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ACL tear

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  • Osteochrondralfx , tibia plataufx
  • After ACL tear, need surgical intervention if planning on returning to competitive/recreational activity. Not for other injuries really, the ACL is he primary knee stabalizer
  • Stronger quads can help in prevention
  • After ACL tear, need surgical intervention if planning on returning to competitive/recreational activity. Not for other injuries really, the ACL is he primary knee stabalizer

Transcript

  • 1. Anuchit NawatthakulSixth year medical studentPhramongkutklao college of medicine
  • 2.  HN : 11593/56Case : A young Thai man 22 yrs , an officerCC : 1 yr PTAPI : 1 yr PTA Pop
  • 3. PH : - no underlying disease - no history of previous surgery - no history of drug allergy - no current medication
  • 4. Physical examnination GA : good conscious , not pale , no jaundice HEENT : normal Heart : normal s1s2 , no murmur Lung : clear , no adventitious sound Abdomen : soft , not tender
  • 5.  Affected part ( Right knee) Swelling , pain on motion Full ROM , normal length valrus / valgus : nrgative ballotment : negative Lachman test : negative Anterior drawer test : positive 2+ Pivot shift test : negative Mc Murray test : negative Apley ’s test : negative Neurovascular : ok
  • 6. 90
  • 7. 30 proximal tibiadistal femur proximal tibia distal femur
  • 8. Pertinent finding Rt knee in jury in football match Swelling Anterior drawer test positive No deformities Normal Neurovascular status
  • 9. Problem list Rt knee injury in football match with anterior drawer test positive
  • 10. Differential Diagnosis Knee ligamentous injury Fracture
  • 11. Ligamentous Injuries ACL injuries PCL injuries MCL injuries LCL injuries
  • 12. ACL Injuries Most MOI are non-contact rotational forces Tibia displaced anteriorly on femur (or vice versa), rotational stress (cutting) or hyperextension May be isolated, but typically due to MOI, other structures (joint capsule, menisci) also injured Positive anterior drawer and/or Lachman’s tests
  • 13. PCL Injuries Most common MOI is fall on flexed knee driving tibia posterior on femur May also occur with rotational and/or hyperextension MOI Often treated non-operatively as quadriceps muscles are able to minimize posterior displacement of tibia on femur Positive posterior drawer and/or posterior sag tests
  • 14. MCL Injuries Most common MOI is blow to lateral knee with resulting valgus tension forces May also be injured by non-contact and/or rotational stresses Positive valgus stress test
  • 15. LCL Injuries Most common MOI is blow to medial knee with resulting varus tension forces Internal rotation of tibia may be secondary contributor to LCL injury Positive varus stress test
  • 16. Meniscal Injuries May be isolated from flexion/hyperflexion with rotation of the knee – “pinched” between tibia and femur Often injured in association with cruciate ligament injury “Classic” symptoms include joint line pain and clicking or locking – helpful but not definitive evaluative tools Limited reliability of special tests
  • 17. Investigation  X-ray  MRI
  • 18. X-ray
  • 19. MRITorn of Anterior Cruciate Lingament (complete tear)Torn medial miniscus ( Basket handle)
  • 20. DiagnosisComplete torn Anterior Cruciate Lingament with torn medial meniscus
  • 21. ACL hyperextension tibia.3. valgus varus internal rotation external rotat4. screw home
  • 22. ACL Injuries Most MOI are non-contact rotational forces Tibia displaced anteriorly on femur (or vice versa), rotational stress (cutting) or hyperextension May be isolated, but typically due to MOI, other structures (joint capsule, menisci) also injured Positive anterior drawer and/or Lachman’s tests
  • 23. Grading ligamentous injury  Grade 1 : Ligament Swelling, localized tenderness  Grade 2 : Ligament stretching partial tear Swelling  Grade 3 : Ligament complete tearMay 12,2009 24
  • 24. Management
  • 25. knee bracejone s bandage NSAID
  • 26. CommercialHinge-Knee Brace
  • 27. Anterior Cruciate Ligament Injury  International Knee Documentation Committee activity level 4 level 1 jumping, pivoting football ,soccer ) level 2 heavy manual work or side-to- side sports (skiing, tennis) level 3 light manual work or noncutting sports (jogging, running)May 12,2009 28
  • 28. Non operative treatment ACL injury level 3 level 4 level 1 level 2 sport activity reconstruction physical therapy Functional brace rehabilitation swelling effusion , hamstrings muscle atrophyMay 12,2009 29
  • 29. Non operative treatment Rehabilitation ROM swelling , effusion strengthening of hamstring muscle for balance power of quadriceps instability
  • 30. Non operative treatment ACL injury  brace brace physical therapy control stability  conservative minimal surgery debridement of articular cartilage defect, trimming or repairing meniscus excising ligament stump procedures ligament reconstructionMay 12,2009 31
  • 31. Surgical treatment ACL injury  intraarticular reconstruction  ACL reconstruction arthroscopic assisted endoscopic techniques transfixation technique hamstring graft fixation femoral tunnelMay 12,2009 32
  • 32. Surgical treatment ACL injury  fixation graft interference screw titanium bioabsorbable screw stable fixation transfix pin screwMay 12,2009 33
  • 33.  Operation : Arthroscopic ACL reconstruction with medial meniscus repair Indication complete tear(grade 3) Medial meniscus tear instability
  • 34. Patient Education , , ,
  • 35. Progress note v/s pain control Morphine , Dynastat on continuous passive motion , Axillary Crutch
  • 36. ReflectionApproch Knee ligament injury-- knee ligament injury-