Common Knee Conditions VMC Seminar April 28 2011

Common Knee Conditions VMC Seminar April 28, 2011 Renton, Washington Fred Huang, MD Valley Orthopedic Associates A Division of Proliance Surgeons, Inc.

Knee Injuries v. Meniscal Tears v. ACL Tears v. Multi-ligament Injuries v. Tibial Plateau Fractures

Healthy Right Knee Source: Knee Ligament Injuries The Staywell Company, 2001

Meniscal Tears v Symptoms – what patients notice § § § v 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 v Arthroscopic surgery to remove torn tissue v Degenerative tears: associated with minimal or no trauma v Degenerative tears often associated with arthritis & not always treated with surgery Source: www. stoneclinic. com Source: www. opsmart. com

Types of Ligament Injuries v ACL very common v MCL most common with ski injuries § Usually treated with bracing for 6 weeks v Combination injuries (ACL w/ MCL most common, but any combo possible) v PCL involved frequently in multi-ligament injuries

ACL Tears Source: Knee Ligament Injuries The Staywell Company, 2001

ACL Tears v v v 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 v Non-operative treatment (Brace? ) v 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 n Sources: Left: www. arthroscopy. com Right: www. orthop. washington. edu

Multi-ligament Knee Injuries Higher energy mechanism than ACL tears v Can be due to a complete knee dislocation v Nerve and/or blood vessel injuries possible v

Multi-ligament Knee Injuries

Tibial Plateau Fractures v Wide spectrum of injury patterns v Often treated surgically to re-establish normal architecture at the joint surface

Tibial Plateau Fractures v CT scans helpful

Tibial Plateau Fixation with Lateral Ligament Repair (Simple)

Tibial Plateau Fixation - Moderate

Tibial Plateau Fixation - Complex

Patello-femoral Pain v v v 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 v Pain worse with standing and better with rest v 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 v Intermediate solution that improves pain and function usually for < 10 years v Allows for continued impact activities v Associated with a longer recovery time (to allow for healing of the osteotomy)

Total Knee Replacement v Reliable solution that improves pain and function usually for >15 years v Physical therapy and home exercises important after surgery v New interest in better pain management, smaller incisions, and accelerated rehab v Not designed for impact activities

Thank You v v Fred Huang, MD www. valleyorthopedicassociates. com