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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