7.Knee injury ( Diagnosis???)

7.Knee injury ACL,PCL,MCL injury -common fracture Contact sport

Knee anatomy 3 bone Patella Tibia femur

1.Ligament 1.Anterior cruciate ligament(ACL) 2.Posterior cruciate ligament(PCL) 3.Medial collateral ligament(MCL) 4.Lateral collateral ligament(LCL)

2.meniscus Medial, lateral meniscus function 1.Transmit load and distribution 2.Increase contact surface area

Knee anatomy

Mechanism injury Pivot sport ( soccer , basketball rugby) Decelerate, jumping Hyperextend rotate Pop sound ( ACL torn)

Clinical Pain ,cannot walk Swelling hematrosis

Knee Exam Deformity Swelling , ballotment Tender - joint line ROM – Flex,extend Muscle –quadricep Special test for ligament

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

2.Varus stress test – lateral collateral ligament ( LCL) Varus stress test in flex 30,full extend

3.Lachman test for ACL (Anterior cruciate ligament)

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

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

treatment On – field - RICE ( ligament injury) - splint ( fracture) - long leg cast (MCL) 4-6week - surgery – 1.Repair - 2.Reconstruction ( 6 week – 6 month)

Ligament Reconstruction ACL Reconstruction

Post operation -Hinge knee brace -Axillary crutch

Meniscus injury

Meniscus tear

Arthroscopic repair

Arthroscopic repair

8.Leg injury Diagnosis ??

Anatomy leg 2 bone 1.Tibia ( weight bearing) Tibia plateau – proximal (knee) Tibia plafond – distal (ankle) 2.Fibula (non weight bearing)

8.Leg injury Common Twist , direct injury Contact sport ( soccer,rugby)

8.1Fracture tibia and fibula Severe pain Deformity Shortening Aware open fracture (Emergency) Neurovascular

treatment On-field – long splint ,transport - clean wound Definite - long leg cast 10-12 week - Surgery in displaced fracture ( 3-6 month)

Surgery with Intramedullary Nail (tibia)

Surgery with External fixator in dirty open fracture tibia

Diagnosis ???

8.2 Muscle cramp Common injury Calf pain, tender Cause – electrolyte imbalance - dehydration - muscle contraction imbalance

8.2 Muscle cramp Muscle contraction imbalance

treatment Passive stretching IV fluid Check electrolyte

9.Ankle injury Diagnosis???

Ankle anatomy 3 bone 1.distal tibia,medial malleolus 2.distal fibula,lateral malleolua 3.talus Ligament 1.medial – deltoid ligament 2.lateral – ATFL,PTFL,CFL

Ankle anatomy

9.Ankle injury Most common Twist, direct injury Soccer,basketball 1.ligament injury -Inversion lateral ankle sprain 2.Fracture ankle

9.1 Ankle sprain Mechanism injury Inversion (common) Lateral injury ,tear Pain Swelling Cannot walk

Ankle sprain

Treatment On field - RICE Definite treatment depend on grade of injury

Grading of ankle sprain Grade 1 (mild) – pain,tender Grade 2 (partial tear) - pain ,swelling - marked tender - good stability

Treatment in Grade 1,2 Ankle support Brace Elastic bandage Splint (2-6 week)

Grade 3 (complete tear) Marked pain,swelling Instability Cannot walk Treatment 1.brace, cast 2.surgery if instability or chronic

9.2 Fracture ankle Tender,pain,swelling Deformity Aware open fracture Neurovascular – post tibia a,n

Fracture ankle

treatment 1.On field - splint Reduction if marked deformity - Direct traction for prevent neurovascular 2. Surgery ( 8-12 week)

Rehabilitation ROM Strength resist

THANK YOU Question ???