Professor Deiary F Kader
Department of Sport, Exercise, Northumbria University, Newcastle
www.oasir.co.uk
Knee Surgeon, Nuffield Hospital, Newcastle upon Tyne
FRACTURES AROUND THE KNEE –
CLINICAL PATTERN RECOGNITION AND APPROPRIATE
ACTION PLANNING

Prof Deiary Kader
Plan
 Knee Osteonecrosis
 Fracture around the Knee
 Advances in ACL Surgery
 Advances in PFJ instability
 PCL & PLC
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Prof Deiary Kader
Nuffield Hospital/Newcastle
ICRC 2015
QEH Gateshead 2005-2015
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QEH
Gateshead Health

Prof Deiary Kader
Knee Osteonecrosis (ON)
Spontaneous ON (SONK)
Secondary ON
Post-arthroscopic ON
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Prof Deiary Kader
Spontaneous Osteonecrosis of the Knee
(SONK)
 Osteonecrosis without an identified cause.
 Females
 Middle age or elderly.
 Epiphysis of medial FC
 Lateral FC, Tibial plateau
 Almost always unilateral.
 Associated with meniscal root tear
 May represent a subchondral insufficiency / stress
fracture

Prof Deiary Kader
Clinical Presentation:
 Sudden onset of severe knee pain (usually non-
specific).
 Can be focused over the medial femoral condyle
 Decreased range of motion with no mechanical block
 Effusion present in the acute stages
 Pain worse on activity

Prof Deiary Kader
Treatment : Non-operative:
 Activity modification
 Rest and non or partial weight bearing
 Analgesia including NSAIDs
 Targeted physiotherapy focusing in range of
motion and quadriceps strengthening

Prof Deiary Kader
Treatment
Operative
Only after conservative Rx -success is variable.
 Retrograde drilling
 a trial with an off-loader brace is
recommended pre-operatively
 High tibial osteotomy (if mal-alignment
present)
 Arthroplasty (in larger lesions and bone
collapse)

Prof Deiary Kader
Outcome of SONK
 Small, isolated lesions often regress and heal
 Medium-sized lesions may regress
 Very large lesions, subchondral collapse will
occur, regardless of treatment

Prof Deiary Kader
Insufficiency Fractures of the
MFC
 Predominance in elderly women
 Osteoporotic bone
 Varus knee
 Obesity
 Trivial trauma
 Mechanical pain
 Increased radionuclide uptake.
 Rest and analgesics consistently ensured a better
outcome within three to four weeks

Prof Deiary Kader
Secondary Osteonecrosis
Subchonrdal AVN
 Often involves both femoral condyles
 Multiple lesions epiphysis, metaphysis, diaphysis ne.
 Typically younger than 45 years
 It is bilateral more than 80%
 Direct risk factors
 Radiation
 Chemotherapy
 Corticosteroid
 Trauma.
 Sickle cell disease or other myeloproliferative

Prof Deiary Kader
Treatment of secondary ON
 Diagnosis at early stages
 Eliminate the causative factor if possible
 Nonsurgical treatment lead to poor outcome
 Drill the lesions, may halt the progression
 Supplement the drilling technique with
 Bone morphogenetic protein
 Growth factors
 MSC

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Prof Deiary Kader
General causes of osteonecrosis include:
• TRAUMA
• CAISSON DISEASE
• HAEMOGLOBINOPATHIES SICKLE CELL DISEASE
• RADIOTHERAPY
• CONNECTIVE TISSUE DISORDERS
• RENAL TRANSPLANTAION
• CORTICOSTEROID EXCESS
• PANCREATITIS
• GOUT
• GAUCHER DISEASE
• ALCOHOL
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Prof Deiary Kader
Post-arthroscopic ON
 Heat damage to the bone
 Trauma during surgery
 Lesions are typically only found in the epiphysis.
 Patient age and sex is not a factor.
 Some of the associated risk factors include
meniscectomy, cartilage débridement, and ACL
reconstruction.

Prof Deiary Kader
Hoffa Fracture

Prof Deiary Kader
 Isolated femoral condylar fractures in the coronal
plane
 Direct anteroposterior force applied to a flexed
knee in a high-energy accident
 Hoffa described the injury in 1904 as generally
involving the lateral femoral condyle

Prof Deiary Kader

Prof Deiary Kader
Sleeve Fracture
Patella

Prof Deiary Kader
Sleeve fracture occurs between the cartilage "sleeve" and
main part of the ossific nucleus
Age 8-12
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Patella Tendon Rupture

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POSTGRAD ORTH Deiary Kader
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Sigond Fracture
pathognomonic of ACL Rupture

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Tibial Eminence Fracture
Meyers and McKeever classification (1959)
 Type I: non displaced
 Type II: partially displaced or hinged
 Type III: completely displaced (Type III)
 Type IIIA (Zifko) involves the ACL insertion
 Type IIIB (Zifko) includes the entire intercondylar eminence.
 Type IV (Zaricznyj 1977): comminution of the fracture fragment.

Treatment
 Casting in extension for type I
 Open reduction and internal fixation.
 Arthroscopic reduction and fixation
 Rarely ACL reconstruction is necessary

Prof Deiary Kader
TP
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Prof Deiary Kader
TP

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Tibial Plateau Fractures

Prof Deiary Kader
Tibial Plateau Fractures

Prof Deiary Kader
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Prof Deiary Kader
Metastatic cancer

Prof Deiary Kader
Only bone cyst

Prof Deiary Kader