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-

Knee Anatomy

Summit Medical GroupOrthopedic Office of Westfield

Knee Anatomy

Summit Medical GroupOrthopedic Office of Westfield

Knee Anatomy

Summit Medical GroupOrthopedic Office of Westfield

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

Summit Medical GroupOrthopedic Office of Westfield

Meniscus TearsWhy do they happen?

Mostly circumferential fibers, few radial “ties”

Tears like a cheap shirt!!!

Summit Medical GroupOrthopedic Office of Westfield

Meniscal TearsMost common source of mechanical knee painMeniscal fragment is “abnormally mobile”

Hang nail of the knee!!

Meniscus Tear=

Cartilage Tear

Summit Medical GroupOrthopedic Office of Westfield

Clinical History of Meniscal Tears

Younger patients usually are injured with a significant TRAUMA

Summit Medical GroupOrthopedic Office of Westfield

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

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

Summit Medical GroupOrthopedic Office of Westfield

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

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

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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

Summit Medical GroupOrthopedic Office of Westfield

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