Knee Joint

Knee Joint

1. Anatomy of the Knee

   • Ligaments
     • Anterior Cruciate Ligament
     • Posterior Cruciate Ligament
     • Medial Collateral Ligament
     • Lateral Collateral Ligament
   • Musckes
     • Anterior Compartment
     • Posterior Compartment
     • Lateral Compartment

2. Articular Cartilage

   • Function
     • provide a smooth, lubricated surface for articulation and to facilitate the transmission of loads with a low frictional coefficient
   • Articular cartilage is hyaline cartilage and is 2 to 4 mm thic
   • articular cartilage does not have blood vessels, nerves, or lymphatics
   • It is composed of a dense extracellular matrix (ECM) with a sparse distribution of highly specialized cells called chondrocytes
   • composed of water, collagen, and proteoglycans, with other noncollagenous proteins and glycoproteins

3. Pain in the knee Joint

   • Metabolic Disorders
   • Arthritis
   • Osteoarthritis
     • a disease of joints that affects all of the weight-bearing components of the joint
       • Articular cartilage
       • Menisci
       • Bone
     • Common Sites
       • Knees
       • Hip
       • Neck and back
       • Feet
       • Hands
     • Natural History
       • Early Stage
         • cartilage gradually starts wearing down
       • Intermediate stage
         • Pain and stiffness in the affected joint, and the pain would always go away with rest.
       • Late stage
         • Healthy lubricating fluid is lost, and the joint affected by osteoarthritis may fill with inflammatory fluids that stretch the joint capsule, causing swelling, more pain, and stiffness.
     • Epidemiology
       • Globally
         • 242 million people have osteoarthritis
         • osteoarthritis costs the Spanish Health System an average of 4,738 million euros
       • Osteoarthritis has become a leading cause of disability in the UAE, accounting for half of all chronic conditions in people 65 years of age
     • Differences between RA and OA
       • Osteophyte formation present in OA
         • Radiological features of OA
           • Reduced Joint space
           • Sclerosis
           • subchondral cyst
         • Bone deposition in subchondral areas
         • Heberden's nodes
         • Bouchard's nodes
       • -ve Rheumatoid factor
       • OA occurs with old age
     • Crepitus
       • Tendons or ligaments snapping over the joint's bony structures. This snapping sometimes causes pain
         • typically either osteoarthritis or rheumatoid arthritis—that causes a joint’s articular cartilage to degenerate. While arthritis often leads to pain
     • Diagnosis
       • Lab Tests
         • In the case of osteoarthritis lab tests are not used to diagnose the case but rather to exclude other possible conditions
         • C-reactive protein
         • Comprehensive metabolic panel
     • Complications
       • Pinched nerve
       • Osteonecrosis
       • Muscle atrophy
       • Stress fractures
     • Management
       • Pharmacological
         • Aim
           • Reduce pain
             • Codeine
               • Pure agonist to natural opiates in our bodies
             • NSAIDs
               • Diclofenac
                 • analgesic, antipyretic and anti-inflammatory effects
             • Acetaminophen
               • anti-pyretic and analgesic
             • Glucosamine
               • It has anti-inflammatory properties and even appeared to help cartilage regeneration
           • maintain or improve function
       • Non-pharmacological
         • Physical exercises
         • Occupational therapy
         • Heat and cold therapies
         • Surgery
           • Knee replacement surgery
             • the surgeons remove the damaged cartilage and bone from the knee. Artificial pieces, called prostheses, are placed in the knee.
             • Complications
               • Infection
               • Bleeding
               • Blood clots
               • Nerve compression in the knee
     • Psychological Impact
       • Depression
       • Anxiety
       • Helplessness
       • Therapies
         • cognitive behavioral therapy
         • Meditation
         • Exercise
     • Social Impact
       • Disability to maintain certain relationships
       • Economical issues

4. Physical Examination

   • Look
     • Backer’s Cyst
     • Valgus
     • Varus
   • Feel
   • Move
     • Stability tests
       • Collateral ligaments
       • Apley’s Distraction
       • Anterior Drawer Test
       • Posterior drawer test
   • Measure, compare to opposite limb, assess

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