ORTHO Flashcards
(35 cards)
RISK FACTORS FOR ACL INJURY
Young age (peak at 16-18 yrs)
Earlier, more intense, and more frequent participation in sport
Variations in bone morphology
Neuromuscular control
Genetic
Hormonal
Different types of meniscal surgery
Arthroscopy + Meniscectomy
Arthroscopy + Meniscus repair
What is an arthroscopy + meniscectomy?
Damaged cartilage is trimmed away
Arthroscopy + Meniscus repair
Sutured together
Autograft
tissue from own body
Allograft
tissue from cadaver
Pros / cons of HS autograft
Easier Sx to perform
↓ knee pain/stiffness post-op,
↓ hamstring strength
↓ incision and faster recovery
↑ laxity/potential graft
lengthening
Pros / cons of Quad autograft
Middle 1/3 of quadriceps tendon
Fixation not as solid
↑ post-op knee pain
↑ laxity/potential graft
lengthening
Pros / cons Patella tendon
Middle 1/3 of tendon
↑ pF knee pain (kneecap, kneeling)
↑ post-op stiffness
↓ knee laxity compared to other methods
COMPARE TRIAL for surgical / conservative management of ACL tear
(IMMEDIATE V DELAYED SURGERY) - 50% of patients randomised to three-months of rehab did not need surgery
Cross bracing protocol findings
90% of patients had evidence of healing on 3-month MRI (continuity of the ACL).
More ACL healing on 3-month MRI was associated with better outcomes.
What does the evidence say for meniscus surgery v conservative management for degenerative meniscal injury
strong evidence in favour of conservative management
MOI of ACL injury
deceleration, change of direction combined with knee valgus load
Common symptoms of ACL
hearing a pop or haemoarthrosis
Presentation of meniscus injury
pain, stiffness, catching/locking and instability
Diff between WEBER FRACTURES
Weber A: # inferior/distal to syndesmosis
Syndesmosis intact
Deltoid ligament intact
+/- medial malleolus #
Usually stable and conservative Mx indicate
WEBER B: # at level of syndesmosis
Syndesmosis intact or partially torn
+/- medial malleolus #
+/- Deltoid ligament damage
Stability varies
May require ORIF
WB as tolerated wearing the CAM-boot
WEBER C: Above level of ankle joint
Syndesmosis damaged/ruptured with widening of joint
Usually Deltoid ligament injury and/or medial malleolus #
Unstable
ORIF required
Altered articulation of talus and the tibia worsening in weight bearing.
Management of Weber A #
Typically don’t need to be casted
Treated in stabilising ankle orthoses
Early function and WBAT
ROM exercises as tolerated
Management of Weber B #
CAM boot
Over 6/52, the patient WBAT in boot
Orthosis stays on at night.
ROM exercises as tolerated
Management of Weber C: #
ORIF: open reduction internal fixation Fracture will be healed using nails of entire shaft.
Generally nails will stay in.
8+ weeks of rehab
Describe the management of Weber B fractures (Kortekangas et al 2019)
80 received 3 weeks of orthosis, 84 received 6 weeks in a cast, 83 received 3 weeks in a cast.
A shorter 3 week period of immobilisation proved non-inferior to traditional 6 weeks in cast immobilisation
What are the considerations, implications advantages and disadvantages of surgical vs conservative management for grade III achilles tendon tears?
Considerations → Early detection is really important.
- Put patient in plantarflexion i.e. boot with heel lifts or cast
- Must be detected within 5 days otherwise surgery is needed.
Conservative:
- Reduced risk of infection
Surgical
- Reduced risk of re-rupture
- Cost
Benefits:
- Unclear which is superior
- Most studies achieve similar results
0-3 mo post achilles surgery
NWB: 8-12 weeks
Keep the leg elevated above heart level (leg straight & propped up on a pillow)
Wear a walking boot that lifts the heel to protect the tendon (ensures foot is in plantarflexion & prevents the tendon from being stretched to maximise healing. Overtime the heel inserts are gradually reduced in height).
Circulation exercises eg ankle pumps, stretching and strengthening of the ankle, hip, quads, etc
Gradually wear the boot less and increase the difficulty of the exercises
3-6-9 months post surgery ACHILLES SURGERY
Advanced strengthening of the ankle and other leg muscles
Gradual return to work and/or sport
Considerations for achilles surgery
Level of activity (may need to reduce non-essential work commitments)
Can the patient use crutches to navigate stairs, etc
Any other LE concerns eg hip pain may affect mobility & sleep
Ensure patient understands NWB
Teach patient to shower –> can’t get surgical site wet initially (plastic bag over the boot? Recommend a seat)
How to put on the boot
Ensure precautions are followed
Continue with upper body workouts
Consider social support ie do they have family/friends
How will patient clean wound alone + complete PROMS?
