The Knee Consultation Made Easy for GP Doctors (Nuffield/ Newcastle)
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Management of knee problems in General Practice
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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
- 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
- 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
- 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
Editor's Notes
- Le probl actuel de la reconstruction monobrin reste le contrôle des rotations. Effectivement nos reconstructions permettent un bon contrôle antero post en extension mais insuffisante en rotation ce qui explique que l’on retrouve a long terme dans les methanalyse environ 15% de ressaut rotatoire