OSTEOARTHRITIS

Shofie Sabatini Verayunia

 Anamnesa

Pasien datang dengan keluhan nyeri lutut

Objective (1)
Objective (2)
 Special Test (1)
• Patellar Grinding: surface of posterior
patella & femur: (+) roughness
 Special Test (2)
• Valgus (MCL) & varus (LCL) stress test:
(+) gapping
 Special Test (3)
• Anterior & Posterior Drawer
• (ACL & PCL): (+) translasi
 Special Test (4)
• Lachman test (ACL): (+) translasi
 Special Test (5)
• Pivot shift test (ACL)
• Supine. Apply IR, valgus
stress, slight flexion. (+)
translasi
• In slight flexion, the
secondary restraints (i.e.,
hamstrings, lateral
femoral condyle, lateral
meniscus) are less
efficient than in full flexion
 Special Test (6)
• McMurray: Meniscus med ER, lat IR: (+)
snap/click
 Special Test (7)
• Apley Compression (meniscus) &
• Distraction (ligament collateral)
Kriteria Diagnosis ACR
Planning
Definition
 Degenerative condition of the joint
articular cartilage with subsequent
formation of marginal osteophytes, sub
chondral bone changes, fibrous reaction of
synovium and capsular thickening.

• OA is a nonerosive, non inflamatory progressive

disorder of the joints leading to deterioration of the
articular cartilage and new bone formation at the joint
syrface and margins. (Cuccurulo, 2015).
Anatomi Sendi Lutut
• 3 sendi: femurotibial, patellofemoral, dan tibiofibular proksimal.
• Femurotibial = sendi synovial (true joint), punya: 1) kartilago
artikular, 2) tulang subkondral, 3) cairan synovial dan 4) kapsul
sendi
• 2o freedom of motion: F/E, IR/ER (IR = saat fleksi)
• Struktur terkait
1. Meniscus: medial (C-shaped) & lateral (O-shaped)
Fx: deepen articular surface; increased force dispersion to the tibial
plateau
2. Ligamen:
a) Cruciate (ACL cegah translasi anterior, PCL cegah translasi
posteror)
b) Collateral (MCL menahan valgus stress, LCL menahan varus
stress)
3. Bursa: outpocketing of synovial membrane
a. Anterior: prepatellar (bursitis = housemaid’s knee), suprapatellar,
infrapatellar
b. Posterior (distensi bursa = Baker’s cyst)
c. Medial: pes anserinus bursa. Antara MCL dan pes anserinus*
* tendon SGT: Sartorius, Gracilis, semiTendinosus
a. Lateral
 Faktor Resiko
• Usia, JK, obesitas, cedera sendi
(>>meniscus/ACL), quadriceps weakness

G enetic
A ging
M etabolism
E xcessive movements
 Patofisiologi OA
• Wear & Tear (karena weight bearing) + Inflamasi
• Kerusakan kartilago: karena pada OA, degradasi>sintesisnya
• Kartilago = kondrosit + matriks ekstrasel.
• Matriks = kolagen + proteoglikan (glikosaminoglikan, as. hyaluronat,
protein) + cairan sendi
• Beban yang berlebih/ mediator inflamasi* → produksi MMP (matrix
metalloproteinase) → degradasi matrix → destruksi
• Destruksi kartilago juga bikin kelainan di tulang subkondral (sklerosis)
& synovium (sinovitis) yang bikin destruksi makin parah.
• *Faktor proinflamasi = COX-2, NO, IL1β, IL-6 dan PGE2
Hub OA dengan penyakit yg lain