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Common Injuries to the Knee. ANTERIOR CRUCIATE INJURIES.

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Presentation on theme: "Common Injuries to the Knee. ANTERIOR CRUCIATE INJURIES."— Presentation transcript:

1 Common Injuries to the Knee

2 ANTERIOR CRUCIATE INJURIES

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4 ACL injuries also commonly occur with hyperextension of the knee, deceleration and valgus stress.

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6 INDICATIONS FOR SURGERY: Complete tear; associated meniscal pathology Well motivated person who will do the rehab program; physiologically young Unwilling to change lifestyle; job and sports require twisting, cutting Minimal evidence of DJD

7 WHEN TO DO SURGERY : Wait at least 3-4 weeks after injury Decrease the swelling Decrease Quad inhibition Decrease hamstring overfiring Decrease scarring Increase ROM; decrease stiffness

8 SURGERIES PERFORMED 1.Bone-tendon-bone with middle 1/3 of patellar tendon 2.Semitendinosis and gracilis: fold them in ½ so have a 4 tendon bundle 3.Allograph: bone-tendon-bone patellar tendon from cadaver Key in surgery is correct isometric placement of the graph.

9 80-90% of patients have a good result with surgery going back to previous levels of activity. Some complications that may arise and give a less than favorable result are: Patellar tendonitis Patellofemoral pain/chondromalacia Limited ROM at extremes; loss of even a few degrees of terminal extension is a problem Stretching out of graph

10 COLLATERAL LIGAMENT INJURIES

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12 MCL tears: most common mechanism is a blow to the outside of the knee followed by planting of the foot and twisting of the knee.

13 There is a high risk of injury to the medial meniscus with MCL tears.

14 KNEE REHAB

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17 PATELLOFEMORAL PAIN SYNDROME

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19 The patella must have balanced muscular forces around it to ride properly in the femoral groove. The VMO should fire before the VL. The VMO/VL ratio should be 1:1 Tight ITB, hamstrings and calf can disrupt muscular balance.

20 OTHER FACTORS CAUSING PFPS: 1.Overpronation 2.Anteversion 3.Weak Hip ER & ABD 4.Tibial Varum 5.Increased Q angle

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22 ILIOTIBIAL BAND SYNDROME

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24 Complains of pain on knee flexion May complain of snapping Pain gets worse on ROM from full flexion to full extension. Often result of: genu varum; over pronation; femoral anteversion; spinal problems.

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26 SHIN SPLINTS

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28 Most common area affected is antereomedial shin. Starts out as muscle/tendon injury Can progress to periosteal injury Can end up as a stress fracture

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30 ANKLE SPRAINS

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33 Ottawa ankle rules

34 JOBST INTERMITTENT COMPRESSION DEVICE

35 ROM exercises Strengthening Proprioception Agility Running/jumping

36 Syndesmotic Injury

37 ACHILLES TENDONITIS

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39 ACHILLES TENDON RUPTURE

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41 LONG REHAB: Average 6-9 months

42 PLANTAR FASCITIS

43 Over pronation Pes cavus foot Tight calf muscles Tibial varum Anteversion Weak ER of hip

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45 Pharmacology

46 DRUGS USED FOR MUSCULOSKELETAL PATHOLOGY Analgesics Drugs that directly affect the healing process Drugs that do both

47 NON STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS) Treatment of inflammatory arthritic diseases Treatment of the “itises”

48 NSAIDS: SIDE EFFECTS Gastrointestinal Irritation and Ulceration Decreased Blood Clotting Kidney Trouble Other

49 Common NSAIDs (OTC) Bayer (aspirin) Tylenol (acetaminophen) Aleve or Naprosyn (naproxen) Advil (ibuprofen)

50 Common NSAIDS (Rx) Celebrex (celecoxib) Voltaren (diclofenac) Lodine (etodolac) Nalfon (fenoprofen) Indocin (indomethacin) Orudis, Oruvail (ketoprofen) Toradol (ketoralac) Daypro (oxaprozin) Relafen (nabumetone) Clinoril (sulindac) Tolectin (tolmetin) Vioxx (rofecoxib

51 Dosing Depends on Goal Avoid negative drug reactions Trial and Error Every patient has a different response Must keep blood levels constant for antiinflammatory response

52 CORTICOSTEROIDS Synthetic derivative of cortisol Mobilizes energy stores Circulatory changes Changes in liver and kidney function Subdue inflammation and immune response

53 ACTION Stabilizes cell membranes which decreases release of inflammatory mediators Inhibits migration of inflammatory cells that are attracted to the injured area.

54 INDICATIONS INFLAMMATORY DISEASES: RA, Lupus, Ankylosing Spondylitis NO! Acute musculoskeletal injuries ???? Chronic musculoskeletal injuries

55 ADMINISTRATION ORAL: Used in tx of diseases which affect multiple joints; Dose pack for chronic musculoskeletal problems LOCAL INJECTION: Used for tendinitis, bursitis, fasciitis TOPICAL USE: Dermatologic effects only

56 SIDE EFFECTS: ORAL Osteoporosis: pathologic fractures Avascular Necrosis Disturb fat and carbo metabolism: increase risk of diabetes; increased fat distribution in trunk and face Hypertension due to NA and H20 retention Steroid myopathy Steroid psychosis

57 SIDE EFFECTS: LOCAL INJECTION No systemic effects False sense of recovery Local tendon/muscle atrophy: rupture Skin changes

58 ANALGESICS Allow early initiation of rehab Improve quality of life for persons with chronic pain Allow patients to tolerate surgery

59 NON-NARCOTIC Acetaminophen: Has central nervous system effect through cental inhibition of prostaglandins Aspirin: Has peripheral effect through peripheral inhibition of prostaglandins NSAIDS: Have analgesic effect on nervous system as well as decreased inflammation

60 NARCOTIC Common property: bind to opioid receptors in brain Results in significant elevation of pain threshold; can be addictive

61 INDICATIONS Mild/moderate musculoskeletal pain: non- narcotics; acetaminophen first choice; NSAIDS may be more logical if inflammation is causing pain, ie acute injuries and inflammatory arthritis Osteoarthritis: acetaminophen Chronic musculoskeletal pain: acetaminophen

62 Continued…… Acute postoperative pain: narcotics; can be given IV or IM Chronic, Severe pain: narcotics See Table 3 for commonly used analgesic drugs

63 SIDE EFFECTS ACETAMINOPHEN: generally safe; liver toxicity ASPIRIN/NSAIDS: as previously covered NARCOTICS: respiratory suppression; sedation, nausea and vomiting; urinary retention; euphoria/dependence

64 ANTIBIOTICS Used to treat or prevent bacterial infections which can occur postoperatively or post compound fracture Classified based on chemical structure and effectiveness against certain bacteria (Table 4)

65 INDICATIONS FOR USE Use drug best suited to fully eradicate the bacteria causing the infection Infection must be cultured to determine what kind it is Sometimes used prophylactically at time of surgery; mostly with patients with compromised immune system Always used with patients with open fractures


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