前交叉韧带损伤的影像学诊断.pdfVIP

Lower Extremity Trauma: An Atlas of Radiologic Findings of ACL Injury SURAJ KABADI UNIVERSITY OF FLORIDA, MS IV Outline  Our Patient Presentation  Evaluation of Acute Knee Pain Appropriateness of Imaging for Acute Knee Pain Anatomy and Injuries of the ACL  Primary Signs of ACL Injury  Secondary Signs of ACL Injury Management of ACL Injury Our Patient: History and Physical  History  KJ is a 36-year-old male who presents to the ER with pain in his left knee  While playing soccer yesterday, he felt his knee “twist” with part of his knee rotating in and part rotating out  He also heard something “pop” in his knee  No swelling or redness; just pain  Physical Exam  Diffusely tender to palpation over knee, but without any swelling  Positive Lachman test with significant laxity Acute Knee Pain: Differential Diagnosis Traumatic  Fractures  Ligamentous or meniscal injury  Effusion or hemarthrosis Non-traumatic  Septic or inflammatory joint  Crystalline disease  OA  Bursitis  Patellofemoral pain syndrome  Baker’s cyst +/- rupture Acute Knee Pain: Physical Exam Signs  Inspection, Palpation, ROM  Provocative Tests  MCL – Valgus Stress Test  LCL Complex – Varus Stress Test  PCL – Posterior Drawer Test  ACL – Anterior Drawer Test, Lachman Test  Menisci – McMurray Test, Apley Compression Test  Patella – Osmond-Clarke Test, Apprehension Test Appropriateness of Imaging: Knee Rules  Ottawa Knee Rules  X-rays are required for acute knee injury with any one of the following: Age 55 years or older Tenderness at head of fibula Isolated tenderness of patella Inability to flex to 90° Inability to bear weight both immediately and in the emergency department (4 steps