The Rational Clinical Examination
David L. Simel, Drummond Rennie
Knee Ligaments and Menisci
Daniel H. Solomon, David L. Simel, David W. Bates, Jeffrey N. Katz, Jonathan L. Schaffer
The first case describes a young man with a probable ACL rupture. The angle of injury, the...
Topics Discussed:
anterior cruciate ligament rupture, knee ligament, knee ligament injury, knee meniscus, knee meniscus tears
Excerpt:
"The first case describes a young man with a probable ACL rupture.
The angle of injury, the presence of a pop, the difficulty bearing
weight, and the transient swelling support this diagnosis. He should
be counseled about his prognosis, encouraged to begin a program
of quadriceps strengthening, and given the option of pursuing surgical reconstruction
if the symptoms are functionally limiting. The second case characterizes
a common scenario in primary care practices, the older patient with
degenerative joint disease and a probable superimposed degenerative
meniscal tear. This patient's functional limitations need
to be assessed carefully. If she is not too impaired, joint aspiration
of the effusion, nonsteroidal anti-inflammatory drugs, quadriceps
strengthening, and a cane may provide enough pain relief and mobility
to make more invasive treatment unnecessary. If conservative management
fails and her symptoms include locking or giving way, arthroscopic
partial meniscectomy may be useful. Patients with substantial impairment
and significant degenerative changes on weight-bearing radiographs
may be candidates for total knee replacement...."
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