Tasty Morsels of EM 020

I keep a little, ever-expanding note on my phone where I jot down little morsels of goodness that I pick up while listening to or reading one of the many excellent sites/podcasts in the useful resource section.

I’ll try and transfer them here for your enlightenment.

Again from the August EMJ a great and reasonable article from an orthopod on ACL injuries. And yes I meant to type that – a great and reasonable article from an orthopod…

Despite a detailed knowledge of the anatomy I still get a bit befuddle by knees. I suspect a lot of this is due to lack of confidence and any real serious teaching on orthopaedics. Like most of my training it’s been picked up on the job and in a very disorganised way.  this review gives a lovely simple account of the ACL and in particular I appreciate the diagnostic tips and the refusal to use the “skip to an MRI” option.

  • isolated ACL in only 10%
  • ACL composed of two bundles; anteromed and posterolat
  • main supply is mid geniculate art
  • if no bony injury but immediate swelling then high proportion of ACL injury (to whatever degree)
  • Lachman better than pivot-shift and better than ant drawer
  • Note that the Lachman test was found to have high 90s for both sens and spec
  • exam probably best 10 days later when less pain and spasm
  • MRI has sens of only 85% and they state that is an adjunct to diagnosis
  • two signs on x-ray
    • segond – lt capsular avulsion
    • avulsion of tibial eminence

In terms of treatment:

  • mobilisation can’t be overemphasised
  • unclear if functional braces are useful
  • physio good for ROM and needed prior to delayed repair
  • because of variable response many don’t need repair
  • feeling of not trusting knee or give way is reasonable indication for surgery
About Andy Neill

EM Reg/Resident based near Dublin. Former anatomy lecturer, theology student and occasional musician @andyneill | + Andy Neill | Contact

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