1. Common Knee Conditions VMC Seminar April 28, 2011 Renton, Washington Fred Huang, MD Valley Orthopedic Associates A Division of Proliance Surgeons, Inc.

2. Knee Injuries  Meniscal Tears  ACL Tears  Multi-ligament Injuries  Tibial Plateau Fractures

3. Healthy Right Knee Source: Knee Ligament Injuries The Staywell Company, 2001

4. Meniscal Tears  Symptoms – what patients notice  Swelling  Catching and locking  Pain with pivoting and squatting  Exam Findings – what doctors find  Swelling (fluid on the knee)  Tenderness at the site of the tear  Pain with flexion/twisting

5. Meniscal Tears  Arthroscopic surgery to remove torn tissue  Degenerative tears: associated with minimal or no trauma  Degenerative tears often associated with arthritis & not always treated with surgery Source: www.opsmart.com Source: www.stoneclinic.com

6. Types of Ligament Injuries  ACL very common  MCL most common with ski injuries  Usually treated with bracing for 6 weeks  Combination injuries (ACL w/ MCL most common, but any combo possible)  PCL involved frequently in multi-ligament injuries

7. ACL Tears Source: Knee Ligament Injuries The Staywell Company, 2001

8. ACL Tears  Twisting and/or cutting – often a non-contact injury  Usually unable to continue sporting activity  Swelling within 1-2 hours Source: Knee Ligament Injuries The Staywell Company, 2001

9. MRI – ACL and Meniscal Tears

10. ACL Tears - Treatment  Non-operative treatment (Brace?)  Surgical treatment  Only after motion returns to normal  Graft options: hamstrings, patellar tendon, quad tendon, or allograft  Associated procedures: meniscal or cartilage procedures

11. ACL Reconstruction Sources: Left: www.arthroscopy.comwww.arthroscopy.com Right: www.orthop.washington.edu

12. Multi-ligament Knee Injuries  Higher energy mechanism than ACL tears  Can be due to a complete knee dislocation  Nerve and/or blood vessel injuries possible

13. Multi-ligament Knee Injuries

14. Tibial Plateau Fractures  Wide spectrum of injury patterns  Often treated surgically to re-establish normal architecture at the joint surface

15. Tibial Plateau Fractures  CT scans helpful

16. Tibial Plateau Fixation with Lateral Ligament Repair (Simple)

17. Tibial Plateau Fixation - Moderate

18. Tibial Plateau Fixation - Complex

19. Patello-femoral Pain  Frequent cause for ANTERIOR knee pain  Pain worsened by running, squatting, stair-climbing, and lunges  Often associated with grinding/popping at the kneecap  MRI’s often “normal”  Treatment consists of formal P.T., NSAID’s, weight loss, and occasional steroid injections

20. Knee Arthritis  Pain worse with standing and better with rest  Physical Exam:  Stiffness & swelling  Deformity (bow-legged versus knock-kneed)

21. Knee Arthritis – Treatment Options Standard treatments:  1. Medicines  2. Injections  3. Surgery (replacement usually)

22. Knee Arthritis Treatment – Tibial Osteotomy  Intermediate solution that improves pain and function usually for < 10 years  Allows for continued impact activities  Associated with a longer recovery time (to allow for healing of the osteotomy)

23. Total Knee Replacement  Reliable solution that improves pain and function usually for >15 years  Physical therapy and home exercises important after surgery  New interest in better pain management, smaller incisions, and accelerated rehab  Not designed for impact activities

24. Thank You  Fred Huang, MD  www.valleyorthopedicassociates.com