Knee Dislocation: Spectrum of Injury, Evolution of Treatment & Modern Outcomes

Size: px
Start display at page:

Download "Knee Dislocation: Spectrum of Injury, Evolution of Treatment & Modern Outcomes"

Transcription

1 Knee Dislocation: Spectrum of Injury, Evolution of Treatment & Modern Outcomes William M Weiss, MD MSc FRCSC Orthopedic Surgery & Rehabilitation Sports Medicine, Arthroscopy & Extremity Reconstruction

2 Outline Spectrum of Injury Ligamentous Pathology Associated Injuries Treatment Emergent Definitive Outcomes

3 It is unlikely that any single physician personally cares for more than a few knee dislocations in a lifetime of practice JBJS 1971

4 Epidemiology Less than 0.25% of all Orthopedic injuries Likely under-reported 20-50% spontaneous reduction Variable levels of awareness: Trauma Center Sports Medicine General Orthopedics

5 Spectrum of Injury High Energy: MVC or fall from height Dashboard injury Low Energy: Sports injury Rotational Ultra-Low Velocity Injury Morbid Obesity» BMI > 35

6 Pathology Significant soft tissue disruption typically >3 ligaments Meniscal injury Chondral injury Vascular injury Nerve injury

7 Pathology Limb threatening Injury! This is an amputation through the knee that is held on by the skin Wise Orthopedic Mentor

8 Vascular Injury Popliteal artery injury 15% of all dislocations 50% of AP dislocations Tethered in popliteal fossa Fibrous tunnels:» Adductor hiatus» Soleus muscle

9 Nerve Injury Common peroneal nerve: ~25% (10-40%) Tethered at fibular neck Varus - Tension Direct injury Tibial nerve less common

10 Nerve Injury Worsening outcomes: No injury -> Partial -> Complete

11 Fracture Present in 60% Tibia & Femur most common Avulsion Rim Osteochondral

12 Prognosis Historically Poor Laxity and poor function Extremely Limited return to pre-injury state Frequent complications Modern reconstruction techniques to improve outcomes

13 Stability conferred by: Ligaments Muscle/tendon Menisci Bony articulations Anatomy

14 Anatomy

15 Kennedy Classification Anterior: ~50% Hyper-ext Intimal tear from traction Posterior: 25% Load in flexion (dashboard) 25% vascular - complete tear Lateral: <15% Peroneal nerve injury Medial: <5% Rotatory: <5% Often irreducible

16 Schenk Classification

17 Presentation Trauma w knee pain +/- deformity Obvious deformity: Reduce immediately Dimpling of MFC through medial capsule» Irreducible» Contraindication -> skin necrosis

18 Reduction Traction -> Reversal of Deformity

19 Presentation No deformity: ~50% spontaneous reduction Subtle signs:» Swelling, effusion, subluxation, instability

20 Physical Examination Anterior Cruciate Ligament Posterior Cruciate Ligament Lateral Collateral Ligament Posterolateral Corner Medial Collateral Ligament Posteromedial Corner

21 Physical Examination

22 Physical Examination

23 Physical Examination

24

25 IR - PMC ER - PLC

26 Vascular Examination Both before AND after reduction!! Serial examinations MANDATORY!! Palpation +/- US Dorsalis Pedis Posterior Tibial

27 Vascular Examination If pulses PRESENT and normal Does NOT rule out vascular injury Measure ABI» If > 0.9 = serial exam, 100% NPV» If < 0.9 = Duplex US or CT Angio Vascular Consult

28 Vascular Examination If pulses ABSENT or diminished REDUCE and reassess If still absent: IMMEDIATE surgical exploration» Ischemia time >8 hrs = 86% amputation rate If pulses present post-reduction:» ABI -> Serial exam vs CT Angio +/- vascular consult

29 Radiographs May be normal Spontaneous Reduction ~50% Hints: Asymmetric or irregular joint space Subluxation Avulsion fractures = Capsular avulsions Osteochondral defects

30 Magnetic Resonance Imaging Evaluation of: Ligaments, cartilage, meniscus For Surgical Planning Should be obtained AFTER acute treatment

31 Initial Treatment Reduce knee & Re-Examine vascular status Splint in degrees flexion» External Fixator if UNSTABLE Confirm reduction w X-rays in brace/splint Vascular consult IF indicated Arterial injury on CT Angio or Duplex US Absent or diminished pulses postreduction

32 Non-Operative Treatment Casting vs Immobilization Largely Historic Limited indications Poor outcomes Laxity Limited function

33 Emergent Operative Treatment Indications: Vascular injury needing repair Open fracture and/or dislocation Irreducible Dislocation Compartment syndrome Obesity? Multi-Trauma?

34 Emergent Operative Treatment Treatment Principles: External fixation Vascular intervention» Excision damaged segment» Repair w reverse saphenous vein graft Fasciotomies post vascular repair

35 Definitive Operative Treatment Ligament Repair vs Reconstruction Often delayed 6 weeks of immobilization Dependent on: Vascular repair Injury pattern

36 Definitive Operative Treatment Improved outcomes with: Single stage treatment Treatment within 3 weeks Reconstruction vs Repair Collaterals -> Cruciates

37 Definitive Operative Treatment Principles: Early collateral repair +/- reconstruction Cruciate reconstruction PCL as central pivot Anatomic reconstruction Early single procedure PCL -> ACL -> MCL/POL and/or LCL/PLC Every knee dislocation is a unique injury requiring individualized treatment Wise Orthopedic Mentor

38 Postoperative Treatment Early mobilization Functional bracing No consensus Early ROM? Early WB? Trials ongoing

39 Complications Arthrofibrosis % More common w delayed mobilization Laxity or Instability - 30% Peroneal Nerve Injury - 25% Posterolateral dislocations Neurolysis & Tendon Transfers Tib Post -> lateral cuneiform = dorsiflexion Vascular Compromise - <20%

40 Outcomes Non-operative treatment = poor results Historical Repair -> Reconstruction Early mobilization Return to function Good Results

41 Literature Problems Series typically ~10 to 30 patients Tertiary centers compiling larger Limited follow up Limited by career of surgeon Outcomes largely subjective Complicated by additional injury

42 El Paso Experience TTUHSC/UMC Knee Dislocation Protocol Updated 2016 Algorithm for emergent management Guidelines for investigation Based on: Minimizing morbidity Current best evidence

43 El Paso Experience I 5 II 3 III M 3 III L 3 IV 2 V 1 TOTAL 17 Associated Injuries: MM Root: 3 LM Root: 2 Popliteal Artery: 2 Nerve: 2 Fracture: 5

44 El Paso Experience n = 14 (17) Age 33 BMI 27 Follow Up: ~8 months Lysholm - 63 IKDC - 54 KOOS: Symptoms - 69 Pain - 70 ADL -72 Sports - 46 QOL - 40 Tegner Overall - 60

45 Questions? Thanks!

Mohammad Ayati,M.D Department of Orthopaedics, Yazd University of Medical Science.

Mohammad Ayati,M.D Department of Orthopaedics, Yazd University of Medical Science. IN THE NAME OF GOD Mohammad Ayati,M.D Department of Orthopaedics, Yazd University of Medical Science. Devastating injury resulting from : high-energy usually from MVC or fall from height commonly a dashboard

More information

Treatment of Acute Traumatic Knee Dislocations

Treatment 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 information

Treatment of Acute Traumatic Knee Dislocations

Treatment 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 information

Treatment of Acute Traumatic Knee Dislocations

Treatment 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 information

ALGORITHM IN EMERGENCIES

ALGORITHM IN EMERGENCIES ALGORITHM IN EMERGENCIES S. ZAFFAGNINI T. ROBERTI DI SARSINA, A. GRASSI CLINICA ORTOPEDICA II LAB. di BIOMECCANICA e INNOVAZIONE TECNOLOGICA Dir. Prof. S. Zaffagnini UNIVERSITA di BOLOGNA ISTITUTO ORTOPEDICO

More information

KNEE DISLOCATION. The most common injury will be an anterior dislocation, and this usually results from a hyperextension mechanism.

KNEE DISLOCATION. The most common injury will be an anterior dislocation, and this usually results from a hyperextension mechanism. KNEE DISLOCATION Introduction Dislocation of the knee is a severe injury associated with major soft tissue injury and a high incidence of damage to the popliteal artery. There is displacement of the tibia

More information

ACL Athletic Career. ACL Rupture - Warning Features Intensive pain Immediate swelling Locking Feel a Pop Dead leg Cannot continue to play

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 information

Considerations in Multiligament Knee Injuries

Considerations 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 information

Financial Disclosure. Medial Collateral Ligament

Financial 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 information

Disclosures. Outline. The Posterior Cruciate Ligament 5/3/2016

Disclosures. 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 information

Management of Knee Dislocations

Management 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 information

ACL AND PCL INJURIES OF THE KNEE JOINT

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,

More information

Imaging 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 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 information

Management of Multi-ligament Knee Sports Injuries

Management of Multi-ligament Knee Sports Injuries Management of Multi-ligament Knee Sports Injuries Aimee S. Klapach, MD Sports and Orthopaedic Specialists Allina Health Sports Medicine Conference June 15, 2018 Objectives Background On field assessment

More information

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 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 information

Anatomy and Sports Injuries of the Knee

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

More information

1) Emergent treatment Frank Avilucea 15 min Incidence and associated injuries

1) Emergent treatment Frank Avilucea 15 min Incidence and associated injuries OTA 2017 Complex Knee Dislocations Objectives: 1) Understand emergent treatment and associated injuries 2) Review acute, staged, and delayed treatment options for knee dislocation 3) Understand complications

More information

Posterolateral Corner Injuries of the Knee: Pearls and Pitfalls

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%

More information

Knee Injury Assessment

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

More information

Meniscal Root Tears: A Silent Epidemic

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,

More information

SOFT TISSUE INJURIES OF THE KNEE: Primary Care and Orthopaedic Management

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

More information

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. 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

More information

Knee Joint Assessment and General View

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

More information

General Concepts. Growth Around the Knee. Topics. Evaluation

General 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 information

Differential Diagnosis

Differential 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 information

UNUSUAL ACL CASE: Tibial Eminence Fracture in a Female Collegiate Basketball Player

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

More information

POSTEROLATERAL CORNER RECONSTRUCTION WHEN AND HOW?

POSTEROLATERAL CORNER RECONSTRUCTION WHEN AND HOW? OTHER KNEE SURGERIES POSTEROLATERAL CORNER RECONSTRUCTION WHEN AND HOW? Written by Jacques Ménétrey, Eric Dromzée and Philippe M. Tscholl, Switzerland Injury of the posterolateral corner (PLC) is relatively

More information

Patellofemoral Pathology

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

More information

TABLE E-1 Search Terms and Number of Resulting PubMed Search Results* Sear Search Terms

TABLE E-1 Search Terms and Number of Resulting PubMed Search Results* Sear Search Terms Moksnes eappendix Page 1 of 15 TABLE E-1 Search Terms and Number of Resulting PubMed Search Results* Sear ch Search Terms No. of Studies #1 Anterior cruciate ligament [MeSH] 7768 #2 Child [MeSH] 1,371,559

More information

ASSESSMENT AND MANAGEMENT OF THE KNEE AND LOWER LIMB.

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

More information

Lower Extremity Dislocations: Management and Triage on the Field

Lower Extremity Dislocations: Management and Triage on the Field Lower Extremity Dislocations: Management and Triage on the Field Scott J Tarantino, MD Towson Orthopaedic Associates, Towson, MD None Disclsures Purpose To provide you with knowledge which may guide you

More information

Reconstruction of the Ligaments of the Knee

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

More information

Overview Ligament Injuries. Anatomy. Epidemiology Very commonly injured joint. ACL Injury 20/06/2016. Meniscus Tears. Patellofemoral Problems

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

More information

Anterior Cruciate Ligament Surgery

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

More information

Case Report Reverse Segond Fracture Associated with Anteromedial Tibial Rim and Tibial Attachment of Anterior Cruciate Ligament Avulsion Fractures

Case Report Reverse Segond Fracture Associated with Anteromedial Tibial Rim and Tibial Attachment of Anterior Cruciate Ligament Avulsion Fractures Hindawi Case Reports in Orthopedics Volume 2017, Article ID 9637153, 4 pages https://doi.org/10.1155/2017/9637153 Case Report Reverse Segond Fracture Associated with Anteromedial Tibial Rim and Tibial

More information

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) 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 information

Ankle Ligament Injury: Don t Worry- It s Only a Sprain Wes Jackson MD Orthopaedic Foot & Ankle

Ankle Ligament Injury: Don t Worry- It s Only a Sprain Wes Jackson MD Orthopaedic Foot & Ankle Ankle Ligament Injury: Don t Worry- It s Only a Sprain Wes Jackson MD Orthopaedic Foot & Ankle Outline I. Epidemiology II. Classification and Types of Sprains III. Anatomy IV. Clinical Assessment and Imaging

More information

MCL Injuries: When and How to Repair Scott D. Mair, MD

MCL 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 information

Original Report. The Reverse Segond Fracture: Association with a Tear of the Posterior Cruciate Ligament and Medial Meniscus

Original Report. The Reverse Segond Fracture: Association with a Tear of the Posterior Cruciate Ligament and Medial Meniscus Eva M. Escobedo 1 William J. Mills 2 John. Hunter 1 Received July 10, 2001; accepted after revision October 1, 2001. 1 Department of Radiology, University of Washington Harborview Medical enter, 325 Ninth

More information

The Knee. Prof. Oluwadiya Kehinde

The Knee. Prof. Oluwadiya Kehinde The Knee Prof. Oluwadiya Kehinde www.oluwadiya.sitesled.com The Knee: Introduction 3 bones: femur, tibia and patella 2 separate joints: tibiofemoral and patellofemoral. Function: i. Primarily a hinge joint,

More information

BAD RESULTS OF CONSERVATIVE TREATMENT OF ACL TEARS IN CHILDREN. Guy BELLIER PARIS France

BAD RESULTS OF CONSERVATIVE TREATMENT OF ACL TEARS IN CHILDREN. Guy BELLIER PARIS France BAD RESULTS OF CONSERVATIVE TREATMENT OF ACL TEARS IN CHILDREN Guy BELLIER PARIS France TREATMENT OF ACL TEARS IN CHILDREN CONTROVERSIAL DIAGNOSIS clinical exam X-rays (stress) M.R.I. arthroscopy ACL TEARS

More information

Knee injuries are probably one of the most common orthopaedic problems encountered in general practice, particularly among recreational athletes.

Knee injuries are probably one of the most common orthopaedic problems encountered in general practice, particularly among recreational athletes. The injured knee Knee injuries are probably one of the most common orthopaedic problems encountered in general practice, particularly among recreational athletes. J WALTERS, FC (Orth) SA Department of

More information

Imaging of the Athle/c Knee: injuries associated with ACL disrup/on

Imaging of the Athle/c Knee: injuries associated with ACL disrup/on Imaging of the Athle/c Knee: injuries associated with ACL disrup/on Brian Petersen, MD Associate Professor of Radiology and Orthopaedics Chief of MSK Radiology University of Colorado CU Sports Medicine

More information

Knee Contusions and Stress Injuries. Laura W. Bancroft, M.D.

Knee 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 information

FUNCTIONAL ANATOMY: Knee and Leg

FUNCTIONAL ANATOMY: Knee and Leg ACSM Team Physician Course San Antonio Feb 2015 FUNCTIONAL ANATOMY: Knee and Leg Marlene DeMaio, MD Professor, Orthopaedic Surgery Marshall University VAMC Huntington, WV Mary Lloyd Ireland, MD Professor

More information

Presented at the Johnson&Johnson Registrar Congress, Durban, February 2009

Presented at the Johnson&Johnson Registrar Congress, Durban, February 2009 INSTRUCTIONAL ARTICLE SA ORTHOPAEDIC JOURNAL Winter 2009 / Page 35 I N S T R U C T I O N A L A RT I C L E Acute dislocations of the knee HR Hobbs, Registrar, Department of Orthopaedics J Walters, Professor

More information

Knee Multiligament Rehabilitation

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

More information

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribute.

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

More information

W. Dilworth Cannon, M.D. Professor of Clinical Orthopaedic Surgery University of California San Francisco

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

More information

Lateral ligament injuries of the knee

Lateral ligament injuries of the knee Knee Surg, Sports Traumatol, Arthrosc (1998) 6:21 25 KNEE Springer-Verlag 1998 Y. Krukhaug A. Mølster A. Rodt T. Strand Lateral ligament injuries of the knee Received: 22 January 1997 Accepted: 20 June

More information

Anterolateral Ligament. Bradd G. Burkhart, MD Orlando Orthopaedic Center Sports Medicine

Anterolateral Ligament. Bradd G. Burkhart, MD Orlando Orthopaedic Center Sports Medicine Anterolateral Ligament Bradd G. Burkhart, MD Orlando Orthopaedic Center Sports Medicine What in the world? TIME magazine in November 2013 stated: In an age filled with advanced medical techniques like

More information

Treatment of meniscal lesions and isolated lesions of the anterior cruciate ligament of the knee in adults

Treatment 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 information

No Disclosures. Topics. Pediatric ACL Tears

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

More information

ACL Updates. Doron Sher. Knee, Shoulder and Elbow Surgeon. MBBS MBiomedE FRACS(Orth) Dr Doron Sher Knee & Shoulder Surgery

ACL Updates. Doron Sher. Knee, Shoulder and Elbow Surgeon. MBBS MBiomedE FRACS(Orth) Dr Doron Sher Knee & Shoulder Surgery ACL Updates Doron Sher MBBS MBiomedE FRACS(Orth) Knee, Shoulder and Elbow Surgeon What s New in ACL Reconstruction? History Examination Investigations Graft Placement Graft Choice Rehabilitation Routine

More information

Impact of surgical timing on the clinical outcomes of anatomic double-bundle anterior cruciate ligament reconstruction

Impact 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

HIGH-ENERGY TRAUMA OF THE LOWER EXTREMITY NORDIC FORUM 2016, AARHUS

HIGH-ENERGY TRAUMA OF THE LOWER EXTREMITY NORDIC FORUM 2016, AARHUS HIGH-ENERGY TRAUMA OF THE LOWER EXTREMITY NORDIC FORUM 2016, AARHUS Ken F. Linnau, MD, MS Emergency Radiology Harborview Medical Center University of Washington Seattle, WA ACKNOWLEDGMENTS Nicole Kansier,

More information

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribution.

This presentation is the intellectual property of the author. Contact them for permission to reprint and/or distribution. 42 ND Annual Symposium on Sports Medicine UT Health Science Center San Antonio School of Medicine January 22-24, 2015 PCL injuries- only 5 to 10% of all knee ligament injuries. Incidence of PCL injury

More information

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 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 information

Case. 5 year old with 2 weeks leg pain and now refusing to walk + Fevers, lower leg swelling, warmth Denies and history of trauma or wounds

Case. 5 year old with 2 weeks leg pain and now refusing to walk + Fevers, lower leg swelling, warmth Denies and history of trauma or wounds Case 5 year old with 2 weeks leg pain and now refusing to walk + Fevers, lower leg swelling, warmth Denies and history of trauma or wounds Exam I: Swelling over entire tibia extending to foot P: Tenderness

More information

Surgery-Ortho. Fractures of the tibia and fibula. Management. Treatment of low energy fractures. Fifth stage. Lec-6 د.

Surgery-Ortho. Fractures of the tibia and fibula. Management. Treatment of low energy fractures. Fifth stage. Lec-6 د. Fifth stage Lec-6 د. مثنى Surgery-Ortho 28/4/2016 Indirect force: (low energy) Fractures of the tibia and fibula Twisting: spiral fractures of both bones Angulatory: oblique fractures with butterfly segment.

More information

Eric F.Recihman et al. / International Journal Of Advances In Case Reports, 2015;2(24):

Eric F.Recihman et al. / International Journal Of Advances In Case Reports, 2015;2(24): e - ISSN - 2349-8005 INTERNATIONAL JOURNAL OF ADVANCES IN CASE REPORTS Journal homepage: www.mcmed.us/journal/ijacr ROTATORY KNEE DISLOCATION: AN UNCOMMON INJURY Eric F. Reichman* Department of Emergency

More information

Case Report Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture

Case Report Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture Case Reports in Orthopedics Volume 2015, Article ID 527428, 5 pages http://dx.doi.org/10.1155/2015/527428 Case Report Posterolateral Corner Injury Associated with a Schatzker Type 2 Tibial Plateau Fracture

More information

THE TREATMENT OF KNEE LIGAMENT INJURIES. Ziali Sivardeen

THE 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 information

Joints of the Lower Limb II

Joints of the Lower Limb II Joints of the Lower Limb II Lecture Objectives Describe the components of the knee and ankle joint. List the ligaments associated with these joints and their attachments. List the muscles acting on these

More information

Anterior Cruciate Ligament (ACL) Injuries

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

More information

Lower Extremity Sports Injuries

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

More information

The Role of the Anterolateral Ligament in Knee Stability

The 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 information

Kineto. Orthopaedics & Rehabilitation Products

Kineto. 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 information

MIDFOOT INJURIES-ARE WE UNDERTREATING IT? Mr Rajiv Limaye Mr Prasad Karpe University Hospital of North Tees 3 rd Foot and Ankle Symposium

MIDFOOT INJURIES-ARE WE UNDERTREATING IT? Mr Rajiv Limaye Mr Prasad Karpe University Hospital of North Tees 3 rd Foot and Ankle Symposium MIDFOOT INJURIES-ARE WE UNDERTREATING IT? Mr Rajiv Limaye Mr Prasad Karpe University Hospital of North Tees 3 rd Foot and Ankle Symposium Introduction Increasing sports injuries RTA and traumatic injuries

More information

Rehabilitation Guidelines for Anterior Cruciate Ligament (ACL) Reconstruction

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

More information

40 th Annual Symposium on Sports Medicine. Knee Injuries In The Pediatric Athlete. Disclosure

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

More information

ANTERIOR CRUCIATE LIGAMENT INJURY

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

More information

MEDIAL EPICONDYLE FRACTURES

MEDIAL EPICONDYLE FRACTURES MEDIAL EPICONDYLE FRACTURES Demographic 20% of elbow fractures 60% of which are associated with elbow dislocation. 75% in boys between 6-12 years 20% of elbow dislocation with ME fracture, the ME is incarcerated

More information

Columbia/NYOH Department of Orthopaedics Shoulder, Elbow, and Sports Medicine Service Competency Requirements

Columbia/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 information

Grant H Garcia, MD Sports and Shoulder Surgeon

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:

More information

Recognizing common injuries to the lower extremity

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

More information

Avulsion fracture of femoral attachment of posterior cruciate ligament: a case report and literature review

Avulsion fracture of femoral attachment of posterior cruciate ligament: a case report and literature review Case Report Page 1 of 5 Avulsion fracture of femoral attachment of posterior cruciate ligament: a case report and literature review Yongwei Zhou, Qining Yang, Yang Cao Department of Orthopedics, Jinhua

More information

3/21/2011 PCL INJURY WITH OPERATIVE TREATMENT A CASE STUDY PCL PCL MECHANISM OF INJURY PCL PREVALENCE

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

More information

The Knee. Two Joints: Tibiofemoral. Patellofemoral

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?

More information

Doron Sher. 160 Belmore Rd, Randwick Burwood Rd, Concord. MBBS, MBiomedE, FRACS FAOrthA

Doron 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 information

SLARD Symposium: MCL s Injuries

SLARD Symposium: MCL s Injuries SLARD Symposium: MCL s Injuries ISAKOS 11 th Biennial Congress Tue June 6 th 2017 13:30 14:15 Shanghai, China Gustavo A. Rincón, MD Chairman Department Orthopedic Surgery Hospital de San José Bogotá -

More information

Femoral Shaft Fracture

Femoral Shaft Fracture Femoral Shaft Fracture The femoral shaft is well padded with muscles(an advantage in protecting the bone from all but the most powerful forces)but the disadvantage is that fractures are often severely

More information

Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery. By: Aun Lauriz E. Macuja SAC_SN4

Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery. By: Aun Lauriz E. Macuja SAC_SN4 Nursing Management: Musculoskeletal Trauma and Orthopedic Surgery By: Aun Lauriz E. Macuja SAC_SN4 The most common cause of musculoskeletal injuries is a traumatic event resulting in fracture, dislocation,

More information

Ankle Arthroscopy.

Ankle Arthroscopy. Ankle Arthroscopy Key words: Ankle pain, ankle arthroscopy, ankle sprain, ankle stiffness, day case surgery, articular cartilage, chondral injury, chondral defect, anti-inflammatory medication Our understanding

More information

The Impact of Age on Knee Injury Treatment

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

More information

7/20/14. Patella Instability. Alignment. PF contact areas. Tissue Restraints. Pain. Acute Blunt force trauma Disorders of the Patellafemoral Joint

7/20/14. 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 information

Medical Practice for Sports Injuries and Disorders of the Knee

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****

More information

ACL INJURIES WHEN TO OPERATE

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

More information

MRI grading of postero-lateral corner and anterior cruciate ligament injuries

MRI grading of postero-lateral corner and anterior cruciate ligament injuries MRI grading of postero-lateral corner and anterior cruciate ligament injuries Poster No.: C-2533 Congress: ECR 2012 Type: Educational Exhibit Authors: J. Lopes Dias, J. A. Sousa Pereira, L. Fernandes,

More information

CASE ONE CASE ONE. RADIAL HEAD FRACTURE Mason Classification. RADIAL HEAD FRACTURE Mechanism of Injury. RADIAL HEAD FRACTURE Imaging

CASE ONE CASE ONE. RADIAL HEAD FRACTURE Mason Classification. RADIAL HEAD FRACTURE Mechanism of Injury. RADIAL HEAD FRACTURE Imaging CASE ONE An eighteen year old female falls during a basketball game, striking her elbow on the court. She presents to your office that day with a painful, swollen elbow that she is unable to flex or extend

More information

Clin Podiatr Med Surg 19 (2002) Index

Clin Podiatr Med Surg 19 (2002) Index Clin Podiatr Med Surg 19 (2002) 335 344 Index Note: Page numbers of article titles are in bold face type. A Accessory soleus muscle, magnetic resonance imaging of, 300 Achilles tendon injury of, magnetic

More information

Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE

Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE Surgical Care at the District Hospital 1 18 Orthopedic Trauma Key Points 2 18.1 Upper Extremity Injuries Clavicle Fractures Diagnose fractures from the history and by physical examination Treat with a

More information

CLINICS IN SPORTS MEDICINE

CLINICS IN SPORTS MEDICINE Clin Sports Med 25 (2006) 365 369 CLINICS IN SPORTS MEDICINE A Acetabular labrum, tears of, hip arthroscopy in, 264 Acetabular rim, trimming of, and labral repair, new method for, 293 297 Acetabulum, femoral

More information

42 nd Annual Symposium on Sports Medicine. Knee Injuries In The Pediatric Athlete. Disclosure

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

More information

Arthroscopy Of the Ankle.

Arthroscopy Of the Ankle. Arthroscopy Of the Ankle www.fisiokinesiterapia.biz Ankle Arthroscopy Anatomy Patient setup Portal placement Procedures Complications Anatomy Portals Anterior Anteromedial Anterolateral Anterocentral Posterior

More information

BASELINE QUESTIONNAIRE (SURGEON)

BASELINE QUESTIONNAIRE (SURGEON) SECTION A: STUDY INFORMATION Subject ID: - - Study Visit: Baseline Site Number: Date: / / Surgeon ID: SECTION B: INITIAL SURGEON HISTORY B1. Previous Knee Surgery: Yes No Not recorded B2. Number of Previous

More information

Anterior Cruciate Ligament (ACL)

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

More information

Unicompartmental Knee Resurfacing

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

More information

Slide 1. Slide 2. Slide 3. The Thrower s Elbow: When to Operate. Medial Elbow Pain in the Athlete. Goal of This Talk

Slide 1. Slide 2. Slide 3. The Thrower s Elbow: When to Operate. Medial Elbow Pain in the Athlete. Goal of This Talk Slide 1 The Thrower s Elbow: When to Operate Luke S. Oh, MD Massachusetts General Hospital Team Physician, Boston Red Sox Team Physician, New England Revolution Consultant, Harvard University Athletics

More information