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Knee SPORTS INJURIES

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KNEE SPORTS INJURIES

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Knee SPORTS INJURIES

  1. 1. Injuries of the Knee Joint Dr.RAJAT JANGIR Consultant Arthroscopy and Sports Injury MS Ortho (Ahmedabad) Fellow Arthroscopy(S.Korea) Dip Sports Med IOC
  2. 2. Gross Anatomy: Skeletal Structure 22
  3. 3. Gross Anatomy: Meniscus  Fibrocartilaginous structures Vascular periphery (2-3 mm) Medial meniscus Cresent-shaped Thinner , less mobile Lateral meniscus Circular Thicker, more mobile
  4. 4. Gross Anatomy: Ligaments  MCL  LCL  ACL  PCL  MPFL Meniscofemoral ligament
  5. 5. Patellar Dislocation  Predisposition  Genu valgum  Overweight  Patellar hypermobility  Weak quadriceps  Mechanisms  Direct contact to medial side  External tibial rotation with forceful quadriceps contraction
  6. 6. Patellar Dislocation: Diagnosis  Obvious if not yet reduced  Patellar hypermobility/ apprehension test  X-ray/MRI only necessary to rule out osteochondral fractures, other associated injuries
  7. 7. Patellar Dislocation: Treatment  Knee extension  Aspiration to relieve discomfort  Crutches, PRICES Taping  Rehabilitation focusing on Vastus medialis Surgery-  Osteochondral fracture  Complete rupture of MPFL
  8. 8. Meniscal Tears  Shear force from femur  Traumatic or degenerative  Athletes, elderly  Vascular zone?  Horizontal  Within substance  Longitudinal  Bucket handle – ACL risk  Radial or vertical  Parrots beak
  9. 9. Meniscus tear: Diagnosis  Examination  McMurray’s test  Apley’s compression test  MRI  Low-signal intensity (black triangle ) = normal  White interruption = lesion  Arthroscopy as last resort
  10. 10. When to repair…...
  11. 11. When to repair
  12. 12. Medial Collateral Ligament  Attached to fibrous capsule and MM  Injury rarely isolated – “unhappy triad”  Can tear with external rotation (skiing), but more commonly from valgus or abduction force (football)  Pain localized to medial joint line, but can subside following Grade III tear
  13. 13. MCL: Diagnosis: Examination  Valgus stress test  First at 30  Again at full extension  Rule out PCL tear  Anterior drawer test with external rotation of tibia
  14. 14. MCL: Diagnosis: Imaging  X-ray  Exclude Epiphyseal fracture  Enlarged joint space = tear  MRI  Normal MCL looks thin, taut, low-signal  Grade I: indistinct MCL (edema)  Grade II: thicker, looser  Grade III: severe edema
  15. 15. MCL: Treatment  Crutches + PRICES + rehab for Grade I, II only if isolated  Grade III tears require surgical repair  Surgery  Acute: Repair  Chronic: Reconstruction
  16. 16. Lateral Collateral Ligament  Sprained least frequently  BF, popliteus, ITB  Flexed Adduction knee = isolated tear  Anteromedial blow  hyperextension/ postero-lateral corner injury  Risk to common peroneal nerve
  17. 17. LCL: Diagnosis: Examination  Varusstress test At 30, then full extension  Ext. rotation recurvatum Recurvatum + ext rotation + varus = PL corner injury  Dial Test
  18. 18. LCL: Imaging and Treatment  MRI  Coronal oblique scan  Sagittal scan to rule out fibular fracture, avulsion  Tear looks less taut or discontinuous – no thickening  Treatment  Similar to MCL  Grade III usually requires surgery
  19. 19. Anterior Cruciate Ligament  Most common knee injury among athletes  AM fibers taut in flexion  Check anterior displacement  PL fibers taut in extension  Check rotation  Hyperextension, internal rotation – rarely isolated injury from contact force  “unhappy triad”  Intersubstance (70%) (LEFT KNEE)
  20. 20. ACL: Diagnosis: Examination  History, large hemarthrosis  Anterior drawer test  NOT RELIABLE BY ITSELF  Lachman test  Knee only flexed 30  Pivot shift
  21. 21. ACL: Diagnosis: Imaging  X-ray  Segond fracture of lateral tibial condyle  ACL tear with it 75- 100%  Tibial spine avulsion in young patients  MRI – 95% accuracy  All 3 planes in full extension  Edema/hemorrhage often obscures ACL Normal ACL Torn ACL
  22. 22. ACL: Treatment  Extrasynovial, heals poorly  Partial, isolated tears may be treated conservative  Most tears, athletes will require reconstruction
  23. 23. Posterior Cruciate Ligament  Broader, longer, stronger  PM and AL fiber bundles  Receives better vasc. from MGA, synovial membrane  Tears much less frequently  Only in isolation when “dashboard knee” injury  Hyperextension in sports, especially Posterior view Anterior view Medial femoral condyle
  24. 24. PCL: Diagnosis  Posterior drawer test  Neutral start vital!  Gravity or sag test  X-ray to confirm sag test  MRI negative positive
  25. 25. PCL: Treatment  PRICES , rehab, bracing for most isolated tears Grade I Drawer  Rehab focused on quadriceps muscles for compensatory anterior drawer  Prognosis good because better blood supply = revascularization
  26. 26. Anatomical ACL Reconstruction ?  What was the need for Anatomic reconstruction when Conventional Transtibial Reconstruction was done
  27. 27. “Matched Anatomic” Single Bundle
  28. 28. Patient Positioning  Unrestricted Knee flexion  High tourniquet  High Thigh Post with padding to facilitate knee flexion.
  29. 29. Graft Harvesting hamstring Tendon Stripper Tendon
  30. 30. AAM Portal positioning is Important  more perpendicular orientation of the femoral guide pin  produces a shorter ACL femoral tunnel and a more circular-shaped tunnel
  31. 31. Tibial tunnel making
  32. 32. Tibial Drilling Position Tibial Pin Tibial Tunnel
  33. 33. THANK YOU

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