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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