WHAT SHOULD WE ASK FOR? X-RAYS X-RAYS 9 anterior 9 anterior - PDF document

The Complex Knee Webinar April 30 th 1pm CST What would you do with this case? CASE Nº2 Robert LaPrade Lars Engebretsen Tim Spalding Robert LaPrade @jorge chahla Hosted by @jachahla CLINICAL PRESENTATION PHYSICAL EXAM PHYSICAL EXAM Antalgic Gait 17 y/o male Significant instability Trampolin Accident - May 2009 Heel Height R 14 vs 3cm Rt Knee Anterior KD Emergent Popl Art Bypass Graft Posterior Drawer 3+ Ex Fix for 2 months- Unrecognized Prox Tibial Fx No Varus, Increased Valgus Unable to participate in higher level activity Positive Dial Test at 30 and 90º X-RAYS Narrowing vs Pseudo-narrowing WHAT SHOULD WE ASK FOR? X-RAYS X-RAYS 9º anterior 9º anterior Tibial slope Tibial slope

X-RAYS CT ANGIO Valgus Gapping IMAGING PHYSICAL EXAM X-RAYS Alignment - Moderate Genu Varus Malunion anteromedial tibial plateau fx Difference Saggital tibial slope = 9º anterior slope)- 18º diff CL side 34mm Varus stress xrays - NO Gapping Valgus stress xrays - Inconclusive PCL stress xrays - 34mm PHYSICAL EXAM WHAT TO DO? STRATEGY PHYSICAL EXAM Significant Recurvatum What do we tell the patient? Expectations? Single Stage vs Staged Varus Malalignment If 2 stages… how much time apart? Anterior Tibial Slope What order? PCL G III Tear - ACL Status unclear Other considerations? Collateral Ligaments - MCL Status Unclear PHYSICAL EXAM FIRST STAGE PHYSICAL EXAM Medial Gapping ACL Posterior Lachman ACL Attenuated LFC Drawer Test Test No Drive Through Sign PLC LTP Popliteus Intact T L P

FIRST STAGE PHYSICAL EXAM POST OSTEOTOMY HEEL HEIGHT TEST X-RAYS X-RAYS 5mo FU 19mm side to side difference SECOND STAGE PHYSICAL EXAM X-RAYS 6 months after Deep Hardware Removal Restoration Neutral Tibial Slope Alignment DB PCL Reconstruction w Achilles Allograft sMCL Reconstruction ACLR BTB Allograft X-RAYS X-RAYS 4mm side to side difference Restoration Neutral Tibial Slope Alignment

9MO FOLLOW UP X-RAYS Able to walk comfortably Mild Instability Quad still weak What do you do NO SSD Difference CLINICAL PRESENTATION 20 y/o male Trampolin Injury CASE Nº3 Lars Engebretsen PHYSICAL EXAM PHYSICAL EXAM STRATEGY PHYSICAL EXAM ACL, PCL, PLC What do we tell the patient? Expectations? Peroneal Nerve Injury Single Stage vs Staged Vascular Injury If 2 stages… how much time apart? Tibial Fracture Ex Fix? Considerations for vascular repair? Other considerations? X-RAYS PHYSICAL EXAM STRATEGY Ex Fix Ex Fix - How much time? Pop. Art. Repair Ex Fix Removal - Scope or no scope? Motion Goals? Second Stage?

X-RAYS BTB ACLR 4 wks after DB PCLR 2 wks of ROM CASE Nº4 PLC Recons Lars Engebretsen MEET THE PATIENT! •300 matches for Norway •827 goals for Norway •33 years old •1988 OG: Silver •1992 OG: Silver •1996 OG: No. 4 •1997 WC: Silver •1999 WC: Gold •2000 OG: Bronze Not just the ACL! Not Just the ACL PHYSICAL EXAM DIAGNOSIS PHYSICAL EXAM STRATEGY ACL PLUS! How would you approach this? Leave alone / treat cartilage Rehab RTS? Will she make the olympics? How do we manage expectations?