Common Knee Conditions by: Fred Huang
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VMC Seminar April 28, 2011
Renton, Washington
Fred Huang, MD Valley Orthopedic Associates
A Division of Proliance Surgeons, Inc.
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Meniscal Tears ACL Tears Multi-ligament Injuries Tibial Plateau Fractures
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Healthy Right Knee
Source: Knee Ligament Injuries The Staywell Company, 2001
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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
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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
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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
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ACL Tears
Source: Knee Ligament Injuries The Staywell Company, 2001
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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
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MRI – ACL and Meniscal Tears
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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
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ACL Reconstruction
Sources: Left: www.arthroscopy.com Right: www.orthop.washington.edu
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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
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Multi-ligament Knee Injuries
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Tibial Plateau Fractures
Wide spectrum of injury patterns
Often treated surgically to re-establish normal architecture at the joint surface
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Tibial Plateau Fractures
CT scans helpful
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Tibial Plateau Fixation with Lateral Ligament Repair (Simple)
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Tibial Plateau Fixation - Moderate
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Tibial Plateau Fixation - Complex
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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
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Knee Arthritis
Pain worse with standing and better with rest
Physical Exam: Stiffness & swelling Deformity (bow-legged
versus knock-kneed)
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Knee Arthritis – Treatment Options
Standard treatments: 1. Medicines 2. Injections 3. Surgery
(replacement usually)
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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)
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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
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Thank You
Fred Huang, MD www.valleyorthopedicassociates.com