This document discusses knee injuries and disorders (IDKs) of the ligaments and cartilages. It begins by describing the anatomy of the knee joint, which is the largest joint in the body. It is a synovial hinge joint composed of the femur, tibia, patella, and fibula. The knee joint contains ligaments like the anterior and posterior cruciate ligaments, and medial and lateral collateral ligaments that stabilize the knee. It also contains menisci that act as shock absorbers. Common knee disorders involve sprains or tears of these ligaments and tears of the menisci. Physical trauma is usually the cause of IDKs, often from sports injuries or accidents. The document then
The document discusses internal derangements of the knee, focusing on injuries to ligaments and cartilages. It describes the anatomy of the knee joint and then examines several specific ligament injuries in more detail, including the medial collateral ligament, lateral collateral ligament, and anterior cruciate ligament. For each, it covers anatomy, mechanisms of injury, clinical findings, and treatment approaches. The most common derangements involve injuries to the medial collateral ligament, medial meniscus, and anterior cruciate ligament.
This is the Presentation on the topic "Pathomechanics of Knee Joint".
The presentation includes images and a clip for proper understanding. The sentences are framed in the way that you can learn it in a easy way.
The document summarizes the biomechanics of the elbow joint. It discusses the static and dynamic stabilizers of the elbow, including the primary static constraints of the ulnohumeral articulation, anterior bundle of the MCL, and lateral collateral ligament complex. It also describes the osteology and articular surfaces of the elbow joint and how flexion and extension enhance osseous stability. Key soft tissues like the medial and lateral collateral ligament complexes are explained. The roles of the coronoid process, radial head, and muscles in dynamic stabilization are highlighted. Joint forces at the elbow are distributed between the ulnohumeral and radiocapitellar joints.
The document provides information on anterior cruciate ligament (ACL) injuries, including:
1. The ACL originates from the femur and inserts into the tibia, resisting anterior tibial translation and medial rotation. ACL injuries most commonly result from rapid changes in direction during sports.
2. Physical examination of ACL injuries involves tests like the Lachman test and anterior drawer test to assess knee stability. MRI is also used for diagnosis.
3. Treatment involves RICE initially, followed by either nonsurgical rehabilitation with bracing or surgical reconstruction using grafts like the patellar tendon. Reconstruction aims to restore stability and function to prevent further knee damage.
This document provides an overview of internal derangements of the knee, including injuries to ligaments and menisci. It describes the anatomy of the knee joint and the key ligaments - anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Examination techniques for each ligament are outlined. Meniscal injuries and examination tests like McMurray's test and Apley's test are also reviewed. Treatment options discussed include physical therapy, bracing, and surgical reconstruction or repair depending on the injury and individual factors.
Anatomy and Biomechanics of the Elbow Jointorthoprince
The elbow is stabilized both statically by bony articulations and ligaments, and dynamically by muscles. The three primary static stabilizers are the ulnohumeral articulation, anterior bundle of the MCL, and lateral collateral ligament complex. Muscles that cross the elbow act as dynamic stabilizers. The coronoid process, radial head, and ligaments all play important roles in stability, with the MCL and LCL being the primary soft tissue constraints. Proper biomechanics and force distribution across the elbow joint are necessary for normal function.
The document provides information on ligament injuries of the knee, specifically ACL injury. It describes the anatomy of the ACL and other major ligaments of the knee. It discusses the mechanisms of acute ligament injuries, their clinical features, imaging, and treatment options. For acute injuries, treatment may involve bracing, physiotherapy, or reconstruction depending on the ligaments involved and severity of injury. Chronic ligament instability can lead to abnormal knee motion and giving way, requiring further assessment and possibly reconstruction to restore stability.
The knee is prone to injuries like ACL tears, meniscus tears, and patellar tendinitis. ACL tears often require surgery and extensive rehabilitation, while meniscus tears can be treated with physical therapy or arthroscopic surgery. Patellar tendinitis is typically managed with rest, physical therapy, and anti-inflammatory medications. Knee clinics offer specialized care for these injuries, with knee specialists providing accurate diagnosis and personalized treatment plans to facilitate prompt recovery and long-term joint health.
The document discusses internal derangements of the knee, focusing on injuries to ligaments and cartilages. It describes the anatomy of the knee joint and then examines several specific ligament injuries in more detail, including the medial collateral ligament, lateral collateral ligament, and anterior cruciate ligament. For each, it covers anatomy, mechanisms of injury, clinical findings, and treatment approaches. The most common derangements involve injuries to the medial collateral ligament, medial meniscus, and anterior cruciate ligament.
This is the Presentation on the topic "Pathomechanics of Knee Joint".
The presentation includes images and a clip for proper understanding. The sentences are framed in the way that you can learn it in a easy way.
The document summarizes the biomechanics of the elbow joint. It discusses the static and dynamic stabilizers of the elbow, including the primary static constraints of the ulnohumeral articulation, anterior bundle of the MCL, and lateral collateral ligament complex. It also describes the osteology and articular surfaces of the elbow joint and how flexion and extension enhance osseous stability. Key soft tissues like the medial and lateral collateral ligament complexes are explained. The roles of the coronoid process, radial head, and muscles in dynamic stabilization are highlighted. Joint forces at the elbow are distributed between the ulnohumeral and radiocapitellar joints.
The document provides information on anterior cruciate ligament (ACL) injuries, including:
1. The ACL originates from the femur and inserts into the tibia, resisting anterior tibial translation and medial rotation. ACL injuries most commonly result from rapid changes in direction during sports.
2. Physical examination of ACL injuries involves tests like the Lachman test and anterior drawer test to assess knee stability. MRI is also used for diagnosis.
3. Treatment involves RICE initially, followed by either nonsurgical rehabilitation with bracing or surgical reconstruction using grafts like the patellar tendon. Reconstruction aims to restore stability and function to prevent further knee damage.
This document provides an overview of internal derangements of the knee, including injuries to ligaments and menisci. It describes the anatomy of the knee joint and the key ligaments - anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). Examination techniques for each ligament are outlined. Meniscal injuries and examination tests like McMurray's test and Apley's test are also reviewed. Treatment options discussed include physical therapy, bracing, and surgical reconstruction or repair depending on the injury and individual factors.
Anatomy and Biomechanics of the Elbow Jointorthoprince
The elbow is stabilized both statically by bony articulations and ligaments, and dynamically by muscles. The three primary static stabilizers are the ulnohumeral articulation, anterior bundle of the MCL, and lateral collateral ligament complex. Muscles that cross the elbow act as dynamic stabilizers. The coronoid process, radial head, and ligaments all play important roles in stability, with the MCL and LCL being the primary soft tissue constraints. Proper biomechanics and force distribution across the elbow joint are necessary for normal function.
The document provides information on ligament injuries of the knee, specifically ACL injury. It describes the anatomy of the ACL and other major ligaments of the knee. It discusses the mechanisms of acute ligament injuries, their clinical features, imaging, and treatment options. For acute injuries, treatment may involve bracing, physiotherapy, or reconstruction depending on the ligaments involved and severity of injury. Chronic ligament instability can lead to abnormal knee motion and giving way, requiring further assessment and possibly reconstruction to restore stability.
The knee is prone to injuries like ACL tears, meniscus tears, and patellar tendinitis. ACL tears often require surgery and extensive rehabilitation, while meniscus tears can be treated with physical therapy or arthroscopic surgery. Patellar tendinitis is typically managed with rest, physical therapy, and anti-inflammatory medications. Knee clinics offer specialized care for these injuries, with knee specialists providing accurate diagnosis and personalized treatment plans to facilitate prompt recovery and long-term joint health.
This document discusses the kinesiology of the knee joint, including:
- Anatomy and function of ligaments like the ACL, MCL, and LCL
- Biomechanics that put the ACL at risk for injury during landing or cutting motions
- Gender differences in ACL injury rates related to neuromuscular control and strength
- Muscles that act on the knee joint like the quadriceps and hamstrings
- Patellofemoral joint mechanics involving the patella tracking in the femoral groove
- Internal and external torque demands on the quadriceps muscle throughout knee flexion
The document provides information on anterior cruciate ligament (ACL) reconstruction surgery and rehabilitation. It describes the function of the ACL, common injury mechanisms, surgical procedure which replaces the torn ACL with a graft, and postoperative rehabilitation aims which focus on regaining full extension and flexion while controlling swelling in the early phases before progressing to strength exercises. The goal of surgery and rehabilitation is to prevent repeated instability and allowing return to sport activities in most patients.
This document discusses the biomechanics of various knee ligaments including the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL). It describes the anatomy and function of each ligament, noting that they resist different motions like valgus, varus, anterior/posterior tibial translation, and rotation. The roles and tensions of the ligaments change with knee position. Muscle forces can also impact ligament strains.
This document provides an overview of the biomechanics of various knee ligaments and structures. It describes the anatomy and function of the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, posterior cruciate ligament, posterior capsule ligaments, and iliotibial band. Each structure's role in resisting different motions at the knee joint is discussed, as well as how their function may change with knee position. Muscular effects on ligament strain are also reviewed.
acl arthroscopic reconstruction single bundle vs double bundledrabhichaudhary88
The document discusses anterior cruciate ligament (ACL) repair, including a comparison of single bundle versus double bundle ACL reconstruction techniques. It provides details on ACL anatomy, biomechanics, injury mechanisms, treatment options, and surgical procedures. It also reviews findings from journal articles regarding clinical outcomes of single versus double bundle reconstruction.
Total knee arthroplasty by dr..ammar m.sheetAmmar Sheet
This document provides information on total knee arthroplasty (TKA). It discusses knee anatomy and biomechanics. It describes the different designs of knee prostheses including unconstrained, constrained, and mobile bearing. It outlines surgical techniques for TKA including approaches, alignment, and balancing ligaments. It discusses indications and contraindications for TKA as well as techniques to ensure proper patellar tracking and joint line restoration. The goal of TKA is to relieve pain, correct alignment and restore function of the knee joint.
PT Management of Fractures of Condyles of FemurNavKalsi1
This document discusses the management of fractures of the femoral condyles. It begins by classifying distal femur fractures, which include fractures of the femoral condyles. It then describes the conservative and surgical treatment options for supracondylar fractures and intercondylar fractures of the femur. Conservative treatment involves traction and casting, while surgical options include external or internal fixation devices. Post-treatment physiotherapy aims to restore range of motion, strength, and function. Exercises and weight bearing status progress over 16 weeks as healing allows. Potential complications are also outlined.
The knee joint is complex and vulnerable to injury due to high stress. Common acute injuries include patellar dislocation, meniscal tears, and ligament sprains. Patellar dislocation occurs when the patella is displaced from its normal position, often due to direct impact or forceful quadriceps contraction. Meniscal tears are caused by the menisci receiving poor blood supply in their centers, making tears difficult to heal. Ligament sprains range in severity from minor fiber tears to complete ruptures. Understanding the knee's anatomy is important for diagnosing and treating these injuries.
The knee joint is composed of two articulations, the tibiofemoral joint and patellofemoral joint. The tibiofemoral joint allows 3 degrees of freedom of motion and contains the femoral condyles which articulate with the menisci and tibial plateaus. The menisci improve joint congruence and distribute weight forces. Ligaments such as the ACL, PCL, MCL and LCL provide stability to the joint. The patellofemoral joint contains the patella which articulates with the femur and is stabilized by surrounding structures like the quadriceps tendon.
This document discusses ACL injuries, including anatomy, biomechanics, mechanisms of injury, classification, clinical examination, diagnostic imaging, risk factors, and treatment options. The ACL attaches the femur to the tibia and prevents anterior tibial translation. Common mechanisms of injury include abduction, flexion, and internal rotation of the femur. Clinical examination involves assessing ligament laxity using stress tests like Lachman and pivot shift. Treatment may involve non-operative rehabilitation, repair if an avulsion fracture is present, or reconstruction using autografts like patellar or hamstring tendons. Proper graft placement and fixation are important for reconstruction to restore knee stability.
This document discusses ankle instability and chronic ankle sprains. It begins by describing the anatomy of the ankle joint and its ligaments. It then explains that ankle sprains are common injuries, often caused by an inversion mechanism. Chronic ankle instability can develop after repeated sprains and is characterized by recurrent sprains, pain, and a feeling of the ankle giving way. Treatment of ankle sprains focuses on RICE initially, followed by bracing and physical therapy to improve strength, range of motion and proprioception. Surgery is rarely needed except for severe, unresolving cases.
The document discusses the anterior and posterior cruciate ligaments of the knee. It describes that the ACL and PCL connect the tibia and femur bones and help provide stability to the knee joint. The ACL is most commonly injured ligament due to sports injuries or other traumatic events to the knee. Treatment options include conservative rehabilitation or surgical reconstruction of the injured ligament using a graft. Post-surgical rehabilitation is a lengthy process focusing initially on reducing pain and swelling, regaining range of motion, and gradually progressing strength and functional exercises over 3-6 months.
The ankle is a three bone joint composed of the tibia, fibula, and talus. The talus articulates superiorly with the tibial plafond and posteriorly and medially with the posterior and medial malleoli. Laterally, it articulates with the fibular malleolus. The ankle joint is saddle-shaped and wider anteriorly than posteriorly. During dorsiflexion, the fibula rotates externally through the tibiofibular syndesmosis to accommodate the widened anterior surface of the talar dome. Displacement of the talus within the ankle mortise by only 1 mm decreases the contact area by 42%.
The document summarizes the roles and functions of various ligaments in the knee complex. It discusses the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and other ligaments. It describes how each ligament resists different motions like varus, valgus, rotation and translation. It also explains how the ligaments work together and how their functions change with the position of the knee. The roles of muscles in loading and stabilizing the ligaments is also summarized.
Dislocation of the knee joint can be a serious injury, especially if there is damage to blood vessels which can lead to limb loss if missed. The knee can dislocate in various positions such as anteriorly, posteriorly, or medially/laterally. Over half of dislocations are anterior or posterior, which have a high risk of popliteal artery injury. Knee dislocations require reduction and splinting, followed by examination and imaging to check for injuries to ligaments, blood vessels, and nerves.
The document provides an overview of the biomechanics of the knee joint, including its structural components and functional movements. It describes the tibiofemoral and patellofemoral joints, the bones that make up the knee (femur and tibia), supporting ligaments (ACL, PCL, MCL, LCL), menisci, and the range of motions involved in flexion/extension, rotation, and abduction/adduction. It also discusses how the cruciate ligaments and "screw home mechanism" aid in locking the knee during full extension and unlocking it to allow flexion.
This document summarizes ACL anatomy, function, injury mechanisms, diagnosis, and rehabilitation. It describes that the ACL attaches between the tibia and femur and prevents anterior tibial translation. Injury is common in pivoting sports and usually involves valgus stress. Diagnosis involves physical exam tests like Lachman and MRI. Treatment options are surgery or rehabilitation, with surgery indicated for active individuals to prevent reinjury. Rehabilitation after reconstruction progresses from protection to moderate then minimum protection over 6-9 months, emphasizing range of motion, strength, proprioception and return to activity.
The ankle is a three bone joint composed of the tibia, fibula, and talus. The talus articulates superiorly with the tibial plafond and posteriorly with the posterior malleolus of the tibia. Laterally, it articulates with the fibula. Ankle fractures are commonly evaluated using plain films of the ankle in AP, mortise, and lateral views. Stress views may also be used to evaluate ligament injuries. Classification systems like Lauge-Hansen describe the mechanism of injury and associated soft tissue damage. Accurate reduction and restoration of the ankle mortise is important for surgical treatment of unstable ankle fractures.
1. Elbow dislocations are most commonly caused by falls onto an outstretched hand and involve the disruption of the lateral and medial collateral ligaments and elbow capsule.
2. Simple elbow dislocations without fractures are typically treated non-operatively with closed manipulation and immobilization for less than 3 weeks to avoid stiffness.
3. Operative treatment is considered if closed reduction cannot be maintained or for recurrent dislocations and involves repair of the lateral collateral ligaments through bone tunnels or anchors.
The document discusses lumbar disc disease and degenerative disc disease. It begins by describing the anatomy of the lumbar spine including vertebrae, discs, and ligaments. It then discusses the intervertebral disc structure and how degeneration occurs due to loss of water content. Disc degeneration can lead to herniations which are classified as protrusions, extrusions, or sequestrations depending on the shape. Common signs and symptoms include low back pain and sciatica. Evaluation involves patient history, physical exam, and MRI to diagnose the specific herniation type. Treatment options may include conservative care or surgery depending on the severity of symptoms.
The document discusses lumbar disc herniation, including its anatomy, causes, symptoms, diagnosis, and treatment options. It describes the functional spinal unit made up of vertebrae and intervertebral discs. Lumbar disc herniation occurs when a tear in the outer ring of the disc allows the inner nucleus pulposus to protrude out. Common symptoms are back pain radiating into the leg. Diagnosis involves physical exam and imaging tests like MRI. Treatment options include conservative care with rest and medications or surgical procedures like discectomy to remove herniated disc material pressing on nerves.
This document discusses the kinesiology of the knee joint, including:
- Anatomy and function of ligaments like the ACL, MCL, and LCL
- Biomechanics that put the ACL at risk for injury during landing or cutting motions
- Gender differences in ACL injury rates related to neuromuscular control and strength
- Muscles that act on the knee joint like the quadriceps and hamstrings
- Patellofemoral joint mechanics involving the patella tracking in the femoral groove
- Internal and external torque demands on the quadriceps muscle throughout knee flexion
The document provides information on anterior cruciate ligament (ACL) reconstruction surgery and rehabilitation. It describes the function of the ACL, common injury mechanisms, surgical procedure which replaces the torn ACL with a graft, and postoperative rehabilitation aims which focus on regaining full extension and flexion while controlling swelling in the early phases before progressing to strength exercises. The goal of surgery and rehabilitation is to prevent repeated instability and allowing return to sport activities in most patients.
This document discusses the biomechanics of various knee ligaments including the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL). It describes the anatomy and function of each ligament, noting that they resist different motions like valgus, varus, anterior/posterior tibial translation, and rotation. The roles and tensions of the ligaments change with knee position. Muscle forces can also impact ligament strains.
This document provides an overview of the biomechanics of various knee ligaments and structures. It describes the anatomy and function of the medial collateral ligament, lateral collateral ligament, anterior cruciate ligament, posterior cruciate ligament, posterior capsule ligaments, and iliotibial band. Each structure's role in resisting different motions at the knee joint is discussed, as well as how their function may change with knee position. Muscular effects on ligament strain are also reviewed.
acl arthroscopic reconstruction single bundle vs double bundledrabhichaudhary88
The document discusses anterior cruciate ligament (ACL) repair, including a comparison of single bundle versus double bundle ACL reconstruction techniques. It provides details on ACL anatomy, biomechanics, injury mechanisms, treatment options, and surgical procedures. It also reviews findings from journal articles regarding clinical outcomes of single versus double bundle reconstruction.
Total knee arthroplasty by dr..ammar m.sheetAmmar Sheet
This document provides information on total knee arthroplasty (TKA). It discusses knee anatomy and biomechanics. It describes the different designs of knee prostheses including unconstrained, constrained, and mobile bearing. It outlines surgical techniques for TKA including approaches, alignment, and balancing ligaments. It discusses indications and contraindications for TKA as well as techniques to ensure proper patellar tracking and joint line restoration. The goal of TKA is to relieve pain, correct alignment and restore function of the knee joint.
PT Management of Fractures of Condyles of FemurNavKalsi1
This document discusses the management of fractures of the femoral condyles. It begins by classifying distal femur fractures, which include fractures of the femoral condyles. It then describes the conservative and surgical treatment options for supracondylar fractures and intercondylar fractures of the femur. Conservative treatment involves traction and casting, while surgical options include external or internal fixation devices. Post-treatment physiotherapy aims to restore range of motion, strength, and function. Exercises and weight bearing status progress over 16 weeks as healing allows. Potential complications are also outlined.
The knee joint is complex and vulnerable to injury due to high stress. Common acute injuries include patellar dislocation, meniscal tears, and ligament sprains. Patellar dislocation occurs when the patella is displaced from its normal position, often due to direct impact or forceful quadriceps contraction. Meniscal tears are caused by the menisci receiving poor blood supply in their centers, making tears difficult to heal. Ligament sprains range in severity from minor fiber tears to complete ruptures. Understanding the knee's anatomy is important for diagnosing and treating these injuries.
The knee joint is composed of two articulations, the tibiofemoral joint and patellofemoral joint. The tibiofemoral joint allows 3 degrees of freedom of motion and contains the femoral condyles which articulate with the menisci and tibial plateaus. The menisci improve joint congruence and distribute weight forces. Ligaments such as the ACL, PCL, MCL and LCL provide stability to the joint. The patellofemoral joint contains the patella which articulates with the femur and is stabilized by surrounding structures like the quadriceps tendon.
This document discusses ACL injuries, including anatomy, biomechanics, mechanisms of injury, classification, clinical examination, diagnostic imaging, risk factors, and treatment options. The ACL attaches the femur to the tibia and prevents anterior tibial translation. Common mechanisms of injury include abduction, flexion, and internal rotation of the femur. Clinical examination involves assessing ligament laxity using stress tests like Lachman and pivot shift. Treatment may involve non-operative rehabilitation, repair if an avulsion fracture is present, or reconstruction using autografts like patellar or hamstring tendons. Proper graft placement and fixation are important for reconstruction to restore knee stability.
This document discusses ankle instability and chronic ankle sprains. It begins by describing the anatomy of the ankle joint and its ligaments. It then explains that ankle sprains are common injuries, often caused by an inversion mechanism. Chronic ankle instability can develop after repeated sprains and is characterized by recurrent sprains, pain, and a feeling of the ankle giving way. Treatment of ankle sprains focuses on RICE initially, followed by bracing and physical therapy to improve strength, range of motion and proprioception. Surgery is rarely needed except for severe, unresolving cases.
The document discusses the anterior and posterior cruciate ligaments of the knee. It describes that the ACL and PCL connect the tibia and femur bones and help provide stability to the knee joint. The ACL is most commonly injured ligament due to sports injuries or other traumatic events to the knee. Treatment options include conservative rehabilitation or surgical reconstruction of the injured ligament using a graft. Post-surgical rehabilitation is a lengthy process focusing initially on reducing pain and swelling, regaining range of motion, and gradually progressing strength and functional exercises over 3-6 months.
The ankle is a three bone joint composed of the tibia, fibula, and talus. The talus articulates superiorly with the tibial plafond and posteriorly and medially with the posterior and medial malleoli. Laterally, it articulates with the fibular malleolus. The ankle joint is saddle-shaped and wider anteriorly than posteriorly. During dorsiflexion, the fibula rotates externally through the tibiofibular syndesmosis to accommodate the widened anterior surface of the talar dome. Displacement of the talus within the ankle mortise by only 1 mm decreases the contact area by 42%.
The document summarizes the roles and functions of various ligaments in the knee complex. It discusses the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and other ligaments. It describes how each ligament resists different motions like varus, valgus, rotation and translation. It also explains how the ligaments work together and how their functions change with the position of the knee. The roles of muscles in loading and stabilizing the ligaments is also summarized.
Dislocation of the knee joint can be a serious injury, especially if there is damage to blood vessels which can lead to limb loss if missed. The knee can dislocate in various positions such as anteriorly, posteriorly, or medially/laterally. Over half of dislocations are anterior or posterior, which have a high risk of popliteal artery injury. Knee dislocations require reduction and splinting, followed by examination and imaging to check for injuries to ligaments, blood vessels, and nerves.
The document provides an overview of the biomechanics of the knee joint, including its structural components and functional movements. It describes the tibiofemoral and patellofemoral joints, the bones that make up the knee (femur and tibia), supporting ligaments (ACL, PCL, MCL, LCL), menisci, and the range of motions involved in flexion/extension, rotation, and abduction/adduction. It also discusses how the cruciate ligaments and "screw home mechanism" aid in locking the knee during full extension and unlocking it to allow flexion.
This document summarizes ACL anatomy, function, injury mechanisms, diagnosis, and rehabilitation. It describes that the ACL attaches between the tibia and femur and prevents anterior tibial translation. Injury is common in pivoting sports and usually involves valgus stress. Diagnosis involves physical exam tests like Lachman and MRI. Treatment options are surgery or rehabilitation, with surgery indicated for active individuals to prevent reinjury. Rehabilitation after reconstruction progresses from protection to moderate then minimum protection over 6-9 months, emphasizing range of motion, strength, proprioception and return to activity.
The ankle is a three bone joint composed of the tibia, fibula, and talus. The talus articulates superiorly with the tibial plafond and posteriorly with the posterior malleolus of the tibia. Laterally, it articulates with the fibula. Ankle fractures are commonly evaluated using plain films of the ankle in AP, mortise, and lateral views. Stress views may also be used to evaluate ligament injuries. Classification systems like Lauge-Hansen describe the mechanism of injury and associated soft tissue damage. Accurate reduction and restoration of the ankle mortise is important for surgical treatment of unstable ankle fractures.
1. Elbow dislocations are most commonly caused by falls onto an outstretched hand and involve the disruption of the lateral and medial collateral ligaments and elbow capsule.
2. Simple elbow dislocations without fractures are typically treated non-operatively with closed manipulation and immobilization for less than 3 weeks to avoid stiffness.
3. Operative treatment is considered if closed reduction cannot be maintained or for recurrent dislocations and involves repair of the lateral collateral ligaments through bone tunnels or anchors.
The document discusses lumbar disc disease and degenerative disc disease. It begins by describing the anatomy of the lumbar spine including vertebrae, discs, and ligaments. It then discusses the intervertebral disc structure and how degeneration occurs due to loss of water content. Disc degeneration can lead to herniations which are classified as protrusions, extrusions, or sequestrations depending on the shape. Common signs and symptoms include low back pain and sciatica. Evaluation involves patient history, physical exam, and MRI to diagnose the specific herniation type. Treatment options may include conservative care or surgery depending on the severity of symptoms.
The document discusses lumbar disc herniation, including its anatomy, causes, symptoms, diagnosis, and treatment options. It describes the functional spinal unit made up of vertebrae and intervertebral discs. Lumbar disc herniation occurs when a tear in the outer ring of the disc allows the inner nucleus pulposus to protrude out. Common symptoms are back pain radiating into the leg. Diagnosis involves physical exam and imaging tests like MRI. Treatment options include conservative care with rest and medications or surgical procedures like discectomy to remove herniated disc material pressing on nerves.
The talus bone is a critical link between the foot and leg. It has a high risk of osteonecrosis following fractures due to its unique vascular anatomy. Talus fractures are classified based on the location of the break - including fractures of the head, neck, body, lateral process, or posterior process. Treatment depends on the fracture type and degree of displacement but may include closed reduction, open reduction with internal fixation, or fusions. Hawkins classification is used for talar neck fractures to guide treatment and prognosis.
- The patient presented with an acute ankle fracture dislocation of the left ankle secondary to a motor vehicle accident. Imaging showed a displaced fracture of the medial and lateral malleolus.
- The plan is to perform a closed or open reduction with multiple pinning of the lateral and medial malleolus of the left ankle as an urgent case. Laboratory results were notable for elevated inflammatory markers.
- Key ankle anatomy and the classification of pediatric ankle fractures are discussed to guide treatment, which may involve non-operative management with casting or operative intervention with pinning depending on the fracture pattern and displacement.
This document describes a surgical plan for a right hand procedure involving debridement, wound exploration, and repair of flexor tendons in digits 2 through 5. It then provides pre-operative lab results and discusses the surgical exposure using a Bruner's zigzag and midlateral incision. Details are given on zone 2 flexor tendon repair technique, suturing methods, and post-operative rehabilitation protocols including passive motion, Kleinert, and Duran methods. Potential complications are listed as infection, skin flap necrosis, tendon rupture, tendon adherence, and contracture. Outcomes are evaluated using the Boyes scale measuring finger tip flexion.
The triangular fibrocartilage complex (TFCC) is an important ligamentous structure that stabilizes the distal radioulnar joint and allows forearm rotation; injuries are often caused by falls onto an outstretched hand and cause ulnar-sided wrist pain and decreased forearm rotation. Physical exams like the piano key test and MRI are used to diagnose TFCC injuries which are typically first treated conservatively with splinting and medications but may require surgical repair or debridement if non-operative treatment fails.
This document provides information on fractures of the metacarpals and phalanges in the hand. It discusses the anatomy of these bones and classifies common types of fractures such as boxer's fractures, Bennett's fractures, and fractures of the metacarpal heads and necks. Treatment approaches are outlined depending on the location and severity of the fracture, including closed or open reduction with internal fixation using K-wires, plates, or external fixation. Complications like malunion are also reviewed. The goal is rapid restoration of hand function through appropriate splinting and surgical techniques when needed.
This document discusses the brachial plexus and muscle testing at different neurological levels from C5 to T1. It provides details on muscles innervated, reflex and sensation testing, and functions at each level. Specifically, it notes that C5 controls the deltoid and biceps muscles, C6 controls wrist extensors, C6 and C7 both innervate the biceps, and C7 controls triceps, wrist flexors and finger extensors. C8 governs finger flexors. A summary is then provided listing the motor and sensory levels from C5 to T1.
A 6-year-old male presented with a closed, displaced fracture of the left lateral condyle humerus after falling on his outstretched hand while playing. Physical exam revealed pain, swelling, and loss of motion in the left elbow. Imaging confirmed an AO type 13B1.1 Milch type II Weiss type 3 fracture. The plan is for closed versus open reduction and multiple pinning of the left lateral condyle. Risks include cubitus varus, spur formation, and delayed or non-union due to the fracture being intra-articular with poor blood supply and constant motion from surrounding muscles and ligaments.
This document summarizes the agenda and key topics covered in a 3-day workshop on application of Ilizarov ring fixators. The workshop involved hands-on practice with cadaveric models to learn techniques like identifying anatomical landmarks, safe pin placement zones, constructing the ring fixator, and performing corticotomies. Participants were grouped according to institution and taught principles of ring fixator application to the femur and tibia, including advantages, indications, components, and the sequence for removing the implanted fixator.
The document summarizes foot anatomy including:
1) There are 26 bones in the foot divided into the hindfoot, midfoot, and forefoot.
2) Ossification of the bones occurs at different times from birth through childhood.
3) Key bones of the foot include the talus, calcaneus, cuboid, navicular, cuneiforms, metatarsals and phalanges. Joints between the bones include the subtalar joint and transverse tarsal joint.
Biomechanics of Fractures and Fracture Fixation.pptxNelJohnFailagao
1. Biomechanics is essential for understanding how fractures occur and how to best treat injuries. The fixation system must be stable and strong enough to allow early mobility before healing is complete.
2. There are four basic forces that act on bones - compression, tension, torsion, and bending. Materials have an elastic range where they return to their original shape and a plastic range where permanent deformation occurs.
3. Implant failure can be biological, due to patient factors, or mechanical, such as screw breakage or plate failure. Characteristics like screw length, diameter, and bone density affect fixation strength.
hematic appreciation test is a psychological assessment tool used to measure an individual's appreciation and understanding of specific themes or topics. This test helps to evaluate an individual's ability to connect different ideas and concepts within a given theme, as well as their overall comprehension and interpretation skills. The results of the test can provide valuable insights into an individual's cognitive abilities, creativity, and critical thinking skills
Unlocking the mysteries of reproduction: Exploring fecundity and gonadosomati...AbdullaAlAsif1
The pygmy halfbeak Dermogenys colletei, is known for its viviparous nature, this presents an intriguing case of relatively low fecundity, raising questions about potential compensatory reproductive strategies employed by this species. Our study delves into the examination of fecundity and the Gonadosomatic Index (GSI) in the Pygmy Halfbeak, D. colletei (Meisner, 2001), an intriguing viviparous fish indigenous to Sarawak, Borneo. We hypothesize that the Pygmy halfbeak, D. colletei, may exhibit unique reproductive adaptations to offset its low fecundity, thus enhancing its survival and fitness. To address this, we conducted a comprehensive study utilizing 28 mature female specimens of D. colletei, carefully measuring fecundity and GSI to shed light on the reproductive adaptations of this species. Our findings reveal that D. colletei indeed exhibits low fecundity, with a mean of 16.76 ± 2.01, and a mean GSI of 12.83 ± 1.27, providing crucial insights into the reproductive mechanisms at play in this species. These results underscore the existence of unique reproductive strategies in D. colletei, enabling its adaptation and persistence in Borneo's diverse aquatic ecosystems, and call for further ecological research to elucidate these mechanisms. This study lends to a better understanding of viviparous fish in Borneo and contributes to the broader field of aquatic ecology, enhancing our knowledge of species adaptations to unique ecological challenges.
When I was asked to give a companion lecture in support of ‘The Philosophy of Science’ (https://shorturl.at/4pUXz) I decided not to walk through the detail of the many methodologies in order of use. Instead, I chose to employ a long standing, and ongoing, scientific development as an exemplar. And so, I chose the ever evolving story of Thermodynamics as a scientific investigation at its best.
Conducted over a period of >200 years, Thermodynamics R&D, and application, benefitted from the highest levels of professionalism, collaboration, and technical thoroughness. New layers of application, methodology, and practice were made possible by the progressive advance of technology. In turn, this has seen measurement and modelling accuracy continually improved at a micro and macro level.
Perhaps most importantly, Thermodynamics rapidly became a primary tool in the advance of applied science/engineering/technology, spanning micro-tech, to aerospace and cosmology. I can think of no better a story to illustrate the breadth of scientific methodologies and applications at their best.
The technology uses reclaimed CO₂ as the dyeing medium in a closed loop process. When pressurized, CO₂ becomes supercritical (SC-CO₂). In this state CO₂ has a very high solvent power, allowing the dye to dissolve easily.
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
The use of Nauplii and metanauplii artemia in aquaculture (brine shrimp).pptxMAGOTI ERNEST
Although Artemia has been known to man for centuries, its use as a food for the culture of larval organisms apparently began only in the 1930s, when several investigators found that it made an excellent food for newly hatched fish larvae (Litvinenko et al., 2023). As aquaculture developed in the 1960s and ‘70s, the use of Artemia also became more widespread, due both to its convenience and to its nutritional value for larval organisms (Arenas-Pardo et al., 2024). The fact that Artemia dormant cysts can be stored for long periods in cans, and then used as an off-the-shelf food requiring only 24 h of incubation makes them the most convenient, least labor-intensive, live food available for aquaculture (Sorgeloos & Roubach, 2021). The nutritional value of Artemia, especially for marine organisms, is not constant, but varies both geographically and temporally. During the last decade, however, both the causes of Artemia nutritional variability and methods to improve poorquality Artemia have been identified (Loufi et al., 2024).
Brine shrimp (Artemia spp.) are used in marine aquaculture worldwide. Annually, more than 2,000 metric tons of dry cysts are used for cultivation of fish, crustacean, and shellfish larva. Brine shrimp are important to aquaculture because newly hatched brine shrimp nauplii (larvae) provide a food source for many fish fry (Mozanzadeh et al., 2021). Culture and harvesting of brine shrimp eggs represents another aspect of the aquaculture industry. Nauplii and metanauplii of Artemia, commonly known as brine shrimp, play a crucial role in aquaculture due to their nutritional value and suitability as live feed for many aquatic species, particularly in larval stages (Sorgeloos & Roubach, 2021).
The ability to recreate computational results with minimal effort and actionable metrics provides a solid foundation for scientific research and software development. When people can replicate an analysis at the touch of a button using open-source software, open data, and methods to assess and compare proposals, it significantly eases verification of results, engagement with a diverse range of contributors, and progress. However, we have yet to fully achieve this; there are still many sociotechnical frictions.
Inspired by David Donoho's vision, this talk aims to revisit the three crucial pillars of frictionless reproducibility (data sharing, code sharing, and competitive challenges) with the perspective of deep software variability.
Our observation is that multiple layers — hardware, operating systems, third-party libraries, software versions, input data, compile-time options, and parameters — are subject to variability that exacerbates frictions but is also essential for achieving robust, generalizable results and fostering innovation. I will first review the literature, providing evidence of how the complex variability interactions across these layers affect qualitative and quantitative software properties, thereby complicating the reproduction and replication of scientific studies in various fields.
I will then present some software engineering and AI techniques that can support the strategic exploration of variability spaces. These include the use of abstractions and models (e.g., feature models), sampling strategies (e.g., uniform, random), cost-effective measurements (e.g., incremental build of software configurations), and dimensionality reduction methods (e.g., transfer learning, feature selection, software debloating).
I will finally argue that deep variability is both the problem and solution of frictionless reproducibility, calling the software science community to develop new methods and tools to manage variability and foster reproducibility in software systems.
Exposé invité Journées Nationales du GDR GPL 2024
The debris of the ‘last major merger’ is dynamically youngSérgio Sacani
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
The debris of the ‘last major merger’ is dynamically young
KNEE REVIEW-FAILAGAO.pptx
1.
2. It is a term used to cover a group of disorders
involving disruption of the normal functioning
of the ligaments or cartilages (menisci) of the
knee joint.
3. Bones & Articulations
Largest joint in the body
Synovial hinge type of a
joint
Mainly articulation of four
bones ;femur, tibia, patella,
fibula
Each articulation covered
with hyaline cartilage;
The primary articulation
between Condyles of
femur & tibia
4. LIGAMENTS
Dense structures of
connective tissue that
fasten bone to bone &
stabilise the knee.
Inside the knee are
two major ligaments-
anterior & posterior
cruciate ligaments
5. • Two other ligaments are
located outside the knee –
Medial & Lateral collateral
ligaments. They act to stabilise
knee sideways motion.
• The patellar tendon connects
lower part of patella with
upper part of tibia. Part of this
tendon is used in
Reconstructing a torn ACL
6. • MENISCI
Two menisci are in
each knee.
• Act as shock
absorbers & also help
in spreading weight .
• A meniscus is
frequently torn at the
same time as ACL
tears during injury.
7. • The following disorders may be met with:-
• Sprain or tear of the medial collateral ligament.
• Sprain or tear of the lateral collateral ligament.
• Partial or complete rupture of the anterior cruciate ligament.
• Rupture of the posterior cruciate ligament.
• Tear of the medial semilunar cartilage. This may take the
form of a longitudinal spilt (bucket handle tear), or an
anterior or posterior horn tear.
• Tear of the lateral semilunar cartilage. The same variations
occur as with a medial cartilage tear.
• Tear of a degenerate meniscus.
• Cyst of a semilunar cartilage, usually the lateral.
• THE COMMONEST DERANGEMENT IS MEDIAL COLLATERAL
LIGAMENT INJURY FOLLOWED BY MEDIAL MENISCUS INJURY
AND ACL
8. • Physical trauma is the cause of the vast majority of
IDKs.
• The majority of acute knee injuries result from a
valgus and/or twisting strain. Most commonly, they
involve the medial joint structures and the anterior
cruciate ligament.
• The type of physical trauma causing IDK may be a
sports injury, a road traffic accident or an
occupational stress; by far the most common at the
present time is a sports injury.
9. • The most frequent cause of damage to the medial
collateral ligament is forced valgus injury to the
knee
• Lateral collateral ligament injuries are much less
common, as varus stress to the knee occurs much
less frequently than valgus stress.
• Anterior cruciate ligament injury occurs from forced
valgus stress to the fully extended knee.
• Posterior cruciate ligament injury is liable to occur
in motor car accidents caused by high velocity
trauma, with posterior dislocation of the tibia on a
flexed knee, as in a dashboard impact
10. • Meniscus tears occur when substantial
rotational stresses are applied to the flexed
knee. They are particularly common in
footballers, when the player is tackled from
the side; they are also liable to occur in other
sports such as hockey, tennis, badminton,
squash and skiing.
11. Anatomy:
MCL is composed of superficial & deep portions
superficial MCL
anatomically this is the middle layer of the Medial
compartment
proximal attachment: posterior aspect of medial femoral
condyle.
distal attachment: metaphyseal region of the tibia, upto 4-5
cm distal to the joint, lying beneath the pes anserinus
12. function:
provides primary restraint to valgus stress at the
knee providing from > 60-70% of restraining force
depending on knee flexion angle:
at 25° of flexion, the MCL provides 78% of the
support to valgus stress;
at 5° of flexion, it contributes 57% of the support
against valgus stress;
13. superficial ligament can be divided into
anterior & posterior portions;
anterior fibers of superficial portion of
ligament appear to tighten with knee flexion
of 70 to 105 deg;
posterior fibers form the posterior oblique
ligament
14. anatomically this is the third (deep) layer of the medial
compartment which in many cases will be separated
from the superficial MCL (layer II) by a bursa (which
allows sliding of the tissues during flexion)
divided into meniscofemoral and meniscotibial
ligaments
inserts directly into edge of tibial plateau & meniscus
firmly attaches to the meniscus but does not provide
significant resistance to valgus force
15. valgus stress test
clinical findings may be subtle even with complete
injury;
it is helpful to anchor the thigh on the table with the
knee and leg off the edge of the table;
opening of 5-8 mm compared to opposite knee may
indicate complete tear;
determine the point of maximal tenderness to
determine whether the tear has occurred
proximally, mid-substance, or distally;
16. instability in slight flexion:
anterior portion of the medial capsule is primary
stabilizer at 30 deg of flexion;
hence at 30 flexion, testing is specific for just MCL;
instability in extension:
posterior portion of the MCL, posterior oblique
ligament, ACL, medial portion
of posterior capsule & possibly PCL;
18. • Non Operative Treatment:
• optimum healing of the medial collateral ligament occurs
when the torn ends are in contact
healing potential is directly related to size of the gap
between the torn ends
healing of extra-articular ligaments is analogous to healing
of other soft tissue structures, through production and
remodeling of scar tissue
maturation of scar occurs from 6 weeks to upto one year
• although the maturing scar tissue has only about 60% of
the strengh of the normal MCL, ultimate load to failure is
unchanged (since the amount of scar tissue is larger
than original ligamentous tissue)
19. • with concomitant MCL and ACL tears, most
surgeons now recommend ACL reconstruction
after the valgus stability has returned
• the one exception might be the MCL tear
arising from the tibial insertion
20. • surgical plan depends on whether injury is proximal,
mid substance or distal
femoral avulsion:
• with femoral avulsion, it is important to remember
that reattachment anterior to its orgin may limit
knee flexion where as posterior placement may
cause ligament laxity
the knee should be held flexed at 30 deg and held
in varus when the ligament is reattached
21. Discussion
lateral collateral ligament is primary restraint to varus
angulation
LCL also acts to resist internal rotation forces
cutting of LCL in combination with either anterior or
PCL results in large increase in varus opening
22. testing with extension:
LCL resists approximately 55 % of applied load at full extension
cruciate ligaments (primarily ACL) resist approx 25% of moment at
full extension
significant instability in full extension indicates complete LCL tear as
well as a tear of either the ACL or PCL ligament
note that LCL instability in extension which occurs with peroneal
palsy is a knee dislocation until proven otherwise
23. role of LCL increases with joint flexion, as posterolateral structures
become lax
with joint flexion,resistance by ACL decreases, but large forces are
found in PCL at 90 degrees of flexion
LCL is primary restraint to varus stress at 5* & 25*Flexion
lateral capsular structure provide secondary support
iliotibial band & popliteus muscles have dynamic stabilizing role
24. allograft reconstruction:
With chronic posterolateral injury, Achilles tendon allograft
may be indicated
Main goal is to create a checkrein to external rotation
At the level of Gerdy's tubercle, a bone tunnel is created in
the posterolateral tibia, just medial to the fibular head
Attachment of the IT band to the intermuscular septum
may have to be freed for optimal exposure
25. Allograft bone plug (9 mm graft and tendon) is contoured
to fit the tunnel, and is secured with an interference screw
Tendinous portion of the graft is then secured in the region
of the popliteus insertion with a bone anchor
Anchor site should not allow more than 3 mm of motion
with knee flexion and extension
With this technique, the strong stability provided by the
allograft may help compensate for disruption of the arcuate
complex
26. • The ACL is a broad ligament joining the anterior
tibial plateau to the posterior intercondylor notch.
• The tibial attachment is to a facet, in front of &
lateral to anterior tibial spine.
• Femoral attachment is high on the posterior aspect
of the lateral wall of the intercondylar notch.
• It is composed of multiple non-parellel fibres which
though not anatomically separate, act as three
distinct bundles i.e. anteromedial, posterolateral &
intermediate.
27. The biomechanical function of the ACL is complex for
it provides both mechanical stability & proprioceptive
feedback to the knee.
In its stabilising role it has four main functions;
1.Restrains anterior translation of tibia.
2.Prevents hyperextention of knee.
3.Acts as a secondary stabiliser to valgus stress,
reinforcing medial collateral ligament.
28. contd….
4.Controls rotation of tibia on
the femur in femoral
extention of 0-30 degrees.
The final role is the main
clinical function of ACL.
29. This critical function in the range of 0-30* is important for
movements such as side-stepping & pivotting.
30. • T he ligament is surrounded by synovium,thus making it
extra synovial.
• Blood supply
• primarily from the middle genicular Artery which
pierces the posterior capsule & enters the intercondylar
notch near femoral attachment.
• Additional supply comes from retropatellar pad of fat
via the inferior medial & lateral geniculate arteries.
• NERVE SUPPLY: Posterior articular nerve
31. • Rupture of ACL causes significant short term &
long term disability.
• With each episode of instability there is
subluxation of tibia on the femur, causing
stretching of the enveloping ligaments &
abnormal shear stress on the menisci & on the
articular cartilage.
• Delay in the diagnosis & treatment gives rise to
increased intrarticular damage as well as the
stretching of secondary capsular ligaments.
32. The long term outlook for an ACL deficient knee is
for the development of significant osteoarthrosis.
CAUSES OF ACL RUPTURE
1.Most common cause of ACL rupture is traumatic
force applied to the knee in a twisting moment.
This can occur with direct or indirect force.
2.Patients with narrow intercondylar notch are
more prone to rupture their ACL.
33. 3. Patients with genu recurvatum tend to be more
likely to rupture their ACL & are more difficult to
treat.
4.Patients with generalised ligamentous disorder.
5.Familial predisposition has been found to play a
role in some patients especially those who
sustain bilateral ACL tears.
34. • Begins with a non contact deceleration, jumping or cutting
action.
• Other mechanisms of injury include external forces applied
to the knee.
• The patient often describes the knee as having been
hyperextended or popping out of the joint & then reducing.
A pop is being frequently heard or felt. The patient usually
has fallen to the ground & is not immediately able to get
up. Resumption of activity is not possible & walking is often
difficult. Within a few hours knee swells & aspiration of
joint reveals haemarthosis. In this scenario ,the likelihood
of ACL injury is greater than 70%.
35. Examination
ANTERIOR DRAWER TEST
With the knee flexed to 90*, verification of relaxation of
hamstrings is confirmed. With foot stabilised & in neutral
rotation, a firm but gentle grip on the proximal tibia is achieved.
36. • An anterior force is applied to the proximal tibia with a
gentle to & fro motion to assess for increased translation
compared to contralateral knee. 5mm is the upper limit of
anterior tibial displacement normally.
37. • Drawer sign is minimal in isolated ACL rupture.
Abnormal displacement >5mm is permitted by loss
of restraint by ACL & more so when associated with
insufficiency of medial CL or capsular ligament.
• When an intact PCL is rendered very taut by forcible
internal rotation of tibia, it stabilises the knee to the
extent that the anterior drawer sign is negated.
• If internal rotation of tibia does not lessen the
anterior drawer sign, the PCL is also insufficient.
38. • Especially when the ligamentous Insufficiency is confined to
the ACL,the anterior drawer sign is unreliable.
• With knee flexed to 90 degrees for classical anterior sign,
medial meniscus being attached to tibia, abuts against
acutely convexed surface of medial femoral condyle & has
“door stopper” effect preventing or hindering anterior
translation of tibia.
• With knee extended, relationship is changed.
• Comparatively flat weight bearing surface of femur does
not obstruct forward motion of tibia when anterior stress
is applied.
39. • One hand secures and
stabilises the distal femur
while the other hand
grasps the proximal tibia.
• A gentle anterior translation
force is applied to the
proximal tibia.
40. • Examiner assesses for a
firm/solid or soft
endpoint.
• Stabilisation of right knee
during an examination
under anaesthesia.
41. • Application of anterior tibial translation force with
significant ant. translation of the tibia on the femur in an
ACL deficient knee.
• When veiwed from side,
a silhoutte of the inferior
pole of patella,
patellar tendon &
proximal tibia shows slight
concavity.
• Disruption of ACL &
anterior translation of tibia
obliterates the patellar
tendon slope.
42. • Patient rotated 20* from supine towards the unaffected
side. With slight distal traction on the leg,a valgus &
internal rotation force is applied to the extended knee.
44. • Pivot shift in an ACL deficient knee,in the
initial stages of knee flexion,the tibia will be
anterolaterally subluxed on the distal femur
with application of valgus & internal
rotation at the knee.
45. • With further flexion of knee(past 30*) the illiotibial
band goes from an extendor to flexor of knee &
tibial anterolateral subluxation reduces back in
place.
46. • Isolated tear produces only small
subluxation, greater subluxation occurs when lateral
capsular complex or semimembranosus corner also
is deficient.
• DISADVANTAGES:
• Severe valgus instability may make this test difficult
to do because of lack of medial support.
FLEXION ROTATION DRAWER TEST
Combines anterior drawer & pivot shift test.
Mild degree of valgus stress & anterior pressure on
upper calf are applied to elicit the positive test.
47.
48. • Plain roen.often are normal, however,a tibial
eminence fracture indicates an avulsion of the tibial
attachment of ACL.MRI is the most helpful.
49. 1.PRIMARY SIGNS:
Nonvisualisation
Disruption of the substance of ACL by increased abnormal signal
intensity
Abrupt angulation
Wavy appearance
Abnormal ACL axis.
2.SECONDARY SIGNS:
Segonds fracture
osteochondral fracture
Anterior translation of tibia
Pivot shift
Bone bruises.
50.
51. LEFT-Normal ACL in axial plane;
RIGHT: Non-visualisation as primary sign of ACL tear with
ill-defined edema & haemorhage in the usual location of
the ACL in the I/C NOTCH.
52. ACL tear with non-linearity
of ligament; mild angulated
ACL
segonds fracture in a
patient with ACL tear.
53. • Anterior translation
of tibia as a
secondary sign of ACL
tear.
• Tangential line to the
posterior margin of
tibia passes through
the posterior horn of
lateral Meniscus
(uncovered meniscal
sign).
• In normal knee, this
line passes posterior
to the meniscus.
54. • Conservative or non-operative Rx
• Surgical Rx
• Indications of non-operative Rx
isolated ACL tears ; likely to be succesfull in patients with partial tears
& no instability symptoms.
complete tears & no symptoms of knee instability during low demand
sports who are willing to give up high demand sports
Who do light manual work or live sedentary habits
Whose growth plates are still open(children)
55. NON-OPERATIVE RX:- consists of
Progressive physical therapy & rehabilitation can
restore the knee to a condition close to its
preinjury state.
Educate the patient how to prevent knee
instability.
This may be supplemented with the use of
hinged knee brace.
56. INDICATIONS
• Patients with knee instability, pain, swelling or giving way
should consider surgical reconstruction of the knee.
• In some cases reconstruction is necessary because of
damage to menisci or articular cartilage of the knee.
• Progressive premature degenerative changes in patients
with unstable knee may also be an indication.
57. • CHOICE of RX mainly depends on assesment of
three patient factors:
• AGE: The child ,the adolescent, the young adult,
the middle aged & the elderly represent different
surgical problems.
• FUNCTIONAL DISABILITY:
• It may vary from undiagnosed asymptomatic
rupture to a patient whose knee gives way on daily
basis.
58. FUNCTIONAL REQUIREMENTS:
Vary from sedentary patients with low activity
requirements, through those patients with an
active social sporting life or physically
demanding work, to the elite athelete whose
fame & fortune depends upon a highly
functional knee.
Rupture of ACL in the child or elderly is very
rare & are usually Rx conservatively.
Rupture in the adolescent is not uncommon &
presents its own problems because of skeletal
immaturity. Most isometric reconstructions
place the growth plate at risk.
59. Reconstruction may be delayed up to skeletal
maturity. However, in elite adolescent athelete
with an acute rupture it is possible to repair
the ligament early & to supplement this with
semitendinosus & gracilis reconstruction. This
is possible by performing surgery within the
epiphysis.
Vast majority of patients fall in to young adult
& middle aged persons. Males are more
frequently seen than females though this
pattern is reversed in skiers where a
disproportionate no. of female skiers are
injured.
60. • Before any surgical Rx, patient is sent to physical
therapy.
• Resolution of inflammation & return of full motion
reduce the incidence of postoperative stiffness
• It usually takes 2 to 3 weeks from the time of
injury to achieve full range of motion.
• It is also recommended that some ligament
injuries be braced & allowed to heal prior to ACL
surgery.
61. • Repair of ACL either isolated or with augmentation.
• Reconstruction with either autograft, allograft or
syntheticsp
• Primary repair of the ACL is no longer
recommended because repaired ACL have generally
been shown to fall overtime.
• The torn ACL is generally replaced by a substitute
graft made of tendon.The grafts commonly used:
PATELLAR TENDON AUTOGRAFT;HAMSTRING TENDON;QUADRICEPS TENDON
62.
63.
64. ANATOMY
• Intra-articular but extrasynovial, static stabiliser of knee:
• composed of two major parts:Large anterior part that
forms the bulk of the ligament & a smaller portion that
runs obliquely to the back of tibia.
• PCL is attached proximally to the posterior part of the
latral surface of the medial condyle.The tibial attachment
is to a depression behind & below the intra-articular
portion of tibia with a slip usually blending with the
posterior horn of the latral meniscus.
65.
66.
67.
68. • Progressive tightening of the PCL occurs during internal
rotation of tibia with the knee in either flexion or full
extension.
• Also in full extension the PCL allows only minimal
abduction or adduction widening of the knee despite
complete removal of accessory supports;the extensor
retinaculum, capsular ligaments, collateral ligaments &
posterior capsule.
• This fact emphasis the importance of the PCL as the
basic stabiliser of the knee, while the ACL & collateral
ligaments augment its stabilising effect.
69. provides restraint against hyperextension,
against posterior displacement of tibia in flexed
knee,
internal rotation of the tibia &
valgus/varus angulation-particularly in extended
knee.
70. • ACUTE TEAR: Requires much more force than to tear ACL.
• Following ways:
• 1.Severe rotational injury; an external rotation-valgus injury or an
internal rotation-varus injury produces tear of PCL assoc. with
disruption of MCL or LCL.The PCL is interupted at its midportion or
at its femoral attachment.
• 2.Hyperextension injury: Tibial attachment is avulsed usually
• 3.Direct trauma to upper tibia while the knee is flexed-Dashboard
injury.
• 4.Complete dislocation of knee.
71. • History of severe trauma is elicited.
• Degree of both immediate pain & inability to bear weight
on the injured knee is highly variable.
• These are more pronounced when capsule is intact &
haemarthrosis is confined within the joint.
• They may be minimal when the posterior capsule is
disrupted & blood escapes from the joint.
72. • Objective findings are:
• tenderness in the popliteal fossa;
• swelling in allmost all cases.
• Posterior drawer sign in allmost 60% of cases.
73. • With knee flexed to approx. 90*, verification of complete
relaxation of hamstrings is confirmed by palpation .
74. • With foot in neutral
rotation & stabilised, a firm
but gentle posterior
translation force is applied
to proximal tibia.
• Initial starting point for a
posterior drawer test(foot
in NR, knee flexed to 90*)
75. • Application of posterior
translation force results
in posterior subluxation
of tibia on the femur in
a patient with PCL
deficient knee.
76. TIBIAL BACK DROP TEST
In this test, the examiner compares the prominence of the proximal tibia
to the femoral condyles with the knee flexed to 80*.
In a PCL deficient knee, the knee will be posteriorly subluxed due to
gravity.
79. • It is performed with
the knee flexed to
80deg & in neutral
rotation.Its starting
point is in effect the
tibial drop back test.
80. • From its initial relaxed
position, the patient is
asked, to contract
Quadriceps muscle
(straighten out his leg
without extending his
knee) while examiner
applies counter
pressure against the
ankle.
83. ROENGENOGRAPHIC FINDINGS:
• Plain radiographs usually normal.
• Stress radiography assists in the diagnosis of PCL
injuries.
• Increased posterior translation of 8mm or more
in stress roeng.is indication of complete rupture.
• A contrast arthogram may reveal evidence of
ligament disruption.
• Arthroscopic evaluation should be done to assess
the damage to both the cruciates & to define
additional lesions.
84. • MRI studies are more reliable for diagnosis of
PCL tears than ACL tears.
85. • NON-OPERATIVE TREATMENT:
The quoted criteria for non-operative RX include:
• (1).A posterior drawer test of < 10mm with the tibia in
neutral rotation(posterior drawer excursion decreases
with internal rotation of tibia on femur).
• (2). < 5* of abnormal rotatory laxity(specifically,
abnormal external rotation of the tibia with the knee
flexed 30*,indicating posterolateral instability).
• (3).No significant valgus-varus abnormal laxity.
86. OPERATIVE TREATMENT
• Reconstruction is usually delayed for 1 to 2 weeks
after injury to allow painful intra-articular reaction
to subside & to allow the patient to regain full
motion and some strength.
• Clinically, isolated acute PCL disruptions are
repaired if the ligament is avulsed with a fragment
of bone.
• Knee is examined arthroscopically before any open
surgical procedure.
87.
88.
89. • Various grafts used are :
(1).Patellar tendon graft.
(2).Bone-patellar tendon-bone graft.
(3).Tendo-achillis bone graft.
(4).Illiotibial band.
(5).Medial head of gastrocnemius tendon.
(6).Hamstring tendon.
(7).Lateral meniscus.
90.
91. • Loss of motion is the most common complication aside from from usual postoperative
complication.
• Flexion loss is more common than extension loss.
• Failure to obtain objective stability is another common complication.
• Failure of reconstruction may be the result of untreated associated ligamentous injuries
such as the posterolateral corner, which allow excessive forces to be applied to the graft.
92. • Neurological complications(injuries) can result
from excessive tourniquet time & manifest as
neuropraxia.
• Vascular complicatons include
laceration, thrombosis,& intimal injury to the
popliteal artery.Viewing the tip of reamer & guide
pin at all times can prevent this injury.
• Osteonecrosis of medial femoral condyle has
been reported-cause thought to be local trauma
to the subchondral bone from both soft tissue
dissection & drilling.
93.
94. • The menisci are C-shaped or semicircular
fibrocartilaginous structures with bony attachment
at anterior and posterior tibial plateau. The medial
meniscus is C-shaped, with a posterior horn larger
than the anterior horn in the anteroposterior
dimension.
• The capsular attachment of medial meniscus on the
tibial side is referred to as the coronary ligament. A
thickening of the capsular attachment in the
midportion spans from the tibia to femur and is
referred to as the deep medial collateral ligament.
95. • The lateral meniscus is also anchored
anteriorly and posteriorly through bony
attachments and has an almost semicircular
configuration. It covers a larger portion of the
tibial articular surface than does medial
meniscus
96. • The fibrocartilaginous structure of the meniscus
has a varied architecture of coarse collagen
bundles.
• At birth the entire meniscus is vascular.
• By age 9 months, the inner one-third has become
avascular. This decrease in vascularity continues
by age 10 years, when the meniscus closely
resembles the adult meniscus.
97. • In adults, only 10 to 25% of the lateral meniscus
and 10 to 30% of the medial meniscus is vascular.
This vascularity arises from superior and inferior
branches of the medial and lateral genicular
arteries, which form a perimeniscal capillary
plexus.
• Because of the avascular nature of the inner two-
thirds of the meniscus, cell nutrition is believed to
occur mainly through diffusion or mechanical
pumping.
98. • The classification of meniscal tears provides a
description of pathoanatomy. The types of
meniscus tears are:
• Longitudinal tears that may take the shape of a
bucket handle if displaced
• Radial tears
• Parrot-beak or oblique flap tears
• Horizontal tears and
• Complex tears that combine variants of the
above.
99. • Most meniscal injuries can be diagnosed by
obtaining a detailed history.
100. – Meniscus tears are sometimes related to trauma;but
significant trauma is not necessary.
– A sudden twist or repeated squatting can tear the
meniscus.
– Meniscus tears typically occur as a result of twisting or
change of position of the weight-bearing knee in varying
degrees of flexion or extension.
101. Pain from meniscus injuries is commonly intermittent;
usually the result of synovitis or abnormal motion of the
unstable meniscus fragment & is localized to the joint
line.
Mechanical complaints: Descriptions by patients are
often nonspecific but include reports of clicking,
catching, locking, pinching or a sensation of giving way.
Swelling usually occurs as a delayed symptom or may
not occur at all. Immediate swelling indicates a tear in
the peripheral vascular aspect.
Degenerative tears often manifest with recurrent
effusions due to synovitis.
102. Joint line tenderness
– Joint line tenderness is an accurate clinical sign.This
finding indicates injury in 77-86% of patients with
meniscus tears. Despite the high predictive value,
operative findings occasionally differ from the
preoperative assessment.
– The examiner must differentiate collateral ligament
tenderness that may extend further toward the
ligament attachment sites above and below the joint
line.
103. • Effusion
– Effusion occurs in approximately 50% of the patients
presenting with a meniscus tear.
– The presence of an effusion is suggestive of a peripheral
tear in the vascular or red zone (especially when
acute),an associated intra-articular injury, or synovitis.
• Range of motion
– A mechanical block to motion or frank locking can occur
with displaced tears.
– Restricted motion caused by pain or swelling is also
common.
104. • These techniques cause impingement by creating
compression or shearing forces on the torn
meniscus between the femoral and tibial surfaces.
105. The McMurray test:
• This maneuver usually elicits pain or a reproducible
click in the presence of a meniscal tear.
• The medial meniscus is evaluated by extending the
fully flexed knee with the foot/tibia internally
rotated while a varus stress is applied.
• The lateral meniscus is evaluated by extending the
knee from the fully flexed position, with the
foot/tibia externally rotated while a valgus stress is
applied to the knee.
• One of the examiner's hands should be palpating
the joint line during the maneuver.
106.
107. • Differential diagonosis
• Anterior Cruciate Ligament Injury
• Medial Synovial Plica Irritation
• Contusions
• Patellofemoral Joint Syndromes
• Iliotibial Band Syndrome
• Pes Anserine Bursitis
• Knee Osteochondritis Dissecans
• Posterior Cruciate Ligament Injury
• Lateral Collateral Knee Ligament Injury
• Lumbosacral Radiculopathy
• Medial Collateral Knee Ligament Injury
• Articular cartilage pathology including arthritis
• Crystalline deposition diseases including gout and pseudogout
(chondrocalcinosis)
• Ipsilateral hip disease:Osteonecrosis of the femur or tibia
108. • Plain radiography: An AP weight-bearing view, PA
45* flexed view, lateral view and Merchant
patellar view should be obtained to rule out
degenerative joint changes (arthritis) or fractures
• Arthrography: Historically, arthrography was the
standard imaging study for meniscal tears but it
has been replaced now by MRI.
• MRI: This is the standard imaging study for
imaging meniscus pathology and all intra-articular
disorders.
111. • A home physical therapy program or simple rest with activity
modification, Ice and NSAIDs is the nonoperative management of
possible meniscus tears.
• The physical therapy program goals are to minimize the effusion,
normalize gait, normalize pain-free range of motion, prevent
muscular atrophy, maintain proprioception and maintain
cardiovascular fitness. Choosing this course of treatment must
include consideration of the patient's age, activity level, duration of
symptoms, type of meniscus tear, and associated injuries such as
ligamentous pathology
• A trial of conservative treatment should be attempted in all but the
most severe cases, such as a locked knee secondary to a displaced
bucket-handle tear
112. • The main complication at this stage of treatment is
the absence of healing and failure of symptoms to
resolve.
• The natural history of a short (<1 cm), vascular,
longitudinal tear is often one of healing or
resolution of symptoms.
• Stable tears with minimal displacement,
degenerative tears, or partial-thickness tears may
become asymptomatic with nonoperative
management.
113. • Most meniscal tears do not heal without
intervention.
• If conservative treatment does not allow the patient
to resume desired activities, his or her occupation,
or a sport, surgical treatment is considered.
• Surgical treatment of symptomatic meniscal tears is
recommended because untreated tears may
increase in size and may abrade articular cartilage,
resulting in arthritis
114. Indications:-
• Symptoms persist.
• If the patient cannot risk the delay of a potentially unsuccessful period of
observation.
• In cases of a locked knee.
• Principle of meniscus surgery is to save the meniscus.
• Tears with a high probability of healing with surgical intervention are
repaired.
• Most tears are not repairable and resection must be restricted to only the
dysfunctional portions, preserving as much normal meniscus as possible.
115. • Surgical options include partial meniscectomy or meniscus
repair (and in cases of previous total or subtotal
meniscectomy, meniscus transplantation).
• Arthroscopy, a minimally invasive outpatient procedure
with lower morbidity, improved visualization, faster
rehabilitation, and better outcomes than open meniscal
surgery, is now the standard of care.
116. • Partial meniscectomy is the treatment of choice for tears in
the avascular portion of the meniscus or complex tears that
are not amenable to repair.
• Meniscus repair is recommended for tears that occur in the
vascular region (red zone or red-white zone), are longer
than 1 cm, involve greater than 50% of the meniscal
thickness, and are unstable to arthroscopic probing.
117. Human allograft meniscal transplantation
is a relatively new procedure but is being
performed increasingly frequently.
Specific indications and long-term results
have not yet been clearly established.
Meniscus transplantation requires further
investigation to assess its efficacy in
restoring normal meniscus function and
preventing arthrosis.
118. • Recovery Phase
• Rehabilitation Program
• Physical Therapy
• Physical therapy during recovery is directed
toward the same goals as those in the acute
phase.
• For partial meniscectomy, patients may return to
low-impact or nonimpact workouts such as
stationary cycling or straight-leg raising on the
first postoperative day and may advance rapidly
to preoperative activities
119. • When a meniscus repair is performed, the
rehabilitation is typically more intensive.
• Three main issues are considered in the
rehabilitation of meniscus repairs: knee
motion, weight bearing, and return to sports.
• A common protocol is avoidance of weight
bearing for 4-6 weeks, with full motion
encouraged.
120. • Complications
• Reported complication rates for arthroscopic meniscectomy
range from 0.5-1.7% and these can occur intraoperatively or
postoperatively.
• Intraoperative complications include anesthetic problems,
articular cartilage damage, vessel or nerve injury or instrument
failure.
121. • Postoperative complications include anesthetic concerns,
thrombophlebitis, hemarthrosis, infection, stiffness,
persistent pain, effusion or synovitis.
• Reported complication rates for meniscus repairs range
from 1-30%.
• The list of complications is the same as that for
meniscectomies, with a greater concern for neurovascular
injury. Additionally, failure to heal or meniscal reinjury can
occur.