Common Knee Conditions by: Fred Huang


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Valley Orthopedic Associates physician. Dr. Fred Huang gives a seminar on Common Knee Conditions

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Common Knee Conditions by: Fred Huang

  1. 1. VMC Seminar April 28, 2011 Renton, Washington Fred Huang, MD Valley Orthopedic AssociatesA Division of Proliance Surgeons, Inc.
  2. 2.  Meniscal Tears ACL Tears Multi-ligament Injuries Tibial Plateau Fractures
  3. 3. Healthy Right KneeSource: Knee Ligament InjuriesThe Staywell Company, 2001
  4. 4. Meniscal Tears  Symptoms – what patients notice   Swelling   Catching and locking   Pain with pivoting and squatting  Exam Findings – what doctors find   Swelling (fluid on the knee)   Tenderness at the site of the tear   Pain with flexion/twisting
  5. 5. Meniscal Tears  Arthroscopic surgery to remove torn tissue Source:  Degenerative tears: associated with minimal or no trauma  Degenerative tears often associated with arthritis & not always treated with surgery Source:
  6. 6. Types of Ligament Injuries   ACL very common   MCL most common with ski injuries   Usually treated with bracing for 6 weeks   Combination injuries (ACL w/ MCL most common, but any combo possible)   PCL involved frequently in multi-ligament injuries
  7. 7. ACL TearsSource: Knee Ligament InjuriesThe Staywell Company, 2001
  8. 8. ACL Tears  Twisting and/or cutting – often a non-contact injury  Usually unable to continue sporting activity  Swelling within 1-2 hours Source: Knee Ligament Injuries The Staywell Company, 2001
  9. 9. MRI – ACL and Meniscal Tears
  10. 10. ACL Tears - Treatment  Non-operative treatment (Brace?)  Surgical treatment   Only after motion returns to normal   Graft options: hamstrings, patellar tendon, quad tendon, or allograft   Associated procedures: meniscal or cartilage procedures
  11. 11. ACL Reconstruction  Sources: Left: Right:
  12. 12. Multi-ligament Knee Injuries  Higher energy mechanism than ACL tears  Can be due to a complete knee dislocation  Nerve and/or blood vessel injuries possible
  13. 13. Multi-ligament Knee Injuries
  14. 14. Tibial Plateau Fractures  Wide spectrum of injury patterns  Often treated surgically to re-establish normal architecture at the joint surface
  15. 15. Tibial Plateau Fractures  CT scans helpful
  16. 16. Tibial Plateau Fixation withLateral Ligament Repair (Simple)
  17. 17. Tibial Plateau Fixation - Moderate
  18. 18. Tibial Plateau Fixation - Complex
  19. 19. Patello-femoral Pain  Frequent cause for ANTERIOR knee pain  Pain worsened by running, squatting, stair-climbing, and lunges  Often associated with grinding/popping at the kneecap  MRI’s often “normal”  Treatment consists of formal P.T., NSAID’s, weight loss, and occasional steroid injections
  20. 20. Knee Arthritis  Pain worse with standing and better with rest  Physical Exam:   Stiffness & swelling   Deformity (bow-legged versus knock-kneed)
  21. 21. Knee Arthritis – Treatment OptionsStandard treatments:   1. Medicines   2. Injections   3. Surgery (replacement usually)
  22. 22. Knee Arthritis Treatment – Tibial Osteotomy  Intermediate solution that improves pain and function usually for < 10 years  Allows for continued impact activities  Associated with a longer recovery time (to allow for healing of the osteotomy)
  23. 23. Total Knee Replacement  Reliable solution that improves pain and function usually for >15 years  Physical therapy and home exercises important after surgery  New interest in better pain management, smaller incisions, and accelerated rehab  Not designed for impact activities
  24. 24. Thank You  Fred Huang, MD