The problem knee : diagnosis and management in the younger patient

253 Pages·2012·6.799 MB·ix, 242 s. : ill. (some col.) ; 26 cm\253

by  Malcolm F Macnicol, Franky Steenbrugge

The
Problem Knee
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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
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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
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Project Editor: Joanna Silman
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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
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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
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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
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