Shepard Splain, DO

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Surgical Management of Knee Pain

• Shepard Splain, DO
• Chairman, Orthopaedic Surgery
• Brookdale University Hospital
• and Medical Center

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NEVER
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MUST HAVE A DIAGNOSIS
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HISTORY

• ACUTE EVENT
• INSIDIOUS ONSET

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• Physical Examination
• INSPECTION
• PALPATION
• Joint Specific tests
• VARUS
• VALGUS
• LACHMANS
• POSTERIOR DRAWER
• QUADRICEPS ACTIVE TEST

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Varus Stress
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Pivot Shift
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Lachmans Test
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Radiology

• Xray
• MRI

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• AGE AFFECTS OUR THOUGHT PROCESS

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• ADOLESCENT
• Osteochondral Defect
• IN SITU
• DETACHED HINGED
• FREE

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Discoid Meniscus

• TYPES
• SYMPTOMS
• MRI
• ARTHROSCOPIC TREATMENT
• RESHAPING

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OSGOOD SCHLATTERS

• PATHOPHYSIOLOGY
• TREATMENT

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• PROGRESSING TO TIBIAL TUBERCLE AVULSION

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TIBIAL SPINE AVULSION

• Mechanism

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• PROGNOSIS IS NOT ALWAYS FAVORABLE!

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Adult Problems

• TRAUMATIC
• FRACTURES
• SUPRACONDYLAR FEMUR FRACTURES
• PATELLA FRACTURE
• TIBIAL PLATEAU
• NONFRACTURE
• LIGAMENTOUS INJURY
• MENISCAL

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Adult problems

• DEGENERATIVE
• PALLIATIVE
• ARTHROSCOPY
• DEFINITIVE
• Total Knee Arthroplasty

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Adult Problems

• INFLAMMATORY
• Collagen vascular disease--palliative treatment
  ie. synovectomy
• Infectious arthritis
• wbc's in knee aspirate gt 50,000
• organisms on gram stain
• ESR, CRP
• Drain except in low virulence organisms or GC

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CUTTING EDGE SURGERY

• UNICOMPARTMENTAL KNEE REPLACEMENT
• MENISCAL TRANSPLANT
• CARTILAGE REGENERATION PROCEDURES
• MOSIACPLASTY
• MICROFRACTURE
• CARTILAGE TRANSPLANT

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Indications for UKR

• Age (gt60 years)
• Weight (lt82kg)
• Level of activity
• Pain
• Range of motion
• Angular deformity (lt15º)
• Acceptable intraoperative findings
• Kozinn SC, Scott RD. Unicondylar knee
  arthroplasty. JBJS 71145, 1989.
• Thornhill, Scott. Surgical reconstruction of the
  Arthritic knee II. Clin Orthop 202. April 1989.

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Chondrocyte TransplantLars Peterson
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Osteochondral AllograftsAllan Gross-Toronto
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Shell Allografts
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Periosteal GraftsShawn ODriscoll
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Abrasion ArthroplastyJohnson 1981
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Microfracture/DrillingSteadman/Pridie
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Thank you