Chondromalacia Patellae
The patella, knee cap, is a thick circular-triangular bone which articulates with the femur and protects the anterior articular surface of the knee joint. It provides a bony surface that is able to withstand the compression placed on the quadriceps tendon during kneeling and friction that occurs during flexion and extention of the knee while running. It also provides additional leverage for the quadriceps in placing the tendon more anteriorly, farther from the joint’s axis, causing it to approach the tibia from a postion of greater mechanical advantage. The patella is the largest sesamoid bone in the human body.
Chondromalacia patellae is a knee problem that is symptomatic of marathon runners, basketball players, and power lifters. Chondromalacia is due to an irritation of the undersurface of the patella. The undersurface of the patella is covered with a layer of smooth cartilage and normally this cartilage glides smoothly across the knee during action. Some individuals, the patella tends to rub against one side of the knee joint and the cartilage surface becomes irritated and knee pain follows.
http://en.wikipedia.org/wiki/Chondromalacia_patellae
http://en.wikipedia.org/wiki/Chondromalacia_patellae
Great Saphenous Vein Graft
Great saphenous vein is a large subcutaneous vein that spans the length of the thigh and leg. It is formed by the union of the drsal vein of the great toe and dorsal venous arch of the foot. The GSV ascends anterior to the medial malleolus, passes posterior to the medial condyle of the femur, anastomoses freely with the small saphenous vein, transverses the saphenous opening in the fascia lata, and empties into the femoral vein. The GSV is sometimes used for coronary arterial bypasses because it is easily accessible, has usable lengths between perforating veins and tribuatries, and the walls of the GSV have a high percentage of muscular and elastic fibers compared to other superficial veins. Saphenous vein grafts are used to bypass obstructions in blood vessels, i.e. intracoronary thrombosis. Since veins have values, which aid in the transport of blood back to the heart, the saphenous vein must be inverted so the values don’t obstruct blood flow.
http://en.wikipedia.org/wiki/Great_saphenous_vein
Transplantation of Gracilis
The gracilis is a long, strap-like muscle and is the most medial muscle of the thigh. It is part of the adductor group of muscles, and is the weakest and most superficial of the group. The gracilis muscle crosses the hip and knee joint; it joins two other joint muscles (sartorius and semitendinosus). These three muscles have a common distal attachment point, collectively known as the pes anserinus, into the superior part of the medial surface of the tibia. The gracilis’s proximal attachment point is the inferior pubic ramus below the symphysis. The gracilis can be removed from the adductor group because of its weak contributions. The gracilis is often transplanted, or part of it, with nerves and blood vessels to replace damaged muscle in the hand. This process has produced good digital flexion and extension. The gracilis can also be dislocated from its distal attachment and repositioned to create a replacement for a nonfunctional external and sphincter.
http://en.wikipedia.org/wiki/Gracilis_muscle
http://en.wikipedia.org/wiki/Gracilis_muscle
Chondromalacia
ReplyDeleteWould this have anything to do with some sort of trauma or injury to the the knee during athletic activity or just normal wear & tear? I've done research on patellar luxation, more commonly found in small-breed dogs. Luxation in humans is commonly found after an ACL injury. The luxation would cause "grinding" of the knee-cap against that surface as well and major joint pain.
In humans, luxations would be more commonly described as "dislocations," in which the knee-cap would slip in and out of place. This causes intense pain and swelling.
Treatment options for dislocation/luxation are limited to either surgery or physical therapy; and usually involve both depending on severity of the injury.
Another type of knee injury, although not always as immediately disastrous as a ligament tear, is a tear in the meniscus. Twisting beyond the normal range of motion can result in a minor tear that heals itself, if treated properly, to a more major tear that requires removal of the meniscus in order to facilitate recovery. This removal, even a partial removal, can lead to osteoarthritis later in life. The location of the tear often determines whether the meniscus can heal itself. A minor tear in the inner 2/3 of the medial meniscus has a lower probability of healing because of the limited blood supply. A similar tear in the outer 1/3 of the medial meniscus has a much better chance of healing fully with the proper care because of the better blood supply.
ReplyDeleteMeniscus healing is difficult to obtain at any age since the majority of the meniscus has little blood supply, thus making it avascular. Ultimately, the goal is to save as much of the meniscus as possible to avoid problems later in life. This is why small tears are often left alone if there are no other co-existing injuries such as an ACL tear. If surgery is necessary, a meniscectomy is performed. The goal of this procedure is to minimize or eliminate symptoms. A better alternative is repairing the meniscus by stitching the tear. This procedure has a relative advantage over the typical arthroscopic procedures in that if it is not successful, the procedure can be repeated. At the worst, if this procedure fails and a re-repair is not possible, then a partial meniscectomy can be performed.
Resource:
http://orthoinfo.aaos.org/topic.cfm?topic=a00358
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