7.Knee injury7.Knee injury ( Diagnosis???)( Diagnosis???)

7.Knee injury7.Knee injury ACL,PCL,MCL injury -commonACL,PCL,MCL injury -common fracturefracture Contact sportContact sport

Knee anatomyKnee anatomy

3 bone3 bonePatellaPatellaTibia Tibia femurfemur

1.Ligament1.Ligament

1.Anterior cruciate ligament(ACL)1.Anterior cruciate ligament(ACL)

2.Posterior cruciate ligament(PCL)2.Posterior cruciate ligament(PCL)

3.Medial collateral ligament(MCL)3.Medial collateral ligament(MCL)

4.Lateral collateral4.Lateral collateral ligament(LCL ligament(LCL))

2.meniscus2.meniscus Medial, lateral meniscusMedial, lateral meniscus functionfunction 1.Transmit load and distribution1.Transmit load and distribution 2.Increase contact surface area2.Increase contact surface area

Knee anatomyKnee anatomy

MechanismMechanism injuryinjury Pivot sport Pivot sport

( soccer , ( soccer , basketball rugby)basketball rugby)

Decelerate, Decelerate, jumpingjumping

HyperextendHyperextend rotaterotate Pop sound ( ACL Pop sound ( ACL

torn)torn)

ClinicalClinical Pain ,cannot walkPain ,cannot walk Swelling Swelling hematrosishematrosis

Knee Exam Knee Exam

DeformityDeformity Swelling , ballotmentSwelling , ballotment Tender - joint lineTender - joint line ROM – Flex,extendROM – Flex,extend Muscle –quadricepMuscle –quadricep Special test for ligamentSpecial test for ligament

1.Valgus stress test – 1.Valgus stress test – Medial Medial collateral ligament ( MCL)collateral ligament ( MCL)

2.Varus stress test – 2.Varus stress test – lateral lateral collateral ligament ( LCL)collateral ligament ( LCL)

Varus stress test in flex 30,full extend Varus stress test in flex 30,full extend

3.Lachman test for ACL 3.Lachman test for ACL (Anterior cruciate ligament)(Anterior cruciate ligament)

3.Anterior drawer test (ADT) for 3.Anterior drawer test (ADT) for ACL ACL (Anterior cruciate (Anterior cruciate ligament)ligament)

• 4.Posterior drawer test for.Posterior cruciate .Posterior cruciate ligament (PCL)ligament (PCL)

treatmenttreatment On – fieldOn – field

- RICE ( ligament injury)- RICE ( ligament injury)

- splint ( fracture)- splint ( fracture) Ligament injuryLigament injury

- long leg cast (MCL) 4-6week- long leg cast (MCL) 4-6week

- surgery – - surgery – 1.Repair1.Repair

- 2.Reconstruction- 2.Reconstruction

( 6 week – 6 month)( 6 week – 6 month)

Ligament Ligament ReconstructionReconstruction

ACL ACL ReconstructionReconstruction

Post operationPost operation -Hinge knee brace -Hinge knee brace -Axillary crutch-Axillary crutch

Meniscus Meniscus injuryinjury

Meniscus Meniscus injuryinjury

Meniscus tearMeniscus tear

Arthroscopic repairArthroscopic repair

Arthroscopic repairArthroscopic repair

8.Leg injury8.Leg injury Diagnosis ??Diagnosis ??

Anatomy legAnatomy leg 2 bone 2 bone 1.Tibia1.Tibia ( weight ( weight

bearing)bearing)

Tibia plateauTibia plateau – – proximal (knee)proximal (knee)

Tibia plafondTibia plafond – distal – distal

(ankle)(ankle) 2.Fibula 2.Fibula (non (non

weight bearing)weight bearing)

8.Leg injury8.Leg injury CommonCommon Twist , direct injuryTwist , direct injury Contact sportContact sport ( soccer,rugby)( soccer,rugby)

8.1Fracture8.1Fracture tibia and fibulatibia and fibula

Severe painSevere pain DeformityDeformity ShorteningShortening Aware open Aware open

fracturefracture

(Emergency)(Emergency) NeurovascularNeurovascular

treatmenttreatment On-fieldOn-field – – long splint ,transportlong splint ,transport - clean wound- clean wound Definite Definite - long leg cast - long leg cast 10-12 10-12

weekweek - - Surgery in displaced Surgery in displaced

fracturefracture ( 3-6 month)( 3-6 month)

Surgery with Intramedullary Surgery with Intramedullary NailNail (tibia)(tibia)

Surgery with External fixator in Surgery with External fixator in dirty open fracture tibiadirty open fracture tibia

Diagnosis ???Diagnosis ???

8.2 Muscle cramp8.2 Muscle cramp

Common injuryCommon injury Calf pain, tenderCalf pain, tender Cause – electrolyte Cause – electrolyte

imbalanceimbalance

- dehydration- dehydration

- muscle contraction - muscle contraction imbalanceimbalance

8.2 Muscle cramp8.2 Muscle cramp

Muscle contraction imbalanceMuscle contraction imbalance

treatmenttreatment

Passive stretchingPassive stretching IV fluid IV fluid Check electrolyteCheck electrolyte

9.Ankle injury9.Ankle injury Diagnosis???Diagnosis???

Ankle anatomyAnkle anatomy 3 bone3 bone

1.distal tibia,medial 1.distal tibia,medial malleolusmalleolus

2.distal fibula,lateral 2.distal fibula,lateral malleoluamalleolua

3.talus3.talus Ligament Ligament

1.medial – deltoid ligament1.medial – deltoid ligament

2.lateral – ATFL,PTFL,CFL2.lateral – ATFL,PTFL,CFL

Ankle anatomyAnkle anatomy

9.Ankle injury9.Ankle injury

Most commonMost common Twist, direct injuryTwist, direct injury Soccer,basketballSoccer,basketball 1.ligament injury1.ligament injury

-Inversion lateral ankle -Inversion lateral ankle sprainsprain

2.Fracture ankle2.Fracture ankle

9.1 Ankle sprain9.1 Ankle sprain

Mechanism injuryMechanism injury Inversion Inversion

(common)(common) Lateral injury ,tearLateral injury ,tear PainPain SwellingSwelling Cannot walkCannot walk

Ankle sprainAnkle sprain

Treatment Treatment

On fieldOn field

- RICE- RICE Definite treatment depend on Definite treatment depend on

grade of injurygrade of injury

Grading of ankle Grading of ankle sprainsprain

Grade 1 (mild)Grade 1 (mild) – pain,tender– pain,tender

Grade 2 (partial tear)Grade 2 (partial tear)

- pain ,swelling- pain ,swelling

- marked tender- marked tender

- good stability- good stability

Treatment in Treatment in Grade 1,2Grade 1,2

Ankle supportAnkle support BraceBrace Elastic bandageElastic bandage Splint (2-6 week)Splint (2-6 week)

Grade 3 (complete tear)Grade 3 (complete tear)

Marked pain,swellingMarked pain,swelling InstabilityInstability Cannot walkCannot walk

Treatment Treatment 1.brace, cast1.brace, cast 2.surgery if instability 2.surgery if instability

or chronicor chronic

9.2 Fracture ankle9.2 Fracture ankle Tender,pain,swellingTender,pain,swelling DeformityDeformity Aware open fractureAware open fracture Neurovascular – post tibia a,nNeurovascular – post tibia a,n

Fracture ankleFracture ankle

treatmenttreatment 1.On field1.On field - splint - splint Reduction if marked Reduction if marked

deformitydeformity - Direct traction for - Direct traction for

prevent prevent neurovascular neurovascular

2. Surgery2. Surgery ( 8-12 week) ( 8-12 week)

RehabilitationRehabilitation

ROMROM StrengthStrength resistresist

THANK YOUTHANK YOU

Question ???