ACL with medial meniscus Dr Mostakim .pptx

ACL injury Case presentation

1. Welcome To Clinical Case Presentation Dr. Mohammed Arif Hossain MS Phase- B Resident Orthopaedic surgery Unit- Violet (1)

2. Particulars of the patient Name : Mostakim Age : 17 years Sex : Male Address : Narsingdi Date of admission : 19.04.2025 Ward : 115 Bed :01 Registration no.: 3002/42 Mobile no: 01610258131

3. History sheet

4. Chief Complaints Feeling of insecurity for 9 months following twisting injury to the left knee. Difficulty in running for same duration.

5. History of present illness According to the statement of the patient, he was reasonably well 9 months back. Then accidentally he got twisting injury over his left knee during playing football. Immediately after injury he felt severe pain in his affected knee and could not continue his game. He developed swelling in his affected knee immediately, for which he consulted with local physician and treated conservatively with analgesics and rest. Few days later the pain and swelling subsided gradually.

6. Cont. He complained of feeling of insecurity or giving way in the left knee during running and in downstair movements. He gave no history of locking in the affected knee joint. He had no history of morning stiffness and other joints problem. He is normotensive, non diabetic & non asthmatic.

7. Past history : Nothing contributory. Treatment history : He took treatment in the form of analgesics and physiotherapy. Drug history : Took some analgesics. Allergic history : No known drug or food allergy. Personal history : Non-smoker . Immunization history : Immunized as per EPI schedule and took two doses of vaccine against COVID 19. Socioeconomic status : He belongs to middle class family .

8. General Examination Appearance : Anxious Body built : Average Decubitus : On choice Anemia : Absent Jaundice : Absent Dehydration : Absent Pulse : 78 beats/min BP : 110/70 mmHg Temperature : 98.0◦ F R/R : 16 breaths/min

9. Systemic E xaminations

10. Respiratory system Inspection: Shape of the chest : Normal Deformity of chest : Absent Visible Impulse/engorged vein : Absent Respiration pattern : Abdomino -thoracic M ovement of the chest : Symmetrical Respiratory rate & rhythm : 16 breaths/min & regular

11. Palpation: Trachea : Centrally placed Apex beat : Palpable on left 5 th intercostal space just medial to the midclavicular line Vocal fremitus : Equal on both sides Chest expansion : 5 cm (Normal 5-7cm) (Continued)

12. Percussion: Percussion note : R esonan t Upper border of liver dullness : In the r ight 5 th intercostal space along the midclavicular line Auscultation : Breath sound : Vesicular Vocal resonance : Equal on both side No added sound (Continued)

13. Cardiovascular system Inspection: No swelling, deformity or scar mark V isible cardiac pulsation : Absent Engorged vein : Absent Palpation: Apex beat : Palpable at left 5th intercostal space just medial to the midclavicular line Thrill/ left parasternal heave: Absent

14. Percussion: Area of superficial cardiac dullness : Normal Auscultation: Heart sound ( S1+ S2) : Normal No added sound (Continued)

15. Alimentary system Inspection: S hape of the abdomen : Scaphoid Umbilicus : C entrally placed & inverted Movement with respiration : P resent V isible vein : Absent Visible cough impulse : Absent Hair distribution : N ormal Hernial orifices are intact.

16. Palpation: Temperature : Normal Tenderness : Absent M uscle guard or rigidity : Absent L ocalized swelling : Absent Shifting dullness : Absent Liver, spleen & kidney : N ot palpable (Continued)

17. Auscultation: Bowel sound - P resent (Continued)

18. Nervous system Higher psychic function : Normal. Cranial nerve : Reveal ed no abnormality . Motor function : Normal Sensory function : Intact Reflex : All superficial & dee p reflexes were normal

19. Loco regional Examination Look : Gait is normal. Squatting is possible. No swelling or scars mark around the left knee. No genu varus or valgus deformity. Apparent muscle wasting over left thigh .

20. Feel : Temperature is Normal. Joint line tenderness is absent. Muscle wasting 2 cm in left thigh. Patellar bulge test is negative. Distal neurovascular status is Intact.

21. Move: Left hip, knee and ankle joints movement- full ROM.

22. Special tests Tests Right Left Sag sign Negative Negative Anterior drawer test Negative Positive on neutral & 15° external rotation of left leg. Lachman test Negative Positive Varus stress test Negative Negative valgus stress test Negative Negative

23. Special tests Tests Right Left McMurray test for medial meniscus Negative Negative McMurray test for lateral meniscus Negative Negative Thessal y’s test Negative Negative Duck waddling test Negative Negative Apley’s Grinding test Negative Negative

24. Salient features Mostakim , 17 years old male, hailing from Narshingi admitted in this hospital with the complaints of feeling of insecurity following twisting injury to the left knee during playing football for 9 months and occasional pain in the left knee for same duration. Immediately after injury he felt severe pain in his affected knee and could not continued his game. He noticed that swelling developed in his left knee immediately, for which he consulted with local physician and treated conservatively with analgesics and rest. Few days later pain and swelling subsided gradually

25. He also noticed feeling of insecurity or giving away in the left knee during walking and running, especially in up stair and down stair movement. He also developed occasional pain in left knee for 9 months and pain was mild and localized in nature. He gave no history of locking in the affected knee joint. He had no history of morning stiffness, other joints problems. With these features he admitted from OPD to orthopaedic unit II.

26. On general examination and systemic examination, no abnormalities are detected. On loco-regional examination, Gait is normal and squatting is possible. Muscle wasting absent. No genu varus or valgus deformity. Temperature is Normal. Joint line tenderness is absent . Synovial thickening is absent. Patellar bulge test is negative. Distal neurovascular status is Intact.

27. Sag sign is absent. Anterior drawer test positive in neutral positon of left foot. Lachman test is positive on left side. Varus stress test is negative and valgus stress test is negative on left. Apley’s Grinding test negative and McMurray tests for medial meniscus test are positive. Left Hip, knee and ankle joints have full ROM.

28. Provisional diagnosis A case of 09 months old anteromedial rotatory instability of the left knee in a 17 years old male.

29. X-ray Left Knee A/P & Lateral view

30. MRI of left knee joint, sagittal view

31. MRI of left knee joint, sagittal view

32. MRI of left knee joint, Coronal view

33. MRI of left knee joint, Coronal view

34. MRI of Left knee , coronal view

35. MRI of Left knee joint, axial view

36. MRI of left knee joint, Axial view

37. Investigations Blood group- A (+) ve Hb %- 16.8 g/dl RBS -3.90 mmol /l Serum creatinine - 0.70 mg/dl S.electrolytes - Na- 137 mmol /L K- 3.9 mmol /L Cl- 101 mmol /L CXR- Normal

38. HBsAg - Negative Anti HCV- Negative HIV I & II -Negative

39. Clinical Diagnosis A case of 09 months old tear of ACL with Bucket Handle tear in the medial meniscus of the left knee in a 17 years old male.

40. Unit plan Arthroscopic evaluation and arthroscopic assisted left ACL reconstruction by Peroneus Longus tendon graft and partial meniscectomy.

41. Thank you