Name: PowerPoint Presentation
Uploaded: 2022-03-31
Duration: 9 min 26 s
Description: CASE STUDY 3: ELLIE’S INJURY. By Senthur Sarveswaran, Laura Wolde Mekuria , Andres Alonso Krispin Mesa, Kritisha Rangmang , Cipriani LaGrange-Kelvin, Sharmee Pathmalingam , Hiya Bablani , Sabriin Nunow.

CASE STUDY 3: ELLIE’S INJURY. By Senthur Sarveswaran, Laura Wolde Mekuria , Andres Alonso Krispin Mesa, Kritisha Rangmang , Cipriani LaGrange-Kelvin, Sharmee Pathmalingam , Hiya Bablani , Sabriin Nunow. 

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By Senthur Sarveswaran,  Laura Wolde Mekuria ,  Andres Alonso Krispin Mesa, Kritisha  Rangmang , Cipriani LaGrange-Kelvin, Sharmee  Pathmalingam ,  Hiya  Bablani ,  Sabriin  Nunow

Profile picture of Andres Alonso Krispin Mesa.

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EMS450U - Exploring Engineering 30 th  March 2022

KNEE’S ANATOMY. Diagram Description automatically generated. 

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LACHMAN & ANTERIOR DRAWER TESTS. PHYSICAL TESTS. A drawing of a dog Description automatically generated with low confidence. 

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LACHMAN TEST   With the knee flexed to 30 o  and with anterior force applied to the proximal tibia.  Knees that present an injured ACL have more movement anterior translation and provides a less firm endpoint while an intact ACL would limit anterior translation and provides a distinct endpoint.  ANTERIOR DRAWER TEST  Performed by flexing the knee to 90 o  and with anterior force applied to the proximal tibia (Figure 2).  If the tibia displaces more ahead than compared to a uninjured normal knee, then the test is positive

Figure 1: Schematic demonstrating the Lachman test

Figure 2: Schematic demonstrating the anterior drawer test

M C MURRAY’S TEST. PHYSICAL TESTS. The patient’s knee needs to be forcibly flexed to evaluate the medial meniscus As the femur passes over a tear in the meniscus, a click may be heard or felt. When the click is palpated in the initial degrees from full flexion it indicates a posterior tear If the click is palpated later when the knee is further flexed the tear is more anterior.. 

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The patient’s knee needs to be forcibly flexed to evaluate the medial meniscus  As the femur passes over a tear in the meniscus, a click may be heard or felt.  When the click is palpated in the initial degrees from full flexion it indicates a posterior tear If the click is palpated later when the knee is further flexed the tear is more anterior.

Examination for medial
meniscal tear
Examination for lateral
meniscal tear

Figure 3. Schematic demonstrating the  McMurray’s test

1069789876-preview.mp4. MRI AND ARTHROSCOPY. FURTHER TESTS. 

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MRI  is a non-invasive test performed to get a better diagnosis through a more up-close picture of the knee. The MRI creates better images of soft tissues like the anterior cruciate ligament. However, an MRI is usually not required to make the diagnosis of a torn ACL it’s just normally recommended when there is some disagreement on the physical tests, or it is suspected that there could be further injuries present   Arthroscopy  is an invasive procedure that was also used to look inside a joint via a  thin tube with a light source that is inserted through a small cut in the skin into a joint.

JOINT STABILITY TEST RESULTS. ANTERIOR DRAWER & LACHMAN TEST The three tests show an increase in the degree of anterior translation. M C MURRAY’S TEST Click on lateral aspect during flexion with internal rotation. Initial degrees from full flexion.. 

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ANTERIOR DRAWER & LACHMAN TEST The three tests show an increase in the degree of anterior translation.  M C MURRAY’S TEST  Click on lateral aspect during flexion with internal rotation. Initial degrees from full flexion.

Figure 6: Images above show results of arthroscopy

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Normal Knee                Ellie's Right Knee

Normal Knee            Ellie's Right Knee

Figures 7 (left) and 8 (right) :  Comparison of  an MRI between Ellie’s normal and injured  knee

Nonsurgical treatments such as a brace to protect from instability to strengthen the surrounding ligaments to provide greater stability.. 

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Nonsurgical treatments  such as a brace to protect from instability to strengthen the surrounding ligaments to provide greater stability.

Surgical reconstruction  A surgeon will remove the damaged ACL and replace it with tissue to help a new ligament grow in its place. A surgeon will remove the damaged ACL and replace it with tissue to help a new ligament grow in its place.

Choice of treatment dependent on factors such as:       Age        Your activity level       The severity of your injury Medication - anti-inflammatory drugs can help in reducing swelling and pain. For intense pain, the doctor may inject your knee with steroid medication.    Physiotherapy - Typically takes a few days to a week  for the knee to be in working order. In physiotherapy, exercises will be done to strengthen the muscles around the knee and aid in regaining full range of motion.

Figure 9:  Image of brace supporting knee

Figure 10: Image  of an arthroscopic procedure

16180357-preview.mp4. 1024744646-preview.mp4. SURGERY EXAMPLES. 

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Grade 1 or 2 don’t normally require surgery Grade 3 meniscus tears usually require surgery, which may include: Arthroscopic repair  — An arthroscope is inserted into the knee to see the tear. One or two other small incisions are made for inserting instruments. Many tears are repaired with dartlike devices that are inserted and placed across the tear to hold it together.  Arthroscopic partial meniscectomy  — The surgery is to remove a small piece of the torn meniscus to get the knee functioning normally. Arthroscopic total meniscectomy  — Occasionally, a large tear of the outer meniscus can be treated efficiently using this treatment, a procedure in which the entire meniscus is removed.

Figures 11(top) and 12 (bottom): Video showing Arthroscopic surgery procedures

abstract. . Three-phase model that allows graded progression (12 months course) :​ Return to participation – participating in rehabilitation and training but at a low level.​ Return to sport – returning to their specific sport but not at the normal skill level.​ Return to performance – participating in their specific sport and performing at or above their pre-injury level​. 

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Three-phase model that allows graded progression (12 months course) :​ Return to participation – participating in rehabilitation and training but at a low level.​ Return to sport – returning to their specific sport but not at the normal skill level.​ Return to performance – participating in their specific sport and performing at or above their pre-injury level​

The six identified criteria for discharge to sport are as follows:​ Isokinetic Strength Testing​ Four Hop Tests consisting of a running T-test Single Hop Triple Hop Triple Crossover Hamstring-to-quadriceps muscle strength ratio​

An ACL and lateral meniscus injury can be a catastrophic sports injury to sustain with a lengthy and dedicated rehabilitation programmed required. Recent guidelines can standardize and streamline the criteria used to determine when athletes are truly ready to progress.

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SUGGESTIONS TO REDUCE LIKELIHOOD OF KNEE INJURIES

Figures 18 & 19: Images of football players demonstrating incorrect technique  (left) against correct technique (right) .

Figures 16 (left)  & 17 (right) : Images above showing exercises that be done to develop muscle groups

Returning to a sport varies according to different physical functioning and contextual factors. Tests can determine whether a reconstructed knee is as functional as the other knee and up to the rigors of a particular sport . The possibility of Ellie to return to professional football after an ACL tear is likely but only after 1-2 years.. 

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Returning to a sport varies according to different physical functioning and contextual factors. Tests can determine whether a reconstructed knee is as functional as the other knee and up to the rigors of a particular sport .  The possibility of Ellie to return to professional football after an ACL tear is likely but only after 1-2 years.

The recovery time and ability to return to sports depends on how diligently one follows physical therapy and at-home instructions.  Time until an athlete can return to playing sports again:  After shaving or cutting away the rough edges of the torn meniscus: 7-9 weeks   Meniscus repair: 5½ months   Meniscus transplant: 7½-16½ months. The possibility of 100% recovery and Ellies return to the sport depends on the severity of the injury.

LIKELIHOOD OF THE PATIENT BEING ABLE TO RETURN TO PROFESSIONAL SPORTS

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THANK YOU. REFERENCES. [1] [2] [3] [4] [5] [6]. 

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