Advances in cartilage and soft tissue injuries of the knee
|
|
- Katrina Tate
- 5 years ago
- Views:
Transcription
1 Advances in cartilage and soft tissue injuries of the knee Dr Tim McMeniman BSc(Med)/MBBS (UNSW), FRACS (Orth) Senior Lecturer, University of Queensland
2 Declarations Mater Health Services Visiting Medical Officer University of Queensland Senior Lecturer Private Orthopaedic Practice - BOSMC No royalties or consultancies
3 Outline Posterior horn menisal avulsion and repair ACL Reconstruction Rationale and current issues PCL and collateral ligament injuries Patella instability PRP injections Explanation and applications Chondral replacement
4 Posterior root avulsion Increasingly recognised - MRI 2 groups of patients Acute traumatic younger Sudden onset pain in older patients with early degeneration Consequences Accelerated chondral degeneration Osteonecrosis
5 Selected Literature Contact pressure increases to that of total meniscectomy Harner et al, JBJS(A) 2008 and 2009 Repair restores function, but not completely Kim et al, KSSTA 2013 Suture fixation in the meniscus is the critical factor La Prade et al, AJSM 2014
6
7
8
9
10 Typical history 2 groups Those associated with ACL disruption Usual features of an ACL rupture, more severe pattern of injury Isolated avulsion
11 Isolated avulsion Often older patient (50+) Knee with minimal preceding symptoms Minor or no recollection of a significant antecedent injury
12 Isolated avulsion Significant pain usually medial and posterior, NSAIDs often of little benefit Night pain Associated significant swelling Mechanical features not prominent Often resort to walking aides
13 Technique 2 Portal arthroscopy Menisco-tibial portion of the MCL frequently needs to be released Drilling under direct vision from anteromedially to the posterior root of the meniscus Sutures are placed in the horn Sutures retrieved down the bone tunnel by use of a lead suture
14
15
16
17
18
19
20
21 Case example 43 yo tradesman ACL rupture? 3 years prev - untreated Minor instability episodes Playing AFL - major instability episode
22 Arthroscopy
23
24
25
26
27
28
29
30
31
32
33
34 Postoperative Rehab Much as for a normal meniscal repair Protected weight bearing (NWBing to PWBing) out to 6/52 Avoidance of loaded flexion >90 deg out to 3 months. All patients followed to 3 months routinely (2/6/12 week appts)
35 BOSMC series P Myers/T McMeniman/B Collins 51 Patients Follow-up 3 months to 12 years Age range 12 to 71 years (Average 49.7) One bilateral case - 12 months between presentations
36 Outcomes Patients followed to 3 months all report decrease in pain aside from 1 in our series Established AVN at time of surgery Often patients notice immediate decrease in pain? Deep MCL release? LA? Non weight bearing? Effect of Meniscal repair
37 Complications Reoperation 1 DVT 2 Below knee 1 Above knee
38 Meniscal dettachment If recognised should be dealt with Safe and reproducible technique Chondral damage (Age) not necessarily a contraindication If not repaired - the remnant posterior horn should not be extensively resected. Anticoagulation post op advisable
39 ACL reconstruction What is it?
40
41 ACL normal and ruptured
42 ACL reconstruction What does it do? Stabilises the knee in rotation and prevents the tibia moving forward on the femur. What are the consequenses of injury? Instability Further damage to meniscii and cartilage surfaces
43 ACL reconstruction How does it get injured Sidestep gone wrong Netball Touch Football Contact injury Hyperextension Snow skiing and to a lesser extent snowboarding
44
45 Symptoms Pain Swelling almost immediately Blood Stiffness pain and swelling slowly subside over 2 to 4 weeks Instability the reason to reconstruct
46 Pivot Shift Test
47 Treatment options Live life in a straight line Rehabilitation Reconstruction
48 ACL Indications Symptomatic instability despite appropriate rehabilitation 1 strike, your out (PM Philosophy) Anticipated high demand pivoting activity Controversial Recent studies Roe et al (North Syd) Spontaneous healing of ACL in 3% KANON study (Lund University, Sweden) No difference in randomised controlled trial of surgical versus non surgical Choi et al AJSM 2012 hamstring tendon regeneration
49 Graft Choice Autograft Hamstrings Bone Patella Tendon Bone (BPTB) Quads tendon Allograft As above plus tib post, tendo achilles Synthetic Numerous tried over the years Unfortunately high failure rate LARS ligament may do better
50
51 ACL Reconstruction - Fixation
52 Results Excellent for stability 95% success Rerupture rate 2 to 5 % No evidence as yet that it prevents osteoarthritis Highly controversial I strongly believe a stable knee is less likely to develop arthritis.
53 PCL Multiligamentous injury MCL/PCL likely an exception if managed well non surgically Grade 3 laxity with symptomatic instability Implies posterior capsule injury (PLC/POL) Lars ligament Evidence as yet a little light Not to prevent OA
54 MCL Rarely requires surgical intervention Most often proximal tears which heal well Always residual laxity test with co-contraction Proximal avulsion with ongoing symptoms, especially in external rotation Williams et al JBJS(B) Distal avulsion Stenner lesion of the knee Chronic laxity and instability (+/- ACL recon)
55
56 LCL and Posterolateral corner Repair if 3 weeks old or less Reconstruct if beyond acute phase? Role of extent of laxity Dial test 90 and 30
57
58
59
60 Anterolateral ligament of the knee
61
62 Multiligamentous knee dislocation Uncommon injury in sport Heterogenous group of injuries NV status 1 st priority Good evidence for early surgical repair or reconstruction of these injuries
63 Meniscal tears To repair or not In conjunction with ligamentous injury Ideal patent, normal meniscal tissue, in conjunction with ACL recon, vascular zone. Controversial Isolated meniscal tears Radial tears Meniscal root avulsions Technique: Inside-out or fast fix Inside out remains the gold standard
64 Patella instability 3 factors in stability of the PFJ (or any joint) Bony Static soft tissue Dynamic soft tissue 1 st time dislocators rehab Only indication is a chondral or ostochondral loose body.
65 Patellar instabaility Patella alta Trochlea dysplasia Increase Q angle Ligamentous laxity Ruth Wynne-Davies MPFL injury Role of rotation
66 Patella Alta Lower over higher Insall-Salvati /-0.13 Blackburne- Peele 0.95 normal
67
68
69
70 Q angle < 15 deg in men <20 deg in women Race dependant High intraobserver variablity Value of TTTG
71 MPFL
72 MPFL
73 Patella tendinopathy Management rarely surgical Role of injections PRP Dextrose Open excision for large areas of chronic tendinosis Arthroscopic debridement of proximal tendon and distal pole of patella
74 Platelet Rich Plasma (PRP) Derived from patients own blood Centrifuged 4 x platelet count Multiple growth factors Injected with or without activator
75 PRP: What is it used for? Non surgical Tennis and golfer s elbow Patella tendinitis Plantar fasciitis Knee osteoarthritis
76 PRP: What is it used for Surgical in combination with Achilles tendon repair Rotator cuff repair ACL reconstruction Chondral injury
77 PRP: Does it work? Many small studies showing a benefit when compared traditional results or with placebo Problems: Most of these conditions self limiting There is an expense associated with the techniques use
78 Surgery for cartilage defects Difficult surgical problem No clear solution Many options but no magic bullet
79 Options Debridement Microfracture Autologous chondrocyte implantation ACI, MACI, allograft chondrocyte etc Mosaicplasty
80 Debridement Pro Quick and easy No significant rehab Minimal pain in short term Cheap Cons Long term degeneration almost guaranteed Ongoing pain likely
81 Microfracture Pros Relatively easy Cheap, A/S Good long term follow up with reasonable results Cons Significant rehab period Not good for large lesions Late failure rate now recognised
82 Chondrocyte implantation Pros: Better cartilage on testing?slightly better long term results than microfracture ep in big defects Cons Very expensive 2 operations Usually open Just been removed from MBS
83 Mosaciplasty Pros: One operation Normal cartilage Reasonable results Cons: Donor site morbidity Results inferior in series to other methods Open operation
84 Thanks for your attention Questions?
ACL Athletic Career. ACL Rupture - Warning Features Intensive pain Immediate swelling Locking Feel a Pop Dead leg Cannot continue to play
FIMS Ambassador Tour to Eastern Europe, 2004 Belgrade, Serbia Montenegro Acute Knee Injuries - Controversies and Challenges Professor KM Chan OBE, JP President of FIMS Belgrade ACL Athletic Career ACL
More informationPatellofemoral Pathology
Patellofemoral Pathology Matthew Murray, MD UT Health Science Center/UT Medicine Sports Medicine and Arthroscopic Surgery I have disclosed that I am a consultant for Biomet Orthopaedics. Anterior Knee
More informationAnterior Cruciate Ligament (ACL) Injuries
Anterior Cruciate Ligament (ACL) Injuries Mark L. Wood, MD The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. The incidence of ACL injuries is currently estimated
More informationACL AND PCL INJURIES OF THE KNEE JOINT
ACL AND PCL INJURIES OF THE KNEE JOINT Dr.KN Subramanian M.Ch Orth., FRCS (Tr & Orth), CCT Orth(UK) Consultant Orthopaedic Surgeon, Special interest: Orthopaedic Sports Injury, Shoulder and Knee Surgery,
More informationSOFT TISSUE INJURIES OF THE KNEE: Primary Care and Orthopaedic Management
SOFT TISSUE INJURIES OF THE KNEE: Primary Care and Orthopaedic Management Gauguin Gamboa Australia has always been a nation where emphasis on health and fitness has resulted in an active population engaged
More informationMedical Practice for Sports Injuries and Disorders of the Knee
Sports-Related Injuries and Disorders Medical Practice for Sports Injuries and Disorders of the Knee JMAJ 48(1): 20 24, 2005 Hirotsugu MURATSU*, Masahiro KUROSAKA**, Tetsuji YAMAMOTO***, and Shinichi YOSHIDA****
More informationOverview Ligament Injuries. Anatomy. Epidemiology Very commonly injured joint. ACL Injury 20/06/2016. Meniscus Tears. Patellofemoral Problems
Overview Ligament Injuries Meniscus Tears Pankaj Sharma MBBS, FRCS (Tr & Orth) Consultant Orthopaedic Surgeon Manchester Royal Infirmary Patellofemoral Problems Knee Examination Anatomy Epidemiology Very
More informationANTERIOR CRUCIATE LIGAMENT INJURY
ANTERIOR CRUCIATE LIGAMENT INJURY WHAT IS THE ANTERIOR CRUCIATE LIGAMENT? The anterior cruciate ligament (ACL) is one of four major ligaments that stabilizes the knee joint. A ligament is a tough band
More informationW. Dilworth Cannon, M.D. Professor of Clinical Orthopaedic Surgery University of California San Francisco
Knee Pain And Injuries In Adults W. Dilworth Cannon, M.D. Professor of Clinical Orthopaedic Surgery University of California San Francisco Pain Control Overview Narcotics rarely necessary after 1 st 1-2
More informationMinimally Invasive ACL Surgery
Minimally Invasive ACL Surgery KOCO EATON, M.D. T A M P A B A Y R A Y S ( 1 9 9 5 P R E S E N T ) T A M P A B A Y B U C C A N E E R S ( 2 0 1 5 2 0 1 6 ) T A M P A B A Y R O W D I E S ( 2 0 1 4 2 0 1 7
More informationThe Impact of Age on Knee Injury Treatment
The Impact of Age on Knee Injury Treatment Focus on the Meniscus Dr. Alvin J. Detterline, MD Sports Medicine and Orthopaedic Surgery Towson Orthopaedic Associates University of Maryland St. Joseph Medical
More informationACL INJURIES WHEN TO OPERATE
ACL INJURIES WHEN TO OPERATE Ziali Sivardeen BMedSci, (MRCS), AFRCS, FRCS (Tr & Orth) Consultant Trauma and Orthopaedic Surgeon (Shoulder, Knee and Sports Injuries) ziali@theolympiaclinic.com www.theolympiaclinic.com
More informationAnterior Cruciate Ligament (ACL)
Anterior Cruciate Ligament (ACL) The anterior cruciate ligament (ACL) is one of the 4 major ligament stabilizers of the knee. ACL tears are among the most common major knee injuries in active people of
More informationKNEE INJURIES IN SPORTS MEDICINE
KNEE INJURIES IN SPORTS MEDICINE Irving Raphael, MD June 13, 2014 RSM Medical Associates Head Team Physician Syracuse University Outline Meniscal Injuries anatomy Exam Treatment ACL Injuries Etiology Physical
More informationAnatomy and Sports Injuries of the Knee
Anatomy and Sports Injuries of the Knee I. Anatomy II. Assessment III. Treatment IV. Case Study V. Dissection Anatomy Not a hinge joint 6 degrees of freedom Flexion/Extension Rotation Translation Anatomy
More informationAnterior Cruciate Ligament Surgery
Anatomy Anterior Cruciate Ligament Surgery Roger Ostrander, MD Andrews Institute Anatomy Anatomy Function Primary restraint to anterior tibial translation Secondary restraint to internal tibial rotation
More informationACL Rehabilitation and Return To Play
ACL Rehabilitation and Return To Play Seth Gasser, MD Director of Sports Medicine Florida Orthopaedic Institute Introduction Return to Play: the point in recovery from an injury when a person is safely
More informationSTATE OF THE ART OF ACL SURGERY (Advancements that have had an impact)
STATE OF THE ART OF ACL SURGERY (Advancements that have had an impact) David Drez, Jr., M.D. Clinical Professor of Orthopaedics LSU School of Medicine Financial Disclosure Dr. David Drez has no relevant
More informationOn Field Assessment and Management of Acute Knee Injuries: A Physiotherapist s Perspective
On Field Assessment and Management of Acute Knee Injuries: A Physiotherapist s Perspective Jessica Condliffe Physiotherapist / Clinic Manager TBI Health Wellington Presentation Outline Knee anatomy review
More informationMedical Diagnosis for Michael s Knee
Medical Diagnosis for Michael s Knee Introduction The following report mainly concerns the diagnosis and treatment of the patient, Michael. Given that Michael s clinical problem surrounds an injury about
More informationNo Disclosures. Topics. Pediatric ACL Tears
Knee Injuries in Skeletally Immature Athletes No Disclosures Zachary Stinson, M.D. 2 Topics ACL Tears and Tibial Eminence Fractures Meniscus Injuries Discoid Meniscus Osteochondritis Dessicans Patellar
More informationANTERIOR CRUCIATE LIGAMENT (ACL) INJURIES
ANTERIOR CRUCIATE LIGAMENT (ACL) INJURIES WHAT IS THE ACL? The ACL is a very strong ligament on the inside of the knee. It runs from the femur (thigh bone) obliquely down to the Tibia (shin bone). The
More informationGrant H Garcia, MD Sports and Shoulder Surgeon
What to Expect from your Anterior Cruciate Ligament Reconstruction Surgery A Guide for Patients Grant H Garcia, MD Sports and Shoulder Surgeon Important Contact Information Grant Garcia, MD Wallingford:
More informationKnee Contusions and Stress Injuries. Laura W. Bancroft, M.D.
Knee Contusions and Stress Injuries Laura W. Bancroft, M.D. Objectives Review 5 types of contusion patterns Pivot shift Dashboard Hyperextension Clip Lateral patellar dislocation Demonstrate various stress
More informationManagement of Knee Dislocations
Management of Knee Dislocations Thomas J. Gill, MD Chief, Sports Medicine Service Massachusetts General Hospital Associate Professor of Orthopedic Surgery Harvard Medical School Complex Challenging Multi-Ligament
More informationWhat is an ACL Tear?...2. Treatment Options...3. Surgical Techniques...4. Preoperative Care...5. Preoperative Requirements...6
Table of Contents What is an ACL Tear?....2 Treatment Options...3 Surgical Techniques...4 Preoperative Care...5 Preoperative Requirements...6 Postoperative Care...................... 7 Crutch use...8 Initial
More informationFinancial Disclosure. Medial Collateral Ligament
Matthew Murray, M.D. UTHSCSA Sports Medicine Financial Disclosure Dr. Matthew Murray has no relevant financial relationships with commercial interests to disclose. Medial Collateral Ligament Most commonly
More informationTreatment of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults
QUICK REFERENCE GUIDE Treatment of meniscal s and isolated s of the anterior cruciate ligament of the knee in adults June 2008 AIM OF THE GUIDELINES To encourage good practices in the areas of meniscal
More informationMCL Injuries: When and How to Repair Scott D. Mair, MD
MCL Injuries: When and How to Repair Scott D. Mair, MD Professor and Team Physician: Orthopaedic Surgery University of Kentucky School of Medicine Disclosure Institution: Research/Education Smith-Nephew
More informationReconstruction of the Ligaments of the Knee
Reconstruction of the Ligaments of the Knee Contents ACL reconstruction Evaluation Selection Evolution Graft issues Notchplasty Tunnel issues MCL PCL Posterolateral ligament complex Combined injuries Evaluation
More informationWhat to Expect from your Anterior Cruciate Ligament (ACL) Reconstruction Surgery A Guide for Patients
What to Expect from your Anterior Cruciate Ligament (ACL) Reconstruction Surgery A Guide for Patients Sources of Information: http://orthoinfo.aaos.org http://www.orthoinfo.org/informedpatient.cfm http://www.sportsmed.org/patient/
More informationDoron Sher. 160 Belmore Rd, Randwick Burwood Rd, Concord. MBBS, MBiomedE, FRACS FAOrthA
Doron Sher MBBS, MBiomedE, FRACS FAOrthA 160 Belmore Rd, Randwick 47 49 Burwood Rd, Concord www.kneedoctor.com.au www.orthosports.com.au Medial PatelloFemoral (MPFL) And AnteroLateral Ligament (ALL) Reconstruction
More informationRehabilitation Guidelines for Anterior Cruciate Ligament (ACL) Reconstruction
Rehabilitation Guidelines for Anterior Cruciate Ligament (ACL) Reconstruction The knee is the body's largest joint, and the place where the femur, tibia, and patella meet to form a hinge-like joint. These
More informationDisclosures. Outline. The Posterior Cruciate Ligament 5/3/2016
The Posterior Cruciate Ligament Christopher J. Utz, MD Assistant Professor of Orthopaedic Surgery University of Cincinnati Disclosures I have no disclosures relevant to this topic. Outline 1. PCL Basic
More informationMedial Meniscal Root Tears: When to rehab? When to repair? When to debride. Christopher Betz, DO Orthopedics Sports Medicine Bristol, CT
Medial Meniscal Root Tears: When to rehab? When to repair? When to debride Christopher Betz, DO Orthopedics Sports Medicine Bristol, CT Disclosure Consultant Mitek Smith and Nephew-biologic patch Good
More informationKnee Dislocation: Spectrum of Injury, Evolution of Treatment & Modern Outcomes
Knee Dislocation: Spectrum of Injury, Evolution of Treatment & Modern Outcomes William M Weiss, MD MSc FRCSC Orthopedic Surgery & Rehabilitation Sports Medicine, Arthroscopy & Extremity Reconstruction
More informationKnee Injuries. PSK 4U Mr. S. Kelly North Grenville DHS. Medial Collateral Ligament Sprain
Knee Injuries PSK 4U Mr. S. Kelly North Grenville DHS Medial Collateral Ligament Sprain Result from either a direct blow from the lateral side in a medial direction or a severe outward twist Greater injury
More informationA Patient s Guide. ACL Injury: Ø Frequently asked questions on injury, Ø Preoperative and postoperative. surgery and recovery.
ACL Injury: A Patient s Guide Ø Frequently asked questions on injury, surgery and recovery Ø Preoperative and postoperative guidelines Mia S. Hagen, M.D. Assistant Professor Department of Orthopaedics
More information40 th Annual Symposium on Sports Medicine. Knee Injuries In The Pediatric Athlete. Disclosure
40 th Annual Symposium on Sports Medicine Travis Murray, MD Assistant Professor University of Texas Health Science Center San Antonio Knee Injuries In The Pediatric Athlete Disclosure Dr. Travis Murray
More informationTHE TREATMENT OF KNEE LIGAMENT INJURIES. Ziali Sivardeen
THE TREATMENT OF KNEE LIGAMENT INJURIES Ziali Sivardeen AIMS ACL PCL MCL Lateral & Posterolateral Corner Multi-Ligament Injuries Take Home Messages Anterior Cruciate Ligament Natural History Does not heal
More informationMeniscal Root Tears: Evaluation, Imaging, and Repair Techniques
Meniscal Root Tears: Evaluation, Imaging, and Repair Techniques R O B E R T N A S C I M E N TO, M D, M S C H I E F OF S P O RT S M E D I C I N E & SH O U L D E R S U R G E RY N E W TO N- W E L L E S L
More informationWhat is new in CrCl surgery in humans
What is new in CrCl surgery in humans ESVOT meeting, Lodi, Italy September 12, 2015 Stephen Bresina, Sc.D. Kyon & Scyon Orthpoaedics Failure Mechansim 30 % in USA due to contact (American Football) Non-contact
More informationNEW DEVELOPMENTS IN MENISCAL SURGERY
NEW DEVELOPMENTS IN MENISCAL SURGERY Written by Peter Verdonk, Belgium and Francesco Perdisa, Italy Meniscectomy is one of the most common procedures in orthopaedic surgery, capable of returning the knee
More informationDiagnosis and Management of Knee Conditions. Jenny Love / Lynn Robertson AFLAR Oct 2009
Diagnosis and Management of Knee Conditions Jenny Love / Lynn Robertson AFLAR Oct 2009 AIMS Review 4 common Knee Conditions: Anterior knee pain Meniscal Injuries Ligament injuries ACL Osteoarthritis Discuss
More informationAnterior Cruciate Ligament (ACL) Reconstruction: Rehabilitation
Anterior Cruciate Ligament (ACL) Reconstruction: Rehabilitation Andy Phillipson MB ChB FRCS (Orth) Consultant Orthopaedic Surgeon Introduction The ACL is one of the most important ligaments in the knee.
More informationMeniscal Root Tears: A Silent Epidemic
Meniscal Root Tears: A Silent Epidemic TRIA Orthopedic and Sports Medicine Conference February 9 th, 2018 Robert F. LaPrade, M.D., Ph.D. Chief Medical Officer Steadman Philippon Research Institute Co-Director,
More information42 nd Annual Symposium on Sports Medicine. Knee Injuries In The Pediatric Athlete. Disclosure
42 nd Annual Symposium on Sports Medicine Travis Murray, MD Assistant Professor University of Texas Health Science Center San Antonio January 23, 2015 Knee Injuries In The Pediatric Athlete Disclosure
More informationOrthopaedic Surgeon. ACL Surgery Informed Consent MARTHA S VINEYARD
Orthopaedic Surgeon ACL Surgery Informed Consent MARTHA S VINEYARD HOSPITAL ACL Surgery Informed Consent 1 Orthopaedic Surgeon MARTHA S VINEYARD HOSPITAL Department of Orthopaedics ANTERIOR CRUCIATE LIGAMENT
More informationDouble Bundle ACL Reconstruction using the Smith & Nephew Outside-In Anatomic ACL Guide System
Knee Series Technique Guide Double Bundle ACL Reconstruction using the Smith & Nephew Outside-In Anatomic ACL Guide System Luigi Adriano Pederzini, MD Massimo Tosi, MD Mauro Prandini, MD Luigi Milandri,
More informationPATIENT GUIDE TO CARTILAGE INJURIES
Lucas Wymore, MD Sports Medicine 23000 Moakley Street Suite 102 Leonardtown MD 20650 Office Phone: 301-475-5555 Office Fax: 301-475- 5914 Email: lwymore@somdortho.com PATIENT GUIDE TO CARTILAGE INJURIES
More information3/21/2011 PCL INJURY WITH OPERATIVE TREATMENT A CASE STUDY PCL PCL MECHANISM OF INJURY PCL PREVALENCE
PCL PCL INJURY WITH OPERATIVE TREATMENT A CASE STUDY K. Anderson, S. Hjortedal, Y. Jingi, E. Sutcliffe & S. Witschen Washington State University Origin Posterior aspect of tibia Insertion Medial femoral
More informationHuman ACL reconstruction
Human ACL reconstruction current state of the art Rudolph Geesink MD PhD Maastricht The Netherlands Human or canine ACL repair...!? ACL anatomy... right knees! ACL double bundles... ACL double or triple
More informationAnterior Cruciate Ligament Injuries
Anterior Cruciate Ligament Injuries One of the most common knee injuries is an anterior cruciate ligament sprain or tear.athletes who participate in high demand sports like soccer, football, and basketball
More informationIntroduction Knee Anatomy and Function Making the Diagnosis
Introduction Knee injuries are a very common problem among active individuals. It is important for us to understand how your knee was injured. Most knee injuries are associated with non-contact mechanisms.
More informationACL Injury: Does It Require Surgery?-OrthoInfo - AAOS
ACL Injury: Does It Require Surgery?-OrthoInfo - AAOS ACL Injury: Does It Require Surgery? The following article provides in-depth information about treatment for anterior cruciate ligament injuries. The
More informationWhy does it matter? Patellar Instability 7/23/2018. What is the current operation de jour? Common. Poorly taught. Poorly treated
Patellar Instability It s Really Not That Difficult! David Shneider MD East Lansing, MI www.patellamdcom Detroit Sports Medicine Foundation July 2018 Why does it matter? Common Poorly taught Poorly treated
More informationIdeal Candidate for Cartilage Restoration. Large or Complex Lesions
Complex Biological Knee Reconstruction: Bipolar, Multifocal Lesions and Osteoarthritis William Bugbee, MD Attending Physician, Scripps Clinic 18 th International Sports Medicine Fellow s Conference Ideal
More informationKnee MRI Update Case Review 2009 Russell C. Fritz, M.D. National Orthopedic Imaging Associates San Francisco, CA
Knee MRI Update Case Review 2009 Russell C. Fritz, M.D. National Orthopedic Imaging Associates San Francisco, CA Meniscal Tears -linear increased signal extending to an articular surface is the hallmark
More informationDepartment of Orthopaedics
Department of Orthopaedics ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY What is the Anterior Cruciate Ligament (ACL)? The anterior cruciate ligament (ACL) is one of four major ligaments that stabilize
More informationDupuytrens contracture
OA Wrist Ganglion/Cysts Dupuytrens contracture Carpal Tunnel Syndrome Carpal Tunnel pathway For advice on management of CTS please follow link to Map of Medicine Trigger Finger Trigger finger pathway For
More informationImaging the Athlete s Knee. Peter Lowry, MD Musculoskeletal Radiology University of Colorado
Imaging the Athlete s Knee Peter Lowry, MD Musculoskeletal Radiology University of Colorado None Disclosures Knee Imaging: Radiographs Can be performed weight-bearing or non-weight-bearing View options
More informationColumbia/NYOH Department of Orthopaedics Shoulder, Elbow, and Sports Medicine Service Competency Requirements
Updated 2/8/10 Columbia/NYOH Department of Orthopaedics Shoulder, Elbow, and Sports Medicine Service Competency Requirements Patient Care Faculty will evaluate the resident s ability to obtain History,
More informationIKDC DEMOGRAPHIC FORM
IKDC DEMOGRAPHIC FORM Your Full Name Your Date of Birth / / Your Social Security Number - - Your Gender: Male Female Occupation Today s Date / / The following is a list of common health problems. Please
More informationevicore MSK joint surgery procedures requiring prior authorization
evicore MSK joint surgery procedures requiring prior authorization Moda Health Commercial Group and Individual Members* Updated 1/30/2018 *Check EBT to verify member enrollment in evicore program Radiology
More informationDifferential Diagnosis
Case 31yo M who sustained an injury to L knee while playing Basketball approximately 2 weeks ago. He describes pivoting and hyperextending his knee, which swelled over the next few days. He now presents
More informationGeneral Concepts. Growth Around the Knee. Topics. Evaluation
General Concepts Knee Injuries in Skeletally Immature Athletes Zachary Stinson, M.D. Increased rate and ability of healing Higher strength of ligaments compared to growth plates Continued growth Children
More information3/13/2018. Cartilage Cases. Case. Physical exam
Cartilage Cases Aaron J. Krych, MD Professor, Orthopedic Surgery Sports Medicine Fellowship Director Sports Medicine Research Fellowship Director Mayo Clinic 2014 MFMER slide-1 Case 19 yo F division I
More informationThe Role of the Anterolateral Ligament in Knee Stability
The Role of the Anterolateral Ligament in Knee Stability Albert O. Gee, MD Assistant Professor Orthopaedics and Sports Medicine University of Washington CU Sports Medicine Fall Symposium September 22,
More informationKineto. Orthopaedics & Rehabilitation Products
Member of Vincent Medical Holdings Limited Kineto Orthopaedics & Rehabilitation Products Our orthopaedic and rehabilitation products comprise of a variety of adjustable rehabilitation braces for support,
More informationThe Aging Athletes Knee
The Aging Athletes Knee Douglas P Tewes Orthopedic Sports Medicine Lincoln Orthopedic Center 1 Common Sports Knee Injuries Cartilage defects/chondromalacia Meniscal tears ACL tear Articular Cartilage injury/chondromalacia
More informationACL RECONSTRUCTION HAMSTRING METHOD. Presents ACL RECONSTRUCTION HAMSTRING METHOD. Multimedia Health Education
HAMSTRING METHOD Presents HAMSTRING METHOD Multimedia Health Education Disclaimer Stephen J. Incavo MD This movie is an educational resource only and should not be used to make a decision on Anterior Cruciate
More informationASSESSMENT AND MANAGEMENT OF THE KNEE AND LOWER LIMB.
ASSESSMENT AND MANAGEMENT OF THE KNEE AND LOWER LIMB www.fisiokinesiterapia.biz Overview History Examination X-rays Fractures and Dislocations. Soft Tissue Injuries Other Knee/Lower limb Problems Anatomy
More informationICL 2: Cartilage Early Osteoarthritis & Cartilage Repair Pathogenesis Diagnosis: Imaging/Bio-marker Treatment Alignment
Preliminary Program TOSSM 2019 (Sheraton Hua Hin. Thursday 25- Saturday 27 May 2019) Thursday.25 July 2019 08.00-09.00 ICL 1: Knee Getting good results in ACL reconstruction Patient selection and graft
More informationAFX. Femoral Implant. System. The AperFix. AM Portal Surgical Technique Guide. with the. The AperFix System with the AFX Femoral Implant
The AperFix System AFX with the Femoral Implant AM Portal Surgical Technique Guide The Cayenne Medical AperFix system with the AFX Femoral Implant is the only anatomic system for soft tissue ACL reconstruction
More informationConsiderations in Multiligament Knee Injuries
Considerations in Multiligament Knee Injuries ERIC BERKSON, MD MGH SPORTS MEDICINE TEAM PHYSICIAN, BOSTON RED SOX ASSISTANT PROFESSOR, HARVARD MEDICAL SCHOOL JULY 26, 2018 Disclosures Neither I nor my
More informationChondral Injuries in the Athlete
Chondral Injuries in the Athlete Michael J. Stuart MD Professor of Orthopedic Surgery Chair, Division of Sports Medicine Mayo Clinic 2013 MFMER slide-1 Michael J. Stuart MD February 5, 2014 Financial Relationships
More information10/30/18. Disclosures. Recurrent Patellar Instability. Management of Recurrent Patellar Instability
Management of Recurrent Patellar Instability Miho J. Tanaka, MD Associate Professor Director, Women s Sports Medicine Program ORTHOPAEDIC SURGERY Disclosures None Recurrent Patellar Instability Lack of
More informationRecurrent Traumatic Patellar Dislocation: Case Example and Tying it all Together?? Christopher M. Larson MD
Recurrent Traumatic Patellar Dislocation: Case Example and Tying it all Together?? Christopher M. Larson MD Disclosures Consultant: Smith & Nephew A3 surgical Stockholder: A3 surgical Case Presentation:
More informationTreatment of Acute Traumatic Knee Dislocations
Treatment of Acute Traumatic Knee Dislocations Angelo J. Colosimo, MD Head Orthopaedic Surgeon University of Cincinnati Athletics Director of Sports Medicine University of Cincinnati Medical Center Associate
More informationTreatment of Acute Traumatic Knee Dislocations
Treatment of Acute Traumatic Knee Dislocations Angelo J. Colosimo, MD Head Orthopaedic Surgeon University of Cincinnati Athletics Director of Sports Medicine University of Cincinnati Medical Center Associate
More informationKnee injures in sports overview. Mohammad Razi MD Rasoul Akram university hospital Tehran
Knee injures in sports overview Mohammad Razi MD Rasoul Akram university hospital Tehran Anatomy Anatomy Medial structures MCL POL postero-medial capsular ligament Augmented by dynamic effect of Semimembranosus
More informationSOFT TISSUE KNEE INJURIES
SOFT TISSUE KNEE INJURIES Soft tissue injuries of the knee commonly occur in all sports or in any activity that requires sudden changes in activity or movement. The knee is a complex joint and any injury
More informationMeniscal Tears/Deficiency in Athletes
Meniscal Tears/Deficiency in Athletes A. Amendola MD Professor of Orthopaedic Surgery Director of Sports Medicine Duke University 1 2 Meniscal tears Introduction Meniscal tears are one of the most frequent
More informationORTHOPEDICS BONE Recalcitrant nonunions In total hip replacement total knee surgery increased callus volume
ORTHOPEDICS Orthopedics has to do with a variety of tissue: bone, cartilage, tendon, ligament, muscle. In this regard orthopedic and sports medicine share the same tissue targets. Orthopedics is mostly
More informationLower Extremity Sports Injuries
Lower Extremity Sports Injuries AAP Musculoskeletal Boot Camp Sigrid F. Wolf, MD Pediatric Sports Medicine Fellow Northwestern University Lurie Children s Hospital Disclosure I have no relevant financial
More informationWhat is the most effective MRI specific findings for lateral meniscus posterior root tear in ACL injuries
What is the most effective MRI specific findings for lateral meniscus posterior root tear in ACL injuries Kazuki Asai 1), Junsuke Nakase 1), Kengo Shimozaki 1), Kazu Toyooka 1), Hiroyuki Tsuchiya 1) 1)
More informationTHURSDAY, FEBRUARY 21, 2019
6:00 AM - 6:40 AM REGISTRATION & BREAKFAST 6:40 AM Welcome and Introduction 7:00 AM - 8:30 AM SHOULDER INSTABILITY - PART I THURSDAY, FEBRUARY 21, 2019 William N. Levine, MD 7:00 AM Shoulder Examination
More informationSpecialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries. Cartilage Surgery. The Knee.
Specialists in Joint Replacement, Spinal Surgery, Orthopaedics and Sport Injuries Cartilage Surgery The Knee CARTILAGE INJURY Treatment of cartilage injury remains one of the most significant challenges
More informationHip, Knee and Shoulder Surgery
Hip, Knee and Shoulder Surgery Policy Number: MM.06.030 Lines of Business: HMO; PPO; QUEST Integration; Medicare Advantage Section: Surgery Place(s) of Service: Outpatient; Inpatient Original Effective
More informationFigure 3 Figure 4 Figure 5
Figure 1 Figure 2 Begin the operation with examination under anesthesia to confirm whether there are any ligamentous instabilities in addition to the posterior cruciate ligament insufficiency. In particular
More informationGoals &Objectives. 1. Review the anatomy of the knee 2. Practice your hands-on skills 3. By the end of the workshop:
Clinical Knee Exam Goals &Objectives 1. Review the anatomy of the knee 2. Practice your hands-on skills 3. By the end of the workshop: Be able to categorize knee injuries Understand the significance of
More informationA comparison of arthroscopic diagnosis of ramp lesion and pre-operative MRI evaluation
A comparison of arthroscopic diagnosis of ramp lesion and pre-operative MRI evaluation Yasuma S, Nozaki M, Kobayashi M, Kawanishi Y Yoshida M, Mitsui H, Nagaya Y, Iguchi H, Murakami H Department of Orthopaedic
More informationLateral knee injuries
Created as a free resource by Clinical Edge Based on Physio Edge podcast episode 051 with Matt Konopinski Get your free trial of online Physio education at Orthopaedic timeframes Traditionally Orthopaedic
More informationHISTORY AND INDICATIONS OF LATERAL TENODESIS IN ATHLETES
HISTORY AND INDICATIONS OF LATERAL TENODESIS IN ATHLETES Written by Philippe Landreau, Qatar The treatment of anterior cruciate ligament injuries remains challenging in young athletic populations. A residual
More informationACL Reconstruction: What is the Role of Sex and Sport in Graft Choice?
ACL Reconstruction: What is the Role of Sex and Sport in Graft Choice? Jo A. Hannafin, M.D., Ph.D. Professor of Orthopaedic Surgery, Weill Cornell Medical College Attending Orthopaedic Surgeon and Senior
More information7/20/14. Patella Instability. Alignment. PF contact areas. Tissue Restraints. Pain. Acute Blunt force trauma Disorders of the Patellafemoral Joint
Patella Instability Acute Blunt force trauma Disorders of the Patellafemoral Joint Evan G. Meeks, M.D. Orthopaedic Surgery Sports Medicine The University of Texas - Houston Pivoting action Large effusion
More informationOrthopaedic Manual Physical Therapy Series Orthopaedic Manual Physical Therapy Series
THE KNEE Michael McMurray PT, DPT, OCS, FAAOMPT Orthopaedic Manual Physical Therapy Series Charlottesville 2017-2018 Reproduction Without Consent 1 Anterior Cruciate Ligament ACL 148714 reconstructions
More informationYour Practice Online
Your Practice Online Disclaimer P R E S E N T S - PATELLAR TENDON This movie is an educational resource only and should not be used to make a decision on Anterior Cruciate Ligament (ACL) Reconstruction.
More informationPOSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PATIENT INFORMATION SHEET
Introduction POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PATIENT INFORMATION SHEET It has recommended that you undergo an operation to reconstruct your posterior cruciate ligament (PCL). This leaflet aims
More informationImpact of surgical timing on the clinical outcomes of anatomic double-bundle anterior cruciate ligament reconstruction
ISAKOS 2019 12 th -16 th May Cancun, Mexico Impact of surgical timing on the clinical outcomes of anatomic double-bundle anterior cruciate ligament reconstruction Baba R. 1, Kondo E. 2, Iwasaki K. 1, Joutoku
More information