State of the Art Regarding the Management of Multiligamentous Injuries of the Knee

Multiligamentous knee injuries are rare but serious injuries that can threaten limb viability. As such, they require careful management to give patients the best chance of immediate and ultimate functional recovery. However, as these injuries are rare, there is paucity in prospective comparative studies large enough to provide high level evidence for best practice. This lack of comprehensive and convincing evidence has made the management of multiligamentous knee injuries an area of active debate and controversy. The debate on whether surgical management leads to better outcomes than non-operative management, the optimal timing of surgery after injury and whether repair is better than reconstruction is still ongoing. Using the Oxford Levels of Evidence, this review summarises the latest high level evidence to provide answers to these issues. Recommendations for practice have also been offered and assigned a grade using a published scale.

Download Full-text

Achilles tendon rupture: what you need to know

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0593 ◽

2021 ◽

pp. 1-7

Author(s):

A Biggs ◽

G Scott ◽

MC Solan ◽

M Williamson

Keyword(s):

Deep Vein Thrombosis ◽

Achilles Tendon ◽

Best Practice ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Operative Management ◽

Vein Thrombosis ◽

History Of ◽

Non Operative Management ◽

Deep Vein

Heel pain and a history of a ‘pop’ or feeling ‘something go’ are the buzz phrases classically associated with Achilles tendon rupture. However, the diagnosis is often missed in clinical practice because of the assumption that this is a sporting injury suffered only by the young or middle-aged. In a sedentary older patient, the injury may be dismissed as an ankle sprain. If swelling is present but no injury is recalled then deep vein thrombosis is suspected, but Achilles rupture is not. The diagnosis of Achilles tendon rupture is clinical, based on history and examination. Radiological imaging (ultrasound scan) is useful to plan orthopaedic management and exclude concomitant deep vein thrombosis. In most cases, non-operative management with the ankle held plantar flexed in a boot is the current best practice.

Download Full-text

Conservative management of midcarpal instability

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193415613050 ◽

2015 ◽

Vol 41 (1) ◽

pp. 102-109 ◽

Cited By ~ 10

Author(s):

C. Harwood ◽

L. Turner

Keyword(s):

Ankle Joint ◽

Conservative Management ◽

Treatment Guidelines ◽

Wrist Joint ◽

Operative Management ◽

Hand Therapy ◽

Mild Pain ◽

Complex Condition ◽

High Level ◽

Non Operative Management

Midcarpal instability is a complex condition that can present in various forms, from mild pain to debilitating subluxation. Once diagnosed, treatment guidelines for hand therapy are limited by the scarcity of high-level evidence. Evidence does exist for use of proprioceptive awareness and neuromuscular rehabilitation for instability of the knee, shoulder and ankle joint, but studies of similar programmes for the wrist joint have not been published. The purpose of this review is to examine the evidence supporting current concepts in the non-operative management of midcarpal instability, and to provide recommendations for the management of this condition with hand therapy.

Download Full-text

Posterolateral corner knee injuries: a narrative review

EFORT Open Reviews ◽

10.1302/2058-5241.6.200096 ◽

2021 ◽

Vol 6 (8) ◽

pp. 676-685

Author(s):

Francisco Figueroa ◽

David Figueroa ◽

Sven Putnis ◽

Rodrigo Guiloff ◽

Patricio Caro ◽

...

Keyword(s):

Patient Outcomes ◽

Knee Injuries ◽

Operative Management ◽

Posterolateral Corner ◽

Dark Side ◽

Reconstruction Technique ◽

Orthopaedic Literature ◽

And Function ◽

Non Operative Management ◽

Case Basis

Limited knowledge of the anatomy and biomechanics of the posterolateral corner (PLC) of the knee, coupled with poor patient outcomes with non-operative management, resulted in the PLC often being labelled as the ‘dark side’ of the knee. In the last two decades, extensive research has resulted in a better understanding of the anatomy and function of the PLC, and has led to the development of anatomic reconstructions that have resulted in improved patient outcomes. Despite considerable attention in the clinical orthopaedic literature (nearly 400 articles published in the last decade), a standardized algorithm for the diagnosis and treatment of the PLC is still lacking, and much controversy remains. Considering the literature review, there is not a reconstruction technique that clearly prevails over the others. As anatomic, biomechanical, and clinical knowledge of PLC injuries continues to progress, finding the balance between re-creating native anatomy and safely performing PLC reconstruction provides a big challenge. Treatment decisions should be made on a case-by-case basis. Cite this article: EFORT Open Rev 2021;6:676-685. DOI: 10.1302/2058-5241.6.200096

Download Full-text

Assessment and management of adult ankle fractures: understanding the evidence

British Journal of Hospital Medicine ◽

10.12968/hmed.2020.0445 ◽

2021 ◽

pp. 1-9

Author(s):

Grace Yip ◽

Daniel Hay ◽

Tom Stringfellow ◽

Aashish Ahluwalia ◽

Raju Ahluwalia

Keyword(s):

Best Practice ◽

Screw Fixation ◽

Operative Management ◽

Ankle Fractures ◽

Current Evidence ◽

Ankle Stability ◽

Posterior Malleolus ◽

Injury Assessment ◽

Non Operative Management ◽

Tomography Scan

Ankle fractures are a common injury. Assessment should include looking at the mechanism of injury, comorbidities, associated injuries, soft tissue status and neurovascular status. Emergent reduction is required for clinically deformed ankles. Investigations should include plain radiographs and a computed tomography scan for more complex injuries or those with posterior malleolus involvement. An assessment of ankle stability determines treatment, taking into account comorbidities and preoperative mobility which need special consideration. Non-operative management includes splint or cast, allowing for early weightbearing when the ankle is stable. Operative management includes open reduction and internal fixation, intramedullary nailing (of the fibula and hindfoot) and external fixation. Syndemosis stabilisation includes suture button or screw fixation. The aim of treatment is to restore ankle stability and this article explores the current evidence in best practice.

Download Full-text

Functional Neuromuscular Rehabilitation of Posterior Shoulder Dislocation in a High School Baseball Player

Journal of Sport Rehabilitation ◽

10.1123/jsr.13.2.167 ◽

2004 ◽

Vol 13 (2) ◽

pp. 167-182 ◽

Cited By ~ 3

Author(s):

David Logerstedt

Keyword(s):

Operative Management ◽

Rehabilitation Program ◽

Sensorimotor System ◽

Posterior Shoulder Dislocation ◽

Sensorimotor Deficits ◽

Tissue Healing ◽

Posterior Shoulder ◽

High Level ◽

Non Operative Management ◽

Glenohumeral Dislocation

Posterior glenohumeral dislocations are rare, comprising only 4 percent of all shoulder dislocations. While early and accurate diagnosis of a posterior dislocation increases the likelihood of success with non-operative management, traditional rehabilitation may not adequately address the sensorimotor deficits that are evident following dislocation. Restoration of the sensorimotor system is critical to successfully return a throwing athlete safely to sports. The use of functional neuromuscular rehabilitation (FNR) attempts to address deficits in the compromised sensorimotor system. With a good understanding of the specific demands placed on the overhead athlete’s shoulder, knowledge of glenohumeral and scapulothoracic joints’ biome-chanics, respect for the athlete’s level of symptoms and pain, adherence to soft tissue healing, and application of a rehabilitation program that incorporates FNR, an athlete can successfully return to a high level of competition following an acute posterior glenohumeral dislocation.

Download Full-text