Download as PDF, PPTX
More Related Content
Acl injury
- 1. Case presentation ORTHOPEADICS KORAT|EXT. POONYAPORN PHANKOSOL
- 2. Cheif complaint ผู้ป่วยชายอายุ 19ปี มาด้วย เข่าซ้ายบวม 1 ชั่วโมงก่อนมารพ.
- 3. Present illness 1ชั่วโมงก่อนมารพ. ผู้ป่วยเตะฟุตบอล กระโดดลงพื้น เข่า ซ้ายบิดแล้วล้มลง เจ็บหัวเข่าด้านซ้ายทันที ลงน้าหนักได้ไม่ สุด กดเจ็บด้านนอกหัวเข่า ไม่มีขาผิดรูป เดินได้แต่กระเผลก ไม่มีขาชา ไม่มีบาดแผลภายนอก pain score 8/10 เข่า ซ้ายบวมและปวดมากขึ้น จึงมาโรงพยาบาล
- 4. Past history ปฏิเสธโรคประจาตัว ปฏิเสธแพ้ยา,แพ้อาหาร ปฏิเสธยาที่รับประทานประจา ปฏิเสธประวัติผ่าตัด
- 5. Physical examination V/S:BT 37°C PR 84 bpm RR 18 /min BP126/68 mmHg GA: A teenage Thai male, good consciousness HEENT: Not pale conjunctivae, anicteric sclerae Heart: Normal S1S2, No murmur Lung: Clear, no adventitious sound Abdomen: Normoactive bowel sound, soft, not tender Affected part: no deformity, swelling and tender Lt. knee, limit active movement due to pain, full passive ROM, ballottement test positive
- 6. Differential diagnosis ACLinjury Meniscus injury Fracture distal femur/proximal tibia
- 7. Management at ER Film Knee AP, Lateral
- 10. Management at ER Immobilization: On posterior long leg slab D/C Pain control F/U 2 weeks
- 11. 2weeks later ผู้ป่วยมาตรวจติดตามอาการ ยังมีปวดเข่าอยู่เล็กน้อยเข่าไม่บวม เดินพอได้ PE: Anterior drawer test : positive Posterior drawer test : negative Lachman's test : positive Pivot shift test : positive Varus stress test : negative Valgus stress test : negative McMurrey test : negative
- 12.
- 13. MRI Lt. knee Full-thickness tear of ACL Sprain of MCL Grade1 meniscal tear at posterior body of lateral meniscus Minimal bone marrow edema at lateral tibial plateau
- 14.
- 15. Anatomy ORIGIN posterioraspect of the lateral femoral condyle INSERTION middle of the tibial plateau Blood supply Middle geniculate artery Innervation Tibial nerve Golgi tendon receptor
- 16. Anatomy Functions: - Restrain anterior translationof tibia - Prevent hyperextension of the knee - Control rotation of the tibia on femoral extension of 0°-30°
- 17. Cause of ACLinjury The anterior cruciate ligament can be injured in several ways: Changing direction rapidly Stopping suddenly Slowing down while running Landing from a jump incorrectly Direct contact or collision, such as a football tackle
- 18. Anterior drawer test With thepatient lying the supine position, place the knee in 90° of flexion without rotation. Place both hands on the proximal tibia, and pull the upper part of the calf forward. An anterior drawer test is positive when the tibia moves anteriorly without an abrupt, hard endpoint.
- 19. Lachman test With thepatient lying in the supine position, flex the knee 20° to 30° while the heel rests on the end of the exam table. Grasp the femur with the nondominant hand to prevent movement of the upper leg. Then, grasp the lower leg at the proximal tibia and apply a forward tug. This movement should produce a firm endpoint. If the endpoint is not firm or there is increased anterior translation of the tibia, the Lachman test is positive.
- 20. Pivot shift test Whenthe lower leg is stabilized in near full extension. With increasing flexion, a palpable springlike reduction should be observed. A positive pivot shift test usually produces a thud or jerk around 10° to 20° of flexion. During a positive exam, the force created by the examiner will cause the knee joint to slip, giving a positive visual for identifying rotational knee instability.
- 21. Associated injury Meniscus(50%) Articular cartilage (30%) Collateral ligament (30%)
- 22. Grading Grade 1Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable. Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament. Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.
- 23. Symptoms Popping sound Pain with swelling (within 24hr) Loss of full range of motion Tender along joint line Discomfort while walking
- 24. Treatment Initial treatment R.I.C.E Non surgical treatment Surgical treatment
- 25. Nonsurgical treatment Atorn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level Bracing With axillary crutches Physical therapy.
- 26. Surgical treatment Allograft Patellar tendon graft Hamstring tendon graft
- 27.