Knee

Knee

1. Anatomy of knee joint

   • Bones
     • Femur, tibia, and patella
   • Ligaments
     • Extra- capsular
       • LCL, MCL, Oblique popliteal
     • Intra-capsular
       • ACL, PCL, Transverse, Posterior meniscofemoral
   • Menisci
     • Medial and lateral
   • Blood supply
     • Anastomosis of the Knee joint
       • Formed by 10 branches
   • Bursa
   • Examination
     • LOOK
       • Gait, posture, Wasting, Baker's cyst, knee position, and Skin abnormal signs
     • Feel
       • Temperature, Joint, Bony projections, Muscles
     • Move
       • Active and passive, ROM, Crepitus
     • Test
       • McMurray test, Apley Grinding test, Anterior drawer test, Lachman Test, Pivot Shift Test,

2. Structure of cartilage

   • Cells
     • Chondroblasts + Chondrocytes
   • Matrix
     • Ground substance + elastic and collagen fibres
   • Types
     • Hyaline cartilage
       • collagen and elastic fibres are present in equal amounts
         • Supports and reinforces
           • Found in: fatal skeleton, articular surfaces, costal cartilage, and cartilage of nose, trachea, and larynx
     • Elastic cartilage
       • elastic fibres are present in large amounts
         • maintains shape and allows flexibility
           • Found in: external ear and epiglottis
     • Fibrocartilage
       • collagen fibres are present in large amounts
         • strength and ability to absorb compressive shock
           • Found in: Intervertebral discs Pubic symphysis Menisci

3. Osteoarthritis

   • Risk factors
     • Age/sex, disease, genetics, occupation, injury, weight, and muscle weakness
   • Clinical presentation
     • pain, stiffness, swelling, tenderness, and crepitus
   • Pathogenesis
     • trauma of genetic factors
       • damage to articular cartilage or failure of abnormal cartilage under normal joint loading
         • increase water in joint space
           • Erotion
             • Eburnation
               • Bone cysts, osteophytes, sclerosis, and joint space narrowing
   • Treatment
     • 1st line:
       • Therapy: Physical therapy, occupational therapy, Tai chi yoga
     • 2nd line:
       • Medications: Acetaminophen, duloxetine, NSAID
         • Glucosamine
           • one of cartilage building blocks
             • given as supplementation in osteoarthritis
           • Contraindications:
             • patients with shellfish allergy, Pregnant women, Cardiovascular disease, Impaired glucose tolerance
     • 3rd line:
       • Surgeries: Cortisone injection, Joint replacement, Realigning bones, Lubrication injection
         • Arthroplasty
           • Indications
             • Osteoarthritis Rheumatoid arthritis Post traumatic arthritis - Knee Gout - Bone dysplasia - Avascular necrosis - Knee injury
           • Complications
             • Infection, Blood clots, Continued pain.  Neurovascular injury. Fracture
           • prognosis
             • Most artificial knee joints last 10 to 15 years. Some last as long as 20 years.
           • Post Surgery Adaptation
             • 1- Declutter
             • 2- Install fall prevention equipment
             • 3- Prepare a recovery area
             • 4- Move your sleeping quarters
             • 5- Ask for help
   • Diagnosis
     • Arthrocentesis, x-ray, blood test, MRI
   • Complications
     • Reduced mobility, stress fractures, pinched nerve, osteonecrosis, chondrolysis

4. Types of Arthritis and diagnostic tests

   • Rheumatoid arthritis
     • rheumatoid factor and anti-CCP antibodies.
   • Fibromyalgia
     • Blood test (FM/a )
   • Gout
     • joint fluid analysis for uric acid crystals
   • Septic arthritis
     • Joint fluid analysis
   • Systemic lupus erythematosus
     • Erythrocyte sedimentation rate, Kidney and liver assessment or biopsy, Urinalysis,
   • Ankylosing Spondylitis
   • Reactive arthiritis
     • Joint fluid tests (White blood cell count, Infections)

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