Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

ACL Tear
Posted: Jun 7 2020 #(C101489)
A

ACL and Medial and Lateral Meniscal Tears in a 40M

HPI

A 40 year-old-male sustained a twisting injury to his right knee 2 months ago. At the time of the injury, he felt a pop with immediate pain and swelling. He was referred to physical therapy for 6 weeks by his primary care physician. He now presents with complaints of persistent instability, swelling, and true mechanical symptoms with motion.

PMH

His past medical and social history is unremarkable. He is physically active.

PE

On physical exam, there is no clinical malalignment. He has a small joint effusion with a ballotable patella. He has full symmetric ROM with 0-130 degrees of flexion. He has medial and lateral joint line tenderness to palpation with a positive McMurray localizing to both medial and lateral sides. He has a 2B Lachman and guarding to pivot shift tests. but is otherwise ligamentously stable symmetrically to the contralateral side.

Poll
1 of 10
1. Given the persistent instability after 2 months of physical therapy, how would you manage this patient's ACL injury at this point?
Nonoperative (continued PT, activity modification)
3%
55/1385
Operative
92%
1282/1385
Outside my area of expertise - best if I don't vote
3%
48/1385
2. If you choose Operative management, what would you do?
I would not choose Operative management
0%
8/1318
ACL repair
4%
65/1318
ACL reconstruction
91%
1201/1318
Outside my area of expertise - best if I dont vote
3%
44/1318
3. If you choose ACL reconstruction, what graft type would you use?
I would not choose ACL reconstruction
0%
9/1322
Allograft
23%
305/1322
Autograft
71%
943/1322
Xenograft
0%
4/1322
Synthetic graft
0%
12/1322
Outside my area of expertise - best if I don't vote
3%
49/1322
4. If you choose ACL Reconstruction with Autograft, what type of autograft would you use?
I would no choose ACL Reconstruction with Autograft
4%
52/1256
Bone-Patellar tendon-Bone
23%
297/1256
Hamstring tendon
60%
757/1256
Quadriceps tendon
8%
110/1256
Outside my area of expertise - best if I dont vote
3%
40/1256
5. If you choose ACL reconstruction, what technique would you use to establish the femoral tunnel?
I would not choose ACL reconstruction
0%
4/1217
Transtibial
16%
202/1217
Inside-out via Anteromedial portal
53%
649/1217
Outside-in via Anteromedial portal
23%
281/1217
Outside my area of expertise - best if I dont vote
6%
81/1217
6. If you choose ACL reconstruction, what landmark do you find is MOST reliable for establishing the sagittal position of the tibial tunnel?
I would not choose ACL reconstruction
0%
4/1165
Anterior border of the PCL insertion
17%
200/1165
Posterior border of the anterior horn of the lateral meniscus
47%
557/1165
Medial tibial eminence
22%
266/1165
Intermeniscal ligament
3%
45/1165
Outside my area of expertise - best if I don't vote
7%
93/1165
7. If you choose ACL reconstruction, what technique would you use for graft fixation?
I would not choose ACL reconstruction
0%
4/1114
Femoral interference + Tibial interference
27%
304/1114
Femoral interference + Tibial suspensory
5%
65/1114
Femoral suspensory + Tibial suspensory
14%
167/1114
Femoral suspensory + Tibial interference
44%
497/1114
Outside my area of expertise - best if I don't vote
6%
77/1114
8. If you choose ACL reconstruction, would you include Anterolateral ligament (ALL) reconstruction?
I would not choose ACL reconstruction
1%
12/1107
No - I never perform ALL reconstruction
34%
386/1107
Yes - I always perform ALL reconstruction
4%
50/1107
Maybe - If there is persistent intra-operative instability following ACL reconstruction
51%
575/1107
Outside my area of expertise - best if I don't vote
7%
84/1107
9. If you choose Allograft ACL reconstruction, would you culture the graft intra-operatively?
I would not choose Allograft ACL reconstruction
33%
366/1078
No
43%
469/1078
Yes
14%
151/1078
Outside my area of expertise - best if I dont vote
8%
92/1078
10. In this patient, would you give DVT prophylaxis in the immediate postoperative period?
No - I would not give DVT prophylaxis
27%
294/1074
Yes - ASA 81 mg daily
25%
271/1074
Yes - ASA 325 mg daily
13%
150/1074
Yes - other pharmacologic (non ASA)
29%
313/1074
Outside my area of expertise - best if I dont vote
4%
46/1074
PROCEDURE #1

Allograft ACL Reconstruction, Medial and Lateral Meniscal Debridement

Intra-procedure P1
icon
OUTCOMES
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options