Evaluation and Management of Common Knee Disorders
|
|
|
- Madeline Baldwin
- 5 years ago
- Views:
Transcription
1 Evaluation and Management of Common Knee Disorders Chief of Sports Medicine and Shoulder Surgery Beth Israel Deaconess Medical Center Team Physician, Boston Red Sox Harvard Combined Orthopedic Residency Program
2 Conflict of Interest Arun J. Ramappa, MD I have no financial relationships with commercial entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients relevant to the content I am presenting.
3 Disclosures Major League Baseball (MLB) Arthrex, Naples, FL Ceterix Orthopaedics, Menlo Park, CA ConMed Linvatec, Largo, FL Smith & Nephew, Andover, MA Zimmer, Warsaw, IN
4 Common Knee Disorders: Overview Anatomy History Common Knee Disorders - Evaluation - Management Injections vetothiais.com
5 Knee: Bony Anatomy Bones of the Knee Joint - Femur - Tibia - Patella - Fibula Major joints: - Patellofemoral joint - Tibiofemoral joint Tandeter, H.B., et al. Am Fam Physician. 1999
6 Anterior cruciate ligament (ACL) Knee: Ligament Anatomy Posterior cruciate ligament (PCL) Medial collateral ligament (MCL) Lateral collateral ligament (LCL) orthoinfo.aaos.org
7 Knee: Anatomy Meniscus - Fibrocartilage Articular cartilage Tandeter, H.B., et al. Am Fam Physician. 1999
8 Muscles Knee: Muscles/Tendons - Quadriceps - Hamstrings - Patellar Tendon - Popliteus
9 Knee: History Age Occupation Chief Complaint: Pain, Mechanical Symptoms, Stiffness, and Effusion Location Onset Precipitant or Mechanism of Injury Prior Treatment: RICE, Medication, PT, Injections, and Surgery ironstruck.com Limitations/Progression
10 Always order weight-bearing knee X-rays initially!
11 Non weight-bearing X-rays Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
12 Weight-bearing X-rays Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
13 Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery Anatomy Anterior Posterior (AP) View of Both Knees Weight Bearing bidmc.org/sports
14 Arun J. Ramappa, MD AP View of Both Knees Weight Bearing BIDMC Sports Medicine & Shoulder Surgery Lateral View of Right Knee Sunrise View of Right Knee bidmc.org/sports
15 Inspection ROM Ligament testing Palpation Provocative maneuvers Physical Examination
16 Knee Exam: Inspection + ROM Inspection - Effusion - Quad tone ROM Flexion/Extension Passive/Active
17 MCL LCL ACL PCL Exam: Ligament Exam - Valgus stress at 0 and 30 - Varus stress at 0 and 30 - Lachman maneuver - Anterior drawer - Posterior drawer
18 Knee Exam: MCL
19 Knee Exam: ACL
20 Knee Exam: PCL
21 Exam: Medial Joint Line
22 Exam: Lateral Joint Line
23 Exam: McMurray s Test
24 Meniscal Tear Common Knee Disorders Anterior Cruciate Ligament (ACL) Tear Patellofemoral Syndrome Osteoarthritis
25 Case 1 18 y.o. high school senior baseball player Twists knee while swinging Develops pain and knee swelling Unable to resume playing tullahomanews.com
26 Case 1 Exam: Walks with limp Exam: (+) Effusion Exam: Lachman negative Exam: Unable to fully extend knee mikereinold.com
27 Two semilunar fibrocartilaginous wedges - Medial: Semicircular - Lateral: Circular (Cshaped) - Medial > Lateral Function: Menisci - Shock Absorber - Load transmission webmd.com Surgery of the Knee, Joint stabilizer
28 Meniscal Tear - History Mechanism of Injury - Twisting - Flexed knee, planted foot - Rotation - Often insidious onset Symptoms - Swelling (gradual) - Recurrent Effusions - Pain (esp. squatting) - Locking (bucket-handle tears) - Popping - Catching
29 Meniscal Tear - Physical Examination Effusion Joint line tenderness: - Sensitivity 75% - Specificity 28% McMurray s maneuver: - Specificity 97% - Sensitivity 52% Jackson, et al, Annals of Internal Medicine, 2003 Surgery of the Knee, 2002
30 MRI without WB X-ray
31 MRI without WB X-ray Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
32 WB X-rays demonstrate OA Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
33 Total Knee Replacement Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
34 MRI Unnecessary Unnecessary study MRI: $800-$1500 Lower pt satisfaction: extra visit/cost
35 Treatment: Meniscal Tear Activity modification Physical therapy Tylenol/NSAIDs Corticosteroid injection Arthroscopy - Meniscectomy bis.gov - Meniscal Repair
36 Not ALL tears are the same! Unstable tears Degenerative tears Acute, traumatic tears orthoinfo.aaos.org orthoinfo.aaos.org
37 Treatment for Meniscal Tear + OA Katz, J.N., et al. NEJM. 2013
38 Meniscectomy Beneficial For Degenerative Tears? Sihvonen, R., et al. NEJM. 2013
39 Is there a role for surgery in the treatment of meniscal tears?
40 Yes patients with mechanical symptoms: locking, catching, giving way.* Hurr JR, et al, Knee Surg Sports Traumatol Arthrosc, 2015 Sihvonen R, et al, Annals of Internal Medicine, 2016
41 Meniscal Tear Classification Longitudinal Bucket-handle Radial Flap Horizontal Cleavage Degenerative Complex
42 Partial Meniscectomy
43 Increases load transmission Decreases contact area Partial Meniscectomy Leads to osteoarthritis Surgery of the Knee, 2002
44 Displaced Bucket Handle Meniscal Tear Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
45 Meniscal Repair Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
46 Meniscal Repair Much less common than partial meniscectomy Longer rehab: crutches/brace Younger patients: success based on vascularity/biology Healing rates: 75-80% Nepple, et al, JBJS, 2012
47 Case 1: Treatment MRI Reveals displaced meniscal tear Surgery for repair Arun J. Ramappa, MD Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
48 Meniscal Tears: Take Home Points! Not all meniscal tears require surgery! Degenerative tears - PT initially - Surgery if PT fails Tears w/ osteoarthritis - Non-surgical approach Acute, traumatic tears - May require early surgery Gray s Basic Anatomy, 2012 Do NOT order an MRI before ordering WB X-rays!
49 Meniscal Tear Common Knee Disorders Anterior Cruciate Ligament (ACL) Tear Patellofemoral Syndrome Osteoarthritis
50 19 y.o. female college junior injured knee playing soccer Noncontact injury Felt pop Case 2 Needed assistance off field quotesgram.com
51 Exam: (+) effusion Exam: decreased range of motion Case 2 Exam: Lachman maneuver equivocal Smith, B.W., Green, G.A. Am Fam Physician
52 Anterior Cruciate Ligament (ACL) Interconnects the femur and tibia - Crosses the PCL within the center of the knee Function: - Restricts anterior translation of tibia - Rotational stability/ prevents shifting while pivoting orthoinfo.aaos.org
53 Mechanism of Injury: - Typically non-contact - Pivoting or cutting - Contact is usually from lateral side Symptoms: ACL Tear - History - Knee swelling bleacherreport.com - Decreased knee ROM - Instability
54 ACL Tear: Physical Examination Lachman Maneuver: - Most sensitive - Compare sides - Look for endpoint! Anterior Drawer Test Pivot Shift Test Benjaminse, A., et al. JOSPT Gray s Basic Anatomy. 2012
55 Negative Lachman Maneuver
56 Positive Lachman Maneuver
57 MRI Examination of ACL Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
58 ACL Tear: Treatment Activity modification Wean from brace/crutches PT: Focused on achieving normal knee ROM + quad activation Non-operative - bracing SURGERY!
59 ACL Tear Incidence Over 200,000 new ACL injuries occur annually in the USA Often occur concomitantly with meniscal tears Females at risk of sustaining ACL injury 2-8x more than males Sutton, K.M., Bullock, J.M. JAAOS. 2013
60 ACL Tear: Higher Incidence in Females Anatomic (Q Angle, Laxity, and Intercondylar Notch Size) Biomechanical (Landing Position) Environmental (Equipment and Playing Surface) hughston.com Hormonal (Preovulatory > Postovulatory) Beynnon, B.D., et al. J Athl Train. 2008
61 Younger Patients - Hamstring Tendon Autograft Graft Options - Patellar Tendon Autograft Older Patients - Allograft mayoclinic.org
62 ACL Reconstruction Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
63 Do Acute ACL Tears Require Early Surgery? Delayed ACL surgery equivalent to early ACL surgery at 2 year follow-up More than 50% of delayed group had ACL reconstruction Frobell, R.G., et al. NEJM. 2010
64 Risks of Delaying ACL Surgery? Long-term inability to participate in athletics Decrease in quality of life Increase in meniscal injuries Development of osteoarthritis Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports Oiestad, B.E., et al. American Journal of Sports Medicine. 2009
65 A Cost-Utility Analysis ACL Reconstruction vs. Structured Rehabilitation Reconstruction resulted in incremental cost savings of $50,417 compared to rehabilitation Reconstruction provided an incremental QALY gain of 0.72 compared to rehabilitation Mather III, R.C., et al. JBJS. 2013
66 Significant knee effusion Case 2: Treatment Intra-articular injury MRI!!: Reveals ACL tear Prehab PT to increase knee ROM + quad strength Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery Surgery: ACL reconstruction w/ autograft bidmc.org/sports
67 ACL Tear: Take Home Points! Typically sustained through noncontact injury Females > Males Reconstruction should be performed in the athletic/active population Do NOT use allograft reconstruction in young patients
68 Meniscal Tear Common Knee Disorders Anterior Cruciate Ligament (ACL) Tear Patellofemoral Syndrome Osteoarthritis
69 22 y.o. female collegiate runner with knee pain Pain is dull, aching, and located over anterior aspect of knee Difficulty running without pain Case 3 Reports no mechanical symptoms or instability al.milesplit.com
70 Exam: Weakness w/ single leg squat Exam: No effusion Exam: Full ROM Exam: Normal ligament laxity Case 3: Exam Exam: (+) Patellar Grind Test Dixit, S., et al. Am Fam Physician. 2007
71 Patellofemoral Syndrome High risk of development in runners and endurance athletes Mechanism - Overuse (duration or intensity) - Patellar maltracking - Muscular imbalance Symptoms - Dull, aching, anterior knee pain - Often exacerbated with activity cathe.com
72 Patellofemoral Syndrome: X-Rays JF Sarwark, J.F., et al. AAOS. 2010
73 Patellofemoral Syndrome - Examination Evaluate flexibility/strength of quads, hip abductors. J Sign Assess knee ROM Evaluate patellar tracking ( J sign) Patellofemoral compression test A. 90 Flexion B. Full Knee Extension Dixit, S., et al. Am Fam Physician. 2007
74 Single-legged squat
75 Quadriceps flexibility
76 Patellar Grind Test
77 Patellofemoral Syndrome - Treatment Activity Modification RICE NSAIDs/Tylenol Physical Therapy Orthotics and Taping howcast.com Surgery? NO! Barton, C. J., et al. Br J Sports Med. 2011
78 Non-Operative Treatment Rixe, J.A., et al. The Physician and Sports Medicine. 2013
79 Non-Operative Treatment Lower extremity stability, strength, and flexibility Core strengthening Hip abductor Hip external rotator strengthening Quad strengthening Hamstring, ITB, and quad stretching McCall, et al. JPO. 1999
80 Non-Operative Treatment Hip + Quad strengthening Orthotics Patellar Taping Patellar Bracing
81 Physical Therapy Alba-Martin, P., et al. J Phys Ther Sci. 2015
82 Foot Orthoses Barton, C. J., et al. Br J Sports Med. 2011
83 Patellar Taping Paoloni, M., et al. Clin Rheumatol. 2012
84 Activity modification Structured PT program Case 3: Treatment Patellar taping and orthotics sportsrehabcoach.com NO surgery! Return to running Paoloni, M., et al. Clin Rheumatol. 2012
85 Patellofemoral Syndrome: Take home points! Managed through non-operative treatment Physical therapy program focused on quad and hip abductor exercises Taping, orthotics, and bracing can also be beneficial NO surgery!
86 Meniscal Tear Common Knee Disorders Anterior Cruciate Ligament (ACL) Tear Patellofemoral Syndrome Osteoarthritis
87 57 y.o. female with knee pain for 6 months Pain is localized to the medial aspect of the knee Describes a feeling of weakness and stiffness in the knee Case 4 Reports difficulty walking for prolonged periods of time and ambulating bonejoint.net
88 Exam: (+) effusion Case 4 Exam: alignment - bowed Exam: reduced ROM and unable to fully extend Exam: ligament exam normal Exam: medial joint line tenderness Exam: BMI > 30
89 Osteoarthritis History Mechanism - Degenerative process - Develops slowly - Prior injury Symptoms - Swelling - Progressive pain orthoinfo.aaos.org - Decreased knee ROM - Crepitus
90 Diagnosis: Weight-bearing X-rays!
91 Osteoarthritis - Examination Varus/valgus alignment Evaluate swelling Assess knee ROM Joint line tenderness Crepitus bonejoint.net
92 Osteoarthritis: Treatment Rest/PT/ice/activity modification Weight loss/nutritional Counseling Tylenol/NSAIDs Corticosteroid injections Bracing Arthroscopy Joint replacement
93 AAOS AUC GUIDELINES FOR KNEE OSTEOARTHRITIS 2013 RECOMMENDATION STRENGTH OF RECOMMENDATION 1. SELF EDUCATION, STRENGTHENING STRONG 2. WEIGHT LOSS MODERATE 3. AGAINST ACUPUNCTURE STRONG 4. MEDIAL UNLOADER BRACING INCONCLUSIVE 5. NO LATERAL HEEL INSERT MODERATE 6. NO GLUCOSAMINE/CHONDROITIN STRONG 7. NSAIDS/TRAMADOL STRONG 8. CORTICOSTEROID KNEE INJECTION INCONCLUSIVE
94 AAOS AUC GUIDELINES FOR KNEE OSTEOARTHRITIS 2013 RECOMMENDATION STRENGTH OF RECOMMENDATION 9. NO HYALURONIC ACID INJECTIONS STRONG 10. GROWTH FACTOR/PRP INJECTIONS INCONCLUSIVE 11. NO NEEDLE LAVAGE STRONG 12. NO ARTHROSCOPIC DEBRIDEMENT STRONG 13. ARTHROSCOPIC MENISCUS SURGERY INCONCLUSIVE 14. OSTEOTOMY LIMITED 15. SPACER DEVICE CONSENSUS
95 Arthroscopy for Arthritis? Moseley, J.B., et al. NEJM. 2002
96 Placebo=Arthroscopy for OA Sham surgery vs. arthroscopic debridement vs. arthroscopic lavage 44 % Refusal rate: selection bias Male VA pts: generalizable results? Moseley, J.B., et al. NEJM. 2002
97 Arthroscopy for Arthritis? Kirkley, A., et al. NEJM. 2008
98 Osteoarthritis: Total Knee Replacement Arun J. Ramappa, MD BIDMC Sports Medicine & Shoulder Surgery bidmc.org/sports
99 Weight loss Activity modification/pt Case 4: Treatment Corticosteroid injection hellawella.com NO arthroscopy! TKR if symptoms persist
100 Osteoarthritis: Take home points! Treat the patient not the X-ray! Self management: weight reduction and activity modification Non-operative treatment: PT + corticosteroid injection Viscosupplementation is generally ineffective NO Arthroscopy! Total knee replacement if severely limited
101 Diagnostic & Therapeutic Best Approach? - Superolateral Chlorhexidine Knee Injections cc!% lidocaine w/o Epinephrine 1-2 cc (40-80 mg) of corticosteroid Angle needle parallel to the femur with knee extended Hermans J, et al. Semin Arthritis Rheum Douglas, R. KSRR. 2014
102 Knee Injection + Aspiration
103 Special Considerations before Injection Pts with Diabetes - Injection may raise blood glucose levels Pts with HIV Moon, et al, Am J Phys Med Rehabil Wary if on protease inhibitor Ex. Ritonavir/Norvir Can cause iatrogenic Cushing s response Maviki, et al, Skeletal Radiol 2013
104 What About Synvisc? 2012 Anne, W.S., et al. Annals of Internal Medicine Jevsevar, D., et al. JBJS. 2015
105 Evaluation of Common Knee Injuries: Summary When to refer? - ALL Dislocations or instability - Traumatic event with NEW pain or mechanical symptoms - Whenever in doubt bleacherreport.com
106 Evaluation and Management of Common Knee Injuries Thank you!! Questions please Referral: Doctor-Doctor Line: bidmc.org/sports mtn.weekly.com
107 Thank You
Common Knee Disorders: Overview. Knee: Bony Anatomy. Knee: Ligament Anatomy. Knee: Anatomy. Knee: History. Knee: Muscles/Tendons
Common Knee Disorders: Overview Anatomy History Common Knee Disorders - Evaluation - Management Injections vetothiais.com Knee: Bony Anatomy Bones of the Knee Joint - Femur - Tibia - Patella - Fibula Major
Evaluation and Management of Knee Pain. Michael Cassat, MD University of Arkansas for Medical Sciences
Evaluation and Management of Knee Pain Michael Cassat, MD University of Arkansas for Medical Sciences Disclosure I have no actual or potential conflict of interest in relation to this program/presentation.
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
Anterior 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
On 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
I have nothing to disclose
Management of Common Knee Disorders: What You Knee d to Know UCSF Essentials of Women s Health July 8, 2015 Carlin Senter, M.D. I have nothing to disclose Learning objectives: in 1 hour you will be able
W. 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
Goals &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
Physical Examination of the Knee
History: Pain Traumatic vs. atraumatic? Acute vs Chronic Previous procedures done on the knee? Swelling, catching, instability General Setup Examine standing, sitting and supine Evaluate gait Examine hip
Overview 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
Grant 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:
Physical Examination of the Knee
History: Pain Traumatic vs. atraumatic Acute vs Chronic Mechanism of injury Swelling, catching, instability Previous evaluation and treatment General Setup Examine standing, sitting and supine Evaluate
American College of Physicians 2013 Ohio Chapter Scientific Meeting Columbus, OH October 11, 2013
American College of Physicians 2013 Ohio Chapter Scientific Meeting Columbus, OH October 11, 2013 Paul J. Gubanich, MD, MPH Assistant Professor of Internal Medicine/Sports Medicine Team Physician, Ohio
What 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/
ACL 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,
Knee 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
Rehabilitation 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
The examination of the painful knee. Maja K Artandi, MD, FACP Clinical Associate Professor of Medicine Stanford University
The examination of the painful knee Maja K Artandi, MD, FACP Clinical Associate Professor of Medicine Stanford University Objectives of the talk By the end of this talk you will know The important anatomy
Anterior 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
SOFT 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
SOFT 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
RN(EC) ENC(C) GNC(C) MN ACNP *** MECHANISM OF INJURY.. MOST IMPORTANT *** - Useful in determining mechanism of injury / overuse
HISTORY *** MECHANISM OF INJURY.. MOST IMPORTANT *** Age of patient Sport / Occupation - Certain conditions are more prevalent in particular age groups (Osgood Schlaters in youth / Degenerative Joint Disease
Evaluation of the Knee and Shoulder
Evaluation of the Knee and Shoulder Karen J. Boselli, MD Northeast Regional Nurse Practitioner Conference May 2018 Knee Overview History Examination Top 5 diagnoses When to image When to refer Pain most
Recognizing common injuries to the lower extremity
Recognizing common injuries to the lower extremity Bones Femur Patella Tibia Tibial Tuberosity Medial Malleolus Fibula Lateral Malleolus Bones Tarsals Talus Calcaneus Metatarsals Phalanges Joints - Knee
The Knee. Two Joints: Tibiofemoral. Patellofemoral
Evaluating the Knee The Knee Two Joints: Tibiofemoral Patellofemoral HISTORY Remember the questions from lecture #2? Girth OBSERVATION TibioFemoral Alignment What are the consequences of faulty alignment?
KNEE 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
Knee Injury Assessment
Knee Injury Assessment Clinical Anatomy p. 186 Femur Medial condyle Lateral condyle Femoral trochlea Tibia Intercondylar notch Tibial tuberosity Tibial plateau Fibula Fibular head Patella Clinical Anatomy
ANTERIOR 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
KNEE EXAMINATION. Tips & Tricks from an Emergency Physician Perspective. EM Physicians Less Exposed to MSK Medicine
KNEE EXAMINATION Tips & Tricks from an Emergency Physician Perspective Dr P O CONNOR Emergency Medicine Physician EUSEM 10/09/2018 EM Physicians Less Exposed to MSK Medicine Musculoskeletal Medicine becoming
Meniscus Tears. Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella).
Meniscus Tears Information on meniscus tears is also available in Spanish: Desgarros de los meniscus (topic.cfm?topic=a00470) and Portuguese: Rupturas do menisco (topic.cfm?topic=a00754). Meniscus tears
Medical 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****
COMMON KNEE AND SHOULDER INJURIES IN THE YOUNG ATHLETE. Outline 5/11/2017
COMMON KNEE AND SHOULDER INJURIES IN THE YOUNG ATHLETE IRVING RAPHAEL MD Syracuse Orthopedic Specialists Former S.U. Head Team Physician May 19, 2017 Meniscal Injuries anatomy Exam Treatment ACL Injuries
Common Knee Injuries
Common Knee Injuries In 2010, there were roughly 10.4 million patient visits to doctors' offices because of common knee injuries such as fractures, dislocations, sprains, and ligament tears. Knee injury
Lower 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
Ligamentous and Meniscal Injuries: Diagnosis and Management
Ligamentous and Meniscal Injuries: Diagnosis and Management Daniel K Williams, MD Franciscan Physician Network Orthopedic Specialists September 29, 2017 No Financial Disclosures INTRODUCTION Overview of
Non-Surgical vs. Surgical Treatment of Meniscus Tears of the Knee
Non-Surgical vs. Surgical Treatment of Meniscus Tears of the Knee Greg I. Nakamoto, MD FACP Section of Orthopedics and Sports Medicine Virginia Mason Medical Center CASE 1 45 y/o construction worker sent
Diagnosis 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
Prevention and Treatment of Injuries. Anatomy. Anatomy. Chapter 20 The Knee Westfield High School Houston, Texas
Prevention and Treatment of Injuries Chapter 20 The Knee Westfield High School Houston, Texas Anatomy MCL, Medial Collateral Ligament LCL, Lateral Collateral Ligament PCL, Posterior Cruciate Ligament ACL,
Anterior 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
Chapter 20 The knee and related structures
Chapter 20 The knee and related structures Athletic Training Spring 2014 Jihong Park Bones & joints Femur, tibia, fibula, & patella Femur & tibia Weight bearing & muscle attachment Patella functions Anterior
Oh My Aching Knee. Oh My Aching Knee WHO AM I? 10/15/2012. Jan Pieter Hommen, MD Orthopedic Surgeon Sports Medicine Arthroscopy Joint Replacements
Oh My Aching Knee Jan Pieter Hommen, MD Orthopedic Surgeon Sports Medicine Arthroscopy Joint Replacements Oh My Aching Knee Jan Pieter Hommen, MD Orthopedic Surgeon Sports Medicine Arthroscopy Joint Replacements
ASSESSMENT 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
Medical 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
Rehab Considerations: Meniscus
Rehab Considerations: Meniscus Steve Cox, PT, DPT Department of Orthopaedics School of Medicine University of Texas Health Science Center at San Antonio 1 -Anatomy/ Function/ Injuries -Treatment Options
Exam of the Knee and Ankle I HAVE NO FINANCIAL DISCLOSURES RELEVANT TO THIS PRESENTATION
Exam of the Knee and Ankle I HAVE NO FINANCIAL DISCLOSURES RELEVANT TO THIS PRESENTATION Disclosures I have no relevant financial relationships with the manufacturers of any commercial products and or
Anatomy 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
Rehabilitation of an ACL injury in a 29 year old male with closed kinetic chain exercises: A case study
Abstract Objective: This paper will examine a rehabilitation program for a healthy 29 year old male who sustained an incomplete tear of the left ACL. Results: Following a 9 week treatment plan focusing
(Also known as a, Lateral Cartilage Tear,, Bucket Handle Tear of the Lateral Meniscus, Torn Cartilage)
Lateral Meniscus Tear (Also known as a, Lateral Cartilage Tear,, Bucket Handle Tear of the Lateral Meniscus, Torn Cartilage) What is a lateral meniscus tear? The knee joint comprises of the union of two
New Evidence Suggests that Work Related Knee Pain with Degenerative Complications May Not Require Surgery
4 th Quarter 2017 New Evidence Suggests that Work Related Knee Pain with Degenerative Complications May Not Require Surgery By: Michael Erdil MD, FACOEM Introduction It is estimated there are approximately
ACL 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
HANDS ON: Knee Evaluation J. Scott Delaney MD, FRCPC, FACEP, CSPQ
HANDS ON: Knee Evaluation J. Scott Delaney MD, FRCPC, FACEP, CSPQ FACULTY DISCLOSURE Dr. Delaney has no affiliation with the manufacturer of any commercial product or provider of any commercial service
Examination of the Knee
Examination of the Knee Wash your hands & Introduce the exam to the patient Positioning & Draping With the patient supine, make sure both legs are exposed in order to compare each side be sure to use draping
An older systematic review looked at the evidence behind the best approach to evaluate acute knee pain in primary care (Ann Int Med.2003;139:575).
There is so much we don't know in medicine that could make a difference, and often we focus on the big things, and the little things get forgotten. To highlight some smaller but important issues, we've
Medial 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
Rehabilitation Guidelines for Meniscal Repair
Rehabilitation Guidelines for Meniscal Repair 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 bones are supported by a large
Knee Case Studies. You might KNEED to know some of this stuff
Knee Case Studies You might KNEED to know some of this stuff Mark Mildren, MD Specializing in Adult Reconstruction Slocum Center for Orthopedics & Sports Medicine 25 th Annual Orthopedic & Sports Medicine
Anterior 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
STATE 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
Rehabilitation Guidelines for Knee Arthroscopy
Rehabilitation Guidelines for Knee Arthroscopy 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 bones are supported by a large
Epidemiology. Meniscal Injury & Repair. Meniscus Anatomy. Meniscus Anatomy
Epidemiology 60-70/100,000 per year Meniscal Injury & Repair Arthroscopic Mensiscectomy One of the most common orthopaedic procedures 20% of all surgeries at some centers Male:Female ratio - 2-4:1 Younger
BATES VISUAL GUIDE TO PHYSICAL EXAMINATION. OSCE 4: Knee Pain
BATES VISUAL GUIDE TO PHYSICAL EXAMINATION OSCE 4: Knee Pain This video format is designed to help you prepare for objective structured clinical examinations, or OSCEs. You are going to observe and participate
Evaluation and Treatment of Knee Arthritis Classification of Knee Arthritis Osteoarthritis Osteoarthritis Osteoarthritis of Knee
1 2 Evaluation and Treatment of Knee Arthritis John Zebrack, MD Reno Orthopaedic Clinic Classification of Knee Arthritis Non-inflammatory Osteoarthritis Primary Secondary Post-traumatic, dysplasia, neuropathic,
Knee Multiligament Rehabilitation
Knee Multiligament Rehabilitation Orlando Valle, PT, MSPT, SCS, CSCS Director Ironman Sports Medicine Institute TMC Orlando.Valle@memorialhermann.org 4 Major Ligaments ACL PCL MCL LCL (PLC) Anatomy Function
Anterior Knee Pain in Children. Joseph Chorley, MD Associate Professor, Pediatrics Baylor College of Medicine
Anterior Knee Pain in Children Joseph Chorley, MD Associate Professor, Pediatrics Baylor College of Medicine Goals and Objectives To learn how to care for patients with chronic knee pain To be able to
Reconstruction 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
What is Medial Plica Syndrome?
What is Medial Plica Syndrome? It is a congenital disorder in which the thin wall of fibrous tissue extends from the synovial capsule of the knee. Pain usually occurs when the synovial capsule becomes
Meniscal 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,
Patellofemoral 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
Anterior Cruciate Ligament (ACL) Injuries
Anterior Cruciate Ligament (ACL) Injuries This article is also available in Spanish: Lesiones del ligamento cruzado anterior (topic.cfm?topic=a00697) and Portuguese: Lesões do ligamento cruzado anterior
Biomechanics of the Knee. Valerie Nuñez SpR Frimley Park Hospital
Biomechanics of the Knee Valerie Nuñez SpR Frimley Park Hospital Knee Biomechanics Kinematics Range of Motion Joint Motion Kinetics Knee Stabilisers Joint Forces Axes The Mechanical Stresses to which
ADOLESCENT SPORTS INJURIES. Orthopaedics in Motion April 5, 2017 John Lammli, MD
ADOLESCENT SPORTS INJURIES Orthopaedics in Motion April 5, 2017 John Lammli, MD OVERVIEW: Shoulder Injuries Knee Injuries Leg/Ankle Injuries SHOULDER INJURIES Injuries to the shoulder girdle are vast and
Knee Joint Assessment and General View
Knee Joint Assessment and General View Done by; Mshari S. Alghadier BSc Physical Therapy RHPT 366 m.alghadier@sau.edu.sa http://faculty.sau.edu.sa/m.alghadier/ Functional anatomy The knee is the largest
This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.
43 rd Annual Symposium on Sports Medicine UT Health Science Center San Antonio School of Medicine January 22-23, 2016 Intra-articular / Extra-synovial 38 mm length / 13 mm width Fan-shaped structure narrowest-midportion
AAP Boot Camp KNEE AND ANKLE EXAM
AAP Boot Camp KNEE AND ANKLE EXAM Disclosures I have no relevant financial relationships with the manufacturers of any commercial products and or providers of commercial services discussed in this CME
PRINCIPLES OF EXAMNINIG THE KNEE
Welcome! Pignon, Haiti IS IT. GOOD MORNING LORD! OR GOOD LORD, MORNING! PRINCIPLES OF EXAMNINIG THE KNEE Greg Bennett, PT, DSc Excel Physical Therapy Marymount University Rules Hx often diagnostic Least
UNUSUAL ACL CASE: Tibial Eminence Fracture in a Female Collegiate Basketball Player
UNUSUAL ACL CASE: Tibial Eminence Fracture in a Female Collegiate Basketball Player Cheri Drysdale, MEd,, ATC Margot Putukian,, MD Jeffery Bechler,, MD Princeton University How many of you have done an
Checklist for Physical Examination of the Knee Muscuoskeletal Block -- Chris McGrew MD, Andrew Ashbaugh DO
Checklist for Physical Examination of the Knee Muscuoskeletal Block -- Chris McGrew MD, Andrew Ashbaugh DO This handout is for use as a rough guide and study aid. Your instructor may perform certain maneuvers
ACL 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
Musculoskeletal Examination Benchmarks
Musculoskeletal Examination Benchmarks _ The approach to examining the musculoskeletal system is the same no matter what joint or limb is being examined. The affected and contralateral region should both
40 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
Anatomy. ACL PCL MCL LCL Meniscus. Medial Lateral
Skis for Knees Anatomy ACL PCL MCL LCL Meniscus Medial Lateral Knee Anatomy THE KNEE HISTORY Pain (PQRST) Contact vs noncontact Effusions Mechanical symptoms Locking Instability (falls) Initial treatment
Patellofemoral Instability
Disclaimer This movie is an educational resource only and should not be used to manage Patellofemoral Instability. All decisions about the management of Patellofemoral Instability must be made in conjunction
ACL 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
9/24/2012. Greg Bennett, PT, DSc Excel Physical Therapy Marymount University
Greg Bennett, PT, DSc Excel Physical Therapy Marymount University Hx often diagnostic Least to most threatening Sx trump exam Develop consistent routine Don t inflame inflamed tissue 1 1. ESTABLISH OR
No 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
Lateral 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
2/28/2017. Learning Objectives. Hip Joint: Anatomy and Kinesiology
Regional Pain Syndromes: Hip and Knee Srinivas Nalamachu, MD Clinical Assistant Professor, KU School of Medicine President and Medical Director, Pain Management Institute Overland Park, KS Learning Objectives
The 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
42 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
MANAGING KNEE PROBLEMS IN PRIMARY CARE
MANAGING KNEE PROBLEMS IN PRIMARY CARE Mr. James Hahnel MBBS FRCS(Tr&Orth) Orthopaedic Consultant Hip, Knee and Trauma Specialist www.bradfordortho.co.uk www.leedsortho.co.uk CONTENT Anatomy Referral History
Objectives. The BIG Joint. Case 1. Boney Architecture. Presenter Disclosure Information. Common Knee Problems
3:30 4:15 pm Common Knee Problems SPEAKER Christopher J. Visco, MD Presenter Disclosure Information The following relationships exist related to this presentation: Christopher J. Visco, MD: Speaker s Bureau
3/21/2011 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
Clinical Evaluation and Imaging of the Patellofemoral Joint Common clinical syndromes
Clinical Evaluation and Imaging of the Patellofemoral Joint Common clinical syndromes A. Panagopoulos Lecturer in Orthopaedics Medical School, Patras University Objectives Anatomy of patellofemoral joint
Learning Objectives. Meniscal Injuries of the Knee. Meniscal Anatomy. Medial Meniscus. Chock Block Shape. Lateral Meniscus
Meniscal Injuries of the Knee Learning Objectives Edward P. Mulligan, MS, PT, SCS, ATC VP, National Director of Clinical Education HealthSouth Corporation Grapevine, TX Clinical Instructor University of
ACL 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
Unicompartmental Knee Resurfacing
Disclaimer This movie is an educational resource only and should not be used to manage knee pain. All decisions about the management of knee pain must be made in conjunction with your Physician or a licensed
Posterolateral Corner Injuries of the Knee: Pearls and Pitfalls
Posterolateral Corner Injuries of the Knee: Pearls and Pitfalls Robert A. Arciero,MD,Col,ret Professor, Orthopaedics University of Connecticut Incidence of PLC Injuries with ACL Tears Fanelli, 1995 12%
What is arthroscopy? Normal knee anatomy
What is arthroscopy? Arthroscopy is a common surgical procedure for examining and repairing the inside of your knee. It is a minimally invasive surgical procedure which uses an Arthroscope and other specialized
Mastering the Musculoskeletal Exam UCSF Essentials of Women s Health July 7, 2016 Carlin Senter, M.D. Henry Crevensten, M.D.
Mastering the Musculoskeletal Exam UCSF Essentials of Women s Health July 7, 2016 Carlin Senter, M.D. Henry Crevensten, M.D. I have nothing to disclose Outline Knee exam Shoulder exam Knee Anatomy The
emoryhealthcare.org/ortho
COMMON SOCCER INJURIES Oluseun A. Olufade, MD Assistant Professor, Department of Orthopedics and PM&R 1/7/18 GOALS Discuss top soccer injuries and treatment strategies Simplify hip and groin injuries in