Escolar Documentos
Profissional Documentos
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Rizki Rahmadian
Bagian Bedah FK Unand/ RS. Dr. M. Djamil
Padang
Sendi Lutut
Tulang
Patella
Tibia
Fibula
Sendi Lutut
Ligament
Anterior Cruciate
Ligament (ACL)
Posterior Cruciate
Ligament (PCL)
Medial Collateral
Ligament (MCL)
Lateral Collateral
Ligament (LCL)
Popliteal Ligament
Sendi Lutut
Meniskus
Crescent shape
Fibrocartilaginous
Vascularized : arteri
genikular lateral dan
medial
20-30% meniskus
medial dan 10-25%
meniskus lateral
Medial : C shape
Anamnesis dan
Pemeriksaan Fisik
Mekanisme Injuri
Posisi sendi lutut saat terjadi cedera
Weight supporting
Varus atau valgus
Cedera kontak atau non kontak
Cedera non kontak dengan sesasi bunyi
pop : cedera ACL
Cedera kontak dengan sensasi bunyi
pop : cedera ligament kolateral,
meniskus atau fraktur
Hemarthrosis
Penyebab
hemartrosis
1. Ruptur ACL PCL
2. Tear Meniskus
3. Fraktur
osteokondral
4. Robekan kapsul
sendi
Pembengkaan
Evaluasi lengkap
pembengkakan
Intra atau ekstraartikuler
Lokasi pembengkakan
ekstraartikuler
Derajat pembengkaan :
mild, moderate, severe
Akut atau sub akut
Lesi osteokonral
Robekan meniskus
Ruptur Cruciate Ligament
Ruptur collateral ligament
Knee injuries
LESI OSTEOKONRAL
Hunter 1743
From Hippocrates to present age,
it is universally allowed that
ulcerated cartilage is a trouble some
thing & that once destroyed, is not
repaired
Type IV
defect
Cartilage
Cartilage is marvelous:
tough, elastic, durable.
ICRS Arthroscopic
Classification
Lesion Thickness
Grade 0: Normal
Grade I:
Superficial
fissures
Grade II:<1/2
depth
ICRS Arthroscopic
Classification
Lesion Thickness
Grade III: >50%
depth but not thru
subchondral plate.
Grade IV: lesion thru
subchondral plate
OCD lesions
AVN lesions
Treatment options
Some light is now seen at the end of centuries
old dark tunnel.
Benign neglect
Debridement
Pridies perforations
Abrasio Arthroplasty
Kevins Morselized osteochondral mixture
Steadmanns Microfracture
Periosteal Grafting
Perichondrial Grafting
Osteochondral Allograft
Osteochondral Autograft
Mosaicplasty
ACI
Biomaterials
Tujuan Penatalaksanaan
Mengembalikan permukaan tulang rawan
Regenerasi hyalin atau hyalin like
Ideal.
Microfracture
Menghasilkan
fibrocartilage
Bertahan sampai 10 th
Mosaicplasty
Osteochondral graft selinder
Dari permukaan NWB
Ke permukaan WB
Indications:
Non degenerative
1.5 to 4 cm2
Isolated
Absolute contraindications:
Age > 50
Size > 4-8 cm2
Depth > 10 cm.
Hangody et al. JBJS-Am. March 2004; 86-A supp 1: 65-72.
Hangodys Mosaicplasty
831 cases
12-13 years of F/U
Natural History
Good/Excellent results
Type of cartilage:
Hyaline or like 92% femoral condyle
87% in Tibial resurfacing
Life:
79% in patella/ Trochlea
medium to long
Donor site morbidity: 3%
term
good results
Cost: 11000$
only
Knee injuries
RUPTUR MENISKUS
ANATOM
Perimeniscal capillary
plexus (PCP) :
vaskularisasi menuskus
dari perifer
Mekanisme Injuri
Tipe Robekan
Pemeriksaan Fisik
Nyeri saat menerima berat badan
tubuh dan rotasi sendi lutut
Nyeri tekan pada garis sendi
Gejala mekanik : popping, givingway, pembengkakan, locking
Gelaja hilang dengan melakukan
reduksi fragment meniskus secara
manual
Pemeriksaan Fisik
McMurray test
Apley test
etc
IMAGING (MRI)
Penetalaksanaan
Konservatif
Operatif:
Open technique
Inside-out
Outside-in
All inside
Meniscus transplantation
Partial meniscus replacement
SURGICAL TECHNIQUES
Open techniques
An inside-out technique
using vertical sutures
An outside-in technique
using horizontal sutures
An all inside using a
meniscal fixation device
A 10mm meniscal
fixation device
(Biostinger)
Knee injury
CEDERA ANTERIOR
CRUCIATE LIGAMENT
ACL
Anatomi
ACL adalah satu dari 4
ligamentum yang menstabilkan
sendi lutut
Melindungi meniskus dan
permukaan rawan sendi
ACL mencegah translasi anterior
tibia dan internal atau eksternal
rotasi tibia terhadap femur
Mekanisme Cedera
Cedera ACL terjadi
ketika tekanan yang
besar dari bagian
anterior saat posisi
lutut iperekstensi
Robekan biasanya
terjadi pada bagian
tengah ligament,
bagaimanapun robekan
pada bagian proksimal
atau distal dapat terjadi
Diagnosis
Gejala klinis cedera ACL
Anamnesis
Ketahui mekanisme cedera
Sesasi pop dan nyeri
Diagnosis
Diagnosis
History and presentation
+ Lachmans or Anterior Drawer
Imaging
X-ray (avulsion)
MRI
Drawer Sign
Treatment
Rehabilitation
Prehab (Gold-standard)
Implemented immediately after diagnosis
Decrease pain and swelling
Increase ROM, quad strength, and proprioception
>90% of contralateral leg
Prehab allows for quicker post-operative return to
ADLs and physical activity
Rehab
Progression varies depending on graft choice
Also focuses on decreasing pain and swelling, while
increasing ROM, strength, and proprioception
Treatment
Graft choices (4 most commonly used)
Surgical Technique
Surgical Technique
Harvest graft
Expose joint
Remove damaged
ACL, clean, and
make room for new
ACL
Drill tibial and
femoral tunnels
Insert new ACL with
bone plugs (button
approach shown)
Thank You