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7.Knee injury7.Knee injury ( Diagnosis???)( Diagnosis???)
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7.Knee injury7.Knee injury ACL,PCL,MCL injury -commonACL,PCL,MCL injury -common fracturefracture Contact sportContact sport
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Knee anatomyKnee anatomy
3 bone3 bonePatellaPatellaTibia Tibia femurfemur
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1.Ligament1.Ligament
1.Anterior cruciate ligament(ACL)1.Anterior cruciate ligament(ACL)
2.Posterior cruciate ligament(PCL)2.Posterior cruciate ligament(PCL)
3.Medial collateral ligament(MCL)3.Medial collateral ligament(MCL)
4.Lateral collateral4.Lateral collateral ligament(LCL ligament(LCL))
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2.meniscus2.meniscus Medial, lateral meniscusMedial, lateral meniscus functionfunction 1.Transmit load and distribution1.Transmit load and distribution 2.Increase contact surface area2.Increase contact surface area
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Knee anatomyKnee anatomy
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MechanismMechanism injuryinjury Pivot sport Pivot sport
( soccer , ( soccer , basketball rugby)basketball rugby)
Decelerate, Decelerate, jumpingjumping
HyperextendHyperextend rotaterotate Pop sound ( ACL Pop sound ( ACL
torn)torn)
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ClinicalClinical Pain ,cannot walkPain ,cannot walk Swelling Swelling hematrosishematrosis
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Knee Exam Knee Exam
DeformityDeformity Swelling , ballotmentSwelling , ballotment Tender - joint lineTender - joint line ROM – Flex,extendROM – Flex,extend Muscle –quadricepMuscle –quadricep Special test for ligamentSpecial test for ligament
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1.Valgus stress test – 1.Valgus stress test – Medial Medial collateral ligament ( MCL)collateral ligament ( MCL)
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2.Varus stress test – 2.Varus stress test – lateral lateral collateral ligament ( LCL)collateral ligament ( LCL)
Varus stress test in flex 30,full extend Varus stress test in flex 30,full extend
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3.Lachman test for ACL 3.Lachman test for ACL (Anterior cruciate ligament)(Anterior cruciate ligament)
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3.Anterior drawer test (ADT) for 3.Anterior drawer test (ADT) for ACL ACL (Anterior cruciate (Anterior cruciate ligament)ligament)
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• 4.Posterior drawer test for.Posterior cruciate .Posterior cruciate ligament (PCL)ligament (PCL)
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treatmenttreatment On – fieldOn – field
- RICE ( ligament injury)- RICE ( ligament injury)
- splint ( fracture)- splint ( fracture) Ligament injuryLigament injury
- long leg cast (MCL) 4-6week- long leg cast (MCL) 4-6week
- surgery – - surgery – 1.Repair1.Repair
- 2.Reconstruction- 2.Reconstruction
( 6 week – 6 month)( 6 week – 6 month)
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Ligament Ligament ReconstructionReconstruction
ACL ACL ReconstructionReconstruction
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Post operationPost operation -Hinge knee brace -Hinge knee brace -Axillary crutch-Axillary crutch
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Meniscus Meniscus injuryinjury
Meniscus Meniscus injuryinjury
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Meniscus tearMeniscus tear
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Arthroscopic repairArthroscopic repair
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Arthroscopic repairArthroscopic repair
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8.Leg injury8.Leg injury Diagnosis ??Diagnosis ??
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Anatomy legAnatomy leg 2 bone 2 bone 1.Tibia1.Tibia ( weight ( weight
bearing)bearing)
Tibia plateauTibia plateau – – proximal (knee)proximal (knee)
Tibia plafondTibia plafond – distal – distal
(ankle)(ankle) 2.Fibula 2.Fibula (non (non
weight bearing)weight bearing)
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8.Leg injury8.Leg injury CommonCommon Twist , direct injuryTwist , direct injury Contact sportContact sport ( soccer,rugby)( soccer,rugby)
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8.1Fracture8.1Fracture tibia and fibulatibia and fibula
Severe painSevere pain DeformityDeformity ShorteningShortening Aware open Aware open
fracturefracture
(Emergency)(Emergency) NeurovascularNeurovascular
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treatmenttreatment On-fieldOn-field – – long splint ,transportlong splint ,transport - clean wound- clean wound Definite Definite - long leg cast - long leg cast 10-12 10-12
weekweek - - Surgery in displaced Surgery in displaced
fracturefracture ( 3-6 month)( 3-6 month)
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Surgery with Intramedullary Surgery with Intramedullary NailNail (tibia)(tibia)
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Surgery with External fixator in Surgery with External fixator in dirty open fracture tibiadirty open fracture tibia
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Diagnosis ???Diagnosis ???
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8.2 Muscle cramp8.2 Muscle cramp
Common injuryCommon injury Calf pain, tenderCalf pain, tender Cause – electrolyte Cause – electrolyte
imbalanceimbalance
- dehydration- dehydration
- muscle contraction - muscle contraction imbalanceimbalance
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8.2 Muscle cramp8.2 Muscle cramp
Muscle contraction imbalanceMuscle contraction imbalance
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treatmenttreatment
Passive stretchingPassive stretching IV fluid IV fluid Check electrolyteCheck electrolyte
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9.Ankle injury9.Ankle injury Diagnosis???Diagnosis???
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Ankle anatomyAnkle anatomy 3 bone3 bone
1.distal tibia,medial 1.distal tibia,medial malleolusmalleolus
2.distal fibula,lateral 2.distal fibula,lateral malleoluamalleolua
3.talus3.talus Ligament Ligament
1.medial – deltoid ligament1.medial – deltoid ligament
2.lateral – ATFL,PTFL,CFL2.lateral – ATFL,PTFL,CFL
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Ankle anatomyAnkle anatomy
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9.Ankle injury9.Ankle injury
Most commonMost common Twist, direct injuryTwist, direct injury Soccer,basketballSoccer,basketball 1.ligament injury1.ligament injury
-Inversion lateral ankle -Inversion lateral ankle sprainsprain
2.Fracture ankle2.Fracture ankle
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9.1 Ankle sprain9.1 Ankle sprain
Mechanism injuryMechanism injury Inversion Inversion
(common)(common) Lateral injury ,tearLateral injury ,tear PainPain SwellingSwelling Cannot walkCannot walk
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Ankle sprainAnkle sprain
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Treatment Treatment
On fieldOn field
- RICE- RICE Definite treatment depend on Definite treatment depend on
grade of injurygrade of injury
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Grading of ankle Grading of ankle sprainsprain
Grade 1 (mild)Grade 1 (mild) – pain,tender– pain,tender
Grade 2 (partial tear)Grade 2 (partial tear)
- pain ,swelling- pain ,swelling
- marked tender- marked tender
- good stability- good stability
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Treatment in Treatment in Grade 1,2Grade 1,2
Ankle supportAnkle support BraceBrace Elastic bandageElastic bandage Splint (2-6 week)Splint (2-6 week)
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Grade 3 (complete tear)Grade 3 (complete tear)
Marked pain,swellingMarked pain,swelling InstabilityInstability Cannot walkCannot walk
Treatment Treatment 1.brace, cast1.brace, cast 2.surgery if instability 2.surgery if instability
or chronicor chronic
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9.2 Fracture ankle9.2 Fracture ankle Tender,pain,swellingTender,pain,swelling DeformityDeformity Aware open fractureAware open fracture Neurovascular – post tibia a,nNeurovascular – post tibia a,n
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Fracture ankleFracture ankle
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treatmenttreatment 1.On field1.On field - splint - splint Reduction if marked Reduction if marked
deformitydeformity - Direct traction for - Direct traction for
prevent prevent neurovascular neurovascular
2. Surgery2. Surgery ( 8-12 week) ( 8-12 week)
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RehabilitationRehabilitation
ROMROM StrengthStrength resistresist
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THANK YOUTHANK YOU
Question ???