orthopaedics

1. Ahmed Al Issa
Approach to Knee in Varus, Valgus
and Flexion Deformity

2. Hx
 Pain
 Activity related
 Rest pain
 Localized or diffused
 Swelling
 Mechanical symptoms
 Instability
 Physical therapy
 Change in body weight or activity
 Need for assistive devices

3. Hx
 Footwear
 Prior treatment
 NSAIDs
 Injections
 Bracing
 Rehabilitation
 Surgery

4. Ex
 Gait
 Static limb alignment and deformity in the
standing and supine positions
 Joint line tenderness
 Ligaments examination
 ROM
 Patellofemoral or joint-line crepitus

5. Imaging
 Weight bearing AP.
 Non weight bearing true 45-degree flexion lateral
view.
 Weight-bearing anteroposterior radiographs that
include both extremities from the hips to the
ankles.
 Skyline view of patella

8. Case 1
 A 67 year-old woman sustained an ACL tear while
playing basketball when she was 35 years-old.
She has noted progressive leg deformity and
episodes of giving way, and now has pain
preventing activity. Non-operative management
has failed to provide relief.

10. Case 2
 A 40-year-old man has moderate lateral compartment arthritis
several years after undergoing a partial lateral meniscectomy. He
has a correctable 5 degree valgus knee deformity compared to
his other limb. His patellofemoral and medial compartments do
not show any radiographic signs of degenerative changes. His
knee has full range of motion and is stable on exam. After failing
nonoperative treatments, which surgical option is most likely to
give him the best outcome?

11. Case 3
 A 38-year-old female has moderate medial compartment arthritis
several years after undergoing a partial medial meniscectomy.
She has a correctable 5 degree varus knee deformity compared
to her other limb. Her patellofemoral and lateral compartments
do not show any radiographic signs of degenerative changes.
Her knee has full range of motion and is stable on exam. Which
nonoperative treatment option is most likely to give her the best
outcome?

12. Case 4
 54 year old female with rheumatoid arthritis and valgus deformity
left knee.

13. Case 5
 45 year old female, bilateral knee OA since 8
years
 varus 5 degree
ROM 0 TO 90 degree

15. Case 6
 60 years old man. Trauma 2011
ORIF lat tibial plateau. Synthetic bone graft/blocks
used as significant lateral depression.
Removal of implant January 2013.
Ambulatory with a stick
 O/E lateral joint pain and some instability.
Range of motion 5- 105. MCL lax but firm end point.
LCL lax but end point. No neurovascular deficit except
numbness around incision site

19. Thank You