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Orthopaedic Surgery Sports Medicine

Orthopaedic Surgery Sports Medicine. Ryan Dobbs, MD Orthopaedic Sports Fellow November 15 th , 2005. Introduction. Orthopaedic Surgery Sports Medicine Team Coverage Athletic Injuries Surgery of the Shoulder Surgery of the Knee Elbow, hip and ankle arthroscopy. Purpose of this talk.

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Orthopaedic Surgery Sports Medicine

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  1. Orthopaedic Surgery Sports Medicine Ryan Dobbs, MD Orthopaedic Sports Fellow November 15th, 2005

  2. Introduction • Orthopaedic Surgery Sports Medicine • Team Coverage • Athletic Injuries • Surgery of the Shoulder • Surgery of the Knee • Elbow, hip and ankle arthroscopy

  3. Purpose of this talk • Exposure to orthopaedic sports medicine • OrthopAedics – We have to get an A in everything. • Three questions • The questions and the answers are found in this talk.

  4. ACL Injuries

  5. ACL Injuries: Epidemiology • ≈ 100,000 injuries/year • ≈ 1 in 3,000 people in America • > 50,000 ACL reconstructions/year • Majority occur in 15-45 year old group • 1 in 1750 in this age group • 70% occur during sports involvement

  6. ACL Injuries: Cost • ≈ 50,000 reconstruction/year • $17,000 per procedure • ≈ $850 Million • Does not account for • Initial care • Conservative care and rehab of nonoperative management • Long term impact of traumatic DJD whether reconstructed or not

  7. Anatomy: ACL

  8. Anatomy: ACL • Originates lateral aspect of medial tibial spine

  9. Anatomy: ACL • Inserts posteriorly on medial aspect of lateral femoral condyle • Passes through the intercondylar notch in a proximal/post/lateral direction

  10. ACL Function • Limits anterior displacement of tibia on femur • Works in concert with the PCL • To provide anterior and posterior balance to the knee • Balance of femoral translation and roll back with flexion • ACL and PCL are intracapsular and extrasynovial structures

  11. Mechanism of Injury • 70% noncontact • 30% contact • Valgus force most common

  12. Mechanism of Injury • 1. Sharp deceleration during or prior to a change in direction (cutting)

  13. Mechanism of Injury • 2. Single leg landing off-balance, near full extension, slight valgus, with maximally contracted rectus

  14. Presentation of ACL Rupture • Hemarthrosis • Heard or felt a ‘pop’ • Knee ‘gave out’ • Instability since

  15. Physical Exam • Effusion

  16. Physical Exam • Lachman’s exam

  17. Physical Exam • Varus/valgus • Full extension • 30 deg flexion

  18. Physical Exam • Posterior Drawer/Sag • Anterior Drawer

  19. Physical Exam • Pivot-shift

  20. Imaging: Radiographs

  21. Imaging: MRI Normal! NOT!

  22. Imaging: MRI Empty Wall Sign Bone Bruising

  23. ACL Rupture: Management • 1/3 of patients are able to do normal activities without modification • 1/3 of patients modify activities and are able to cope • 1/3 are unable to cope: unstable with daily activities

  24. Treatment!ACL Reconstruction • Anatomical reconstruction of ACL by creation of bone tunnels and recreation of stabilizing soft tissue structure • Performed arthroscopically, with a tourniquet, varying techniques

  25. Knee Question • The most sensitive physical exam test for anterior cruciate deficiency is: • A) Anterior drawer • B) Posterior drawer • C) Lachman’s test • D) Pivot shift test • E) Wallet biopsy

  26. Treatment!ACL Reconstruction Options include bone-tendon-bone and hamstring autografts among others

  27. Treatment!ACL Reconstruction • Harvest Hamstrings

  28. Treatment!ACL Reconstruction • Drill tunnels

  29. Treatment!ACL Reconstruction • Place and stabilize the graft

  30. Treatment!ACL Reconstruction • Different methods of fixation utilized

  31. Knee Question • The anterior cruciate ligament: • A) Limits posterior translation of the tibia relative to the femur • B) Limits anterior translation of the tibia relative to the femur • C) Limits anterior translation of the tibia relative to the fibula • D) Limits anterior translation of the femur relative to the tibia

  32. Shoulder Anatomy

  33. Physical Exam • Inspection • Palpation • Sensation • A/R/U/M • Range of Motion • Impingement • Motor function • Deltoid, Biceps, Triceps, WF, WE, IO, Opponens • Internal rotation, external rotation, forward flexion • Suprapinatus, Infraspinatus, Subscapularis

  34. Physical Examination Neer Sign Hawkins’ Sign

  35. Physical Examination Lift-off test - Subscapularis Belly Press - Subscapularis

  36. Physical Exam Abduction/Internal Rotation – Supraspinatus External Rotation - Infraspinatus

  37. Bony Anatomy

  38. X-ray

  39. Muscles of the Rotator Cuff

  40. Shoulder Question • The four muscles of the rotator cuff are: • A) Supraspinatus, Infraspinatus, Teres Minor, Subscapularis • B) Supraspinatus, Infraspinatus, Teres Major, Subscapularis • C) Supraspinatus, Infraspinatus, Teres Major, Subspinatus • D) Supraspinatus, Infraspinatus, Teres Minor, Subspinatus

  41. Subscapularis Origin: Subscapular fossa Insertion: Lesser tuberosity of the humerus Innervation: Upper and lower subscapular nn.

  42. Supraspinatus Origin: Supraspinatus fossa of scapula Insertion: Superior facet on greater tuberosity of humerus Innervation: Suprascapular nerve

  43. Supraspinatus muscle

  44. Infraspinatus Origin: Infraspinatus fossa of scapula Insertion: Middle facet on greater tuberosity of humerus Innervation: Suprascapular nerve

  45. Teres Minor Origin: Superior part of lateral border of scapula Insertion: Inferior facet on greater tuberosity Innervation: Axillary nerve

  46. Rotator Cuff Question • Name the only rotator cuff muscle not innervated by the suprascapular nerve: • Supraspinatus • Infraspinatus • Teres Major • Subscapularis

  47. Rotator Cuff Tear

  48. Rotator Cuff Repair - Open

  49. Arthroscopy

  50. Rotator Cuff Repair - Arthroscopic

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