PHTH 511 - Pathophyisology I > Cartilage > Flashcards

Cartilage Flashcards

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1
Q

Describe the layers of synovial joints from inner to outermost.

A
  1. Synovial cavity filled with synovial fluid produced by synoviocytes
  2. Articular cartilage (reminants of chondral templates in embryonic stage)
  3. Capsule
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2
Q

What are the components of synovium?

A
  1. Intima
  2. Stroma
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3
Q

What is intima?

A
  • Synoviocytes
  • Produce synovial fluid
  • Phagocytose joint debris
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4
Q

What is stroma?

A
  • Loose or dense irregular connective tissue
  • Blends with fibrous joint capsule
  • Cell populations include macrophages, lymphocytes, mast cells
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5
Q

What is the join capsule composed of?

A

Dense, irregular connective tissue

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6
Q

What is the function of the joint capsule?

A

1) Joint stability
2) Structure
3) Vessel/nerve supply

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7
Q

Joint capsule contains many ______________, involved in joint proprioception.

A

mechanoreceptors

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8
Q

How is the organization of the joint capsule in compared to tendons?

A

Tendons are highly aligned and regular whereas capsule is less regular and sees a lot of variation and directions of force.

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9
Q

What is the joint capsule reinforced by?

A

Areas of dense connective tissue

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10
Q

Joint capsule often blends in with ____________.

A

Ligaments

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11
Q

Describe the composition of articular cartilage.

A

1) Populated by chondrocytes
2) Contain lots of glycosaminoglycan
3) Mainly type II collagen

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12
Q

How does cartilage attach to bone?

A

At the osteochondral junction, collagen fibres
from the radial zone of the calcified cartilage
insert directly into the CORTICAL bone

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13
Q

Why is osteoporosis protective against OA development?

A

Due to the spongyness of the bone in osteoporosis, which adds to shock absorbing capacities.

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14
Q

Describe the “physis”.

A

A plate of proliferating cartilage that unites bones during skeletal growth.

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15
Q

Define Osteochondrosis.

A

Inflammation of cartilage due to overuse or biomechanical factors.
- e.g. Osgood Schlatter in young athletes

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16
Q

Describe the healing of cartilage in synovial joints.

A
  • Cartilage has extremely limited healing capacity due to lack of vessels
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17
Q

In adults, cartilage defects larger than _________ in width or length are thought to rarely, if ever heal.

A

2 mm

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18
Q

What is the definition of primary healing in cartilage?

A

Very small defects can potentially heal by:

1) Local proliferation of chondrocytes
2) Production of new extracellular matrix

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19
Q

What is the definition of secondary healing in cartilage?

A

If the defect extends into the bone then an inflammatory/repair response can occur and healing can happen via scar tissue formation

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20
Q

Define acute chondral injuries.

A

An acute mechanical disruption of articular cartilage.

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21
Q

Describe Type 1 chondral lesions.

A

1) Usually results from a major SHEARING force through the cartilage typically in association with a ROTATIONAL injury
2) May or may not be involvement of other structures (e.g. ligament)

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22
Q

Describe Type 2 chondral lesions.

A

1) Results from EXCESSIVE COMPRESSIVE or ROTATIONAL force
2) Underlying BONE may also be BRUISED (seen on MRI)
3) Sometimes there is a flattening or impression in the centre of the lesion, other times there is an edematous “blister” (underlying hematoma)

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23
Q

Describe Type 3 chondral lesions.

A

1) Probably ROTATIONAL TRAUMA
2) Many athletes cannot recall a specific incident
3) May present similar to a MENISCUS TEAR (sensations of catching or locking)

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24
Q

Describe Type 4 chondral lesions.

A

1) The tear occurs at the tidemark – between the CALCIFIED and NON-CALCIFIED cartilage
2) More common in adults
3) Loose bodies (cartilage fragments) are found most frequently with this type of injury
4) Inflammatory reaction in synovium likely, +/- sensations of catching or locking

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25
T/F: Overall prevalence of full-thickness focal chondral defects in athletes' knees is higher than in general population.
True
26
What are the risk factors for chondral injuries?
1) Trauma to the joint 2) Advancing age
27
T/F: In patients with ankle dislocation, those with chondral lesions had significantly worse outcomes than those without them.
True
28
What is the pathophysiology of chondral injuries?
1) Acute OVERLOAD of cartilage tissue leads to a structural disruption of the extracellular matrix, and necrosis of chondrocytes 2) Increased loading of chondrocytes at the margins of the injury predisposes them to further NECROSIS / injury 3) Often associated with other joint injury, but can occur in isolation 4) Small injuries initiate a cascade of events that can lead to progressive degenerative change, ending finally in OSTEOARTHRITIS
29
Why is the damage progressive in chondral injuries?
1) Lack of HEALING leads to permanent defect 2) Increased TENSION and SHEAR forces across the edge of the lesion predispose to further injury 3) INFLAMMATION in synovium or underlying bone due to release of cartilage/chondrocyte fragments leads to abnormal environment for chondrocytes (catabolic)
30
What are some signs and symptoms of chondral lesions?
1) Asymptomatic initially 2) Pain, muscle spasm, swelling (due to synovial inflammatory reaction to cartilage fragments), catching or locking sensations 3) Identified during management of an associated injury (e.g. ligament rupture, joint subluxation or dislocation)
31
When should be suspect a chondral injury?
If a “simple joint sprain” is painful and swollen for longer than expected
32
What are some diagnostic tests associated with chondral injuries?
MRI and/or arthroscopy may be more helpful
33
Why is X-ray not a useful diagnostic tool for isolated chondral injuries?
An isolated chondral injury appears normal on an X-ray
34
What is the treatment overview for chondral defects less than 2cm^2?
Conservative treatment
35
What is the treatment overview for chondral defects more than 2cm^2?
1) Mosaicplasty 2) Subchondral drilling 3) Periosteal transplant
36
What is the PT treatment overview for chondral injuries?
1) Post-op rehab specific to the procedure used 2) Early continuous passive motion and a period of NWB are prescribed, to prevent complete tissue atrophy, while allowing the graft to heal 3) POLICE 4) E-stim 5) Gradual increase in ROM and load according to surgeon’s guidelines, respecting the times required for tissue healing and monitoring cardinal signs closely
37
What are the hierarchical components of rehabilitation exercise program?
1) Motor re-education and muscle activation 2) Proprioception, strength and flexibility 3) Skill acquisition 4) Return to sport
38
Define Osteoarthritis.
OA is a pathology characterized by morphologic, biochemical, molecular and biomechanical changes of cells and matrix which lead to softening, fibrillation, ulceration and loss of articular cartilage, sclerosis and eburnation of subchondral bone, osteophytes, and subchondral cysts.
39
T/F: Osteoarthritis is a degenerative condition
True
40
What are the structural characteristics associated with OA in synovial joints?
1) Focal loss of bone 2) Thickened capsule 3) Limited synovitis 4) Early focal degenerate lesion 5) Altered bone turnover/ sclerosis 6) Decreased joint space 7) Thickening of bone under the joint
41
Describe the 3 main factors leading to primary OA.
1) Mechanical history --> occupation and BMI 2) Age --> cartilage weakening 3) Genetic predisposition --> poor cartilage matrix production, excessive inflammatory response
42
Define secondary OA.
When OA is caused by another condition.
43
What are the 2 crystal deposition diseases leading to secondary OA?
1) Gout 2) Pseudogout
44
What are the general risk factors for knee OA?
1) Age 2) Increased BMI 3) Particular alignment faults (varus or valgus knee)
45
What is the initial event in OA?
1. Abnormal stress on normal chondrocyte 2. Normal stress on impaired chondrocytes
46
What are the steps in knee OA?
1) Subchondral thickening --> sclerosis of the bone under cartilage 2) Early cartilage lesion 3) Inflammation of synovium 4) Inflammation of chondocytes 5) Inflammation of bone 6) Eburnation, osteophytes, osteonecrosis and bone cysts 7) Joint destruction 8) Soft tissue changes 9) Muscle changes
47
Define "Eburnation".
Fomration of really dense bone
48
Define "bone cysts".
New scar tissue formation under the cartilage
49
What are the soft tissue changes associated with knee OA?
1) Ligaments tend to become lax can be tested with specific ligament tests 2) As OA progresses, laxity disappears or reverses as joint capsule stiffness/ fibrosis develops 3) In combination with pain and muscle weakness, can contribute to knee instability
50
What are the muscle changes associated with knee OA?
1) Ligament changes and increased joint pressure can lead to inhibition of muscles around the joint 2) As little as 5ml effusion in the joint can lead to 25% inhibition of quadriceps activation 3) Muscle wasting, especially VM 4) Feelings of giving way (dynamic instability)
51
What are the boney changes associated with OA?
1) Subchondral bone thickening 2) Osteophytes 3) Loose bodies
52
What are the causes of instability associated with OA?
1) Altered joint mechanics 2) Ligament laxity 3) Muscle inhibition 4) Pain
53
What is the criteria for knee OA?
Presence of knee pain plus at least 3 of following: 1) Age greater than 50 years 2) Morning stiffness lasting less than 30 minutes 3) Crackling or grating sensation (crepitus) 4) Bony tenderness of the knee 5) Bony enlargement of the knee 6) No detectable warmth of the joint to the touch
54
What is a common grading system used for Osteoarthritis?
Kellgren-Lawrence grades
55
Describe "Hemophilia".
- A group of hereditary or spontaneous disorders in which COAGULATION is IMPAIRED, leading to episodes of uncontrolled bleeding - Repetitive bleeding into joint results in synovitis and cartilage breakdown
56
Describe "Gout".
- Uric acid crystals form as a result of excessive uric acid production or insufficient excretion - Crystals are deposited in synovium, cartilage, tendons
57
________ is the most common inflammatory arthropathy.
Gout
58
What population is most affected by gout?
Mainly affects middle aged men and women
59
How is gout diagnosed?
Diagnosed by MD through blood testing for urate
60
What is a useful treatment for gout which is often neglected?
Urate-lowering treatment (ULT)
61
Describe pseudogout.
- Different types of crystals (calcium pyrophosphate) are deposited in synovium and cartilage - No trophi formation
62
What are the risk factors for pseudogout?
1) Age 2) Prior injury 3) Family history
63
How is pseudogout diagnosed?
Diagnosed by MD through x-ray and/or joint aspiration
64
What are the 3 main treatments for gout and pseudogout?
1) NSAIDs 2) Corticosteroids 3) Uric Acid lowering medications (Gout only)
65
What are some non-pharmacological treatment recommendations for gout and pseudogout?
1) Relative rest during flare-ups --> walking aids, bracing, activity modifications 2) Education --> crystal deposition happens even during interval periods and can progress if not medically controlled 3) Appropriate referral
PHTH 511 - Pathophyisology I
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