The Knee: Common Problems and Current Treatment
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The Knee:Common Problems and Current
Treatments
David D Bullek, M.D.Orthopedic Surgery
Surgery of the Knee and Shoulder
Summit Medical GroupOrthopedic Office of Westfield-
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Knee Anatomy
Summit Medical GroupOrthopedic Office of Westfield
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Knee Anatomy
Summit Medical GroupOrthopedic Office of Westfield
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Knee Anatomy
Summit Medical GroupOrthopedic Office of Westfield
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Anatomy of the Meniscus
Lateral meniscus
Medial meniscus
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What does the meniscus do?
• Shock absorber of the knee • Meniscus absorbs 50% of
load when standing
Forces Redirected by Meniscus
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Meniscus Function• Enhance articular conformity
tibia
femur meniscus
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Meniscus TearsWhy do they happen?
Mostly circumferential fibers, few radial “ties”
Tears like a cheap shirt!!!
Summit Medical GroupOrthopedic Office of Westfield
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Meniscal TearsMost common source of mechanical knee painMeniscal fragment is “abnormally mobile”
Hang nail of the knee!!
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Meniscus Tear=
Cartilage Tear
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Clinical History of Meniscal Tears
Younger patients usually are injured with a significant TRAUMA
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Clinical History of Meniscal Tears
Older Patients- do not Older Patients- do not need significant need significant
traumatraumaKneeling, squatting Kneeling, squatting
or simple twistor simple twistMany do not recall any Many do not recall any
traumatic eventtraumatic eventSummit Medical Group
Orthopedic Office of Westfield
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SymptomsClickingKnee SwellingLocking Giving WayIncreased pain with twisting,
squatting or change of direction
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ExaminationJoint line tendernessPositive Apley’s or McMurray’s sign
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Radiographic Evaluation
• Xrays- Standing AP, 45 degree PA, lateral and Merchant view
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MRIMRI is 93% accurate in diagnosis of medial meniscus tears
Accuracy in diagnosis of lateral meniscus tears is 90%
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Treatment Options
•Resect or Repair
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Meniscal RepairIndications Tears in the vascular zone Intact body of the meniscus > than 1cm in size or unstable Stable knee or in conjunction with an
anterior cruciate reconstruction
Red-red tear
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Meniscal Repair Techniques
Sutures
arrows
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Results of Meniscal Repair• 70% success in isolated tears• 90 % success in tears repaired in
conjunction with ACL reconstructions
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Meniscal Resection
• Indicated in the symptomatic mobile meniscus tear not amenable to repair (the majority of tears in adults)
Knee arthroscopySummit Medical Group
Orthopedic Office of Westfield
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Technique of Meniscal ResectionRemove all of mobile fragmentContour the rimPreserve the rim (barrel hoops)Avoid excessive resection
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Results of Partial Menisectomy
Summit Medical GroupOrthopedic Office of Westfield
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Causes of Failure in Arthroscopic Partial Menisectomy
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Arthritis and Meniscal Tears
Results directly related to degree of arthritis
No arthritis -95% satisfactory results @ 3years
Ahlback I(50% jt space narrowing) 65% satisfactory results @ 3 years
Ahlback II and III- poor results
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Recommendations• Standing xrays of
knee determine preexisting OA and need for surgery!
• MRI alone is not sufficient
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The End
Thank YouSummit Medical Group
Orthopedic Office of Westfield