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8 - Pathology of The Knee - D3

8 - Pathology of The Knee - D3 - Salsabeel Matalqah Menisci...

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Salsabeel Matalqah
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Menisci Tears *Common among young active adults. * Common in Football players: flexion of knee joint in addition to twisting . *Little force is needed in middle aged, because fibrosis restricts mobility of meniscus. *After age 50, tears are more commonly due to arthritis than trauma. *Medial Menisci: more prone to injury because of its restricted anatomy due to attachment to the joint capsule and to the tibial collateral ligament make it less mobile.
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Meniscus Tears Classification according to Mechanism ( traumatic Vs degenerative) Pattern of tear ( bucket handle Vs horizontal…. ).
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Menisci Tears Patterns of tears : * Bucket-Handle Tears : The split is vertical, along the circumference of the meniscus leaving anterior and posterior segments attached loosely . Sometimes the torn part displaces towards the center, causing “locking” (extension block).
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Menisci Tears Horizontal tears : * Usually degenerative in origin or due to repetitive minor trauma, or with association with meniscal cysts . * Generally speaking, most of the meniscus is avascular, except the outer third-from capsule-, due to this spontaneous repair doesn’t occur . *The loose part act as a mechanical irritant causing recurrent synovial effusion, and in severe cases secondary osteoarthritis.
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Menisci Tears Clinical Features : Patients may complain of pain at the joint line area , locking, clicking, giving way, and swelling with activity. In ptn >40yrs the main complaint is recurrent giving way or locking. Physical exam: Joint line tenderness (Mostly medial). Joint held slightly flexed. Joint effusion may be present. In late cases quadriceps are wasted. Flexion is full , extension limited.
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_ Joint line tenderness: the most imp and specific test _ Apley’s grind test: Isolates meniscii • Prone with knee flexed,axial load and rotation . - McMurray’s test Flex/ext with varus/valgus and int/ext rotation. • Goal is to get torn piece to pop in and out of place. • Positive if pop or reproduction of pain.
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Menisci Tears Imaging X-ray – Normal MRI – most useful may reveal tears missed by arthroscopy Arthroscopy : Diagnostic and therapeutic . You have to be certain that the lesion you can see is the one causing the patient’s symptoms . Treatment
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8 - Pathology of The Knee - D3 - Salsabeel Matalqah Menisci...

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