Evidence-Based Management of Complex Knee Injuries: Restoring the Anatomy to Achieve Best Outcomes

complex knee injuries laprade
	cover 0
	Preface
		Preface
	content
		Evidence-Based Management of Complex Knee Injuries
			Table of Contents
	copyright
		Copyright
	Dedication and Acknowledgments
		Dedication and Acknowledgments
	List of Contributors
		List of Contributors
	Preface
		Preface
	1 Comprehensive Clinical exam
		1 - Comprehensive Clinical Examination
			Introduction
			Clinical Examination Overview
			Patellofemoral Joint
			Tibiofemoral Joint
				Ligamentous Injuries
					Anterior cruciate ligament
					Posterior cruciate ligament
					Posterolateral corner
					Medial collateral ligament and posteromedial corner
					Advanced topics on ligament examination
			Meniscus and Cartilage Injuries
			Functional Assessment
	2 Plain Radiography of the Knee
		2 - Plain Radiography of the Knee
			Introduction
			Radiographic Views of the Knee
				General Approaches: Tips for Plain Film Review and Reporting
				AP View
				Lateral View
				Tangential (Axial/Sunrise/Skyline) Patellofemoral View
				45-Degree Oblique Views
				Weightbearing Semiflexed PA (Rosenberg) View
				Intercondylar (Tunnel) View
				Tibial Plateau (Tillman-Moore) View
				Long-Leg Alignment Views
				Stress Views
				Indications for Radiographs
			Trauma
				Osteochondral Fractures
				Ligament Injuries and Avulsion Fractures
				Dislocations
				Tendon Injuries
				Stress Fractures
				Apophysitis around the Knee
			Pathological Conditions
				Pathological Conditions of the Meniscus
				Calcifications
				Osteochondritis Dissecans
				Knee Effusions
				Conditions Affecting the Patellofemoral Joint
				Osteoarthritis
				Tumours Around the Knee
			Surgical Considerations
				Extraarticular Ligament Reconstruction
				ACL Reconstruction
				PCL Reconstruction
				MPFL Reconstruction
				Multiligament Reconstruction
				Knee Arthroplasty
			Summary
			Acknowledgement
	3 Magnetic Resonance Imaging
		3 - Magnetic Resonance Imaging of the Knee: Conventional and Novel Techniques
			MRI Basics
			Conventional MRI Techniques
				Cartilage
				Meniscus
				Tendon and Ligament
					Anterior and posterior cruciate ligaments
					Medial collateral ligament
				Extensor Mechanism
			Quantitative and Advanced MRI Techniques
				Collagen-Sensitive Techniques
					Quantification of T2 relaxometry
					Quantification of T2* relaxometry
				Proteoglycan-Sensitive Techniques
					Quantification of T1ρ
					Delayed gadolinium enhanced MRI (dGEMRIC)
				Zero Echo Time MRI for Assessment of Cortical Bone
				Conventional and Novel MRI Techniques for Evaluation of Soft Tissue Near Metal
			Summary
	4 Computed Tomography of
		4 - Computed Tomography of the Knee Joint: Indications and Significance
			Three-Dimensional Modelling and Printing in the Complex Knee
			Computed Tomography in Trauma
			Computed Tomography Assessment of Bone Healing and Union
			Computed Tomography and Soft Tissue Injuries
			Primary Anterior Cruciate Ligament Reconstruction
				Mapping and Tunnel Positions
				Tunnel Diameter
			Multiligament Knee Injury and Computed Tomography
			Osteotomy and Computed Tomography
			Patellofemoral Joint Disorders
	5 Mechanical Malalignment
		5 - Mechanical Malalignment of the Knee Joint: How and When to Address
			Introduction
			Normal Knee Alignment
			Biomechanics of the Knee
			Coronal Malalignment
				Varus
				Valgus
			Sagittal Malalignment
			Clinical Assessment
				History
				Physical Examination
			Radiological Assessment
			Choice of Realignment Procedures
				Valgus-Producing Uniplanar Osteotomy
				Varus-Producing Uniplanar Osteotomy
				Uniplanar Sagittal Correction
				Biplanar Osteotomy
			Results
	6 Anterior Cruciate Ligament
		6 - Anterior Cruciate Ligament
			Anatomy
			Biomechanics
			Diagnosis
				Treatment Algorithm (Operative Versus Nonoperative)
				Conservative Approach
				Surgical Techniques
				Outcomes After ACLR
					Graft source
					Drilling technique
					Single bundle versus double bundle ACLR
					Individualised anatomical ACLR
				Rehabilitation and Return to Play After ACLR
				Future Directions
			Summary
	7 Posterior Cruciate Ligament
		7 - Posterior Cruciate Ligament
			Introduction
			Demographic Characteristics
			Anatomy
				Biomechanics
			Diagnosis
				Imaging
			Treatment
				Surgical Reconstruction Techniques
				The Importance of Tibial Slope for Posterior Cruciate Ligament Injuries
			Postoperative Care
			Clinical Outcomes
			Summary
	8 Repair and Reconstruction mcl
		8 - Repair and Reconstruction of the Superficial Medial Collateral Ligament and the Posteromedial Corner
			Introduction
			Anatomy
				Biomechanical Properties of the Medial Knee Structures
				Diagnosis
					Injury classifications
					Clinical evaluation of valgus instability
					Anteromedial instability and posteromedial injury assessment
				Imaging Evaluation of Medial Injuries
					Stress radiography
					Magnetic resonance imaging
					Ultrasonography
				Treatment Algorithm
				Conservative Treatment
				Indications for Surgical Treatment of MCL Lesion
					Indication for medial repair
					Indication for medial reconstruction
			Surgical Techniques
				MCL Repair Techniques
				Anatomical MCL Reconstruction Techniques
					LaPrade-Engebretsen MCL reconstruction technique
					Danish MCL reconstruction technique
				Rehabilitation
				Postop Rehabilitation After MCL Reconstruction
				Expected Outcomes
					Clinical outcome after MCL repair surgery
					Clinical outcome after anatomical MCL reconstruction
			Future Directions
	9 Posterolateral Corner of the Knee
		9 - Posterolateral Corner of the Knee
			Anatomy and Function
				Fibular (Lateral) Collateral Ligament
				Popliteus Tendon
				Popliteofibular Ligament
				Additional Secondary Structures
				Other Important Structures
			Biomechanics
				Role of Posterolateral Structures in Preventing Varus Rotation
				Role of PLC in Preventing Anterior Translation
				Role of the PLC in Preventing Posterior Translation
				Role of PLC in Preventing Internal Rotation
				Role of the PLC in Preventing External Rotation
				Biomechanical Failure of the PLC Structures of the Knee
				The Effects of Deficient PLC Structures on Cruciate Ligament Grafts
				Mechanism of Injury
			Presentation of Injury
			Physical Examination
			Imaging
			Classification
			Nonoperative (Conservative) Treatment
			Surgical Treatment Options
				Repair Versus Reconstruction
					Nonanatomical fibular-based reconstruction
					Nonanatomical two-tunnel reconstruction
					Anatomical reconstruction
			Outcomes
				Posterolateral Corner Repair
				Posterolateral Corner Reconstruction
				Comparison: Reconstruction Versus Repair
				Rehabilitation
			Conclusion
	10 Anterolateral Ligament and corner
		10 - Anterolateral Ligament and the Anterolateral Corner
			Introduction
			Anatomy
			Histology
			Biomechanics
			Diagnosis
				Clinical Diagnosis
				Diagnostic Imaging Procedures
			Treatment Algorithm
			Reconstruction Technique
				Femoral Socket Identification
				Tibial Socket Identification
				Isometry Test
				Tibial and Femoral Socket Preparation
				Graft Passage and Fixation
				Postoperative Protocol
			Outcomes
			Summary
	11 multiligament knee injury
		11 - Multiligament Knee Injuries
			Introduction
			Epidemiology and Injury Patterns
				Neurovascular Injury
				Classification
			Diagnosis
				History
				Physical Examination
				Imaging
			Treatment
				Operative Treatment
					Ligament repair
					Ligament reconstructions
					Anatomical reconstructions
					Timing of surgery
				Intraoperative Challenges
					Tunnel convergence
					Ligament tensioning
				Outcomes
	12 Arthroscopic Primary Repair of the Cruciate Ligaments
		12 - Arthroscopic Primary Repair of the Cruciate Ligaments
			Introduction
				History of Primary Repair
				The Rationale for Modern-Day Repair
				Indications and Patient Selection
					Patient Selection
					Preoperative Imaging
					Eligibility for Repair
					Timing of Surgery
			Treatment Algorithm
				Surgical Technique
				General Preparation
				Operative Technique for Proximal ACL Tears
				Additional Suture Augmentation
				Other ACL Repair Techniques
				Midsubstance ACL Tears
				ACL Repair with Dynamic Intraligamentary Stabilisation
				Operative Technique for Distal ACL Tears
				Operative Technique for Proximal PCL Tears
				Other PCL Repair Techniques
				Operative Technique for Distal PCL Tears
			Rehabilitation
			Outcomes
				Outcomes of Proximal ACL Repair
				Outcomes of ACL Repair in Children and Adolescents
				Outcomes of DIS Repair
				Outcomes of Proximal PCL Repair
			Future Directions
			Conclusions
	13 Meniscal Pathology Meniscus Anatomy
		13 - Meniscal Pathology: Meniscus Anatomy
			Introduction
			Gross Anatomy
				Medial Meniscus
				Lateral Meniscus
			Associated Ligaments
				Meniscal Roots
				The Anterior Intermeniscal Ligament
				Meniscotibial Ligaments
				Popliteomeniscal Fascicles
				Meniscofibular Ligament
				Meniscofemoral Ligaments
				Microstructure
			Vascular Anatomy
	14 Meniscus Biomechanics
		14 - Meniscus Biomechanics
			Introduction
			Meniscus Kinematics
				Material Properties of the Meniscus
					Viscoelasticity
					Compressive properties
					Tensile properties
					Shear properties
				Functional Properties of the Meniscus
					Load transmission
					Joint stability
					Joint lubrication and nutrition
					Proprioception
					Shock absorption
				Biomechanical Properties of the Meniscus-Associated Ligaments
					Anterior intermeniscal ligament
					Deep medial collateral ligament
					Meniscofemoral ligaments
					Meniscotibial ligaments
					Meniscofibular ligaments
			The Effects of Aging on the Menisci
				Effect of Meniscal Tears on Biomechanical Function
					Vertical tears
					Horizontal tears
					Radial tears
					Root tears and avulsions
			Conclusion
	15 Meniscal Tears Meniscectomy Versus Repair
		15 - Meniscal Tears: Meniscectomy Versus Repair
			Introduction
			The ‘Routine’ Meniscectomy
			The Delayed Trend Towards Repair
				The Decision for Athletes
			Indications for Meniscal Repair
				Traumatic Versus Degenerative Tears
				Concomitant Ligamentous Injuries
				Vascularity of Torn Region
			Common Tear Patterns
				Vertical Tear
					Operative Management for Vertical Tears
				Horizontal Cleavage Tear
					Operative Management for Horizontal Cleavage Tears
				Radial Tear
					Operative Management for Radial Tears
			Meniscal Repair With Sutures: Techniques
				Diagnostic Arthroscopy
				All-Inside Repair
					All-inside technique
				Inside-Out Repair
					Inside-out technique
				Outside-In Repair
					Outside-in technique
				Transtibial Two-Tunnel Repair
					Transtibial two-tunnel technique
			Postoperative Rehabilitation Protocols
				Meniscectomy Postoperative Rehabilitation
				Meniscal Repair Postoperative Rehabilitation
			Meniscal Repair Enhancement
				Bone Marrow Venting Procedure
				Fibrin Clot
				Platelet-Rich Plasma Injections
				Bone Marrow Aspirate and Stem Cells
				Biomaterials
				Clarifying the Usage of Biologics
			Failed Meniscal Repair
			Summary
	16 Meniscal Root Tears
		16 - Meniscal Root Tears
			Introduction
			Anatomy
				Medial Meniscus
				Lateral Meniscus
			Biomechanics and Pathology
			Diagnosis
			Evaluation
				Classification
			Clinical Diagnosis
				Imaging
			Treatment Algorithm
				Nonoperative Treatment
				Meniscectomy
				Surgical Repair Options, Outcomes and Techniques
					One-Tunnel Technique
					Two-Tunnel Technique
					Rehabilitation
			Conclusions
	17 Meniscal Radial Tears
		17 - Meniscal Radial Tears
			Introduction
			Pathoanatomy and Biomechanics
			Diagnosis
			Surgical Treatment
				Repair With Transtibial Tunnels
				Repair With Side-to-Side Sutures Outside In
				Repair With Side-to-Side Sutures All Inside
			Postoperative Management
			Results
			Summary
	18 Meniscal Ramp Lesions
		18 - Meniscal Ramp Lesions
			Introduction
			Anatomy
			Biomechanics
			Diagnosis
				Imaging
				Clinical Characteristics
				Clinical Characteristics
				Intraoperative
			Treatment Strategies
				Meniscal Healing
				Repair Techniques and Outcomes
	19 meniscus defiecency and transplant
		19 - Meniscus Deficiency and Meniscal Transplants
			Introduction
			Patient Selection
			Graft Preservation and Preparation
				Graft Sizing
			Surgical Technique
			Concomitant Pathological Conditions
			Outcomes
				Postoperative Period, Rehabilitation and Return to Sport
			Conclusions
	20 Synthetic Meniscal Substitutes
		20 - Synthetic Meniscal Substitutes
			Introduction
			Tissue Engineering and the Meniscus
				Scaffolds for Meniscus Replacement
					Hydrogels
				Biological Scaffolds for Meniscus Replacement
					Collagen
					Hyaluronic acid
					Silk fibroin
				Synthetic Scaffolds for Meniscus Replacement
					Polyglycolic acid
					Poly-l-lactic Acid and poly-d-lactic acid
					Composite polymer scaffolds
			3D-Printed Meniscus
				Meniscal Scaffolds in Clinical Use
					Collagen Meniscal implant
					Actifit
			Conclusions
			Under Investigation
	21 Basic Science Understanding of Cartilage Repair and Its Clinical Application
		21 - A Basic Science Understanding of Cartilage Repair and Its Clinical Application
			The Osteochondral Unit and Biology of Cartilage Repair
				Articular Cartilage
					Components of Articular Cartilage
				Zone Organisation
				Chondrocytes
				Synovial Fluid
				Subchondral Bone Architecture and Function
				Physiological Transport
				Biology of Osteochondral Repair
				Molecular Factors That Contribute to Repair
			Pathology and Repair
			Basic Techniques of Osteochondral Grafting
	22 Focal Chondral Injuries
		22 - Focal Chondral Injuries
			Introduction
			Microscopic Anatomy of Articular Cartilage
			Diagnosis
				Patient History
				Physical Examination
				Imaging
				Biomarkers
				Diagnostic Arthroscopy
			Nonsurgical Management
			Surgical Treatment Algorithm
				Extrinsic Factors
				Extrinsic Factor I: Malalignment
				Extrinsic Factor II: Meniscal Pathological Conditions
				Extrinsic Factor III: Ligamentous Insufficiency and Knee Instability
				Defect size
				Defect location
			Surgical Techniques
				Debridement
				Abrasion Arthroplasty
				Microfracture
				Osteochondral Autograft Transplantation
				Osteochondral Allograft Transplantation
				Cellular Techniques
					Scaffolds: matrix-induced autologous chondrocyte implantation
					Third-generation ACI (MACI analogue or NOVOCART 3D)
					Minced cartilage (DeNovo Natural Tissue)
					Viable osteochondral allografts (Cartiform)
					Extracellular matrix scaffolds (micronized allogeneic cartilage, or BioCartilage)
			Rehabilitation
				Patellofemoral Lesions
				Tibiofemoral Lesions
			Clinical Outcomes
				Microfracture
				Osteochondral Allograft Transplantation
				Osteochondral Autologous Transplantation
				Autologous Chondrocyte Implantation and Matrix-Induced ACI
				Third-Generation ACI (MACI Analogue; NOVOCART 3D)
				Minced Cartilage (DeNovo Natural Tissue)
				Viable Osteochondral Allografts (Cartiform)
				Extracellular Matrix Scaffolds (Micronized Allogeneic Cartilage, or BioCartilage)
			Summary
	23 OCD Injuries in the Paediatric and Adult Population
		23 - OCD Injuries in the Paediatric and Adult Population
			Introduction
			Epidemiology
			Anatomy and Pathogenesis
			Natural History
			Patient History and Physical Findings
			Imaging and Diagnostic Studies
			Diagnosis and Classification
			Nonoperative Management
			Operative Management
				Reparative Procedures
					Drilling
					Loose body excision
					Internal fixation
				Restorative Procedures
					Microfracture
					Osteochondral autograft transplantation
					Osteochondral allograft
					Autologous chondrocyte implantation
	24 How to Manage the Active Patient with Osteoarthritis Biological Approaches
		24 - How to Manage the Active Patient with Osteoarthritis: Biological Approaches
			Introduction
			Indications
			Platelet-Rich Plasma
				Protocols
				Clinical Outcomes
			Bone Marrow Aspirate Concentrate
				Clinical Outcomes
			Adipose-Derived Mesenchymal Stem Cells
			Alternative Therapies
			Orthopaedic Societal Statements on Orthobiologic Use for Osteoarthritis
			Conclusion
	25 Osteonecrosis of the Knee
		25 - Osteonecrosis of the Knee
			Introduction
			Spontaneous Osteonecrosis
				Aetiology and Pathogenesis
				Clinical Presentation and Diagnosis
				Treatment
					Nonsurgical management
					Surgical management
			Secondary Osteonecrosis
				Aetiology and Pathogenesis
				Clinical Presentation and Diagnosis
				Treatment
					Nonsurgical management
					Surgical management
			Postarthroscopic Osteonecrosis
				Aetiology and Pathogenesis
				Clinical Presentation and Diagnosis
				Treatment
					Nonsurgical management
					Surgical management
	26 Patellofemoral Anatomy and Its Surgical Implications
		26 - Patellofemoral Anatomy and Its Surgical Implications
			Medial Patellofemoral Anatomy
				Proximal Medial Patellar Complex
					Surgical Correlation for Proximal MPFC Patellar Attachment Sites
					Surgical Correlation of Proximal MPFC Femoral Insertion
				Distal Medial Patellar Complex
					Surgical Correlation
				Lateral Patellofemoral Complex
					Biomechanics
				Surgical Correlation
			Conclusions
	27 Treatment Algorithm in Patellofemoral Disorders ‘Le Menu à la Carte’
		27 - Treatment Algorithm in Patellofemoral Disorders: ‘Le Menu à la Carte’
			Patellofemoral Instability
				Trochlear Dysplasia
					Imaging
					Surgical treatment
				Patella Alta
					Imaging
					Surgical treatment
				Malalignment Issues
					Local: TT-TG distance
					Global (torsional rotations): femoral anteversion
					Tibial external rotation
					Coronal: knee valgus
					Patellar tilt
			Summary
	28 Tibial Tuberosity Osteotomies
		28 - Tibial Tuberosity Osteotomies
			Introduction
				Patient History
				Knee Physical Examination
				Limb and Patellofemoral Alignment and Tracking
					Tibiofemoral alignment
					Lateral quadriceps vector
					Patellar height
					Patella positioning
					Patellar tracking
				Imaging for Soft Tissue and Cartilage Status Evaluation
				Arthroscopy
			Tibial Tuberosity Osteotomy Biomechanical Effects
			Tibial Tuberosity Osteotomy Indications
			Indications of Anteromedialisation Tibial Tuberosity Osteotomy
			Outcomes in Pathological Conditions of the Patellofemoral Cartilage
			Indications of Medialisation Tibial Tubercle Osteotomy
			Outcomes in Patellofemoral Instability
			Anteromedialisation and Medialisation Tibial Tubercle Osteotomy Technique in Isolation
			Indications of Distalisation Tibial Tuberosity Osteotomy
			Outcomes in Patellofemoral Instability
			Distalisation Tibial Tuberosity Osteotomy Technique in Isolation
				Lateralisation
				Anteriorisation
				Anterolateralisation
				Proximalisation
				Factors That Influence Decisions Regarding Tibial Tuberosity Osteotomy
			Rehabilitation
			Complications
			Summary
	29 Pathological Torsion of the Lower Limb
		29 - Pathological Torsion of the Lower Limb
			Intrinsic and Extrinsic Limb Factors
			Abnormal Limb Torsion Is Not a New Concept
			Physical Examination and Radiological Work-up for Torsion
			Surgical Details
			Surgical Steps and Tips for AO Proximal Femoral Rotational Osteotomy
			Postoperative Rehabilitation
			Results
			Conclusions
	30 Lateral Patellar Instability
		30 - Lateral Patellar Instability: Diagnosis, Treatment Algorithm, Conservative Approaches, Surgical Techniques, Outcomes, Rehabilitation and Future Directions
			Introduction
			Diagnosis
				Patient History
				Physical Examination
				Imaging
			Treatment
				Conservative Treatment
				Surgical Technique
					Medial patellofemoral ligament reconstruction technique
					Medial quadriceps tendon femoral ligament reconstruction
			Rehabilitation
			Outcomes
				Conservative Management Versus Medial Patellofemoral Ligament Reconstruction
				Medial Patellofemoral Ligament Reconstruction
				Medial Patellofemoral Ligament Repair
				Medial Quadriceps Tendon Femoral Ligament Reconstruction
				Return to Sport
				Concurrent Procedures
			Future Directions and Summary
	31Medial Patellar Instability Primary and Iatrogenic
		31 - Medial Patellar Instability: Primary and Iatrogenic
			Introduction
			Evaluation
				Imaging
			Noniatrogenic Medial Patellar Dislocation
			Iatrogenic Medial Patellar Dislocation
			Treatment
			Summary
	32 Trochleoplasty
		32 - Trochleoplasty
			Introduction
			Anatomy and Biomechanics of the Trochlea
			Clinical Evaluation and Diagnosis
			Imaging and Classification of Trochlear Dysplasia
			Role of Trochlear Dysplasia in Recurrent Patellar Instability
			Trochleoplasty Procedure
				Goals
				Indications and Contraindications
				Techniques
				Postoperative Rehabilitation
			Clinical and Radiographic Outcome After Trochleoplasty
				Trochleoplasty Impact on Stability
				Trochleoplasty Impact on Subjective Outcome
				Trochleoplasty Impact on Patellofemoral Dysplasia
					Anchor 177
						Anchor 178
				Trochleoplasty Complications
			Summary
	33 Injuries of the Patellar Tendon
		33 - Injuries of the Patellar Tendon
			Acute Tears of the Patellar Tendon
				Anatomy
					Epidemiology
					Risk Factors
					Rupture Mechanism
					Diagnosis
					Treatment
					Rehabilitation
					Functional Outcomes
					Patellar Ruptures and Total Knee Arthroplasty
				Patellar Tendinopathy
					Introduction
					Diagnosis
					Conservative Treatment
					Surgical Treatment
			Conclusions
	34 Quadriceps Tendon Injuries
		34 - Quadriceps Tendon Injuries
			Epidemiology
			Anatomy, Biomechanics and Pathogenesis
			History and Physical Examination Findings
			Imaging and Diagnostic Studies
			Operative and Nonoperative Treatment
				Repair at the Bone–Tendon Interface Using Transosseous Bone Tunnels
				Knotless Technique
				Screw-in Anchors
			Postoperative Management
			Clinical Outcomes
			Summary
			Acknowledgement
	35 Knee Arthrofibrosis  How to Prevent and How to Treat
		35 - Knee Arthrofibrosis: How to Prevent and How to Treat
			Introduction
			Pathophysiology
			Risk Factors
			Prevention of Arthrofibrosis
			Clinical Presentation
			Nonsurgical Management
				Physical Therapy
				Continuous Passive Motion
				Postoperative Bracing
			Surgical Treatment
				Manipulation Under Anaesthesia
				Arthroscopic Releases for Improving Flexion
					Suprapatellar and peripatellar releases
				Arthroscopic Releases for Improving Extension
					Anterior interval release
					Intercondylar notch
					Posterior capsular release
				Postoperative Protocol
			Outcomes
			Conclusion
	36 pediatric knee
		36 - The Paediatric Knee
			Introduction
			Growth-Related Considerations
			Paediatric Knee Assessment
				Physical Examination
				Imaging
			Anterior Cruciate Ligament Ruptures
				Unique Concerns in the Paediatric Population
				Surgical Treatment Options
				Physeal-Sparing Iliotibial Band Reconstruction
					Technique
					Outcomes
				All-Epiphyseal Reconstruction
					Technique
					Outcomes
				Partial Transphyseal and Transphyseal Reconstructions
					Technique
					Outcomes
				Postoperative Concerns – Reinjury and Revision Surgery
				Summary
			Meniscal Injuries
				Development
				Diagnosis
				Nondiscoid Meniscus
					Treatment Options
					Outcomes
				Discoid Meniscus
					Diagnosis
					Treatment Options
					Outcomes
			Patellar Instability
				Decision Making – Unique Concerns in the Paediatric Population
				Nonsurgical Treatment Options
				Surgical Treatment Options
					Guided Growth
					Congenital and Obligate/Fixed Dislocations
					Proximal Realignment
					Distal Realignment
				Osteochondral Fractures and Chondral Injuries
					Diagnosis
					Treatment Options
				Summary
			Tibial Eminence Fractures
				Epidemiology and Pathophysiology
				Diagnosis
				Treatment Options
					Nonsurgical Treatment
					Surgical Treatment
				Outcomes and Complications
				Summary
	37 miscillaneus
		37 - Miscellaneous Complex Pathological Conditions of the Knee
			Introduction
			Lateral Patellar Facetectomy
				Preoperative Evaluation
				Surgical Technique
				Postoperative Rehabilitation
				Outcomes
			Fabella Excision for Fabella Syndrome
				Preoperative Evaluation
				Surgical Technique
					Preoperative setup
					Incision and exposure
				Postoperative Rehabilitation
				Outcomes
			Arthroscopic Notchplasty
				Presentation
				Treatment
				Outcomes
				Conclusions
			Snapping Hamstring Syndrome
				Presentation
				Treatment
				Discussion
				Conclusions
			Proximal Tibiofibular Joint Instability
				Anatomy
				Classification
				Treatment
				Surgical Technique
				Postoperative Protocol
				Conclusions
			Patella Baja
				Diagnosis and Surgical Indications
				Surgical Technique
				Postoperative Rehabilitation Protocol
				Further Surgical Intervention
			Summary
	38 intraoperative Management Anaesthesia Tourniquet  Tranexamic Acid Blood Loss and Fluid Management
		38 - Intraoperative Management: Anaesthesia, Tourniquet, Tranexamic Acid, Blood Loss and Fluid Management
			Introduction
			Anaesthesia Considerations for Patients with Knee Injuries
				Anaesthetic Choice and Perioperative Analgesia
			Intraoperative Fluid Management
			Management of Blood Loss During Complex Knee Surgery
				Pneumatic Tourniquet
				Topical and Systemic Antifibrinolytic Agents
	39Preparing the Surgical Team for a Quick and Efficient Procedure
		39 - Preparing the Surgical Team for a Quick and Efficient Procedure
			Introduction
			The Importance of Orthopaedic Surgical Team Teamwork and Efficiency
				Teamwork in the Operating Room: An Efficient Operating Room Is Financially Sound
				Teamwork in the Operating Room: A Cohesive, Efficient Operating Room Is Safer for Patients
				Teamwork in the Operating Room: Effective Teams Stay Together
			Defining the Orthopaedic Surgical Team
				Surgeon
				Physician Assistants
				Athletic Trainer
				Anaesthesia Personnel
				Surgical Technician
				Registered Nursing Staff
				Medical Device Representative
				Imaging Support Personnel
				Students, Residents and Fellows
				Nontraditional Roles of the Orthopaedic Surgical Team
			Characteristics of a Highly Functional Orthopaedic Surgical Team
				Team Composition
				Communication
				Checklist Utilisation
				Present, Transformational Leadership
				Reflection and Learning
			General Orthopaedic Surgical Team Preparation: Day(s) Before Operating
				Core Team Preparation Day(s) Before Operation
					Patient history
					Procedure
					Imaging
					Anticipated changes and complications
				‘Noncore’ Team Member Preparation Day(s) Before Operation
			General Orthopaedic Surgical Team Preparation: Day of Operation
				Preparation of the Operating Room
				Preparation of the Patient
			Orthopaedic Surgical Team Preparation for Complex Knee Procedures
				Diagnosis and Preoperative Considerations of Cartilage Injuries
				Preparation for Surgical Intervention for Cartilage Repair
				Preparations and Considerations for Cartilage Repair: Cartilage Resurfacing Techniques
			Multiligament Knee Reconstructions
				Diagnosis, Imaging and Preoperative Considerations of Multiligament Knee Injuries
				Preparation for Multiligament Knee Surgery: Patient Positioning and Approach
				Preparation for Multiligament Knee Surgery: Graft Considerations
				Preparation for Multiligament Knee Surgery: Tunnel Placement
				Preparation for Multiligament Knee Surgery: Tensioning Sequence
			Meniscus Repair Procedures
				Preoperative Considerations and Considerations for Meniscus Procedures
				Preparation for Surgical Meniscus Repair
				Preparation for Surgical Meniscus Transplant
				Orthopaedic Surgical Team Surgical Preparation for Complex Knee Procedures: Summary
	40 Postoperative Management
		40 - Postoperative Management
			Introduction
			Patient and Family Education and Expectations
			Pain Control
				Intraoperative Nerve Block
				Periarticular Injections
				Oral Medications
				Cryotherapy
			Thromboprophylaxis
				Incidence of Deep Vein Thrombosis and Pulmonary Embolism
				Mechanical Prophylaxis
				Pharmacological Prophylaxis
			Wound Care
			Complications
				Fever
				Infection
				Frostbite
				Arthrofibrosis
			Summary
41 Postoperative Rehabilitation Concepts
	41 - Postoperative Rehabilitation Concepts
		Introduction
		Rehabilitation Phases
			Acute Phase
			Periodisation
			Endurance Phase
			Strength Phase
			Power Phase
		Return-to-Sport Testing and Decision Making
			Timing
			Quadriceps Index
			Hop and Agility Testing
			Biomechanics
			Subjective Outcome Assessments
			Conclusions for Return to Sport
		Summary