Presentation on theme: "Knee Problems ? Sam Rajaratnam Consultant Orthopaedic Surgeon Eastbourne DGH, Horder Centre, Esperance Hospital, Eastbourne."— Presentation transcript:
Knee Problems ? Sam Rajaratnam Consultant Orthopaedic Surgeon Eastbourne DGH, Horder Centre, Esperance Hospital, Eastbourne
Questions & Dilemmas Physiotherapy or Orthopaedic Surgeon ? MRI or Xray ? Which views ? Operate or Not ? Total Knee replacement or Partial ? Can we afford it ?? Which hospital ? Fracture/Knee injury clinic/ Elective setting
Physio vs Surgeon Not mutually exclusive We work in teams Physio – good for weak muscles/extra articular problems/ secondary stiffness Surgeon – can deal with intra-articular pathology
Reminder - Acutely injured knee Intra-articular injuries present with pain and swelling Extra-articular ligament injuries present with pain
MCL Injury Tenderness, stress testing Grade I Local tenderness+slight or no laxity Grade 2 Local tenderness+laxity with endpoint. Grade 3 Complete rupture No endpoint.
Curable - if braced early
ACL History running (high velocity) change of speed and direction “ snap ” or “ pop ” pain immediate swelling (<4hours) unable to play on CLINICAL FINDINGS Swelling is haemarthrosis Restricted range of motion usually due to ACL stump or muscular spasm almost never meniscal tear locking joint in acute primary injury LIGAMENT EXAMINATION LACHMAN PIVOT SHIFT ANTERIOR DRAWER TESTS
Arthroscopic View Torn ACL POST RECONSTRUCTION
Day Surgical Arthroscopic Hamstring ACL - Accelerated Rehabilitation Key Changes Pre ACL Rehab Patient education Improved technique Ice cold saline infusion Advanced Local Blockade Physiotherapy services Key to good results Early reconstruction before meniscal damage has occurred
4. Patella Dislocation - MPFL Traumatic May heal May require MPFL Repair Spontaneous Bad bony alignment Soft Tissue laxity
Cartilage Repair Suitable for 15 – 55 year old Discrete area of chondral damage Stable knee (no ligament instability) Medial femoral condylar defects, Trochlea groove, Patella Various techniques available
MACI & ACI
Can Britain afford it ? Probably not………….but as secondary care clinicians, the decision is easy Treat the patient in front of you as best you can…..
Thank you – Any Questions ? Sam Rajaratnam Consultant Orthopaedic Surgeon Eastbourne DGH Horder Centre, Esperance Hospital, Eastbourne