examination

Issues

Limb alignment

Risk that late posterolateral corner reconstruction will fail in the setting of the varus knee

- varus knee alignment and varus thrust in stance phase

- consider osteotomy first in this setting

Results

Posterolateral Corner Reconstruction

Moulton et al. Am J Sports Med 2016

- systematic review of PCL reconstruction for chronic injuries

- 450 patients

Anatomy

3 primary stabilizers (plus posterolateral capsule)

LCL / Popliteus / Popliteofibular ligament

Laprade et al. AJSM 2003

https://pubmed.ncbi.nlm.nih.gov/14623649/

1.  Lateral collateral ligament

Femoral attachment

Incidence

Most common lower limb neuropathy

Aetiology

Valgus TKR - 3%

HTO - 10%

Direct Trauma / Compression

Knee Dislocation

Tibial fracture

Cast / Dressing

Lateral Meniscus Repair

Indications

Severe LBP 

- most common indication

Ipsilateral knee pain

- less beneficial

Malposition

- especially abduction

Contraindications

Absent abductor mechanism

Flail

Active infection

Insufficient bone stock

Examination

LLD

Definition

Any act or failure to act that

- results in or potentially results in harm / death / physical / emotional / sexual abuse

- by a parent or caretaker who is responsible for the child

4 types

Neglect 

Physical (punch / kick / bite / burn / shake)

Sexual 

Emotional

Risk factors

Epidemiology

70% male

70% positive FHx

20% learning difficulties

DDx toe walking

Early / late onset

Unilateral  / bilateral

1.  Habitual

Toddlers - child can heel walk

2.  Structural

Fixed equinus - CTEV / arthrogryposis

Short / tight T Achilles

Space occupying lesion in calf

Definition

No good definition

- flexible flat foot

- medial longitudinal arch of foot in weight-bearing is in contact with ground or closer to ground than 'normal'

Epidemiology

Common

- almost always bilateral

- strong familial tendency

Aetiology

Physiological

All infants have flat feet

Normal development

1 year:  Bow legs / 15° varus

2 year:  Neutral 

3 year:  Knock knees / 10° valgus

6 year:  Physiological valgus / 6° valgus

Look

Splints

Extend elbow to side

- medial wounds

- extension

Flex elbow to side

- flexion range

Flex elbow to front

- olecranon wound

Extend elbow to front

- anterior wounds

- carrying angle

- forearm wasting

Palm up

- clawing

Screening of Joints

Neck

-  ROM

Shoulder

- behind head / to mouth

- to back pocket 

Elbows

- flex / extend elbows 

- pronation / supination with thumb up & elbows by side

Wrist

- flexion / extension

Hand

- make fist with thumb in and out