Osteoarthritis Knee Joint..
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8/12/2019 Osteoarthritis Knee Joint..
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OSTEOARTHRITIS
KNEE JOINT
YUSUF KHAIRUL
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Pendahuluan
OA merupakan kelainan degenerasi
Pada knee joint gerakan sendi
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Knee
Type ginglymus transversal
Komplek
3 joint : 2 Tibiofemoral joint
Patellofemoral joint
4 ligamen : ACL,PCL,MCL,LCL
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3 plane: sagital, frontal, transversal
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Gerakan :
full extensi – full flexi :0 - 140°
hiperextensi 3 - 4°
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Contact point dari full extensi-full flexi:
bergerak ke posterior
lateral : 5 mmmedial : 12 mm
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Screw Home Mechanism
Contact area medial 1,6 > lateral
Flexi : - LCL kendur, MCL tegang
condylus femur lateral berputar 15 -20° lebih jauh
internal rotasi tibia
Extensi : dihambat ACL menarik Areaintercondilaris ant ke lateral
external rotasi tibia
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Instant center TF joint
Semicirculer
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Patellofemoral joint
2 plane : frontal > dominan
transversal
Gaya reaksi PF jointquadriceps force
knee flexi angle
Flexi = quadriceps force
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Berjalan
Knee tidak pernah extensi total (flexi 5°)
awal stance phase
akhir stance phaseFlexi maksimal 75° = tengah swing phase
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Meniscus
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74% air
fibrocartilago
Fungsi : load bearing, shockabsorption, lubrikasi sendi
# meniscus = contact area 6 2 cm2
tekanan ke cartilago
Flexi gaya 10%
Extensi gaya 50%
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Ligamentum
MCL
2 lapis : superfisial
profundaMenahan valgus stess
Defisiensi 45°
3x cedera meniscus
medial
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LCL
Menahan varus
Extensi = tegang
Flexi > 30° relax
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ACL
Menahan translasi tibia ke anteriorFlexi 90° berperan 85%
Menahan varus / valgus tibia (sekunder)
Flexi 10 - 30° internal rotasi dibantu ACL
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Origo – insertio serabutnya berputar 90°
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PCL
Menahan translasi posterior tibia
2x > kuat ACLDefisiensi = external rotasi
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Primer secunder stabilizer
MCL menahan angulasi valgus
ACL menahan translasi tibia ke anterior +
menahan angulasi valgus
Cedera MCL # instabilitas ACL intak
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Patella
lever arm
Membantu stabilisasi (melawan articuler
surface ke trochlea)
Transmisi guadriceps force
Pelindung condylus femurkosmetik
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Full flexi : lever arm 10%
Extensi 45° : lever arm 30%
Extensi > 45°: lever arm quadriceps
0 - 15° flexi : quadriceps 60%
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OSTEOARTHRITIS
OA kelainan sendi kronik dimana terjadi
pelunakan dan disintegrasi cartilago sendi
disertai pertumbuhan cartilago dan tulang baru pada tepi sendi (osteofit) dan fibrosis
capsular sendi
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ETIOLOGI
Primer :
usia, crystal deposition disease, genetik
Sekunder :trauma, meniscectomy
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Pathogenesis
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PATHOLOGI
Progressive cartilage destruction
Subarticular cyst formation
Sclerosis of the surrounding boneOsteophyte formation
Capsular fibrosis
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CLINICAL FEATURES
Pain
Stiffness
SwellingDeformity
Loss of function
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MANAGEMENT
Early treatmentmaintain
movement&muscle strenght, protect joint
from overload, relieve pain,modity daily
activity.
fisioterapy, load reduction and analgesic
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LATE TREATMENT
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