Evidence-Based Management of Complex Knee Injuries: Restoring the Anatomy to Achieve Best Outcomes

complex knee injuries laprade
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Preface
Preface
content
Evidence-Based Management of Complex Knee Injuries
Table of Contents
copyright
Copyright
Dedication and Acknowledgments
Dedication and Acknowledgments
List of Contributors
List of Contributors
Preface
Preface
1 Comprehensive Clinical exam
1 - Comprehensive Clinical Examination
Introduction
Clinical Examination Overview
Patellofemoral Joint
Tibiofemoral Joint
Ligamentous Injuries
Anterior cruciate ligament
Posterior cruciate ligament
Posterolateral corner
Medial collateral ligament and posteromedial corner
Advanced topics on ligament examination
Meniscus and Cartilage Injuries
Functional Assessment
2 Plain Radiography of the Knee
2 - Plain Radiography of the Knee
Introduction
Radiographic Views of the Knee
General Approaches: Tips for Plain Film Review and Reporting
AP View
Lateral View
Tangential (Axial/Sunrise/Skyline) Patellofemoral View
45-Degree Oblique Views
Weightbearing Semiflexed PA (Rosenberg) View
Intercondylar (Tunnel) View
Tibial Plateau (Tillman-Moore) View
Long-Leg Alignment Views
Stress Views
Indications for Radiographs
Trauma
Osteochondral Fractures
Ligament Injuries and Avulsion Fractures
Dislocations
Tendon Injuries
Stress Fractures
Apophysitis around the Knee
Pathological Conditions
Pathological Conditions of the Meniscus
Calcifications
Osteochondritis Dissecans
Knee Effusions
Conditions Affecting the Patellofemoral Joint
Osteoarthritis
Tumours Around the Knee
Surgical Considerations
Extraarticular Ligament Reconstruction
ACL Reconstruction
PCL Reconstruction
MPFL Reconstruction
Multiligament Reconstruction
Knee Arthroplasty
Summary
Acknowledgement
3 Magnetic Resonance Imaging
3 - Magnetic Resonance Imaging of the Knee: Conventional and Novel Techniques
MRI Basics
Conventional MRI Techniques
Cartilage
Meniscus
Tendon and Ligament
Anterior and posterior cruciate ligaments
Medial collateral ligament
Extensor Mechanism
Quantitative and Advanced MRI Techniques
Collagen-Sensitive Techniques
Quantification of T2 relaxometry
Quantification of T2* relaxometry
Proteoglycan-Sensitive Techniques
Quantification of T1ρ
Delayed gadolinium enhanced MRI (dGEMRIC)
Zero Echo Time MRI for Assessment of Cortical Bone
Conventional and Novel MRI Techniques for Evaluation of Soft Tissue Near Metal
Summary
4 Computed Tomography of
4 - Computed Tomography of the Knee Joint: Indications and Significance
Three-Dimensional Modelling and Printing in the Complex Knee
Computed Tomography in Trauma
Computed Tomography Assessment of Bone Healing and Union
Computed Tomography and Soft Tissue Injuries
Primary Anterior Cruciate Ligament Reconstruction
Mapping and Tunnel Positions
Tunnel Diameter
Multiligament Knee Injury and Computed Tomography
Osteotomy and Computed Tomography
Patellofemoral Joint Disorders
5 Mechanical Malalignment
5 - Mechanical Malalignment of the Knee Joint: How and When to Address
Introduction
Normal Knee Alignment
Biomechanics of the Knee
Coronal Malalignment
Varus
Valgus
Sagittal Malalignment
Clinical Assessment
History
Physical Examination
Radiological Assessment
Choice of Realignment Procedures
Valgus-Producing Uniplanar Osteotomy
Varus-Producing Uniplanar Osteotomy
Uniplanar Sagittal Correction
Biplanar Osteotomy
Results
6 Anterior Cruciate Ligament
6 - Anterior Cruciate Ligament
Anatomy
Biomechanics
Diagnosis
Treatment Algorithm (Operative Versus Nonoperative)
Conservative Approach
Surgical Techniques
Outcomes After ACLR
Graft source
Drilling technique
Single bundle versus double bundle ACLR
Individualised anatomical ACLR
Rehabilitation and Return to Play After ACLR
Future Directions
Summary
7 Posterior Cruciate Ligament
7 - Posterior Cruciate Ligament
Introduction
Demographic Characteristics
Anatomy
Biomechanics
Diagnosis
Imaging
Treatment
Surgical Reconstruction Techniques
The Importance of Tibial Slope for Posterior Cruciate Ligament Injuries
Postoperative Care
Clinical Outcomes
Summary
8 Repair and Reconstruction mcl
8 - Repair and Reconstruction of the Superficial Medial Collateral Ligament and the Posteromedial Corner
Introduction
Anatomy
Biomechanical Properties of the Medial Knee Structures
Diagnosis
Injury classifications
Clinical evaluation of valgus instability
Anteromedial instability and posteromedial injury assessment
Imaging Evaluation of Medial Injuries
Stress radiography
Magnetic resonance imaging
Ultrasonography
Treatment Algorithm
Conservative Treatment
Indications for Surgical Treatment of MCL Lesion
Indication for medial repair
Indication for medial reconstruction
Surgical Techniques
MCL Repair Techniques
Anatomical MCL Reconstruction Techniques
LaPrade-Engebretsen MCL reconstruction technique
Danish MCL reconstruction technique
Rehabilitation
Postop Rehabilitation After MCL Reconstruction
Expected Outcomes
Clinical outcome after MCL repair surgery
Clinical outcome after anatomical MCL reconstruction
Future Directions
9 Posterolateral Corner of the Knee
9 - Posterolateral Corner of the Knee
Anatomy and Function
Fibular (Lateral) Collateral Ligament
Popliteus Tendon
Popliteofibular Ligament
Additional Secondary Structures
Other Important Structures
Biomechanics
Role of Posterolateral Structures in Preventing Varus Rotation
Role of PLC in Preventing Anterior Translation
Role of the PLC in Preventing Posterior Translation
Role of PLC in Preventing Internal Rotation
Role of the PLC in Preventing External Rotation
Biomechanical Failure of the PLC Structures of the Knee
The Effects of Deficient PLC Structures on Cruciate Ligament Grafts
Mechanism of Injury
Presentation of Injury
Physical Examination
Imaging
Classification
Nonoperative (Conservative) Treatment
Surgical Treatment Options
Repair Versus Reconstruction
Nonanatomical fibular-based reconstruction
Nonanatomical two-tunnel reconstruction
Anatomical reconstruction
Outcomes
Posterolateral Corner Repair
Posterolateral Corner Reconstruction
Comparison: Reconstruction Versus Repair
Rehabilitation
Conclusion
10 Anterolateral Ligament and corner
10 - Anterolateral Ligament and the Anterolateral Corner
Introduction
Anatomy
Histology
Biomechanics
Diagnosis
Clinical Diagnosis
Diagnostic Imaging Procedures
Treatment Algorithm
Reconstruction Technique
Femoral Socket Identification
Tibial Socket Identification
Isometry Test
Tibial and Femoral Socket Preparation
Graft Passage and Fixation
Postoperative Protocol
Outcomes
Summary
11 multiligament knee injury
11 - Multiligament Knee Injuries
Introduction
Epidemiology and Injury Patterns
Neurovascular Injury
Classification
Diagnosis
History
Physical Examination
Imaging
Treatment
Operative Treatment
Ligament repair
Ligament reconstructions
Anatomical reconstructions
Timing of surgery
Intraoperative Challenges
Tunnel convergence
Ligament tensioning
Outcomes
12 Arthroscopic Primary Repair of the Cruciate Ligaments
12 - Arthroscopic Primary Repair of the Cruciate Ligaments
Introduction
History of Primary Repair
The Rationale for Modern-Day Repair
Indications and Patient Selection
Patient Selection
Preoperative Imaging
Eligibility for Repair
Timing of Surgery
Treatment Algorithm
Surgical Technique
General Preparation
Operative Technique for Proximal ACL Tears
Additional Suture Augmentation
Other ACL Repair Techniques
Midsubstance ACL Tears
ACL Repair with Dynamic Intraligamentary Stabilisation
Operative Technique for Distal ACL Tears
Operative Technique for Proximal PCL Tears
Other PCL Repair Techniques
Operative Technique for Distal PCL Tears
Rehabilitation
Outcomes
Outcomes of Proximal ACL Repair
Outcomes of ACL Repair in Children and Adolescents
Outcomes of DIS Repair
Outcomes of Proximal PCL Repair
Future Directions
Conclusions
13 Meniscal Pathology Meniscus Anatomy
13 - Meniscal Pathology: Meniscus Anatomy
Introduction
Gross Anatomy
Medial Meniscus
Lateral Meniscus
Associated Ligaments
Meniscal Roots
The Anterior Intermeniscal Ligament
Meniscotibial Ligaments
Popliteomeniscal Fascicles
Meniscofibular Ligament
Meniscofemoral Ligaments
Microstructure
Vascular Anatomy
14 Meniscus Biomechanics
14 - Meniscus Biomechanics
Introduction
Meniscus Kinematics
Material Properties of the Meniscus
Viscoelasticity
Compressive properties
Tensile properties
Shear properties
Functional Properties of the Meniscus
Load transmission
Joint stability
Joint lubrication and nutrition
Proprioception
Shock absorption
Biomechanical Properties of the Meniscus-Associated Ligaments
Anterior intermeniscal ligament
Deep medial collateral ligament
Meniscofemoral ligaments
Meniscotibial ligaments
Meniscofibular ligaments
The Effects of Aging on the Menisci
Effect of Meniscal Tears on Biomechanical Function
Vertical tears
Horizontal tears
Radial tears
Root tears and avulsions
Conclusion
15 Meniscal Tears Meniscectomy Versus Repair
15 - Meniscal Tears: Meniscectomy Versus Repair
Introduction
The ‘Routine’ Meniscectomy
The Delayed Trend Towards Repair
The Decision for Athletes
Indications for Meniscal Repair
Traumatic Versus Degenerative Tears
Concomitant Ligamentous Injuries
Vascularity of Torn Region
Common Tear Patterns
Vertical Tear
Operative Management for Vertical Tears
Horizontal Cleavage Tear
Operative Management for Horizontal Cleavage Tears
Radial Tear
Operative Management for Radial Tears
Meniscal Repair With Sutures: Techniques
Diagnostic Arthroscopy
All-Inside Repair
All-inside technique
Inside-Out Repair
Inside-out technique
Outside-In Repair
Outside-in technique
Transtibial Two-Tunnel Repair
Transtibial two-tunnel technique
Postoperative Rehabilitation Protocols
Meniscectomy Postoperative Rehabilitation
Meniscal Repair Postoperative Rehabilitation
Meniscal Repair Enhancement
Bone Marrow Venting Procedure
Fibrin Clot
Platelet-Rich Plasma Injections
Bone Marrow Aspirate and Stem Cells
Biomaterials
Clarifying the Usage of Biologics
Failed Meniscal Repair
Summary
16 Meniscal Root Tears
16 - Meniscal Root Tears
Introduction
Anatomy
Medial Meniscus
Lateral Meniscus
Biomechanics and Pathology
Diagnosis
Evaluation
Classification
Clinical Diagnosis
Imaging
Treatment Algorithm
Nonoperative Treatment
Meniscectomy
Surgical Repair Options, Outcomes and Techniques
One-Tunnel Technique
Two-Tunnel Technique
Rehabilitation
Conclusions
17 Meniscal Radial Tears
17 - Meniscal Radial Tears
Introduction
Pathoanatomy and Biomechanics
Diagnosis
Surgical Treatment
Repair With Transtibial Tunnels
Repair With Side-to-Side Sutures Outside In
Repair With Side-to-Side Sutures All Inside
Postoperative Management
Results
Summary
18 Meniscal Ramp Lesions
18 - Meniscal Ramp Lesions
Introduction
Anatomy
Biomechanics
Diagnosis
Imaging
Clinical Characteristics
Clinical Characteristics
Intraoperative
Treatment Strategies
Meniscal Healing
Repair Techniques and Outcomes
19 meniscus defiecency and transplant
19 - Meniscus Deficiency and Meniscal Transplants
Introduction
Patient Selection
Graft Preservation and Preparation
Graft Sizing
Surgical Technique
Concomitant Pathological Conditions
Outcomes
Postoperative Period, Rehabilitation and Return to Sport
Conclusions
20 Synthetic Meniscal Substitutes
20 - Synthetic Meniscal Substitutes
Introduction
Tissue Engineering and the Meniscus
Scaffolds for Meniscus Replacement
Hydrogels
Biological Scaffolds for Meniscus Replacement
Collagen
Hyaluronic acid
Silk fibroin
Synthetic Scaffolds for Meniscus Replacement
Polyglycolic acid
Poly-l-lactic Acid and poly-d-lactic acid
Composite polymer scaffolds
3D-Printed Meniscus
Meniscal Scaffolds in Clinical Use
Collagen Meniscal implant
Actifit
Conclusions
Under Investigation
21 Basic Science Understanding of Cartilage Repair and Its Clinical Application
21 - A Basic Science Understanding of Cartilage Repair and Its Clinical Application
The Osteochondral Unit and Biology of Cartilage Repair
Articular Cartilage
Components of Articular Cartilage
Zone Organisation
Chondrocytes
Synovial Fluid
Subchondral Bone Architecture and Function
Physiological Transport
Biology of Osteochondral Repair
Molecular Factors That Contribute to Repair
Pathology and Repair
Basic Techniques of Osteochondral Grafting
22 Focal Chondral Injuries
22 - Focal Chondral Injuries
Introduction
Microscopic Anatomy of Articular Cartilage
Diagnosis
Patient History
Physical Examination
Imaging
Biomarkers
Diagnostic Arthroscopy
Nonsurgical Management
Surgical Treatment Algorithm
Extrinsic Factors
Extrinsic Factor I: Malalignment
Extrinsic Factor II: Meniscal Pathological Conditions
Extrinsic Factor III: Ligamentous Insufficiency and Knee Instability
Defect size
Defect location
Surgical Techniques
Debridement
Abrasion Arthroplasty
Microfracture
Osteochondral Autograft Transplantation
Osteochondral Allograft Transplantation
Cellular Techniques
Scaffolds: matrix-induced autologous chondrocyte implantation
Third-generation ACI (MACI analogue or NOVOCART 3D)
Minced cartilage (DeNovo Natural Tissue)
Viable osteochondral allografts (Cartiform)
Extracellular matrix scaffolds (micronized allogeneic cartilage, or BioCartilage)
Rehabilitation
Patellofemoral Lesions
Tibiofemoral Lesions
Clinical Outcomes
Microfracture
Osteochondral Allograft Transplantation
Osteochondral Autologous Transplantation
Autologous Chondrocyte Implantation and Matrix-Induced ACI
Third-Generation ACI (MACI Analogue; NOVOCART 3D)
Minced Cartilage (DeNovo Natural Tissue)
Viable Osteochondral Allografts (Cartiform)
Extracellular Matrix Scaffolds (Micronized Allogeneic Cartilage, or BioCartilage)
Summary
23 OCD Injuries in the Paediatric and Adult Population
23 - OCD Injuries in the Paediatric and Adult Population
Introduction
Epidemiology
Anatomy and Pathogenesis
Natural History
Patient History and Physical Findings
Imaging and Diagnostic Studies
Diagnosis and Classification
Nonoperative Management
Operative Management
Reparative Procedures
Drilling
Loose body excision
Internal fixation
Restorative Procedures
Microfracture
Osteochondral autograft transplantation
Osteochondral allograft
Autologous chondrocyte implantation
24 How to Manage the Active Patient with Osteoarthritis Biological Approaches
24 - How to Manage the Active Patient with Osteoarthritis: Biological Approaches
Introduction
Indications
Platelet-Rich Plasma
Protocols
Clinical Outcomes
Bone Marrow Aspirate Concentrate
Clinical Outcomes
Adipose-Derived Mesenchymal Stem Cells
Alternative Therapies
Orthopaedic Societal Statements on Orthobiologic Use for Osteoarthritis
Conclusion
25 Osteonecrosis of the Knee
25 - Osteonecrosis of the Knee
Introduction
Spontaneous Osteonecrosis
Aetiology and Pathogenesis
Clinical Presentation and Diagnosis
Treatment
Nonsurgical management
Surgical management
Secondary Osteonecrosis
Aetiology and Pathogenesis
Clinical Presentation and Diagnosis
Treatment
Nonsurgical management
Surgical management
Postarthroscopic Osteonecrosis
Aetiology and Pathogenesis
Clinical Presentation and Diagnosis
Treatment
Nonsurgical management
Surgical management
26 Patellofemoral Anatomy and Its Surgical Implications
26 - Patellofemoral Anatomy and Its Surgical Implications
Medial Patellofemoral Anatomy
Proximal Medial Patellar Complex
Surgical Correlation for Proximal MPFC Patellar Attachment Sites
Surgical Correlation of Proximal MPFC Femoral Insertion
Distal Medial Patellar Complex
Surgical Correlation
Lateral Patellofemoral Complex
Biomechanics
Surgical Correlation
Conclusions
27 Treatment Algorithm in Patellofemoral Disorders ‘Le Menu à la Carte’
27 - Treatment Algorithm in Patellofemoral Disorders: ‘Le Menu à la Carte’
Patellofemoral Instability
Trochlear Dysplasia
Imaging
Surgical treatment
Patella Alta
Imaging
Surgical treatment
Malalignment Issues
Local: TT-TG distance
Global (torsional rotations): femoral anteversion
Tibial external rotation
Coronal: knee valgus
Patellar tilt
Summary
28 Tibial Tuberosity Osteotomies
28 - Tibial Tuberosity Osteotomies
Introduction
Patient History
Knee Physical Examination
Limb and Patellofemoral Alignment and Tracking
Tibiofemoral alignment
Lateral quadriceps vector
Patellar height
Patella positioning
Patellar tracking
Imaging for Soft Tissue and Cartilage Status Evaluation
Arthroscopy
Tibial Tuberosity Osteotomy Biomechanical Effects
Tibial Tuberosity Osteotomy Indications
Indications of Anteromedialisation Tibial Tuberosity Osteotomy
Outcomes in Pathological Conditions of the Patellofemoral Cartilage
Indications of Medialisation Tibial Tubercle Osteotomy
Outcomes in Patellofemoral Instability
Anteromedialisation and Medialisation Tibial Tubercle Osteotomy Technique in Isolation
Indications of Distalisation Tibial Tuberosity Osteotomy
Outcomes in Patellofemoral Instability
Distalisation Tibial Tuberosity Osteotomy Technique in Isolation
Lateralisation
Anteriorisation
Anterolateralisation
Proximalisation
Factors That Influence Decisions Regarding Tibial Tuberosity Osteotomy
Rehabilitation
Complications
Summary
29 Pathological Torsion of the Lower Limb
29 - Pathological Torsion of the Lower Limb
Intrinsic and Extrinsic Limb Factors
Abnormal Limb Torsion Is Not a New Concept
Physical Examination and Radiological Work-up for Torsion
Surgical Details
Surgical Steps and Tips for AO Proximal Femoral Rotational Osteotomy
Postoperative Rehabilitation
Results
Conclusions
30 Lateral Patellar Instability
30 - Lateral Patellar Instability: Diagnosis, Treatment Algorithm, Conservative Approaches, Surgical Techniques, Outcomes, Rehabilitation and Future Directions
Introduction
Diagnosis
Patient History
Physical Examination
Imaging
Treatment
Conservative Treatment
Surgical Technique
Medial patellofemoral ligament reconstruction technique
Medial quadriceps tendon femoral ligament reconstruction
Rehabilitation
Outcomes
Conservative Management Versus Medial Patellofemoral Ligament Reconstruction
Medial Patellofemoral Ligament Reconstruction
Medial Patellofemoral Ligament Repair
Medial Quadriceps Tendon Femoral Ligament Reconstruction
Return to Sport
Concurrent Procedures
Future Directions and Summary
31Medial Patellar Instability Primary and Iatrogenic
31 - Medial Patellar Instability: Primary and Iatrogenic
Introduction
Evaluation
Imaging
Noniatrogenic Medial Patellar Dislocation
Iatrogenic Medial Patellar Dislocation
Treatment
Summary
32 Trochleoplasty
32 - Trochleoplasty
Introduction
Anatomy and Biomechanics of the Trochlea
Clinical Evaluation and Diagnosis
Imaging and Classification of Trochlear Dysplasia
Role of Trochlear Dysplasia in Recurrent Patellar Instability
Trochleoplasty Procedure
Goals
Indications and Contraindications
Techniques
Postoperative Rehabilitation
Clinical and Radiographic Outcome After Trochleoplasty
Trochleoplasty Impact on Stability
Trochleoplasty Impact on Subjective Outcome
Trochleoplasty Impact on Patellofemoral Dysplasia
Anchor 177
Anchor 178
Trochleoplasty Complications
Summary
33 Injuries of the Patellar Tendon
33 - Injuries of the Patellar Tendon
Acute Tears of the Patellar Tendon
Anatomy
Epidemiology
Risk Factors
Rupture Mechanism
Diagnosis
Treatment
Rehabilitation
Functional Outcomes
Patellar Ruptures and Total Knee Arthroplasty
Patellar Tendinopathy
Introduction
Diagnosis
Conservative Treatment
Surgical Treatment
Conclusions
34 Quadriceps Tendon Injuries
34 - Quadriceps Tendon Injuries
Epidemiology
Anatomy, Biomechanics and Pathogenesis
History and Physical Examination Findings
Imaging and Diagnostic Studies
Operative and Nonoperative Treatment
Repair at the Bone–Tendon Interface Using Transosseous Bone Tunnels
Knotless Technique
Screw-in Anchors
Postoperative Management
Clinical Outcomes
Summary
Acknowledgement
35 Knee Arthrofibrosis How to Prevent and How to Treat
35 - Knee Arthrofibrosis: How to Prevent and How to Treat
Introduction
Pathophysiology
Risk Factors
Prevention of Arthrofibrosis
Clinical Presentation
Nonsurgical Management
Physical Therapy
Continuous Passive Motion
Postoperative Bracing
Surgical Treatment
Manipulation Under Anaesthesia
Arthroscopic Releases for Improving Flexion
Suprapatellar and peripatellar releases
Arthroscopic Releases for Improving Extension
Anterior interval release
Intercondylar notch
Posterior capsular release
Postoperative Protocol
Outcomes
Conclusion
36 pediatric knee
36 - The Paediatric Knee
Introduction
Growth-Related Considerations
Paediatric Knee Assessment
Physical Examination
Imaging
Anterior Cruciate Ligament Ruptures
Unique Concerns in the Paediatric Population
Surgical Treatment Options
Physeal-Sparing Iliotibial Band Reconstruction
Technique
Outcomes
All-Epiphyseal Reconstruction
Technique
Outcomes
Partial Transphyseal and Transphyseal Reconstructions
Technique
Outcomes
Postoperative Concerns – Reinjury and Revision Surgery
Summary
Meniscal Injuries
Development
Diagnosis
Nondiscoid Meniscus
Treatment Options
Outcomes
Discoid Meniscus
Diagnosis
Treatment Options
Outcomes
Patellar Instability
Decision Making – Unique Concerns in the Paediatric Population
Nonsurgical Treatment Options
Surgical Treatment Options
Guided Growth
Congenital and Obligate/Fixed Dislocations
Proximal Realignment
Distal Realignment
Osteochondral Fractures and Chondral Injuries
Diagnosis
Treatment Options
Summary
Tibial Eminence Fractures
Epidemiology and Pathophysiology
Diagnosis
Treatment Options
Nonsurgical Treatment
Surgical Treatment
Outcomes and Complications
Summary
37 miscillaneus
37 - Miscellaneous Complex Pathological Conditions of the Knee
Introduction
Lateral Patellar Facetectomy
Preoperative Evaluation
Surgical Technique
Postoperative Rehabilitation
Outcomes
Fabella Excision for Fabella Syndrome
Preoperative Evaluation
Surgical Technique
Preoperative setup
Incision and exposure
Postoperative Rehabilitation
Outcomes
Arthroscopic Notchplasty
Presentation
Treatment
Outcomes
Conclusions
Snapping Hamstring Syndrome
Presentation
Treatment
Discussion
Conclusions
Proximal Tibiofibular Joint Instability
Anatomy
Classification
Treatment
Surgical Technique
Postoperative Protocol
Conclusions
Patella Baja
Diagnosis and Surgical Indications
Surgical Technique
Postoperative Rehabilitation Protocol
Further Surgical Intervention
Summary
38 intraoperative Management Anaesthesia Tourniquet Tranexamic Acid Blood Loss and Fluid Management
38 - Intraoperative Management: Anaesthesia, Tourniquet, Tranexamic Acid, Blood Loss and Fluid Management
Introduction
Anaesthesia Considerations for Patients with Knee Injuries
Anaesthetic Choice and Perioperative Analgesia
Intraoperative Fluid Management
Management of Blood Loss During Complex Knee Surgery
Pneumatic Tourniquet
Topical and Systemic Antifibrinolytic Agents
39Preparing the Surgical Team for a Quick and Efficient Procedure
39 - Preparing the Surgical Team for a Quick and Efficient Procedure
Introduction
The Importance of Orthopaedic Surgical Team Teamwork and Efficiency
Teamwork in the Operating Room: An Efficient Operating Room Is Financially Sound
Teamwork in the Operating Room: A Cohesive, Efficient Operating Room Is Safer for Patients
Teamwork in the Operating Room: Effective Teams Stay Together
Defining the Orthopaedic Surgical Team
Surgeon
Physician Assistants
Athletic Trainer
Anaesthesia Personnel
Surgical Technician
Registered Nursing Staff
Medical Device Representative
Imaging Support Personnel
Students, Residents and Fellows
Nontraditional Roles of the Orthopaedic Surgical Team
Characteristics of a Highly Functional Orthopaedic Surgical Team
Team Composition
Communication
Checklist Utilisation
Present, Transformational Leadership
Reflection and Learning
General Orthopaedic Surgical Team Preparation: Day(s) Before Operating
Core Team Preparation Day(s) Before Operation
Patient history
Procedure
Imaging
Anticipated changes and complications
‘Noncore’ Team Member Preparation Day(s) Before Operation
General Orthopaedic Surgical Team Preparation: Day of Operation
Preparation of the Operating Room
Preparation of the Patient
Orthopaedic Surgical Team Preparation for Complex Knee Procedures
Diagnosis and Preoperative Considerations of Cartilage Injuries
Preparation for Surgical Intervention for Cartilage Repair
Preparations and Considerations for Cartilage Repair: Cartilage Resurfacing Techniques
Multiligament Knee Reconstructions
Diagnosis, Imaging and Preoperative Considerations of Multiligament Knee Injuries
Preparation for Multiligament Knee Surgery: Patient Positioning and Approach
Preparation for Multiligament Knee Surgery: Graft Considerations
Preparation for Multiligament Knee Surgery: Tunnel Placement
Preparation for Multiligament Knee Surgery: Tensioning Sequence
Meniscus Repair Procedures
Preoperative Considerations and Considerations for Meniscus Procedures
Preparation for Surgical Meniscus Repair
Preparation for Surgical Meniscus Transplant
Orthopaedic Surgical Team Surgical Preparation for Complex Knee Procedures: Summary
40 Postoperative Management
40 - Postoperative Management
Introduction
Patient and Family Education and Expectations
Pain Control
Intraoperative Nerve Block
Periarticular Injections
Oral Medications
Cryotherapy
Thromboprophylaxis
Incidence of Deep Vein Thrombosis and Pulmonary Embolism
Mechanical Prophylaxis
Pharmacological Prophylaxis
Wound Care
Complications
Fever
Infection
Frostbite
Arthrofibrosis
Summary
41 Postoperative Rehabilitation Concepts
41 - Postoperative Rehabilitation Concepts
Introduction
Rehabilitation Phases
Acute Phase
Periodisation
Endurance Phase
Strength Phase
Power Phase
Return-to-Sport Testing and Decision Making
Timing
Quadriceps Index
Hop and Agility Testing
Biomechanics
Subjective Outcome Assessments
Conclusions for Return to Sport
Summary