Arthroscopy

Management

Management Summary

 

Stage 0

 

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

 

Stage 1 / Normal X-ray, abnormal MRI

 

Forage: 80% G/E

Bisphosphonates

 

Stage 2 / Abnormal X-ray with cysts and sclerosis

 

A:  As for Stage I

Anterior Instability

Epidemiology

 

Traumatic initial cause in 95%

 

M:F 2:1

 

Age of initial dislocation inversely related to recurrence rate

- patients younger than 20 have a redislocation rate of 90%

- between 20 - 40 years, redislocation rate of 60%

- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)

 

Anatomy & Stability

 

1. Passive Stabilisers

 

Arthroscopy

Position

 

1.  Lateral decubitus

- stabilise patient with beanbag or lateral rests

- apply skin traction to forearm

- place traction pole at foot of table opposite surgeon

- suspend arm with 10 lb weight

- abduction 60°

- forward flexion of 20°

- tilt top shoulder posteriorly 30° so that glenoid is parallel wwith bed

- mark bony landmark

- prep & free drape

 

Osteoarthritis

Non Operative Management

 

Options / ELM POPI

 

Education

Lifestyle Management

- weight loss

- reduce sport

Physiotherapy

Orthotics

- walking stick

- braces

Pharmaceuticals

- NSAIDS

- acetominophen

- glucosamine

Injections

- cortisone

- hyaluronic acid

 

Background

DefinitionKnee OCD MRI Cartilage Intact

 

Osteochondritis Dissecans

- separation of avascular fragment of bone & cartilage

 

Epidemiology

 

M : F = 2:1

 

Mean age 18 years

- can present as young as 9

 

4:1000

 

Background

 

ACL Normal ArthroscopyACL Normal Arthroscopy

 

Anatomy

 

Developmental Anatomy

 

Knee joint first appears as a mesenchymal cleft at 8 weeks gestation

- ACL and PCL separate entities by week 10