Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

well done. Thanks, Seb. So the meniscus we're gonna finish off on, okay. It's a highly specialized fibrocartilage structure. Simple. Yeah, very repetitive. So the meniscus has got multiple functions. It transmits load across the joint. It increases congruity, and it acts as an AP stabilizer. It apparently helps with synovial fluid distribution. And there is a small element of pro preception. Um, I'll describe it for you guys. So the meniscus is made up of a cellular structure which includes your fibro chondrocytes and an EXTRACELLULAR matrix, which is produced by the Fibro chondrocytes. Okay, it's predominantly water, but has got collagen and a non collagen component. And meniscus is type one collagen. Okay, there are a few. There's about 10% of other collagen types, but it's a very small number. So you have to remember one thing. It's type one collagen, the non college and components again, our elastin and protid like hands, which you should now be able to draw. Okay, so this is the structure of our meniscus. In a cross section, we have a deep layer which is made up of these circum French, all collagen fibers. Okay, they are running the full length of this meniscus. They're wrapped in the superficial and surface layer, which are readily organized collagen. Okay. And this is what gives the different types of strength. Okay, So deep fiber in its circumferential, uh, alignment is resisting hoops stresses, and the surface and superficial work together to prevent longitudinal splits forming. And by doing that, resist compression. All right, so I'm going to try and just demonstrate this to you with some spaghetti. Okay, So this if you imagine you can see it, can't you? This is spaghetti. It's fixed at both ends in the same way that your meniscal roots are okay. It hasn't got a superficial or a surface layer. It's literally just the circumstantial fibers. And when I provide a force to it, it spreads out and gets wide. And you can see that there's longitudinal splits in it now. Yeah. So it's not strong a tour. It doesn't resist anything. Okay. And it's not of any use. Yes, I remember that. And then if we take my other sample just broke some spaghetti off here. You can see the end on. Where's my camera? Here. This is your deep fibers end on, and they're covered in a superficial and surface layer. And when I produce a force onto this, where there is it there? It doesn't spread open. Yeah, So you can see that it gives it much more strength. And it's resisting those forces that I'm applying to it. So I've given you to hear they've both got a tear in them, and I'm going to give you to suture techniques. The purple is a vertical, and the pink is a horizontal suture. Which one's stronger, which is the better repair? Uh, the vertical loan will be better because it covers the, uh, the deep layer, Uh, collagen fibers, uh, for the whole circumference. Yeah. So it captures far more of the deep layer, okay, and holds them together. So it's recreating holding them together, like we saw earlier with this one. All right. Whereas when you have just the horizontal, it barely captures any because it's in the direction of the circumstantial fibers. Uh, I tried to demonstrate this on the spaghetti, but I don't know if it'll work. We'll see. We'll try. Uh, too many threads. Okay. So here this bottom one, I have done a vertical, and I've captured quite a lot of the circum French A while fibers, but on the bottom one, I have done a horizontal. Where's the camera? Horizontal. Oh, it's back to front. Sorry. My driving skills are not so good here, and it's only captured a few of the circum French all fibers. Yeah. So this is not a strong repair. Hopefully that came across on the camera. Okay. Do you mind if I ask? You know, the first spaghetti model which had the wrapping around It was that was that to demonstrate how the superficial and surface layers were at a different orientation to the deep vibes. Is that Is that what it was? Yeah. So, basically, when you don't have a superficial or surface layer, this would happen. And that would be a really rubbish viscous. Yeah. It would just spread out every time we walked on it. But when they're wrapped in the superficial surface layer, which is the rope, when I put the force on it, it can't spread open. And so this when we stand on, it doesn't Doesn't flatten. Okay. Cool. Yeah. Happy. Yeah. Cool. Great. So we've said that the vertical one is the strongest because it's capturing more of the fibers. So 30 seconds with your pieces of paper draw the blood supply to the meniscus. Uh, Drummond is your, um, microphone working now? Yeah, mine. Mine works now. German. Have you got some paper that you can draw for this one? Or I think I think Phil's emailed him instructions about, uh, yeah. Oh, Sebastian's got me a picture. Yeah. Good start, Sebastian. Ashok is taking it one step further, Which is good, Good. Good job, Sebastian. Sebastian, you want to talk through yours? You're muted if you're talking to me. So I've got Hang on. Yeah, Alta Meniscus. And in a meniscus. This inner meniscus is more a vascular, and it gets progressively more vascular outside. I think the majority of the supply comes from a sort of a plex. I think it's the peri, uh, something plex PCP, which essentially indicates that this area is more vascularized. It's more. Got more, um, healing capacity. Which is why you prepare here, as opposed to these which are not going to heal very well or some. Good job. Seb. Ash up. Are you going to add something to it? Muted. So the paper zone is called red zone where the preparations are happening, and then the middle one third is the red white zone, which is, um, having a very minimal blood supply. And white red zone has no blood supplies. So when the when the head is happening around the red zone uh, the healing part and Chile is better But, uh, red white zone is, uh, blood supply is less, uh, the healing potential is lower. Yeah, Perfect. So, yeah, between you guys, you've got the perfect drawing. So the pre meniscal plexus, which I think is what said was alluding to supplies predominantly the outer third of the meniscus, which is your red red zone. And then the rest meniscus is split into thirds. And so you have a red, white and a white white zone. Okay, um, we've already mentioned the lads have said there that you'd consider repairing those that are in the red red zone cause they have a good blood supply. But if you were to repair a white white zone, it wouldn't it wouldn't heal. Okay, As you get further to the periphery, you're healing potential increases. Okay? And the ones that you think about healing as we would have said of it in the red red zone. So its location if the patient has got mechanical symptoms that you think would improve and it's an acute acute tear. All right, the pattern. Okay, So some patterns, for example, would be less likely to heal, such as a radial pattern radial pattern in the white white zone. But if it was a radial pattern that went into the red red zone, you might have part of it that healed. Okay, if you have an ipsilateral ACL reconstruction, generally speaking, you would repair the medial ministers at the same time if it was acute enough. And the tissue quality So a degenerative tear that's really macerated, not likely to heal well in the same way that macerated skin wouldn't heal. Well, so what if you don't have one? What happens if you've had a meniscectomy? Okay. When you have a meniscectomy, you have a decreased surface contact area because it's trying to increases your surface your surface contact area, doesn't it? We said that earlier about it's congruity, and that goes down by about 50 to 70% which overall increases the load per unit area when you're walking which, unsurprisingly, gives you arthritis, all right. But what if you're not born with one and anyone know any syndromes associated with absence or hyperplasia of the ministers may not, so I'm going to move on. Uh, so this is a syndrome that can be associated very rarely with absence of the Penis. Guy does anyone you can just say what it is. You don't have to go too crazy about the condition. I know it's one of those heart sink moments in the exam radio club hand, is it? Yeah, So it's a radio club hand, Um, and then it's a there's a little bit more to it than 100% has got Radio Club hand. There's a separating, distinctive feature about this particular radio club hand. Rachel is the thumb still present? That's why, Omar, there's a thumb. Absolutely. So when you have rayed your club hand and a thumb, you're more likely to have thumb hyperplasia. Uh, so it's a syndrome, so you're more likely to have thrombocytopenia associated with Absent Radius, which is tar syndrome. Okay, so whenever you see a radial club hand, you should always look to see if they have a thumb okay? Because obviously, the child needs to have blood tests, so think tar. And this is an autosomal recessive condition associated with thrombocytopenia and absent radius. And very occasionally they can have absence of their meniscus. I, which might just be medial or lateral or both. And it might affect one knee or both. All right, anyone want to take us through? This was one of my stations, by the way. So, um, anyone want to talk through this? Where's, uh, Ignatius? Okay, which is the front, which is the back, Uh, am I at the front or the back front? That tip up? That's the tibia to prostate. Yeah. And am I lateral or medial? That's lateral. That's lateral collateral. We'll come back to that bit. Yes. So lateral and natural. Natural. That's fine. So what is Structure A? That's a CEO ACL. And then structure be PCO PCO good. Um, structure f lateral meniscus. Yeah, And then G is a muscle that is turning into a tendon before. Yeah, So this is a popular tales tendon. Good. Um, And then if I ask you what is the difference between d and C? The N c. So once a ligament. One is a They're both ligaments. Ligament? Oh, orientation. Uh, any of the lads coming up immediately to their exam Want to advance on C and D? Uh huh. So we've got the PCLs here, and there is a structure going in front of the PCL. And there's a structure going behind the PCL. Humphreys and Weiberg Accessory? Yeah. Yeah, absolutely. Which one's which? Oma Humphreys says at the front. And Wiberg's at the back. Perfect. So the way to remember that is either that they're in alphabetical order from the front H versus W or how I used to remember it was Humphrey would have the hump if he wasn't at the front. Okay, whichever takes fancy. Okay. What are the differences? Any of you guys between the lateral meniscus and the medial meniscus? Oh, we've got to, um, um, lateral meniscus is, uh is smaller and is more mobile. Uh, and it's, um No, that's what I got. That's all right. Any advances? So it's small, and it's semicircular. More than c shaped. Yeah, Iggy Yeah. Medials semicircular and has got less mobility. So it covers medial tibial plateau, which is concave in shape and has, um ligament attachments from that's attached to the medial collateral ligament. Yeah, so the medial meniscus is attached along its entire circumference. Okay, whereas the lateral meniscus is not attached at the area of the popliteal hiatus. Okay, Um, so the lateral meniscus can move and displaces about 11 millimeters in the AP plane. The lateral meniscus is more likely to be discoid than the medial meniscus. It's pretty rare to see a discoid medial meniscus. Yeah. Um, what is the disc when meniscus. Iggy, where there's absence of, um, What do you call it? Basically, it's one big disc so that there's no central portion where it's void of Yes, there's no central void. Good. So the transmission of load is abnormal. So we've already talked about the blood supply to the meniscus. This time I want to take it a step further, and you may or may not know the answer to it, and I think it would be kind of totally extra in the FSGs. But does anyone know what happens to the blood supply over time to the meniscus? Oh, I didn't tell him. You go first. It decreases with age. Yeah. What kind of age are we talking about? Um uh, less like by 30. The blood supply is significantly worse and has much less capacity to heal. Yeah, So the meniscus is formed in you, tra about day 45 when you're born, your entire meniscus is vascularized. There is no red, red, red, white, white, white zone. Okay, the whole thing is vascularized. And by about nine months, the central portion starts to become a vascular, and it becomes less and less vascular about the age of 10. And so from 10 onwards, that's when your zones have appeared. If anyone was interested, I thought that was cool. Good. So we've covered this already, Humphrey at the front reberg at the back, and we just recap the blood supply. Um, good. So really, to summarize, we've kind of talked about the macro and the microscopic structure of these tissues. We've talked about how they heal, which is pretty much the same for all three, and we've applied it to some clinical stations and done a little bit of Iver to figure out how they might come up in the exam. Right. Um, top exam tips is always to keep it simple. Don't dig yourself a hole that you can't get yourself back out of. All right. You must must must show you're working. You can't just rush in and deliver kind of level eight evidence without having shown that you understand the basic principles. So a little bit like when you're at senior school doing math, Like if you didn't show your working, you didn't get the points. Even if you got the right answer. Yeah. So do the basics. Well, and do the basic do the basics fest. And ultimately, in the part to it is meant to be a conversation with colleagues. Okay. They don't want a load of detail just thrown, rammed down their throat, so to speak. Okay, They want it to be a conversation. So stop and let them speak and let them guide where they want you to go with the conversation. Right. Any questions, guys? Okay, thanks. No problem. If there's no questions, then I shall head off. Uh, thank you all for signing in is a little bit of a working progress for us. First time that we're using this platform. Um, so if you could do the feedback, that would be very helpful. Thanks. a lot. Okay. No worries, guys. See you soon. Bye. I'll bring you in a big cake. No, no prob six.