Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Posterior Medial Corner Injuries

SYMPTOMS

The symptoms are acute posterior and medial knee pain and haemarthrosis, which is caused by bleeding from the ruptured posterior medial capsule. Since the capsule ruptures, the extent of bleeding is often underestimated. This injury is fairly uncommon but occurs in contact sports such as football, rugby and others.

AETIOLOGY

The typical athlete suffers a hyperextension and valgus rotation sprain. The capsule can rupture partially or completely. This injury is often associated with other injuries to the medial meniscus, cartilage or other ligaments, in particular the medial collateral ligament.

CLINICAL FINDINGS

There is haemarthrosis in most cases. The capsule rupture will make blood penetrate from the joint and cause bruising. With the foot in internal rotation the posterior drawer test shows increased laxity if the rupture is complete but this injury is often missed clinically and found only during arthroscopy or MRI. Since there are often associated injuries, examination must also include tests for other ligaments, menisci and cartilage.

INVESTIGATIONS

Clinical examination is the most important tool for diagnosis and should include tests for all ligaments and other structures in the knee. MRI can verify a capsule tear in most cases but this injury is often noted first on arthroscopy.

TREATMENT

An athlete with haemarthrosis and suspected posterior medial capsule tear should be seen by an orthopaedic surgeon to consider arthroscopy. This procedure can verify the diagnosis and deal with associated injuries that are often missed. This injury may require early open or arthroscopic surgery or bracing over six to twelve weeks.

REFERRALS

Refer to Dr Kevin Yip (+65 9724 1219) senior consultant orthopaedic surgeon for further investigations to verify the extent of the injury. Physiotherapists will be involved in close collaboration with the surgeon.

EXERCISE PRESCRIPTION

Cycling and swimming (but not breaststroke) are good alternatives to keep up general fitness. Rehabilitation back to full sport usually takes around six months.

EVALUATION OF TREATMENT OUTCOMES

Monitor clinical symptoms and signs. Different functional knee scores for different sports are available to measure when the knee allows a return to full sport.

DIFFERENTIAL DIAGNOSES

PCL rupture.

PROGNOSIS

There is very little data regarding the outcome of this particular injury.

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