TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES.

TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES Slide 2 TRATAMIENTO ARTROSCOPICO DE LA ARTOSIS DE RODILLA La Poblacin tiende a mantenerse fsicamente cada vez mas activa y a realizar actividades mas demandante a edades mas avanzadas Artroscopia aparece como un procedimiento mas simple en paciente que por edades o cambios degenerativos menores no son candidatos a una artroplastia Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 3 Cules son los objetivos de una Artroscopia? Remover las partculas inflamatorias y enzimas degradativas Proporcionar superficies lisas de cartlago articular Tratar patologa meniscal Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 4 la evidencia se inclina en demostrar que el tratamiento artroscopico no presenta beneficios sobre el tratamiento conservador Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 5 La artrosis se presenta en : Con mayor prevalencia en mujeres Todo grupo de edades y raza Se reporto que el 50% en personas mayores de 65 aos Artrosis de Rodilla Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 6 La artrosis es el segundo diagnostico primario que causa discapacidad despues de las enfermedades cardiovasculares Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 7 El tratamiento de la artrosis de rodilla: Debe ser etapificado Existir relacin con sntomas y signos Se debe comenzar con medidas simples: Bajar de peso Modificacin de la Actividad Calzado amortiguador kinesioterapia Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 8 Los pacientes que no presente una respuesta favorable al tratamiento conservador, el tratamiento quirurgico es una alternativa con mejores resultados en pacientes entre 40- 60 aos Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 9 Disminuir el dolor Aliviar la funcionalidad objetivos Permite remocin de osteofitos sintomticos Trata eventuales patologas mecnicas coexistentes (lesiones meniscales, cuerpos libres, etc.) beneficios Tratamiento Quirrgico Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 10 Seleccin de paciente y criterio para una Artroscopia Inicio agudo de derrame articular, dolor localizado en interlinea articular o sntomas mecnicos como bloqueo Inicio agudo de sintomatologa despus de un traumatismo especifico Cuerpo libre intrarticular confirmado por imgenes Paciente debe presentar artrosis temprana, ausencia de mal alineamiento significativo, sin disminucin de espacio articular y sin osteofitos importantes Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 11 Tecnica quirurgica cual es la base y finalidad del tratamiento artroscopico de la artrosis? Es el debridamiento o aseo articular, que tiene como finalidad aliviar sintomatologa a travs de la restauracin de la biomecnica de la rodilla Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 12 El procedimiento bsicamente incluye: El aseo articular para dilucin de la concentracin de enzimas degradativas y remocin de productos irritantes de la degeneracin condral, meniscal o sinovial Remocin de cuerpos libres intrarticulares Meniscectomia parcial Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 13 Meniscectomia El proceso patolgico de la artrosis en etapas tardas no solo genera la destruccin del cartlago articular, sino que afecta tambin la integridad de meniscos y ligamentos Cualquier procedimiento sobre el menisco debe ir orientado a mejorar la sintomatologa del paciente Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 14 Un desgarro en un menisco con cambios degenerativos esta asociado a cambios estructurales preexistentes en el cartlago articular que pueden representar una etapa temprana de artrosis Dependiendo de cuanta funcionalidad meniscal se pierda con un desgarro o una reseccin quirrgica, la artrosis se puede acelerar a medida que aumenta la carga biomecnica en el cartlago articular Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 15 La reseccion de una lesion de cuerpo posterior del meniso interno disminuye en dos tercios la capacidad de absorcion de carga Se debe evitar la reseccion del menisco hasta la periferia, ya que elima la capacidad del menisco de soportar cargas Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 16 La extrusin meniscal es otro hallazgo comn en pacientes mayores y es a menudo otro signo de una degeneracin meniscal y artrosis preexistente Una extrusin meniscal puede contribuir a aumentar la estrechez del espacio articular Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 17 Condroplastia La radiofrecuencia ha ganado popularidad como herramienta artroscopica Sus ventajas son: - Fcil de aplicar -Bajo costo - Retraccin del colgeno Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 18 Estudios han demostrado que la condroplastia utilizando radiofrecuencia obtiene superficies lisas que permanecen estables por largos periodos de tiempo Sin embargo, la radiofrecuencia funciona a travs del calor y su desventaja esta en que los condrocitos son extremadamente sensibles a la temperatura Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 19 Sinovectomia y remocin de osteofitos En el casos que la artrosis avanzada se acompae de sinovitis significa que provocara derrames recurrentes, y la Sinovectomia puede estar indicada La reseccin de osteofitos en general no son recomendado, por el riesgo de provocar hemartrosis Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 20 La nica indicacin excepcional para realizar este procedimiento es la presencia de un osteofito anterior en la escotadura intercondilea o patelofemoral que bloque la extensin Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 21 Resultados 50% a 75% de los paciente con Artroscopia refieren una mejora inicial 15% progresa a una artroplastia total de rodilla a un ao 44% presenta una disminucin clnica significativa del dolor a dos aos de seguimiento Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 22 Spahn et al. Examino los resultados de la Artroscopia en pacientes con artrosis medial de rodilla 71% de los pacientes presento pobres resultados Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 23 Sugirio que los factores asociados a mal pronosticos son: Tiempo de evolucin de la artrosis mayor a 24 meses Obesidad Osteofitos mediales Espacio articular menor a 5 mm Tabaco Presencia de defecto condral tibial grado IV y necesidad de una Meniscectomia total o subtotal Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 24 No se debiera considerar una Artroscopia Si existe disminucin severa del espacio articular comprometido ( estadio 3 de Kellgren Lawrence) Tampoco si el eje mecnico de la rodilla pase por la zona de la lesin Tienen pocas posibilidades de ser un procedimiento exitoso Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 25 Estudios Clinicos En el estudio de Framingham sobre indicaciones de Meniscectomia en rodilla artrosica describi: El 56% de los hombres entre 70 y 90 aos sin sintomatologa presenta desgarros meniscales y en pacientes con artrosis radiogrfica este porcentaje aumenta a 82%. Sin embargo, la relacin entre dao meniscal y artrosis es compleja Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 26 Una lesin meniscal en una rodilla sana, puede, eventualmente, llevar al desarrollo de la artrosis por perdida de la funcin meniscal Una rodilla artrosica puede presentar un desgarro meniscal que acelera el proceso degenerativo Esto sugiere que el dao meniscal visible en resonancia magntica antecede a los cambios visibles del cartlago Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 27 Tecnica preferida por el autor Como regla general se debe ser conservador y juicioso en las resecciones para preservar al mximo las estructuras noble de la funcin articular: Cartlago y Menisco Toda estructura inestable debe ser resecada y/o remodelada en su justa medida teniendo en cuenta que los pacientes solo utilizaran sus rodilla en AVD y baja demanda Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 28 Contraindicamos formalmente cualquier tipo de procedimiento que base su xito en respuesta reparativas del paciente, fundamentalmente por los factores de edad y por la severa alteracin de la homeostasis articular que limita seriamente su respuesta regenerativa por ejemplo: microfracturas, meniscorresis, etc Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 29 Normalmente por edad y presencia de factores de riesgo utilizamos tratamiento anticoagulante profilctico con HBPM en el postoperatorio Uso de kinesiologa precoz, con nfasis en la movilizacin, limitacin de la respuesta inflamatorias, drenaje venoso y linftico, mantencin trofismo muscular y el uso transitorio de descarga en la deambulacion Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 30 Conclusin La evidencia es categrica en demostrar que el tratamiento artroscopico no presenta beneficios sobre el tratamiento conservador Siempre se debe tomar cuenta que al momento de evaluar al paciente que los peores resultados de una Artroscopia en artrosis se asocia a mal alineamiento, inestabilidades, artrosis avanzadas, sintomatologa crnica, cirugas previas Aaron RK, Skolnick AH, Reinert Se,et al.Arthroscopic debridement for osteoarthritis of the knee.J Bone joint surg am 2006;88:936-43.Bernstein j, quaccht a perspective on the study of moseley et al : questioning the value of arthroscopic knee sugery for osteoarthristis.cleve clin j med.2003;70(5):405-406-410. Bin SI,Lee SH,Kim CW,Kim th, lee dh results of arthroscopic medial meniscectomy in patient with grabe Ivosteoarthritis of the medial compartment.Arthroscopy 2008 Mar,24(3);264-8. Brian j.cole MD,MBA,and H.Ralph Schumacher, jr,MD. Inyectable corticosteroids in modern practice.J Am acad Orthop surg 2005;13:37-46. Cook JL, Kuroki k, kenter k, marberry k, brawner t, Geiger t, jayabalan P, bal Bs. Bipolar and monopolar radiofrequency treatment of osteoarthritic knee articular cartilage: acute and temporal effects on caartillage compressive stiffnes, permeability, cell synthesis, and extracellular matrix composition.J knee surg 2004 apr; 17(2): 99-108. David D Waddell, MD, and jack M bert MD. The use of hyaluronan after arthroscopic surgery of yhe knee.Artroscopy, vol 26, no 1 ( January), 2010:pp105-111.Dearing j,nutton RW evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;14(3):159-63. Dervin Gf, stiell IG, rody k, grabowski J. effect of arthroscopic debridement for osteoarthritis of the knee on healthrelated quality of life. J bone Joint surgAm 2003;85a(1):1019. Englud, guermazi, lohmander the meniscus in knee osteoarthristis. Rheum Dis Clin N Am 35(2009) 579-590. Moseley JB, Omalley k, Petersen Nj, et al. A controlled trial of arthroscopia surge for osteoarthristis of the knee. N Engl J Med 2002;347: 81-8. Vega J, Golano P, perez- carro L. electrosurgical arthroscopic patellar denervation. Arthroscopy, 2006 sep; 22(9): 1028. E 1-3 Slide 31 LESIONES CONDRALES Slide 32 HISTOLOGIA Cartlago hialino es una forma especializada de tejido conjuntivo Constituidos por elementos celulares denominados CONDROCITOS que disponen en una matriz extracelular dura de tipo gel Las clulas se nutren mediantes difusin a travs de la fase acuosa de la matriz y a partir de los capilares de los tejidos que rodean el cartlago Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 33 PropiedadesElasticidadViscosidad Esto le confiere una dureza y flexibilidad poco habituales Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 34 Tipos de cartlago Fibrocartilaginoso Elstico Hialino Sus Diferencias estn dadas por: - Matriz celular -Fibras de Colgenos - Fibras de Elastina Slide 35 Cartilago Hialino Se presenta en anillos traqueal, la nariz, laringe, superficies articulares Condrocitos se encuentran por debajo del pericondrio Zona mas profunda del cartlago, las lagunas tienen una configuracin hemisfrica o angular Citoplasma presenta una baja densidad, contienen gotas de lpido y cantidades variables de glucgeno Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 36 Matriz Cartilaginosa Es de color azul grisceo y parcialmente traslucida Colgeno que predomina es tipo II, que forma fibras dbiles con estriacin transversal Las fibras de la zona superficial estn orientadas paralelamente y la mas profundas hacia adentro en forma de columnas verticales La orientacin de las fibras son adaptadas para resistir la tensin a la que estn sujetas normalmente Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 37 Dentro de la matriz existen una capsula pericelular, que rodea a las lagunas Esta formada por fibras muy finas de caractersticas similares a la lamina basal Desempea un papel importante en la proteccin de los condrocitos de aquellos cartlagos sometidos a compresin o tensin mecnica La matriz posee mayor concentracin de proteoglicanos Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 38 Cartilago Articular Es un tipo de cartlago hialino, que cubre terminaciones Oseas de la articulaciones sinoviales Es avascular y denervado, el 70%-80% de su peso es agua Constituido por colgeno tipo II, posee poca elastina y un componente menor de glicoprotenas y lpidos Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 39 Se organiza en cuatro capas : 1- Superficial (S) 2- Transicion (T) 3- Medial (M) 4- Calcificada (C) Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 40 Capa Superficial Posee dos zonas Compuesta por un grupo de finas fibrillas con pequeos polisacridos, sin clulas que cubren la articulacin Esta zona es mas profunda y se observan condrocitos de forma elptica dispuesto en un eje mas paralelo a la superficie Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 41 En esta capa los condrocitos secretan una matriz con alta concentracion de colageno y baja concentracion de proteoglicanos La caracteristica estructural de esta capa es que determinan una alta fuerza tensil y resistencia a la compresion superior a las capas profundas Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 42 Capa Transicion Posee mayor grosor que la capa superficial Los condrocitos adoptan una morfologa espiroidal Sus clulas poseen mayor densidad de organelos, recitculo endoplasmatico y aparato de Golgi Sintetizan matriz con fibras colgenos de mayor dimetro con alta concentracin de proteoglicano y menor de concentracin de agua y colgeno Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 43 Capa Medial los condrocitos esferoides ubicados perpendicular a la superficie articular posee fibras de colagenos de gran diametro La concentracion mas alta de proteoglicanos y la mas baja de agua Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 44 Capa Calcificado Es una zona de cartlago calcificado que separa la zona radial del hueso subcondral Contienen muy poco retculo endoplasmatico y aparato de Golgi Las clulas aparecen completamente rodeando el cartlago calcificado, lo que sugiere una baja actividad metablica Estudios sugieren que podra jugar un rol en el desarrollo y progresin de la osteoartritis Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gray t. Outcome of untreated traumatic articular cartilage defects of the knee: a natural history study. J bone joint surg am 2003;85:pag 8-16. Zaleske, David j, md. Cartilage and bone development.American Academy of Orthopaedic Surgeeons Instructional course lectures. Vol. 47, pag. 406-75. 1998. Slide 45 Cartilago Articular Normal La funcin de este cartlago es : Minimizar el estrs sobre el hueso subcondral Distribucin de cargas en la articulacin Disminuye el coeficiente de friccin de las superficies articulares La interaccin con el liquido sinovial proporciona un excelente mecanismo de lubricacin Alford jw, cole bj cartilage restoration, part1: basic science, historial perspective, patient evaluation, and treatment options am j sports med 2005;33 pag 295-306. Brittberg M,Winalski C. Evalution of cartilage injuries and repair. J bone joint surg am 2003;85:pag.58-69. Buckwalter j, md mow van c, ph, and ratcliffe Anthony, phd.restoration of injuried or degenerated articular cartilage. American academy of orthopaedic surgeons.n4; july/agust,1994, pag, 192-201.1994. Buckwalter J.mankin HJ. Articular cartilage. Part II degeneration and ostearthrosis, repair regeneration and transplantation.J.Bone and joint sugery, 1997 79a, pag. 612-632. David figuroa, md, Rafael calvo, m.d, alex vaisman, m.d, Hangody, G.Kish, z karpati. Ostechondral plugs: autogenous osteochondral mosaicplasty for the treatment of focal chondral and osteochondral defects.I operative Technique in Orthopaedics, vol.7, number4,october1997, pag. 312-322.jun-kyo,Suh, phd;et al. basic science of articular cartilage injury and repair. Operative technique in sports medicine vol.3,number 2, pag. 78-86, abril 1995. Kinner B, capito Rm, spector M. Regeneration of articular cartilage.adv biochem eng biotechnol 2005;94:pag 91-123. Menche, David s, md Vagsness, Thomas jr, md; et al. The treatment of isolated articular cartilage lesions in the young individual. American Academy of Orthopaedic Surgeons Instructional Course lectures.Vol.47, pag, 505-515. 1998. ODriscoll SW. The healing and regeneration of articular cartilage. J. bone joint surg am 1998;80:pag.1795-1812. Recht M, bobic V, Burstein D, et al. magnetic resonance imaging of articular cartilage.Clin orthop relatres 2001;391:s379-s396 (suppl). Shelbourne Kd, Jair s, Gra

TRATAMIENTO ARTROSCOPICO DE LA ARTROSIS DE RODILLA INTERNA KINESIOLOGIA UDLA MARA JOSE GONZALES.

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