Valley Orthopedic Associates physician. Dr. Fred Huang gives a seminar on Common Knee Conditions

1. VMC Seminar
April 28, 2011
Renton, Washington
Fred Huang, MD
Valley Orthopedic Associates
A Division of Proliance Surgeons, Inc.

2.  Meniscal Tears
 ACL Tears
 Multi-ligament Injuries
 Tibial Plateau Fractures

3. Healthy
Right
Knee
Source: Knee Ligament Injuries
The Staywell Company, 2001

4. Meniscal Tears
 Symptoms – what patients notice
 Swelling
 Catching and locking
 Pain with pivoting and squatting
 Exam Findings – what doctors find
 Swelling (fluid on the knee)
 Tenderness at the site of the tear
 Pain with flexion/twisting

5. Meniscal Tears
 Arthroscopic surgery to
remove torn tissue
Source: www.stoneclinic.com
 Degenerative tears:
associated with
minimal or no trauma
 Degenerative tears
often associated with
arthritis & not always
treated with surgery
Source: www.opsmart.com

6. Types of Ligament Injuries
 ACL very common
 MCL most common with ski injuries
 Usually treated with bracing for 6 weeks
 Combination injuries (ACL w/ MCL most common,
but any combo possible)
 PCL involved frequently in multi-ligament injuries

7. ACL Tears
Source: Knee Ligament Injuries
The Staywell Company, 2001

8. ACL Tears
 Twisting and/or
cutting – often a
non-contact injury
 Usually unable to
continue sporting
activity
 Swelling within 1-2
hours Source: Knee Ligament Injuries
The Staywell Company, 2001

9. MRI – ACL and Meniscal Tears

10. ACL Tears - Treatment
 Non-operative treatment (Brace?)
 Surgical treatment
 Only after motion returns to normal
 Graft options: hamstrings, patellar tendon,
quad tendon, or allograft
 Associated procedures: meniscal or
cartilage procedures

11. ACL Reconstruction
 Sources:
Left: www.arthroscopy.com
Right: www.orthop.washington.edu

12. Multi-ligament Knee Injuries
 Higher energy mechanism than ACL
tears
 Can be due to a complete knee
dislocation
 Nerve and/or blood vessel injuries
possible

13. Multi-ligament Knee Injuries

14. Tibial Plateau Fractures
 Wide spectrum of injury
patterns
 Often treated surgically to
re-establish normal
architecture at the joint
surface

15. Tibial Plateau Fractures
 CT scans helpful

16. Tibial Plateau Fixation with
Lateral Ligament Repair (Simple)

17. Tibial Plateau Fixation - Moderate

18. Tibial Plateau Fixation - Complex

19. Patello-femoral Pain
 Frequent cause for ANTERIOR knee pain
 Pain worsened by running, squatting,
stair-climbing, and lunges
 Often associated with grinding/popping at the
kneecap
 MRI’s often “normal”
 Treatment consists of formal P.T., NSAID’s,
weight loss, and occasional steroid injections

20. Knee Arthritis
 Pain worse with standing
and better with rest
 Physical Exam:
 Stiffness & swelling
 Deformity (bow-legged
versus knock-kneed)

21. Knee Arthritis – Treatment Options
Standard treatments:
 1. Medicines
 2. Injections
 3. Surgery
(replacement usually)

22. Knee Arthritis Treatment – Tibial Osteotomy
 Intermediate solution that
improves pain and function
usually for < 10 years
 Allows for continued impact
activities
 Associated with a longer
recovery time (to allow for
healing of the osteotomy)

23. Total Knee Replacement
 Reliable solution that improves pain
and function usually for >15 years
 Physical therapy and home exercises
important after surgery
 New interest in better pain
management, smaller incisions, and
accelerated rehab
 Not designed for impact activities

24. Thank You
 Fred Huang, MD
 www.valleyorthopedicassociates.com