Knee Anatomy, approaches & Osteoarthritis

KneeAnatomy, approaches and

Review of OA

Dr. Jayesh A Bhanushali

D.ortho

Registrar, RGMC & CSMH

Kalwa, Thane.

Knee

Radiology leg and Knee

Approaches of the knee joint

1.Anteromedial approaches -

• Anteromedial para patellar

• Subvastus anteromedial

2.Anterolateral approach

3.Posterolateral approach

4.Postero medial approach

5.Medial approaches to the knee and supporting structures

6.Transverse approaches to menisci

7.Lateral approaches to the knee and supporting structures

MEDIAL PARA PATELLAR APPROACH(VON LANGENBECK APPROACH)

SUBVASTUS ANTEROMEDIAL APPROACH

ANTEROLATERAL APPROACH(KOCHER’S APPROACH)

POSTEROMEDIAL APPROACH (HENDERSON APPROACH)

Osteoarthritis

• Osteoarthritis is a non-inflammatory, degenerative condition of joints Characterized by degeneration of articular cartilage and formation of new bone i.e. osteophytes.

Risk factors

Obesity

Abnormal mechanical loading

Inherited type II collagen defects

Hereditary

Poor posture

Injured joints and infection

Pathology

• OA is a degenerative condition primarily affecting the articular cartilage (wear and tear)

1.Articular cartilage - Erosion in weight bearing area

2.Bone - Subchondral cyst, sclerosis, osteophytes.

3.Synovial membrane - Hypertrohy, decreased secretion of fluid

4.Capsule - Fibrous degeneration

5.Ligament - Contracted or elongated

6.Muscle - Wasting

Clinical features of OA

• Pain

• Stiffness

• Restricted movement

• Deformity

• Muscle weakness or wasting

• Joint enlargement and instability

• Crepitus

• Joint Effusion

Imaging

Treatment chart

•Medical

• Surgical

•Regenerative

Surgical

• Knee preserving procedures

1. Intra articular injection

2. Arthroscopic lavage and debridement

3. Corrective osteotomy

4. Mosaicplasty

• Knee replacing surgeries1. TKR

2. UKR

Injections

• Visco supplementations.

• Hydrocortisone.

Arthroscopic lavage

• Joint debridement

• Removal of loose bodies,

• Joint lavage

• Drilling of sclerotic lesions

Corrective osteotomy

• High Tibial Osteotomy

osteotomy is an option in active patients with unicompartmental OA

• The fundamental goals is to unload diseased articular surfaces and to correct angular deformity at the tibiofemoral articulation.

Indications for HTO

• OA With Varus Limb Alignment

• OA With Valgus Limb Alignment

• Osteochondritis Dessicans

• Osteonecrosis

• Posterolateral Instability

• Chondral Resurfacing

HTO types

1. Open wedge

2. Closed wedge

3. Dome

4. Dynamic external fixator

Lateral close wedge

Medial open wedge

Dome osteotomy

Dynamic external fixator

Mosaicplasy

Chondroplasty

THANK YOU