Long Case 2 PCL Injury

                                    Long Case 2
PCL Injury
Introduction
Exposure
General Examination
Apparently Healthing looking ,
Conscious
Well oriented to time place and person
Co-operative
Not in distrees due to pain
………
Moderately built up

Jaundice Pallor Lymph Node Cyanosis  Clubbing Oedema Dyspnoea
Vitals                           BP                    P                      T                      RR
Skin     Hair Distribution                      HEENT
Systemic Examination
Chest
CVS
P/A
Musculoskeletal Examination
Upper Extremity
Spine – C – spine and L-spine
            Head at centre
            Shoulder and Pelvis Leveled
            Normal overlying skin without any dimpling/swelling on the back
            Normal Movement of C-spine ,

Ask patient to stand up
            Thoracic and lumbar spine movements tested

Lower Extremity –
Gait     - Varus / Valgus thrust or walks slowly on a plodding manner loading knees on lateral compartment
Squating – Painful  , One side heel higher than the other
Alignment
           
Pelvis Leveled
            Both patella facing forward ,
Genu Valgum deformity on Right side
            Upper Extremity overlying Greater Trochanter
No flexion contracture at knee
Archs at feet normal
Posterior
( Measure Genu Valgum once you see this and continue downward ..)

Attitude not any partcular on lower extremities






Sitting again


Local Examination of Knee
Look               Skin
                        Swelling – effusion , fluid shift , Patellar floating sign , transillumination ,
                        Discharge
                        Posterior Sag sign
                       
Feel                 Temperature
                        Tenderness
                        Osteophytes
                       
Movements     Flexion / Extension
                        Crepitations
Stability
                        Varus / Valgus Stress Tests
                        Anterior Drawer,Posterior Drawer,Lachman’s ,End points
                        Mc Murray’s
Special Tests
Card on front of knee
 Subtle concavity present with a gap between card and front of knee
Step off sign
Tibial pleateau flush with medial femoral condyle suggesting PCL Disruption

Quadriceps Active drawer Test +
            PCL disruption –tibia moves anteriorly when Quadriceps contracted actively , extending knee from a flexed position against resistance .
           
Distal Circulation
Distal Sensation
Examination – Hip / Ankle / Foot

Neurology – Sensation / power / Tone / Reflexes

Management
Life Style Modification
            Decrease wight with calorie cut down , avoid participating in strenuous exercises
Physiotherapy
            Quadriceps Strengthening exercises
            Braces
            Drugs – Pain Management-  Opoids , NSAIDs , Steroids – Oral or Percutaneous
                        Hyaluronate Injections weekly 3 shots
           
 Discussion
Examine main ligaments
Posterior Sag – See tangentially anterior knee ,
PCL Deficiency – Quadriceps Active test

If PCL injured , what else to examine ?
            Dial test at 30 and 90 degrees

Management Plan ?
            After  Patellectomy and PCL deficiecy ?
            Posterior Stabilized TKR


What do you examine a patient with ACL and MCL injury ?
            Medial joint line
            O’Donoghue’s triad



 Treatment 

 Conservative 
PCL Reconstruction






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