The problem knee : diagnosis and management in the younger patient PDF
Preview The problem knee : diagnosis and management in the younger patient
The Problem Knee TP.indb i 08/11/11 2:31 PM This page intentionally left blank Malcolm Macnicol MBChB, BSc (Hons), MCh, FRCS, FRCSEd (Orth), FRCP, Dip Sports Med Previously Consultant Orthopaedic Surgeon and Senior Orthopaedic Lecturer, Royal Hospital for Sick Children, Royal Infi rmary and Murrayfi eld Hospital, Edinburgh, UK and Franky Steenbrugge MD, PhD, MChOrth, FRCSEd Professor in Orthopaedics, Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, University of Ghent, Belgium; Co-founder of the Belgium Knee Society The Problem Knee Diagnosis and management in the younger patient 3rd Edition TP.indb iii 08/11/11 2:31 PM First published in Great Britain in 1986 by Butterworth Heinemann Second edition 1995 This third edition published in 2012 by Hodder Arnold, an imprint of Hodder Education, a division of Hachette UK 338 Euston Road, London NW1 3BH http://www.hodderarnold.com © 2012 Malcolm F Macnicol and Franky Steenbrugge All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic production in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: Saffron House, 6-10 Kirby Street, London EC1N 8TS Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress ISBN-13 978-1-444-12011-0 1 2 3 4 5 6 7 8 9 10 Commissioning Editor: Francesca Naish Project Editor: Joanna Silman Production Controller: Joanna Walker Cover Design: Julie Joubinaux Indexer: Laurence Errington Typeset in 10.5/12 pt Goudy Old Style Regular by Datapage Printed and bound in Italy by Printer Trento What do you think about this book? Or any other Hodder Arnold title? Please visit our website: www.hodderarnold.com TP.indb iv 08/11/11 2:31 PM Contents Preface vii Acknowledgements ix 1 The mechanism and presentation of injuries to the knee 1 2 Methods of clinical examination 12 3 Investigations 34 4 Paediatric conditions 57 5 Ligamentous injuries 94 6 Meniscal lesions 121 7 Patellofemoral problems 146 8 Fractures around the knee 168 9 Non-traumatic conditions 186 10 Treatment of soft tissue injuries 210 Appendix I Stages in recovery after injury 227 Appendix II Assessment rating scales 228 Tegner activity scale 228 Lysholm knee scores 229 Cincinnati knee rating system 230 Assessment of function 231 Glossary 232 Index 237 v TP.indb v 08/11/11 2:31 PM This page intentionally left blank Preface The knee is a complex and crucial joint, vulnerable in the daily round as well as during sports and in transport or industrial accidents. While the causes of acute or chronic knee symptoms are not always apparent, it is to be hoped that, at very least, an informed questioning and examination of the patient or injured athlete will ensure that needless morbidity is avoided. Whether the sometimes inextricable mix of reactive synovitis, soft tissue and osteochondral damage can be teased apart may eventually depend on the experience and investigative skills of the surgeon; but assuredly a lack of cooperation and free communication with colleagues in other disciplines will retard both the speed and success of treatment. This monograph emphasizes the basic principles in managing a ‘problem knee’ in the younger patient. The interrelationship between skeletal and soft tissues injuries is acknowledged, but in the interests of a simplifi ed and rational approach, separate chapters deal with the different components of the joint, albeit with some repetition. Details about most surgical approaches have been kept to a minimum because these can be learnt effectively only in the operating theatre. Scanning the knee with magnetic resonance imaging, ultrasound or computed tomography has augmented the clinical value of history taking, careful and standardized physical examination, and conventional radiography. However, the unconditional and excessive use of investigations of this sort cannot be condoned. Clinical assessment is still the bedrock of management. Operative intervention for patellar pain, with or without maltracking, is less frequently advised than in the past. The subtleties of patellar instability make surgical procedures prone to patient disappointment. Cruciate ligament reconstruction, on the other hand, is now a relatively safe and satisfactory procedure, particularly for the acute anterior cruciate rupture. The benefi ts of this intervention are now convincing, not least the protection of other structures in the knee that has been stabilized. Meniscal repair and (osteo)chondral grafting are appropriate in selected cases, and after all forms of surgery a more rapid rehabilitation is espoused. The text now incorporates recent advances in surgical management and newer concepts in conservative treatment. As before, systemic conditions are described as they relate to the knee in younger patients but degenerative disease is excluded. An overview of fracture care is presented without elaboration. The fi rst edition of The Problem Knee appealed especially to physiotherapists, family doctors and casualty offi cers. The second edition broadened its appeal to surgical trainees and those in orthopaedic practice. With the welcome assistance of Professor Franky Steenbrugge, who has extensively revised Chapters 5 and 6, it is hoped that this third edition will prove of further value. Chapter 4 on paediatric conditions has also been modernized. vii TP.indb vii 08/11/11 2:31 PM This page intentionally left blank Acknowledgements The authors thank Ian Beggs, Michael Devlin, Alison Green, Robb Kidd and Morag Lunn for their contributions to the third edition. We dedicate the book to our wives and children. ix TP.indb ix 08/11/11 2:31 PM
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