Common Knee ConditionsCommon Knee Conditions

VMC Seminar

April 28, 2011

Renton, Washington

Fred Huang, MDValley Orthopedic Associates

A Division of Proliance Surgeons, Inc.

Knee InjuriesKnee Injuries

Meniscal TearsACL TearsMulti-ligament InjuriesTibial Plateau Fractures

Healthy RightKnee

Source: Knee Ligament InjuriesThe Staywell Company, 2001

Meniscal Tears

Symptoms – what patients notice Swelling Catching and locking Pain with pivoting and squatting

Exam Findings – what doctors find Swelling (fluid on the knee) Tenderness at the site of the tear Pain with flexion/twisting

Meniscal Tears

Arthroscopic surgery to remove torn tissue

Degenerative tears: associated with minimal or no trauma

Degenerative tears often associated with arthritis & not always treated with surgery

Source: www.opsmart.com

Source: www.stoneclinic.com

Types of Ligament Injuries

ACL very common

MCL most common with ski injuries Usually treated with bracing for 6 weeks

Combination injuries (ACL w/ MCL most common, but any combo possible)

PCL involved frequently in multi-ligament injuries

ACL Tears

Source: Knee Ligament InjuriesThe Staywell Company, 2001

ACL Tears

Twisting and/or cutting – often a non-contact injury

Usually unable to continue sporting activity

Swelling within 1-2 hours Source: Knee Ligament Injuries

The Staywell Company, 2001

MRI – ACL and Meniscal Tears

ACL Tears - Treatment

Non-operative treatment (Brace?)

Surgical treatment Only after motion returns to normal Graft options: hamstrings, patellar tendon,

quad tendon, or allograft Associated procedures: meniscal or

cartilage procedures

ACL Reconstruction

Sources:Left: www.arthroscopy.comRight: www.orthop.washington.edu

Multi-ligament Knee Injuries

Higher energy mechanism than ACL tears

Can be due to a complete knee dislocation

Nerve and/or blood vessel injuries possible

Multi-ligament Knee Injuries

Tibial Plateau Fractures

Wide spectrum of injury patterns

Often treated surgically to re-establish normal architecture at the joint surface

Tibial Plateau Fractures

CT scans helpful

Tibial Plateau Fixation withLateral Ligament Repair (Simple)

Tibial Plateau Fixation - Moderate

Tibial Plateau Fixation - Complex

Patello-femoral Pain

Frequent cause for ANTERIOR knee pain Pain worsened by running, squatting,

stair-climbing, and lunges Often associated with grinding/popping at the

kneecap MRI’s often “normal” Treatment consists of formal P.T., NSAID’s,

weight loss, and occasional steroid injections

Knee Arthritis

Pain worse with standing and better with rest

Physical Exam: Stiffness & swelling Deformity (bow-legged

versus knock-kneed)

Knee Arthritis – Treatment Options

Standard treatments: 1. Medicines 2. Injections 3. Surgery

(replacement usually)

Knee Arthritis Treatment – Tibial Osteotomy

Intermediate solution that improves pain and function usually for < 10 years

Allows for continued impact activities

Associated with a longer recovery time (to allow for healing of the osteotomy)

Total Knee Replacement

Reliable solution that improves pain and function usually for >15 years

Physical therapy and home exercises important after surgery

New interest in better pain management, smaller incisions, and accelerated rehab

Not designed for impact activities

Thank You

Fred Huang, MD www.valleyorthopedicassociates.com