Ortho

7/9/99

• Defect in subchondral region in apophysis or epiphysis in Osteomyelitis Desecans
• Joint mice—swelling, effusion, crepitus (noise) (deep knee bend),
• Chondromalacia (cartilage softening)
• Patella
• Excessive loading of the joint
• Disuse
• Complicated by obesity
• Valgus or varus variation of the knee
• Different than DJD (patellar femoral )
• Patellofemoral chondrosis
• Histologic dx—scrap tissue off the back of the patella
• PFA arthralgia—doesn't tell you anything
• Climbing stairs and sitting—anterior knee pain
• Common dx
• Almost all cases, when quads are look at, weakness of vastis medialis

• Patellar tracking disorder—up lateral condyle of femur
• Fissuring in articular cartilage

• ASIS to patella
• 13-18° valgus –normal for adult

Menisci of the knee

• fxn
• similar to labrum—enlarges concavity for the condyles of the femur
• guide in sagittal motion
• prevent displacement—maintain normal Q angle
• increases contact area b/w tibia and femur
• distribute the load
• medial is more firmly attached—helps it to be injured more easily
• medial collateral ligament and lateral

• unhappy triad
• medial meniscus
• medial collateral ligament
• ACL—anterior cruciate ligament

• External rotation for checking medial meniscus
• Internal rotation for lateral meniscus
• Don't heal very well
• Pain and swelling due to peripheral tissue to the meniscus
• Not pain sensitive in of themselves
• Symptoms
• Effusion (swelling)
• Tenderness around the joint line (through the collateral ligaments)
• Collateral ligament tears at its origin or insertion (from the femur)
• Meniscus pain is right in the center
• Quads atrophy—change in the ability of the knee to fxn
• Joint locking and giving way—caused by damaged meniscus interfering w/normal joint articulations
• Can lead to further injury
• Don't have stability in lower extremity

• Clicking or snapping—femur going over abnormality of the meniscus—usually at 90° of knee flexion

• fibrocartilagenous
• avascular—poor healing