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Clinical Anatomy
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Case presentation
• History:
➢ 70 years old lady, DM, HTN
➢ Bilateral mechanical knee pain for 10 years
➢ Progressively increasing with time
➢ Noticed a deformity 2 years back
➢ Deformity and occasional pain in the smalljoints of both hands
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• Knee examination:➢ Varus deformity bilaterally➢ Tender medial joint line bilaterally➢ ROM 10 – 100 degrees
• Hand examination:➢ Multiple small joint nodules➢ No redness
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What do you think?
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Hyaline cartilage
• Decreases friction and distributes loads.➢ Extracellular matrix
1. water (6580%),2. 90% type II collagen (1020%),3. proteoglycans (1015%)
➢ cells (chondrocytes)
• Cartilage is avascular; Nourished by:✓ synovial fluid at the surface✓ subchondral bone at the base
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Pathology
• Articular cartilage ➢ increased water content➢ alterations in proteoglycans: eventual decrease in amount➢ collagen abnormalities: organization and orientation are lost➢ binding of proteoglycans to hyaluronic acid
• Synovium and capsule➢ early phase: mild inflammatory changes in synovium➢ middle phase: moderate inflammatory changes of synovium,
hypervascular➢ late phases: synovium becomes increasingly thick and vascular
• Bone➢ subchondral bone attempts to remodel➢ bone cysts form in late stages
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Stages
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Intraoperatively
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RA