– gastrocs acts as a load absorber during early stance
– partial thickness meniscal tears and full-thickness stable, vertical or oblique tears measuring less than or equal to 10 mm may be left alone.
– during flexion of the knee, the medial meniscus moves 5 mm, the lateral moves about 10; note that the medial meniscus has less mobility – and hence is more prone to getting torn,.
– the most common mechanism of injury of the Achilles tendon is forced dorsiflexion of the plantarflexed foot
– remember to look on the lateral knee x-ray for the height of the patella! If it is way up there – there will be an extension lag.
– in the combined ACL MCL injury, probably best to wait for the knee to be rehabbed before doing anything.
– activity induced osteitis pubis is an overuse syndrome – hot on bone scan on both sides of the symphysis.
– for the patient who has posterior and external rotation displacement at 30 but not at 90, he has a posterolateral complex injury with an intact PCL. Isolated PCL disruption leads to increased posterior translation at 90, but not 30.
– increased external rotation at 30, BUT not at 90 – think posterolateral corner tear!
– “stingers” are neuropraxias of the brachial plexus – the recovery time is variable, anywhere from 2 days to several months. Residual sequela such as permanent muscle atrophy, can also occur and these patients need proper rehab. Do an EMG to define the extent of the injury. These patients should not be allowed back into contact sports until you’ve sorted out their injury
– with the ankle loaded and in neutral, the most important structure in resisting inversion is the bony tibial and talar articulation. In the absence of axial loading, the anterior talofibular and calcaneofibular ligaments are the primary restraints to inversion laxity.
– meniscal cysts are usually lateral, but can be medial. They are usually associated with horizontal cleavage tears – allow fluid out in a ball-valve type mechanism. They are treated by partial meniscectomy and decompression of the cyst into the knee.
– if using interference screws for bone plug fixation, use a screw the same length as the graft bone – if there is a 20 mm length of bone plug, use a 20 mm screw. If you use a longer screw, some of the threadas may cut the tendon graft.
– acute hemarthrosis of the knee alters quads strength by inhibiting muscle firing. The capsular distention, irritation, and pain caused by the effusion inhibits normal motor unit activation and firing.
– for osteochondral lesions of the talus caused by trauma – most are anterolateral; if displaced – open or scope them, consider fixing the fragment or excising it and drilling the base.
– doing a Chrisman Snook lateral ankle ligament reconstruction may cause symptomatic restriction of subtalar motion, because the calcaneofibular arm of the reconstruction crosses the subtalar joint at a different angle than the native CFL.
– os trigonum syndrome presents with posterolateral ankle pain as the posterior process of the talus impinges against the calcaneus with forced plantar flexion. The key is the forced passive plantar flexion causing pain.
– anabolic steroids increase muscle strength; the nonreversible side effect – alopecia (cystic acne, decreased sperm, testicular atrophy, and increased LDL are all reversible); the best test is LDH liver isoenzymes.
– arthroscopic debridement of an arthritic knee has the best chance of working if the normal alignment is maintained. It has poor results in patients with ligamentous laxity, loss of joint space, or abnormal alignment (varus)
– for ACL graft placement – the femoral tunnel placement is key; the tibia is abit more forgiving because the zone of isometricity is larger. If the graft is placed to far forward on the femur, it will be too tight in flexion. If it is too far back, it will be too tight in extension (over the top).
– the anterior horns of the medial and lateral menisci often serve to prevent
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