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Meniscus and cartilage

5 important questions on Meniscus and cartilage

An MRI has been conducted and shows an isolated medial meniscal tear. Shortly after having the MRI scan, the patient presents to the emergency room with increased pain and an inability to straighten his knee after squatting down. On examination, his range of motion is restricted to between 20-90°. X-rays remain normal.
What is the most likely diagnosis?

A. A partial thickness chondral injury.
B. Patellar subluxation.
C. An ACL tear.
D. A locked bucket handle meniscal tear.

D. This is the most likely diagnosis in this situation. The suspicion of a meniscal tear, mechanism involving deep knee flexion and a ‘locked knee’ are all very suggestive.

Due to this history and the markedly restricted ROM (‘locked’ knee) you suspect a displaced bucket handle medial meniscus tear.
Which of the following do you consider to be the most appropriate next step?
A. Repeat the MRI to confirm this diagnosis.
B. Refer the patient to physiotherapy to regain full range of motion.
C. Arrange an urgent orthopaedic consultation and arthroscopy.
D. Reduce the locked knee with a manipulation under sedation.

C. Bucket-handle tears are typically amenable to meniscal repair. Locked knees should be treated urgently with arthroscopic reduction and repair of the displaced fragment. Prompt treatment will help prevent long-term motion loss that can occur in these knees.

The patient is worried about being able to return to competitive football.
Concerning prognostic factors for a successful return to competition, which of the following statements is CORRECT?

A. Patients with more than 12 months of symptoms have better outcomes.
B. A patient’s pre-injury level of football is not a prognostic factor.
C. Older players have a better prognosis than younger players.
D. A history of a meniscectomy suggests a worse outcome.

D. This is correct. Patients with a more favourable mechanical environment (a well aligned, stable knee with intact menisci) have better outcomes.

An OATS mosaicplasty is performed on the patient using three 9mm osteochondral plugs.
After surgery, the patient undergoes a supervised rehabilitation program. Which of the following statements about the rehabilitation is CORRECT?

A. FIFA has developed a core group of exercises (the 11+) to accelerate the rehabilitation of competitive and professional football players.
B. Most patients will benefit from an accelerated rehabilitation program.
C. The rehabilitation program must be individualised to each procedure and athlete.
D. Immediate weight-bearing is allowed.

C.The characteristics of the initial lesion and the type of surgery performed all impact on the patients rehabilitation program. Their post-operative course also dictates their rehabilitation program. For example, athletes with a persisting effusion need to be progressed more carefully.