Case PresentationMultiple Ligament Injury Orthopaedic Summit 2017 - PowerPoint PPT Presentation

Case Presentation…Multiple Ligament Injury Orthopaedic Summit 2017… Wednesday, December 6 Peter A Indelicato MD Emeritus Professor Sports Medicine Department of Orthopedics University of Florida

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 order 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 ?????