Welcome to Athletico’s Webinar Wednesday
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Webinar Agenda Today’s Webinar is from 8:30am to 9:30am CST Agenda • 8:20 am - 8:30 am: Participants join call • 8:30 am: Host Introductions • 8:35 am: Dr Gross, Presentation begins • 9:20 am: Q & A led by Colleen Edmonson of Athletico • 9:30 am: Closing Remarks
Participants If you have a question during the webinar you can enter your question in the Q & A section at the bottom of the page. At the end of the webinar our moderator will pose these questions to Dr Gross. Muted Lines/Operator Assisted Q & A In approximately 48-72 hours after the webinar those of you who have been logged in for the entire webinar will receive an email with the following materials: • Link to surveymonkey. This link is to the evaluation form which must be completed in order to receive your CEU. Once you complete the survey you will be routed to a link to receive your CEU’s. • 1.0 CEU for IL RN, IN Adjuster, CCMC, CRCC, MI RN, Texas Dept. of Insurance • IA RN will be mailed out after the event • A copy of the power point slides
Today’s Speaker: Dr. Lyndon B Gross
EARLY USE OF IMAGING STUDIES TO DIAGNOSE ACUTE WORKERS’ COMPENSATION KNEE INJURIES- CASE STUDIES Lyndon B. Gross, MD, PhD The Orthopedic Center of St. Louis
COMMON KNEE PROBLEMS • Fractures • Tendon injuries • Ligament injuries • Meniscal injuries • Articular Cartilage injuries
ANATOMY OF THE KNEE • Bones • Tendons • Ligaments • Meniscus • Articular Cartilage
ARTICULAR CARTILAGE
ARTICULAR CARTILAGE INJURIES • Difficult to diagnosis • Non-specific symptoms • No distinct physical findings • X-ray studies may be negative • MRI may help confirm examination – MRI Arthrogram • Arthroscopy most accurate
ETIOLOGY OF CARTILAGE INJURIES Sports trauma, work-related trauma or • other injury 1,2 • Chronic instability 3 • Pathologic malalignment 3 • OCD 1 • Meniscal deficiency 3 • Obesity in the presence of moderate malalignment 4 1. Giffin J, et al. Operative Techniques in Orthopaedics. 2001;11:83-89. 2. Chu CR. Operative Techniques in Orthopaedics. 2001;11:70-75. 3. Cole B, et al. Operative Techniques in Orthopaedics. 2001;11:151-154. 4. Felson DT, et al. Arthritis Rheum . 2004;50:3904-3909 .
HOW DO YOU KNOW????
HISTORY • Age • Chief Complaint • Prior Treatment • Onset of Symptoms • Occupation • Mechanism of Injury • Number of Years • Location Working • Instability • Changes in Work • Mechanical Environment Symptoms • Impact on Work
PHYSICAL EXAMINATION • Inspection • Range of Motion • Special Testing • Palpation • Neurovascular Examination
RADIOGRAPHIC EVALUATION • Plain X-rays • MRI Scan • Bone Scan
RADIOGRAPHIC EVALUATION • Plain X-Rays – Standing AP – 45 ° Flexion weight-bearing PA – Lateral – Merchant
MAGNETIC RESONANCE IMAGING • MRI – Noninvasive – Sensitive – T1, T2, FSE, 3D SPGR, MRA
RADIOGRAPHIC EVALUATION
CASE #1
HISTORY • Patient is a 40 y.o. male pilot for the local police department • While at work he missed a step and fell approximately 4ft onto concrete, hitting his left knee. • Patient was seen at occupational medicine • MRI ordered
PHYSICAL EXAM • Swelling • Full ROM • Pain with ROM • Pain with flexion McMurray testing lateral knee • Tender to palpation anterolateral knee
X-RAY STUDIES LATERAL VIEW WB AP VIEW
X-RAY STUDIES FLEXION VIEW MERCHANTS VIEW
MRI FINDINGS
MRI FINDINGS
TREATMENT ALGORITHM • Age • Occupation • Defect size • Surgical intervention with osteoarticular transplantation with allograft (cadaver tissue) to lateral femoral condyle
SURGICAL INTERVENTION Arthroscopy
OSTEOARTICULAR TRANSFER
INITIAL POST OP TREATMENT • Non weight bearing 6 weeks • Hinge brace • CPM machine for 4 weeks • PT for ROM, strength, modalities
PATIENT OUTCOME • Return to sit down duty: 3 wks post op • Full ROM, discontinued brace 6 wks, full weight bearing 9 wks post op • Work conditioning exit evaluation @ 6 months: ability to work HEAVY demand Returned to full duty 6 mo post op • • Released MMI 8 mo post op doing well had just completed police fitness testing
CASE #2
HISTORY • Second Opinion: Patient is a 57 y.o. male custodian at a local high school • He stated he slipped on a wet floor into the “splits” position and hyperextended his right knee.
HISTORY Initial treatment: hamstring strain • Returned to full duty but continued to • complain of knee pain MRI of the knee and diagnosed with a • bone contusion • Cortisone injection and placed on crutches. • Continued pain • Second MRI performed • Second Opinion
SECOND OPINION • Pain with weight bearing • Using crutches • Swelling • Medial pain
PHYSICAL EXAM • Effusion • ROM 0-90 ◦ • Medial sided pain with ROM • Tender to palpation medially
X-RAY STUDIES WB AP VIEW LATERAL VIEW
X-RAY STUDIES PA FLEXION VIEW MERCHANTS VIEW
MRI #1 FINDINGS 8 wks Post Injury
MRI #1 FINDINGS 8 wks Post Injury
MRI #2 FINDINGS 5 Months Post Injury
MRI #2 FINDINGS 5 Months Post Injury
TREATMENT ALGORITHM • Age • Occupation • Lesion size • Surgical intervention with a medial unicompartmental knee arthroplasty
SURGICAL INTERVENTION
POST OP X-RAYS
PATIENT OUTCOME Returned to sit down duty 9 days • post op 8 wks post op ROM 0-120 ◦ with • some soreness, underwent knee aspiration and steroid injection • Regular Duty: 4 mo post op • Full Duty MMI: 5 mo post op
Thank You!!
Thank you for joining us … For those of you who were logged in for the entire presentation, you will be receiving an email within approximately 48-72 hours with a surveymonkey link. This link is to the evaluation for this webinar. You will need to complete the survey. At the end of the survey, you will taken to a link to retrieve your CEU’s (if asked, be sure to say “yes” when it takes you to the trusted site or you will not receive your CEU’s). **Remember only those who participated for the entire duration of the webinar are eligible to receive their CEU’s.
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