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ligamentous injury - Coggle Diagram
ligamentous injury
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-hyperextension injury: ACL
-dashboard injury: PCL
-cross over cut maneuver:
-side-step cut maneuver: MCL first, then meniscus, ACL, and patellar dislocation
-80% of ACL tears have associated osteochondral lesion
-lateral compartment due to abnormal ant/rotary translation
-most commonly occurs at lateral femoral condyle at sulcus terminalis and post lateral tibial plateau
-OC lesion present on MRI 5.5 years later
-OC lesion may be even that predisposes knee joint to post surgical degenerative OA
segond fracture: avulsion fracture of anterolateral margin of lateral tibial plateau associated with ACL tears
-MOI is abnormal IR stress of tibia that causes abnormal amount of tension on central portion of lateral capsular ligament
-"lateral capsular sign"
epidemiology
-1/3000-3500 people each year
-reinjury rate is 12-15% in males, 25-30% in females
-70% due to sport participation
-61% occur in 15-29 y.o., 23% in 30-44 y.o.
-70% are noncontact
anteromedial rotary instability
-classic MOI is football "clip"
-injured structures include MCL, POL, middle third of capsular lig, ACL
anterolateral rotary instability
-MOI is deceleration on planted foot
-slightly flexed knee forced into varus with tibial IR
-ACL, LCL, ITB, and potentially the arcuate complex
posterolateral rotary instability
-varus blow from anterior direction on slightly flexed knee with foot planted
-injured arcuate complex (LCL, POL, popliteus tendon)
straight medial knee instability: valgus force to extended knee
-PCL, MCL, middle third of capsular lig, compressed lateral meniscus, distracted medial meniscus
straight lateral knee instability: varus blow in extension
-PCL, LCL, ITB, middle 1/3 of capsular ligaments, lateral meniscus distracted, medial meniscus compressed
OKC knee extension: max stress falls on ACL at 20 deg knee flexion, beginning at 45 deg
-equal amounts of strain on ACL in OKC and CKC tasks
ACL tear diagnosis with joint arthrometry
-absolute translation >10mm
-bilateral difference >3mm
-99% SN if both criteria met
MRI: 95-100% SN, 50% SP
-90% accurate in acute ACL tear, <24 hours
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outcomes after ACL repair
-88-95% have stable knee at 5 year follow-up
-80-92% return to previous level of play
-BPTB-10-40% have some ant knee pain
-hamstring-6% have ant knee pain
grading for collateral lig injuries
-grade 1: < 5mm opening with stress
-grade 2: 5-10 mm
-grade 3: >10 mm
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