The document summarizes information from an orthopedic seminar on various knee injuries and conditions. It discusses meniscal tears, ACL tears, multi-ligament injuries, tibial plateau fractures, patellofemoral pain, knee arthritis, and knee replacement surgery. Treatment options are provided for each condition including arthroscopic surgery, bracing, physical therapy, injections, and different surgical procedures.

1. VMC Seminar
April 28, 2011
Renton, Washington
Fred Huang, MD
Valley Orthopedic Associates
A Division of Proliance Surgeons, Inc.

2.  Meniscal Tears
 ACL Tears
 Multi-ligament Injuries
 Tibial Plateau Fractures

3. Healthy
Right
Knee
Source: Knee Ligament Injuries
The Staywell Company, 2001

4. Meniscal Tears
 Symptoms – what patients notice
 Swelling
 Catching and locking
 Pain with pivoting and squatting
 Exam Findings – what doctors find
 Swelling (fluid on the knee)
 Tenderness at the site of the tear
 Pain with flexion/twisting

5. Meniscal Tears
 Arthroscopic surgery to
remove torn tissue
Source: www.stoneclinic.com
 Degenerative tears:
associated with
minimal or no trauma
 Degenerative tears
often associated with
arthritis & not always
treated with surgery
Source: www.opsmart.com

6. Types of Ligament Injuries
 ACL very common
 MCL most common with ski injuries
 Usually treated with bracing for 6 weeks
 Combination injuries (ACL w/ MCL most common,
but any combo possible)
 PCL involved frequently in multi-ligament injuries

7. ACL Tears
Source: Knee Ligament Injuries
The Staywell Company, 2001

8. ACL Tears
 Twisting and/or
cutting – often a
non-contact injury
 Usually unable to
continue sporting
activity
 Swelling within 1-2
hours Source: Knee Ligament Injuries
The Staywell Company, 2001

9. MRI – ACL and Meniscal Tears

10. ACL Tears - Treatment
 Non-operative treatment (Brace?)
 Surgical treatment
 Only after motion returns to normal
 Graft options: hamstrings, patellar tendon,
quad tendon, or allograft
 Associated procedures: meniscal or
cartilage procedures

11. ACL Reconstruction
 Sources:
Left: www.arthroscopy.com
Right: www.orthop.washington.edu

12. Multi-ligament Knee Injuries
 Higher energy mechanism than ACL
tears
 Can be due to a complete knee
dislocation
 Nerve and/or blood vessel injuries
possible

13. Multi-ligament Knee Injuries

14. Tibial Plateau Fractures
 Wide spectrum of injury
patterns
 Often treated surgically to
re-establish normal
architecture at the joint
surface

15. Tibial Plateau Fractures
 CT scans helpful

16. Tibial Plateau Fixation with
Lateral Ligament Repair (Simple)

17. Tibial Plateau Fixation - Moderate

18. Tibial Plateau Fixation - Complex

19. Patello-femoral Pain
 Frequent cause for ANTERIOR knee pain
 Pain worsened by running, squatting,
stair-climbing, and lunges
 Often associated with grinding/popping at the
kneecap
 MRI’s often “normal”
 Treatment consists of formal P.T., NSAID’s,
weight loss, and occasional steroid injections

20. Knee Arthritis
 Pain worse with standing
and better with rest
 Physical Exam:
 Stiffness & swelling
 Deformity (bow-legged
versus knock-kneed)

21. Knee Arthritis – Treatment Options
Standard treatments:
 1. Medicines
 2. Injections
 3. Surgery
(replacement usually)

22. Knee Arthritis Treatment – Tibial Osteotomy
 Intermediate solution that
improves pain and function
usually for < 10 years
 Allows for continued impact
activities
 Associated with a longer
recovery time (to allow for
healing of the osteotomy)

23. Total Knee Replacement
 Reliable solution that improves pain
and function usually for >15 years
 Physical therapy and home exercises
important after surgery
 New interest in better pain
management, smaller incisions, and
accelerated rehab
 Not designed for impact activities

24. Thank You
 Fred Huang, MD
 www.valleyorthopedicassociates.com