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Grade IIB Lachman
6%
88/1599
Presence of pivot shift
32%
511/1599
Tenderness over MCL origin without opening on valgus
2%
37/1599
Positive Ober test
1%
14/1599
Painful pop on McMurray test
59%
936/1599
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Factors that have been implicated in the progression of OA in the ACL deficient knee include meniscal lesions, osteochondral lesions, malalignment, and concomitant ligamentous pathology. The painful pop on McMurray test is indicative of a meniscal tear. In the ACL-deficient knee, the posterior horn medial meniscus is felt to be a stabilizer to anterior translation of the tibia – therefore placing it under high loads with translation and leading to a high incidence of secondary meniscal tears in chronic ACL insufficiency. Rupture of the posterior horn leads to even greater anterior translation, increased instability, and ensuing arthritis. Studies have shown ACL combined with PCL rupture to increase the incidence of OA significantly; however, several studies have shown no arthritic progression with associated collateral ligament injury. Louboutin et al reported that the risk of developing osteoarthritis is lower after ACL reconstruction (14%-26% with a normal medial meniscus, 37% with meniscectomy) to untreated ruptures (60%-100%) at 20 year follow-up. The Gillquist paper noted that meniscus tears and subsequent repair, or ACL tears without major concomitant injuries, seem to increase the risk 10-fold (15 to 20% incidence of gonarthrosis) compared with an age-matched, uninjured population (1 to 2%).
2.8
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