This document discusses posterior cruciate ligament (PCL) tears. It begins with an overview of PCL anatomy and mechanisms of injury. It then covers clinical evaluation including physical examination tests like the posterior drawer test. Investigations like MRI are discussed. Finally, the document outlines management approaches for PCL tears, including non-operative treatment for mild injuries and surgical reconstruction or repair for more severe injuries. Surgical techniques like single versus double bundle reconstruction using autografts or allografts are compared. Post-operative rehabilitation protocols are also summarized.
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
Acromioclavicular (AC) joint injury is a term used to describe an injury to the top of the shoulder, where the front of the shoulder blade (acromion) attaches to the collarbone (clavicle).
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
This presentation is made to act as a guide and a short reminder to clinicians and medical students on Volkmann's Ischaemic Contracture, which is a medical condition that can lead to activities limitation and public participation restriction. This presentation explore aspects of the condition such as what it is, causes, how it can be diagnosed, how it can be managed and others.
MCL. LCL.ALL injuries
To understand the relevant anatomy of the side ligaments of the knee
To study the mechanism of injury of each ligament and how to diagnose such injury
To highlight the different treatment options in acute or chronic situations
This presentation is made to act as a guide and a short reminder to clinicians and medical students on Volkmann's Ischaemic Contracture, which is a medical condition that can lead to activities limitation and public participation restriction. This presentation explore aspects of the condition such as what it is, causes, how it can be diagnosed, how it can be managed and others.
Posterolateral corner injuries of knee joint Samir Dwidmuthe
Missed posterolateral corner injuries of knee joint is a common cause for failure of ACL and PCL reconstruction only next to malpositioned tunnels.
Isolated PLC injuries are uncommon, making up <2% of all acute knee ligamentous injuries. Covey JBJS 2001
Incidence of PLC injuries associated with concomitant ACL and PCL disruptions are much more common (43% to 80%). Ranawat JAAOS 2008
A recent (MRI) analysis of surgical tibialplateau fractures demonstrated an incidence of PLC injuries in 68% of cases. Gardner JOT 2005
Take home message
PLC injuries to be ruled out in every case of ACL& PCL rupture.
Neurovascular integrity to be checked in every case.
Grade I & II can be managed conservatively.
Grade III Acute- Repair.
Grade III Chronic- Anatomic PLC recon.
Beware of varus knee alignment.
Patella dislocation is a common problem in the young. Recurrence of dislocation can be significant problem causing pain and discomfort. The assessment and guidelines towards non-surgical and surgical treatment options are discussed here.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
2. Posterior cruciate ligament (PCL) tears
comprise 3% of outpatient knee injuries and
38% of acute traumatic knee hemarthroses
These injuries rarely occur in isolation, and up
to 95% of PCL tears occur in combination with
other ligament injuries
3. Anatomy of PCL
Mechanism of Injury
Clinical Evaluation
Investigations
Management
4. Tibial footprint is located
between the posterior horns of
two menisci about 1–1.5 cm
below the posterior tibial
margin in the ‘PCL facet’
5. AL and PL fibers further extend
upward and medially to be
attached onto the medial
femoral condyle.
ALB is attached mostly to the
roof of the intercondylar notch
and PLB to the medial side of
the wall
7. The PCL is also strengthened
by the meniscofemoral
ligaments (MFL), anteriorly
(ligament of Humphrey) and
posteriorly (ligament of
Wrisberg).
8. Tensile loads are in the range of 2k to 3kN
38 mm in length x 13 mm in diameter
Diameter is 1.3 times larger than the ACL
9. Posterior Tibial Translation
Rotational and Medial/Lateral Stability
Normal Joint contact pressure
10. Restrains posterior tibial translation as the
knee moves from extension to flexion
throughout the arc of motion (0–120°)
especially from 30°–90° flexion
Posteromedial, posterolateral capsule and
collaterals aid in the posterior restraint
between 0° and 30° flexion
11. Covey et al. demonstrated that Posterior
translation of tibia increases by two fold (7.23
± 0.65 mm) at 90° flexion as compared with
20° flexion (3.41 ± 0.77 mm) at 74 N
posteriorly directed force over tibia after
selective sectioning of the PCL
12. The role the PCL plays in the rotational control of the knee
is still unclear, with many contradictory studies published
in the literature
It restricts internal rotation at all flexion angles, PMB
particularly was reported to be controlling rotation beyond
90º of flexion
It acts as a secondary stabilizer to rotational forces when
other ligaments are compromised and other ligaments may
provide control to rotation when the PCL is deficient
13. The deficiency of the PCL results in increased
joint contact pressures in the medial and
patellofemoral compartments
Untreated PCL deficiency have greater
incidence of medial and patellofemoral
compartment degeneration
Results showed significant posterior
subluxation of the tibia at 60° of flexion in the
PCL-deficient specimen, which resulted in
increased contact pressure and pressure
concentration in the medial compartment
14. Direct blow to proximal tibia with a flexed knee
(dashboard injury)
Hyperflexion with a plantar-flexed foot
Hyperextension injury
External rotation force on a weightbearing leg
with the knee in near full extension
16. Exploring the mechanism of injury
Energy or velocity imparted to the knee
during the injury
Did the knee swell up immediately?
Could the patient bear weight? Did the knee
feel unstable?
Current symptoms including pain, stiffness,
instability
18. Posterior drawer test
Posterior sag test (godfrey test)
Quadriceps active test
Dial test
Varus/valgus stress
19. Performed at 90º of knee flexion, and has a
sensitivity of 90% and a specificity of 99%
Isolated PCL translate >10-12mm in neutral
and >6-8mm in internal rotation.
Combined ligamentous injuries translate
> 15mm in neutral and >10mm in internal
rotation.
21. A standard knee series, including
bilateral standing (AP),
AP flexion 45° weight bearing
Lateral and
Merchant patellar radiographs
should be evaluated for any evidence of avulsion
fractures, tibial subluxation and associated knee
injuries and chronic cartilage damage
22. Stress radiography has been gaining
popularity for the diagnosis of multi-
ligamentous knee injuries
It involves the application of a standardized
force to the knee to produce abnormal joint
displacement
23. Several techniques have been described
including hamstring contraction, gravity
assisted, the Telos device and single-leg
kneeling
The Telos device and kneeling have been
shown to be superior to other methods for
reproducibly demonstrating posterior knee
instability
24. A diagnostic algorithm has been validated where
side to side posterior translation difference has
been quantified
1. 0–7 mm = a partial PCL tear
2. 8–11 mm = isolated complete PCL tear
3. ≥12 mm = combined PCL and posterolateral
corner or posteromedial corner knee injury
25. High sensitivity (near 100%) and specificity (near
97%)
MRI is the radiologic study of choice in
diagnosing acute PCL tears, Although chronic
PCL injuries may be apparent on MRI it is not as
sensitive in diagnosing chronic tears
MRI may appear normal as soon as 3 months
following low-to moderate-grade PCL injuries
26. Normal PCL is homogeneously low signal on both
T2 and proton density weighted sequences,
lacking internal striations like ACL.
Normal PCL should measure 6 mm or less, when
measured from anterior to posterior in the
sagittal plane
27.
28.
29. There are two potential pitfalls if one relies
only on the sagittal plane
First, partial tears may be interpreted as
complete tears.
Second, mucoid degeneration may mimic a
PCL tear in the setting of a functionally
stable ligament
30. Nonoperative vs operative
Repair vs reconstruction
Autograft vs allograft
Single vs double bundle
Arthroscopic vs Open technique
Rehabilitation
31. Acute Isolated grade I and Grade II tears
(posterior tibal translation < 10mm)
Asymptomatic patients
Knee should be immobilized for 2-4weeks
Functional dynamic force braces have been
designed to keep the knee in anterior drawer to
avoid laxity during healing
Strengthening of quadriceps and avoiding
hamstrings use
32. Grade III injuries with >10 mm of posterior
tibial displacement
Symptomatic complete tears
PCL tears with other ligamentous injuries
(ACL, MCL, PLC)
Acute bony avulsion injuries of the PCL
attachment
Failure of conservative management
33. Long-term subjective evaluations of patients are very
comparable
At a mean of 17 years after non operative treatment,
Shelbourne et al. found a mean IKDC score of 73,
which compares to IKDC scores of 65 found by 2nd
study of operative treatment that had much less
follow-up times of 9–10 years
34. Arthroscopic primary PCL repair with suture
augmentation can be performed in patients
with proximal soft tissue avulsion tears
Ligament remnants that can be re
approximated to the femoral wall and have
sufficient tissue quality to withhold sutures
can be primarily repaired rest needs
reconstruction
39. Eliminates donor-site morbidity
Multiple ligament injuries in which multiple
grafts will be required
40. Meta-analysis shows that the clinical
outcomes were similar between allograft
and autograft tendons for PCL
reconstruction
41. Theoretically has the advantages of availability,
consistency, and appropriate mechanical strength,
no donor site morbidity and no risk of disease
transmission
Eg. Carbon fiber, dacron, bundled
polytetrafluoroethylene (GORE-TEX™), ABC carbon,
polyester
Longer term follow-up demonstrated recurrent
instability and chronic effusions hence their use is
controversial
42. Only AL bundle is reconstructed during
single-bundle PCL reconstruction
One femoral tunnel is made
Both auto and allografts can be used
43. Both ALB and PMB are reconstructed in
Double bundle PCLR
Theoretically it restore the normal
kinematics
It requires two separate femoral tunnels to
reconstruct ALB and PMB that puts femur at
risk for MFC fractures.
44. This systematic review found that double-
bundle reconstruction was superior to
single-bundle in biomechanical studies BUT
clinical outcomes showed no significant
differences between the two PCL
reconstruction techniques
Preferred technique is a single AL
bundle reconstruction because it
reduces surgery time and clinical
evidence demonstrates no advantage
46. Aims to simulate the tibial and femoral ALB
origins
Incase of DB PCLR a 5-mm bone bridge is
maintained between femoral tunnels
47. The main concern in this technique is the so-
called ‘killer turn’, the sharp angle on the tibial
tunnel exit that may produce abrasion,
attenuation and subsequent graft failure
48. Proximity of neurovascular structures to the PCL
insertion is another challenge. The anterior wall
of the popliteal artery lies approximately 7–10
mm from the posterior border of the PCL at 90°
of flexion
49.
50.
51.
52.
53. If only ALB is reconstructed the graft is
tensioned between 70°-90° of knee flexion
For Double bundle PMB is tensioned is full
knee extension
54. The two strongest advantages of tibial inlay
technique are its secure bone-to-bone
fixation on the tibia, and the elimination of
the “killer turn”
Both open and arthroscopic techniques are in
practice
55. Phase I ( 0 – 6 weeks)
Phase II (6weeks – 6 months)
Phase III (6 Months – 12 Months)
56. 1st 4 weeks= brace locked in full extension, passive
ROM up to 90° flexion, NWB with crutches
After 4 weeks= brace unlocked to 100°, passive ROM
beyond 90°,weight bearing as tolerated with crutches
and brace on
Quad sets ,Straight leg raise (SLR) with brace locked,
Ankle DF and PF, avoid active contraction of hamstrings
Patella mobilization
Discontinue brace and crutches at 6 weeks
57. Passive stretching
Closed chain exercises as tolerated
Maximum knee flexion: 10–15° terminal
flexion deficit is not unusual
Quadriceps strength 80–90 % of the
contralateral limb
58. Quadriceps symmetry
Open and closed chain exercises as tolerated
Return to sport-specific activity as tolerated
59. They found the overall complication
rate for arthroscopic knee surgery was
4.7 %; however, 20.1 % of PCL
reconstructions had a complication
60. Neurovascular injury
Loss of flexion ( 10-20 degrees)
Failure to obtain objective stability
Osteonecrosis of the medial femoral condyle
Editor's Notes
The anterolateral bundle (ALB) arises from superior part of the facet above the shelf and posteromedial bundle (PMB) arises below the shelf.
The PCL footprint on the femur is made up of approximately 55 % anterolateral bundle and 45 % posteromedial bundle. The anterolateral bundle
is the major contributor to PCL strength.
The AL bundle tightens in flexion whereas the PM bundle tightens in extension
The AL bundle tightens in flexion whereas the PM bundle tightens in extension
popliteus muscle may act as a restraint to posterior translation in the PCL-deficient knee
ALB helps in posterior restraint at higher angles while PLB at lower angles
the
In Hyperextension injury ALB is damaged but the PLB
remains intact
Acute examination : Look for obvious deformities, feel temperature pulse neurological assessment move active and passive
Orthobullets
The KT-1000 has not, however, achieved the same level of
acceptance for the quantitative measurement of posterior
instability
The Telos stress X-ray with the measuring template
Low signal intensity = black : high signal intensity = white
Sagittal Proton density and T2 fat-suppressed image with knee in extension
Axial T2 fat-suppressed image shows normal PCL
Complete PCL tear. a Fat-suppressed T2 sagittal demonstrates complete proximal disruption of PCL. Note overlying Wrisburg ligament
( arrow) b Axial image shows empty notch ( star) other than ACL
a T2 fat-suppressed image shows remote, complete nonosseous avulsion of PCL at tibial attachment with proximal retraction. b PD nonfat-suppressed images show marked attenuation of PCL with nonvisualization of femoral attachment
The axial images help us to distinguish mucoid degeneration from PCL tear, because the former demonstrates the “tram-track” sign. The tram-track sign is defined as a single, linear striation in the PCL that does not surface, so is surrounded by low signal in all planes
Graft length is 12-13cm with a 10mm diameter not less than 8mm
The anterolateral route tibial tunnel significantly reduced the sharp graft angulation ("killer turn") at the graft tunnel margin of the proximal tibia, but it did not increase the joint translation as compared with the traditional anteromedial route tibial tunnel. The anterolateral route tibial tunnel is thought to be a better choice when arthroscopic PCL reconstruction is performed with the tunnel technique.