Sports Medicine and Arthroscopy
Principles of Sports Medicine
Candidates must understand ligament injuries (ACL, PCL, MCL, LCL), meniscal tears, cartilage lesions, tendinopathy, and shoulder instability. Know mechanisms, clinical tests, imaging, and treatment algorithms (nonoperative vs operative, rehabilitation).
Key Concepts
- ACL injury: Mechanism: noncontact deceleration/pivot. Tests: Lachman (most sensitive), pivot shift (most specific). Associated injuries: meniscal tears, MCL sprain. Treatment: reconstruction in active patients; rehabilitation for low-demand.
- Meniscal tears: Classification (vertical, horizontal, oblique, radial, flap). Red-red zone (peripheral, vascular) vs red-white vs white-white (avascular). Repair if possible; meniscectomy if not.
- Shoulder instability: Bankart lesion (labral tear), Hill-Sachs lesion (humeral head impaction). Apprehension test, relocation test. Treatment: arthroscopic Bankart repair vs open (Latarjet for bone loss).
- Rotator cuff tears: Supraspinatus most common. Tests: Neer, Hawkins, Jobe's (empty can). Treatment: physical therapy first; surgery for acute full-thickness tears in young patients.
- Cartilage: Microfracture, osteochondral autograft transfer (OATS), autologous chondrocyte implantation (ACI).
Traps
- ACL reconstruction: Graft choice (bone-patellar tendon-bone vs hamstring vs quadriceps). Complications: arthrofibrosis, graft failure, infection.
- Meniscal repair: Best outcomes in peripheral tears <2 cm, in young patients.
- Shoulder dislocation: Recurrence rate high in young athletes; consider surgery after first dislocation.
- Rotator cuff: Massive tears may require tendon transfer or reverse shoulder arthroplasty.
Worked Example
A 22-year-old soccer player sustains a noncontact knee injury with a pop. Exam: positive Lachman and pivot shift. MRI shows ACL tear and a peripheral meniscal tear. Rule of thumb: ACL reconstruction is indicated in young active patients; meniscal repair should be attempted if tear is in the vascular zone (<3 mm from periphery). Rehabilitation is crucial; return to sport after 9-12 months.