Management
Timing
Early < 3 - 6 months
- most common
Early < 3 - 6 months
- most common
Stryker dual mobility
1. Contained Metaphyseal Defect
2. Damaged Metaphyseal
A. One Condyle
B. Both Condyles
3. Deficient Metaphysis +/- collaterals +/- extensor mechanism
Management
- assess stability
- ORIF if needed
10%
70o swing phase
80o climb up stairs
90o climb down stairs + sit down in chair
100o low chair
Stiffness usually subsides at 6-8/52
- generally improves out to 3/12
- slow improvement for up to next 9/12
Up to 8% patients with ACL reconstruction will have recurrent instability and graft failure
- increased with surgical inexperience
1. Be inadequate from the start
- inadequate tension
- poor tunnel placement
Fewer complications than TSR
Simpler procedure
1. Patient factors
A. Recurrent Trauma
- contact athletes higher risk
B. MDI / Ligamentous Laxity / Voluntary dislocaters
C. Poor rehabilitation
- poor motivation
- too rapid
- patients rarely get stiff, better to go very slow
2. Surgeon Factors
A. Unrecognised bony defect
Variable
- may be up to 50% retear over time
- many asymptomatic