Knee Medical Intervention PDF

Medical Intervention Knee JUSTIN TRENT UNIVERSITY OF SAINT MARY IF YOU REFER OUT, WHAT MIGHT AWAIT THE PATIENT? The Path Ahead 1 Medications 2 Minimally Invasive Interventions 3 Surgical Interventions Part One: Medications Muscle Relaxant Medications MEDICATIONS What is it? Neuromuscular Blockers PN...

Medical Intervention Knee JUSTIN TRENT UNIVERSITY OF SAINT MARY IF YOU REFER OUT, WHAT MIGHT AWAIT THE PATIENT? The Path Ahead 1 Medications 2 Minimally Invasive Interventions 3 Surgical Interventions Part One: Medications Muscle Relaxant Medications MEDICATIONS What is it? Neuromuscular Blockers PNS Used in surgery and emergent situations Spasmolytics/Anti-spasmodics CNS Eg. Flexeril, Baclofen Who benefits? Patients with muscle spasm due to overexertion Patients with spasticity Anti-Inflammatory Medications MEDICATIONS What is it? Opioids Oxycodone (OxyContin), Hydrocodone (Vicodin), Codeine, Morphine, Fentanyl NSAIDs Cox-1 and/or Cox-2 Inhibitors (1&2) Aspirin, Ibuprofen, Aleve (2) Celebrex, Meloxicam More effective on joint pain and less digestive issues Who benefits? Patients experiencing pain and/or inflammation Neuropathic Medications MEDICATIONS What is it? Antidepressants SSRI, Tricyclics, SNRI – Chronic Pain Cymbalta – Neuropathic Pain Anticonvulsants Neurontin or Lyrica – Neuropathic Pain Who benefits? Patients with neuropathic conditions (nervebased pain, hyperalgesia, allodynia) Part Two: Minimally Invasive Interventions Corticosteroid Injection MINIMALLY INVASIVE INTERVENTIONS What is it? An injection of anesthetic and corticosteroid into an area of suspected inflammation. Common areas include tendon and intraarticular injection. Who benefits? Individuals with inflammatory conditions. Patellar Tendinopathy Osteoarthritis ~ Wiki Commons Hyaluronic Acid Injection MINIMALLY INVASIVE INTERVENTIONS What is it? An injection of bacterially grown (used to be cox comb) hyaluronic acid into arthritic joints. The molecule holds water in a gel-like state and is thought to lubricate joint surfaces. Who benefits? Individuals with osteoarthritis. Research for this treatment is very poor. You will hear of anecdotal success, and it is still very common; however, many orthopedic groups have pulled it from their list of recommended treatments. ~ Wiki Commons Prolotherapy MINIMALLY INVASIVE INTERVENTIONS What is it? An injection of hypertonic dextrose into a poorly healing area of the body. The solution reactivates the inflammatory response and provides some short-term pain reduction, theoretically giving a second chance or boost to tissue healing. Who benefits? Individuals with recurrent dysfunction. Osteoarthritis Peri-articular and Intra-articular Injection Patellar Tendinopathy Partial ACL Tear ~ Wiki Commons Platelet Rich Plasma (PRP) MINIMALLY INVASIVE INTERVENTIONS What is it? An injection of high-concentration autologous platelets into injured tendons, ligaments, or arthritic joints. The solution can be in/activated (cytokines initiated by calcium chloride) and/or be either leukocyte-rich or -poor. Who benefits? Individuals with mild to moderate connective tissue injury. Most Literature Support for: Knee OA (Hussain, 2017) ~ Wiki Commons Stem Cell Injection MINIMALLY INVASIVE INTERVENTIONS What is it? An injection of stem cells harvested from bone marrow (top) or fat tissue (bottom) into injured tendons, ligaments, or arthritic joints. Stem cells reduce surrounding apoptosis, modulate inflammation, and increase angiogenesis and cellular proliferation. This procedure is often accompanied by PRP. Who benefits? Individuals with moderate to severe connective tissue injury. ~ Kolber, 2019 Part Three: Surgical Interventions Meniscus Repair SURGICAL INTERVENTIONS What is it? Arthroscopic suturing and fixation of the injured area of the meniscus. Who benefits? Patients with meniscus lesions that have not responded to conservative care and are in an area with adequate vascularity. Meniscectomy SURGICAL INTERVENTIONS What is it? Arthroscopic removal and debridement of the injured area of the meniscus. Who benefits? Patients with meniscus lesions that have not responded to conservative care and are in an area with inadequate vascularity. Microfracture SURGICAL INTERVENTIONS What is it? Arthroscopic debridement of the joint surface is followed by surgical puncture (micropenetration) of the underlying bone. This tissue disruption allows bone marrow clotting to bring stem cells which stimulate new, healthy bone and cartilage growth. Who benefits? Patients with focal chondral defects. ACL Reconstruction SURGICAL INTERVENTIONS What is it? Surgical removal of the injured ACL and replacement with a graft harvested from the patellar ligament, the semitendinosis, or an organ donor (allograft). Multiple techniques exist for attachment of the graft material. Who benefits? Patients who experienced a tear of their ACL. Total Knee Replacement SURGICAL INTERVENTIONS What is it? Open surgical removal of the distal femur and proximal tibia. Components are implanted on the femur and into the shaft of the tibia and (often) held with bone-cement. The patella may or may not be resurfaced, and the cruciates may or may not be spared. Who benefits? Patients with moderate to severe osteoarthritis. IF YOU REFER OUT, WHAT MIGHT AWAIT THE PATIENT?