The Knee Consultation Made Easy for GP Doctors (Nuffield/ Newcastle)

1. Professor Deiary F Kader Department of Sport, Exercise, Northumbria University, Newcastle www.oasir.co.uk Knee Surgeon, Nuffield Hospital, Newcastle upon Tyne THE KNEE CONSULTATION MADE EASY GP TALK AT NEWCASTLE NUFFIELD HOSPITAL

2. Prof Deiary Kader Arthroplasty  Primary TKR  Revision TKR  Uni Knee  Patellofemoral Open Surgery  Osteotomy (HTO)  Chondroplasty  Patella Stabilisation Arthroscopy  Meniscal Excision  Meniscal Repair  Microfracture  ACL reconstruction  Revision ACL  PCL reconstruction  Multiple Ligament Recon

3. Prof Deiary Kader 1. Arthritis 2. Meniscus 3. Ligament (ACL, PCL, MCL) 4. Patellofemoral 5. Red Flag ◦ Fracture ◦ Infection ◦ Tumour

4. Prof Deiary Kader History Pain  Duration  Onset  Type Give way Stair problems Trauma Examination Tenderness Osteophytes Effusion Drawer test 5 Min Knee Consultation

5. Prof Deiary Kader 1 Red Flags 2 OA 3 Meniscus 4 Ligaments 5 Patella History Rest pain Tumor Trauma Fracture Fever Infection Dull pain Toothache Sharp pain Locking Giveway Stairs Rising from a chair Examination General tenderness Fixed flexion osteophytes Tender joint line Effusion Drawer test Lachman Grinding Short Knee Consultation

6. Prof Deiary Kader Pain Duration 2-4 wks Conservative Onset Rest (Red Flag) Mechanical (OA or Instability) Type Dull (OA) Sharp (Meniscal tear) Give way 1-Ligaments 2-Patella Instability Stairs Patellofemoral dysfunction Short Knee Consultation

7. Prof Deiary Kader 1. Arthritis 2. Meniscus 3. Ligament (ACL, PCL, MCL) 4. Patellofemoral 5. Red Flag ◦ Fracture ◦ Infection ◦ Tumour

8. Prof Deiary Kader

9. Prof Deiary Kader OA Nonoperative treatment  Weight loss  Exercise  Patient education  Analgesia, (NSAIDs)  Bracing rarely  Intra-articular (IA) injections. Cochrane reviews  Steroids (better than placebo but not longer than 4wks  HA more prolonged effect than steriods

10. Microfracture Operative treatment Chondral Damage treated with Microfracture

11. Prof Deiary Kader Autologous Cartilage Implantation

12. Prof Deiary Kader Open or close wedge Osteotomy

13. Prof Deiary Kader When to offer joint replacement The pain should be significant and disabling. Night pain is particularly distressing

14. Prof Deiary Kader MENISCAL RESECTION & REPAIR

15. Prof Deiary Kader History Meniscal Injury  Acute event  Delayed swelling  Effusion….. Swelling after exercise  Pain  Catching  Locking

16. Prof Deiary Kader Meniscal Tear Management :-  Excision  60% of people over 65yrs have incidental tears  Repair  Transplant  Replacement

19. Prof Deiary Kader POSTGRADORTH Deiary Kader ??????

20. Prof Deiary Kader Menx Allograft Indications  Physiologically young and active  Symptomatic (in the future ??prophylactically)  Neutral alignment  Normal stability  No more than grade II-III Cartilage damage  Understand the risk of disease transmission  Post operative compliance & expectation  No knee abuser and Not in BMI >35

21. Prof Deiary Kader ACL Injuries FRCS(Tr&Orth) Revision Course

22. Prof Deiary Kader Valgus + ER POP

23. Prof Deiary Kader Non-Operative Treatment  Activity modification (swimming, bicycling, jogging on flat ground)  Muscle Training (Hamstrings strength)  Proprioceptive Training  Bracing (reduce anterior drawer)

24. Prof Deiary Kader Surgical Treatment Indications:  Subjective instability (non-coper)  In children and adolescents  Multiligament injury

25. Prof Deiary Kader Intra-articular ACL Reconstruction

26. Prof Deiary Kader Hamstring BTB Grafts / Fixations Quads

27. Prof Deiary Kader ANTEROLATERAL LIGAMENT ALL

28. Prof Deiary Kader OPEN ALL Recon

29. Prof Deiary Kader MCL

30. Prof Deiary Kader Medial Collateral Ligament Exam  Opening @ 30o only  Isolated MCL Injury  Opening @ 0o  Injury to Posteromedial Capsule  Usually with ACL +/or PCL injury

31. Prof Deiary Kader Treatment Acute isolated MCL tear I Simple rest, ice, compression bandage, early physiotherapy. 2 Wks II Hinged brace, WBAA, 2-3weeks III Hinged brace 30-90/ Surgical 3-4 wks Operative treatment depend on site and patient Chronic isolated MCL tear – simple reapproximation – tend to elongate and stretch therefore needs Augmentation with semitendinosis Combined injury ACL and MCL→Reconstruction ACL and non-operative treatment MCL I-II but surgical for III  MCL

32. Prof Deiary Kader Posterior Cruciate Ligament

35. 35 PCL Reconstruction

36. Prof Deiary Kader PATELLA CLINIC Evidence based intervention History and outcome measures Lysholm ,Oxford, Kujala Scores Clinical examination Imaging

37. Prof Deiary Kader Instability can be easier to treat Pain primary or secondary

38. Prof Deiary Kader Patellar Dislocation  Re-dislocation rate  First Time 17-20%  Second Time 44%-71%  High dissatisfaction following conservative Rx

39. Prof Deiary Kader Med Epicondyle Add Tubercle Patella MPFL

41. Prof Deiary Kader Bony Tunnel

42. Prof Deiary Kader 1.4 cm Patella alta

46. Prof Deiary Kader Kurdistan/Iraq Thank you

The Knee Consultation Made Easy for GP Doctors (Nuffield/ Newcastle)

The Knee Consultation Made Easy for GP Doctors (Nuffield/ Newcastle)

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