Knee Ligament Injuries

May 12,2009

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Knee Ligament Injuries

(disability) morbidity)

(

May 12,2009

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Major ligament 4
1. 2. 3. 4. Anterior cruciate ligament (ACL) Posterior cruciate ligament (PCL) Medial collateral ligament (MCL) Lateral collateral ligament (LCL) Posterolateral structures (PLS)

May 12,2009

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2009 4 .Knee ligament May 12.

Diagnosis approach to the injured knee Direction of force structure Valgus force Varus force Valgus force MCL MCL injury .2009 5 . LCL injury . Rotation Hyperextension ACL Polytrauma long bone lower extremity fracture Edema onset Hemathrosis pop ACL tear May 12.

baseline May 12.2009 extension flexion 6 .Physical Examination (inspection) : ligament injury Fracture (palpitation) relax .

Physical Examination ( ligament ACL PCL specific May 12.2009 ( stability test ) ) lachman¶ s test most sensitive most posterior drawer test 7 .

2009 femur 8 .Lachman¶s test : 20-30 proximal tibia distal femur tibia => Positive sign May 12.

Posterior drawer test ( PDS ) Posterior cruciate ligament ( PCL) : PCL tibia : May 12.2009 end point ( tibia ) 90 drop back tibia soft PDS positive 9 .

Investigation Plain X-ray serious knee injury exclude fracture Avulsion fracture osteochondral fracture MRI knee injury soft tissue ligament meniscus bony lesion severity prognosis Arthroscopy May 12.2009 10 .

localized tenderness Grade 2 : Ligament stretching partial tear Swelling Grade 3 : Ligament complete tear May 12.Grading ligamentous injury Grade 1 : Ligament Swelling.2009 11 .

2009 external support 12 .Medial Collateral Ligament Injury (MCL injury ) Signs and Symptoms contract valgus external rotation lower lateral thigh upper medial leg MCL grade 3 May 12.

Investigation of MCL injury X-rays Ap.2009 13 .lateral view MRI May 12.

Treatment of MCL injury Conservative multiple ligament injuries . MCL grade 3 tear MCL ACL MCL conservative ~ 4-6 evaluate ACL reconstruction conservative treatment May 12.2009 14 .

2009 cruciate ligament injury mechanism hyperextension varus load Diagnosis varus stress 30 varus opening posterolateral injury posterior translation varus varus external rotation 30 15 .Lateral Collateral Ligament Injury May 12.

2009 16 .Treatment LCL injury conservative grade 3 instability 3 May 12.

2. 3.Anterior Cruciate Ligament Injury ACL ACL ligament anterior displacement tibial ACL varus / valgus ACL hyperextension knee Check to internal / external rotation Tibial 17 1. May 12. 4.2009 .

swelling usually develops within 2 to 3 hours ( hemathrosis 70%) May 12.Diagnosis ACL injury ACL injury 1. feeling a pop 50% 3.2009 18 . twisting injury to the knee 2. being unable to continue their activity 4.

contusion aspiration effusion Diagnosis Therapeutic hemathrosis gross May 12.2009 19 .Physical Examination ACL injury Acute ACL injury abrasion .

2009 20 .Physical Examination ACL injury Chronic ACL injury test tibial knee ACL injury Lachman¶s test passive motion femur locked chronic meniscal tear May 12.

98% Specificity partial complete 50% May 12.2009 21 .Radiography ACL damage plain X-ray AP. meniscal tear bone bruise sensitivity MRI detect ACL injury 90% . Lateral view Chronic case notch( ) MRI diagnosis .

soccer ) level 2 heavy manual work or side-toside sports (skiing. pivoting (football . running) level 4 sedentary activity without sports ( ) May 12.Anterior Cruciate Ligament Injury International Knee Documentation Committee activity level 4 level 1 jumping.2009 22 . tennis) level 3 light manual work or noncutting sports (jogging.

Non operative treatment ACL injury level 3 level 2 sport activity reconstruction physical therapy Functional brace rehabilitation .2009 23 . swelling effusion . hamstrings muscle atrophy level 4 level 1 May 12.

Non operative treatment ACL injury brace therapy brace physical control stability May 12.2009 conservative minimal surgery debridement of articular cartilage defect. trimming or repairing meniscus excising ligament stump procedures ligament reconstruction 24 .

Surgical treatment ACL injury intraarticular reconstruction ACL reconstruction arthroscopic assisted endoscopic techniques transfixation technique hamstring graft fixation femoral tunnel May 12.2009 25 .

2009 26 .Surgical treatment ACL injury fixation graft interference screw titanium bioabsorbable screw stable fixation transfix pin screw May 12.

valgus external rotation May 12.Posterior Cruciate Ligament Injury PCL translation posterior tibia varus .2009 27 .

Diagnosis of PCL injury Acute mechanism Acute : echymosis limit motion May 12.2009 Chronic injury Abrasion proximal tibia Direct injury 28 .

Treatment Acute PCL injury Nonoperative treatment PCL injury posterior translation 10 mm.2009 29 . surgical reconstruction May 12. aggressive rehabilitative program posterior 10 -15 mm.

2.2009 30 . PCL avulsion posterior tibial translation 10-15 mm posterior drawer test Knee flexion 90 3. grade 3 MCL ACL posterolateral injury May 12.Operative treatment PCL injury Indication for operative treatment 1.

Operative treatment PCL injury PCL reconstruction single double bundle arthroscopic technique May 12.2009 31 .