Description
In this presentation, Dr. Rahul Bhattachharyya discusses the management of a locked native knee, focusing on two common cases: a displaced bucket handle meniscal tear and an osteochondral injury. He starts with a real-life case of a 34-year-old woman who experienced a twisting knee injury, leading to a locked knee with a range of motion between 20 to 90 degrees and medial joint line tenderness. An MRI revealed a double PCL sign indicative of a bucket handle tear, prompting prompt treatment via an acute knee clinic, where she received a meniscal repair within four weeks using a combination of all inside and inside-out techniques for better mechanical stability.
Dr. Bhattachharyya elaborates on the surgical methodology, emphasizing the use of multiple sutures to enhance strength and load distribution for optimal healing.
He then introduces another patient, a 32-year-old woman with an acute patella dislocation, reiterating the efficient acute knee pathway that facilitated timely MRI and surgery, which involved arthroscopic removal of fragments followed by open fixation of osteochondral fragments.
Further, he talks about a third case demonstrating the phenomenon of osteogenic muscle inhibition (AMI), which occurs after knee injuries resulting in a locked knee not due to mechanical blockage but due to muscle activation failure. He shares details of a research study he conducted, finding a significant incidence of AMI in acute knee injuries, mostly correlating with patella dislocation and ACL injuries.
Dr. Bhattachharyya emphasizes the importance of understanding these knee pathologies and the appropriate clinical pathway to ensure timely and effective treatment and reduce the risk of complications such as arthrofibrosis.