November 19, 2015

Does everyone who has ruptured her/his ACL need a knee reconstruction? Prof Mark Hutchinson

18 minutes

Dr. Mark Hutchinson is professor of orthopaedics and head of the sports medicine services at the University of Illinois College of Medicine. He has been a team physician for the WNBA Chicago Sky, USA gymnastics, USA Field Hockey, USA Basketball and Team USA at two World University Games and the Paralympics Games.

In this second of a two-part set, he discusses management of the patient who presents with recent onset of acute knee pain. You might be surprised by some of what this orthopaedic surgeon says!

Timeline:

1:30m - Does everybody who ruptures an ACL need a knee reconstruction?

2:00m - How do you advise the person who wants to play soccer?

3:00m - How can you tell whether someone will make a good recovery or not with exercise therapy (not surgery)?

4:00m - OK for patients to go through a trial of physio to see if they are going to be stable or not

5:30m - Management of children who rupture their ACL. It’s a hot topic. On the one hand kids may be less compliant with ACL-risky behaviours than adults; on the other hand, operating and crossing growth plates can cause significant problems

7:30m - The key study by Håvard Moksnes and Lars Engebretsen – ACL injuries in kids (http://www.ncbi.nlm.nih.gov/pubmed/26025937) (not open access)

7:45m - How to discuss ACL management options with patients directly – ‘Tell us what you say to the patient Hutch’ (An introduction to shared decision-making)

9:15m - Non-operative, quality physiotherapy for ACL deficient patients

10:15m - Does ACL reconstruction prevent osteoarthritis?

11:15m - The elephant in the room – what about management of the patient whose ACL reconstruction has reruptured?

12:45m - Injuring the other knee – a disaster that occurs all too often!

13:30m - Psychological factors: a neglected part of the equation? http://bjsm.bmj.com/content/48/21/1543.abstract

14:30m - Return to play after reconstruction: the mind matters too! What is the optimal time for collagen healing? Coordination training, functional tests.

16:45m - Return to play with an unoperated knee: with a focus on neuromuscular training exercises

Links:

Previous BJSM podcasts:

Pearls on knee examination: http://ow.ly/UBy3v

Pearls on treating shoulder conditions and one wrist bonus: http://ow.ly/UBym

YouTube videos on Physical Examination have been viewed more than 5 million times! https://www.youtube.com/user/BJSMVideos

YouTube video: 39-minute lecture by Associate Editor Dr Clare Ardern on similar issues – return to play after ACL injury https://youtu.be/P_JJf0h6rhU

Want a replay from last week? (1st podcast in this set) A 40-year old patient presents with an acute exacerbation of knee pain – Professor Hutchinson discusses whether arthroscopy is helpful in the arthritic knee. Which ones need orthopaedic referral?

https://soundcloud.com/bmjpodcasts/mark-hutchinson?in=bmjpodcasts/sets/bjsm-1

Return to Play conference 2016: April 9-11, London (UK). The immensely successful annual Football Medicine Strategies conference focuses on Return to Play for all football injuries – not just ACL. Give this one serious consideration – top programme with over 100 invited speakers, terrific international audience (you will feel at home), friendly atmosphere and convenient venue. All the benefits of London without the need to own an expensive home there! http://www.footballmedicinestrategies.com/en/

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