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
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