ Necessary to detect associated meniscal or ligament pathology

Differential diagnosis

■ Meniscal tear
■ Osteochondritis dissecans
■ Atraumatic osteonecrosis/avascular necrosis

Acute Cartilage Injuries Of the Knee
Acute Cartilage Injuries Of the Knee

Sprain, Types of injury and treatment of Ligament Sprain

Treatment

■ Evaluate alignment
➣ If malalignment, consider osteotomy
■ Arthroscopy to determine lesion:
➣ Size
➣ Containment
➣ Depth
■ Depth of lesion (Outer bridge classification)
➣ Grade I – Softening of cartilage
➣ Grade II – Fibrillations
➣ Grade III – Fissuring
➣ Grade IV – Full thickness to bone


■ Grade I – No treatment


■ Grade II and III
➣ Arthroscopic debridement results in replacement with fibrocartilage – poor wear characteristics
■ Grade IV
➣ Mesenchymal stem cell stimulation
 Microfracture or drilling into subchondral bone results in replacement with fibrocartilage
➣ Substitution replacement
 Replacement of defect with autograft or allograft plug(s); also known as mosaicplasty or OATS

physiotherapy management in Fractures

Procedure

➣ Biologic replacement
 Requires two surgeries: autologous chondrocytes are harvested and cultured, then later placed into the defect and covered with periostium
 Results in hyaline cartilage – better wear characteristics


Disposition

N/A

Prognosis

■ Acute cartilage injury results in release of degradative enzymes (stromelysin), which contributes to further cartilage breakdown.
■ Treatment with thermal probe may cause death down to subchondral bone.
■ Partial-thickness lesions do not heal without treatment
➣ May cause meniscal injury and cartilage injury to opposite side of joint
■ Full-thickness defects 0–1 cm2 that are well contained do well with drilling or microfracture
■ Full-thickness defects 1–2 cm2 that are well contained do well with drilling, microfracture, or OATS procedure
➣ 50–70% good results at 5 years
■ Full-thickness defects >2 cm2 that are well contained do well with autologous chondrocyte implantation
➣ Depending on location 70–90% good results at 8–10 years
➣ Can be treated with OATS procedure with minimal long-term data available
■ Large poorly contained lesions have lower probability of regeneration success
➣ Result in lower levels of function that ultimately may require TKA
➣ Can be treated with large shell allografts (experimental)

caveats and pearls

■ Early arthroscopy for classification and treatment will prevent additional chondral and meniscal injury.
■ Meniscal pathology, ligamentous instability, and significant malalignment, if untreated, will all result in chondral injury.
■ Advances in imaging technology are not yet sufficient to detect and classify these injuries

Joint Dislocation/subluxation, Complications in joint Dislocation/subluxation

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Dr .Lalit Choudhary
Hii everyone, I'm Dr Lalit Choudhary PT. Born and brought up in delhi. Practicing as a professional PHYSIOTHERAPIST. As a therapist I love to interact with others and and get myself updated regarding all the social issues which are leading my countrymen to distress themselves. Yes, I agree that Iam a workaholic but my work gives me immense pleasure but there are sometimes when I feel stressed up so to relax myself I travel to new places, meet new people and try to adopt their culture. Most of the time I like to travel hills as it helps me to relax and enjoy our nature beauty. For being a good therapist and to deal with all the difficulties I always prefer to be good listener and have good patience that is what my strength is. I also work as a social worker and the Founder of thesocialphysiofitnessclub and PHYSIO FIT INDIA. In last I just want to say that " I believe that physical therapy is not just a therapy but actually a remedy which not only make you physically fit but also adds happiness, joy and more days to your life." So don't just sit and thought now it's time to stand and work on yourself.

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