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Knee Injuries Ligaments

VIEWS: 6 PAGES: 5

									                                                                                 11/11/2010




                                                                     On Tap
                                                   Anatomy
                                                   Injury Mechanisms
                                                   Presentation Patterns
                                                   Diagnosis & Exam Tips
                                                   Treatment
                   KNEE INJURIES                   When to refer
                         LIGAMENTS

              Gehron Treme, MD
              UNM Orthopaedic Sports Medicine




             Anatomy & Function




Evaluation & Clinical Presentation              Multiligament Knee Dislocation
   What was the activity?                         Rare
   Injury Description                             High Energy
   Swelling?                                      Associated Trauma
   Return to Play?                                ACL/PCL + MCL/LCL
   Evaluation or Imaging?                         Emergent Evaluation
   Previous similar injury?                       NV Exam
                                                   Admission




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                       Clinical Evaluation                          Clinical Evaluation
                           History/Mechanism                           History/Mechanism
   Isolated Collateral Injuries                   ACL
     Varus
     Valgus
                                                       Non Contact Pivot
     Blow or Moment                                   Combined with Collateral

   Corner Injury
       Rotatory force
       Anterolateral or Anteromedial
        contact

   Combined Injury
       Non-contact pivot
       High energy multiligament injury




                       Clinical Evaluation
                           History/Mechanism
                                                                               Exam
                                                   Suspect based on history
   PCL
                                                   XR
       Isolated
           Dashboard                              Compare to uninjured side
           Fall on Knee
                                                   Assess knee
       Combined with                                  What is Reduced?
        PLC                                            Effusion?
                                                       Skin changes
                                                       Alignment
                                                       Motion
                                                       Neurovascular
                                                       Ligaments




                                     Exam                                      Exam
                                  Collaterals                              Collaterals
   Collaterals
     Assess @ 0 & 30 deg
     Isolate and quantify joint
      line opening
     Bounce?
     TTP?
     Rotation
           Supine at 90 deg
           Prone at 30 and 90 deg
                Inc @ 30 = PLC injury
                Inc @ 30 & 90 = PCL
                 and PLC injury
                Medial Injury?




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                       Exam                              Exam
                       Grading                          Collaterals




                                        Do they open in extension?




                       Exam                              Exam
                        PCL                                ACL

   Posterior Drawer
   Sag
   Rotation

   Grade?




             And Don’t Forget…                 Initial Management
                                               Negative XR and Pending MRI

                                    Swelling Control
                                    Brace?
                                    WBAT



                                    MOTION




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                       Imaging
                             MRI
                                           Non-op Ligament Treatment
                                      Who?
                                        Isolated Grade I or II Collaterals
                                        Isolated PCL
                                        ACL in low demand patients
                                        Medically unfit



                                      How?
                                          Rehab
                                              Motion
                                              Strengthen Dynamic Stabilizers
                                              Core
                                              RTP  Motion, Strength, Agility




                 When To Refer                        Surgical Evaluation
   1 + 1 = Referral                  Other Injury?
   Any “Grade III” Injury            Age
   Skeletally Immature               Activity Level
   Head Scratchers                   Goals
                                      Functional Instability
   Functional Instability
                                      What Else?
                                        Social
                                        Smoker
                                        Medical




              ACL Reconstruction                       PCL Reconstruction




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Collateral Reconstruction                         For The Test
                               Suspect Based on History
                               XR’s
                               Check the other knee
                               Can’t Fake Swelling
                               Early motion and weight bearing

                               Send on
                                 Combined or Grade III Injuries
                                 Functional Instability
                                 Kids
                                 Cloudy Pictures




   gtreme@salud.unm.edu




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