results

Aetiology

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

History

Initially

- lose velocity / accuracy

Develop medial pain

40% ulna nerve symptoms

Results 

90% fusion rates

Lose70% sagittal plane ROM

Disadvantages of Arthrodesis 

Non union rates up to 12%

Decreased gait speed

Poor mobility over uneven surfaces

History

First generation (late 70s early 80s) 

Results

Aim

Attempt to reduce outliers in all 3 planes of the knee

- improve alignment

- theoretically improve survival and outcomes

Types

Image based

Pre-op CT

- uncommon

- resource heavy

Options

1. Always resurface

2. Never resurface

3. Selectively resurface

Decision Making

Controversial

- literature divided on issue

Historically

- poor outcomes due to poor implant design

- now improved designs

- non resurfacing also improved due to better design and improved techniques in regard to tracking and rotation

Aim

UKA is intended to be load sharing

- correct to neutral or slight varus

HTO is a load-shifting / load-sparing procedure

- over correct into valgus

UKA v TKR

Advantages UKA

1.  Rapid rehabilation

Background

Meniscectomy 

- resect 30%

- increases contact pressures 3.5 x

- shock absorbing capacity reduced to 20% normal

Results of partial & total meniscectomy are very poor in children

- meniscectomy in children is a last resort

- repair amenable tears

- treat others non-operatively

- only real indication for meniscectomy is locked knee not amenable to repair

Epidemiology

Adolescent apophyseal avulsion

- treat non operatively

- unless displaced > 2 cm

Adult

- soft tissue avulsion

Aetiology

Usually associated with sporting activities

- skiing

- water skiing

Violent contraction

- knee extended

- hip flexing

Anatomy

Epidemiology

Usually young patients

- 15 - 40

15% compound

Aetiology

High velocity injury

- MBA

- MVA

- pedestrian v car

- fall from height

Emergency Managment

EMST principles

- need for transfusion not uncommon

Definition

Pigmented Villo-Nodular Synovitis

- benign inflammatory process that arises in synovial tissues

- contains significant amounts of hemosiderin

Epidemiology

Age: 20 - 50

Sex: M > F

Types

A.  Diffuse

- throughout joint synovium

- more difficult to treat / excise fully