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

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

3. Knee anatomy
3 bone
Patella
Tibia
femur

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

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

7. Knee anatomy

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

9. Clinical
Pain ,cannot walk
Swelling
hematrosis

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

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

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

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

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

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

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

17. Ligament Reconstruction
ACL Reconstruction

18. Post operation
-Hinge knee brace
-Axillary crutch

19. Meniscus injury

20. Meniscus tear

21. Arthroscopic repair

22. Arthroscopic repair

23. 8.Leg injury
Diagnosis ??

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

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

26. 8.1Fracture tibia and fibula
Severe pain
Deformity
Shortening
Aware open fracture
(Emergency)
Neurovascular

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

28. Surgery with Intramedullary Nail (tibia)

29. Surgery with External fixator in dirty open fracture tibia

30. Diagnosis ???

31. 8.2 Muscle cramp Common injury Calf pain, tender
Cause – electrolyte imbalance
- dehydration
- muscle contraction imbalance

32. 8.2 Muscle cramp
Muscle contraction imbalance

33. treatment
Passive stretching
IV fluid
Check electrolyte

35. 9.Ankle injury
Diagnosis???

36. 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

37. Ankle anatomy

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

39. 9.1 Ankle sprain Mechanism injury Inversion (common)
Lateral injury ,tear
Pain
Swelling
Cannot walk

40. Ankle sprain

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

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

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

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

45. 9.2 Fracture ankle Tender,pain,swelling Deformity Aware open fracture
Neurovascular – post tibia a,n

46. Fracture ankle

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

48. Rehabilitation
ROM
Strength
resist

49. THANK YOU
Question ???