Case PresentationMultiple Ligament Injury Orthopaedic Summit 2017 - - PowerPoint PPT Presentation

Case Presentation…Multiple Ligament Injury

Peter A Indelicato MD Emeritus Professor Sports Medicine Department of Orthopedics University of Florida

Orthopaedic Summit 2017… Wednesday, December 6

Disclosure

• No conflict of interest

associated with this presentation….refer to published disclosure

Panelists

• Moises Cohen, MD
• Walter Shelton, MD
• Tom DeBerardino, MD
• Thomas Carter, M
• Greg Fanelli, MD
• Kevin Bonner, MD
• Matt Provencher, MD
• John Richmond, MD

Panel Discussion Points…Rapid Fire

• What vascular studies do you
• rder if any and when ?
• When do you consider a non-

surgical approach and why ?

• If vascular repair is required, when

do you decide bracing or external fixation?

• When do you decide to stage the

surgery…what ligaments and when ?

• Primary repair, reconstruction, or

combined?

• Graft selection?

Case #1 …History

• 21 y/o football player

sustained this injury to his left knee 4 hours ago…

Physical Exam in ER

• Compatible with a

complete tear of the MCL, ACL, PCL….

• Pulses present but

asymmetrical….

• X-rays….

Panel Discussion Points…Rapid Fire

• What vascular studies

do you order if any ?

• If vascular repair is

necessary, when do you decide bracing or external fixation?

Imaging Studies

Posteriomedial capsule torn Lateral and posterlateral side Intact……

Panel Discussion Points…Rapid Fire

• What is your surgical

timing…what ligaments and when?

• If the injury was 3 weeks old

before you first saw the patient, how would that effect repair vs reconstruction ?

• Graft selection ?

Panel Discussion Points…Rapid Fire

• When, if ever, do you

repair an isolated PCL ?

• When you have a

ACL/”partial” posterolateral tear, when, if ever, do you leave the posterolateral corner alone ?

In conclusion….

• What are the two

biggest mistakes to avoid when dealing with an acute multi- ligamentous knee injury ?

Questions ?????

Case #2

• 21 y/o male soccer player sustained an

non-contact, twisting injury to his knee….felt a “pop” and was diagnosed as having a complete tear of his ACL as well as a Grade II tear of his MCL….

Case #2

• An MRI shows a “bone bruise” but no

meniscal or other intra-articular pathology

Case #2

• A local orthopedist first sees him four days

post injury, and his physical exam revealed PAINFUL, limited motion from 20 - 80 degrees with tenderness along ORIGIN of MCL…..

• The next day, he was brought to the OR

and underwent a mid-third autogenous patellar tendon arthroscopic ACL reconstruction….

Case #2

• Eight weeks later, he is referred to you

…patient, at that time, complains of continued PAIN since surgery and, despite focusing on early ROM with full extension, his exam reveals a ROM from 20 - 90 degrees of motion….

• What’s the problem….”Cyclops” lesion or

arthrofibrosis ?????

How do you differentiate a “cyclops” lesion vs arthrofibrosis ???

Questions ?????