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Examination of Knee Joint in a Child
Published in Nirmal Raj Gopinathan, Clinical Orthopedic Examination of a Child, 2021
The test is performed with the patient supine (Figure 10.21). The examiner holds the patient’s heel with one hand and stabilizes the knee with the other. The joint lines are palpated with the examiner’s thumb and fingers. The patient’s knee is then flexed maximally. To test the lateral meniscus, the tibia is rotated internally, and the knee is extended from maximal flexion to about 90° and vice versa. The examination of the whole of the posterior part of the menisci, beginning from the middle to their posterior attachment, is permitted by this gradual maneuver of flexion and extension. Added compression to the lateral/medial meniscus can be produced by placing valgus/varus stress, respectively, across the joint line while the knee is being extended. The occurrence of a click accompanied by a previously experienced sensation of pain as occurred when the knee gave way is indicative of a meniscal tear.
Paper 1
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A 70 year old male patient has pain in his right knee following a skiing injury. Numerous skeletal radiographs over the past 10 years demonstrate signs of an asymmetrical, polyarticular arthropathy not previously investigated. The patient has an MRI of the knee which reveals a horizontal medial meniscus tear. Other findings include marginal erosions and several lesions around the joint. These lesions are isointense to muscle on T1 weighted imaging, heterogeneously low signal on T2 sequences and enhance following gadolinium administration. One of these lesions is minimally infiltrating the patellar tendon.
Physiologically Based Treatments
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
A 55-year-old patient had the medial meniscus removed. He developed osteoarthrosis and a varus deformity 3 years later. A dense triangle beneath the medial plateau revealed a concentration of joint pressure (Fig. 35A). A barrel vault osteotomy was performed, slightly overcorrecting the deformity. The patient was subsequently pain free, had a full range of movement, and worked normally. At the 4 year follow up, the medial plateau was underlined by subchondral dense bone symmetrical with the lateral subchondral sclerosis (Fig. 35B). The pressure was again evenly distributed over the large weight-bearing surfaces.
Rongjin Niantong Fang ameliorates cartilage degeneration by regulating the SDF-1/CXCR4-p38MAPK signalling pathway
Published in Pharmaceutical Biology, 2022
Jun Chen, Nan Chen, Ting Zhang, Jie Lin, Yunmei Huang, Guangwen Wu
Thirty rats were randomly divided into the blank, model, and treatment groups (n = 10). After a week of routine feeding, rats were anaesthetised by intraperitoneal injection of 3% pentobarbital sodium (30 mg/kg). (Liu et al. 2005; Chen et al. 2016; Wu et al. 2019; Xu et al. 2021). Briefly, the rat model of OA was established using modified Hulth’s method in all groups except the blank group. A 1 cm longitudinal incision was made on the skin of the medial right-posterior knee, the medial collateral and anterior cruciate ligaments were transected via the medial approach, and the medial meniscus was removed. Then the joint capsule was sutured layer by layer. The blank group only received a 1 cm longitudinal incision on the skin of the medial right-posterior knee, and the skin was sutured. A prophylactic antibiotic with sodium penicillin (200,000 units) was given 3 days after surgery. The drawer test was used to determine whether the cruciate ligaments were transected.
The presence of high-grade pivot shift test preoperatively is associated with inferior functional outcomes
Published in The Physician and Sportsmedicine, 2022
Ravi Gupta, Anil Kapoor, Akash Singhal, Bharath Mali Patil, Parth Bansal
It was observed that the patients having lateral meniscus tear or both menisci tear were more likely to have high-grade pivot shift test. Previously also, it was reported that high-grade rotational instability is associated with lateral meniscus tear [4,5,37–41], and high-grade anterior laxity is associated with medial meniscus tear [14,42,43]. Musahl et al. in their cadaveric study observed that lateral meniscus is an important restrain to anterior translation of the tibia during the pivot shift test, whereas medial meniscus restrains to anteriorly directed force on the tibia during Lachman test [44]. But this remains still elusive as other authors have refuted these findings and have reported other results [13,14]. Dejor et al. in their study reported that patients with medial meniscus tear were more likely to have high-grade pivot shift as compared to patients having lateral meniscus tear [14]. Further, Zaffagnini et al. reported that medial meniscus tear was associated with increased anterior displacement in the pivot shift test [45]. In the present study, it was observed that medial meniscus tear was not associated with high-grade pivot shift.
Trends in the surgical treatment of meniscal tears in patients with and without concurrent anterior cruciate ligament tears
Published in The Physician and Sportsmedicine, 2020
Steven F. DeFroda, Daniel S. Yang, Joseph C. Donnelly, Steven L. Bokshan, Brett D. Owens, Alan H. Daniels
Question exists as to the optimal management of meniscal tears in the setting of ACLR. In 2009 Fetzer et al. performed a subanalysis of the Multicenter Orthopaedic Outcomes Network (MOON) patients who underwent ACL tear to characterize which patients were ideal candidates for meniscal repair and to determine the US market for repair. In their study of patients with ACL tears, 36% of patients had an associated medial meniscus tear while 44% had a lateral meniscal tear [17]. Within their cohort, 69% of medial tears, and 88% of lateral tears were managed with either meniscectomy or benign neglect. The tear patterns were retrospectively reviewed and it was determined that with regards to potential ‘future treatment’ options 30% of all tears would be eligible for biologic repair, 32% would be candidates for advanced repair, and 36% would be candidates for scaffold replacement [17]. While some of these treatments were speculative in nature, this study did point out a rather large market for meniscal repair with current techniques, namely the 36% of ACLR patients with medial tears, and the 44% with lateral tears. This study was published just prior to the time points investigated in this paper and may have an influence on physicians with regards to attempting more repairs in the face of ACLR, although this was relatively constant in this investigation. Overall patients were 3 times more likely to undergo concomitant meniscectomy during the study period than repair.