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