VMC Seminar April 28, 2011

Renton, Washington

Fred Huang, MD Valley Orthopedic Associates

A Division of Proliance Surgeons, Inc.

 Meniscal Tears  ACL Tears  Multi-ligament Injuries  Tibial Plateau Fractures

Healthy Right Knee

Source: Knee Ligament Injuries The 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 Injuries The 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.com Right: 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 with Lateral 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