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