@JonnyOrtho @doctorgelber @FixnBones @doctbgriffith @txsportsdoc @ChrisCampMD @MDMillerMDUVA @NuelleSportsMD @AJ_JohnsonMD @ChrisTuckerMD Recon with patient HT vs Quad. Great one to preserve the stump.
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Ian Al’Khafaji
284 posts
Ian Al’Khafaji
@SurfOrthoMD
Hip/Knee Orthopaedic Surgeon 🇦🇺, Doc for @WSL, keen surfer/traveler
Melbourne, Victoria شامل ہوئے Ocak 2021
236 فالونگ101 فالوورز
How would you treat this isolated #ACL tear? Mid 20s, recreational athlete. #orthotwitter @doctorgelber @FixnBones @doctbgriffith @txsportsdoc @ChrisCampMD @MDMillerMDUVA @NuelleSportsMD @AJ_JohnsonMD @ChrisTuckerMD
Athens, GA 🇺🇸 English
@NuelleSportsMD IO repair with 4 suture leads. These loose a bit of extension which will help her. ? RAMP on MRI
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ACL Friday!
Interesting case: how would you treat this isolated tibial sided ACL avulsion in a skeletally mature F (late teens) who also has 10 degrees of knee hyperextension? 1/4
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@generalorthomd @PeltMD @jointdocShields @CenterRotation @NaanDerthaal @tdd340 @ChrisGraysonMD1 Not you that’s for sure!
The argument thats UKAs can just be converted to a “primary TKA” is not always true. Robots can help us avoid poor positioning of implants but they are limited to the quality of the surgical plan.
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@SurfOrthoMD @PeltMD @jointdocShields @CenterRotation @NaanDerthaal @tdd340 @ChrisGraysonMD1 Who said it was well-positioned?
Definitely too much slope, large resection, valgus over correction…and a steep penalty with now having constrained revision implant in his 50s. 😔
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I didn't do the index surgery. Did the slight valgus (over?)correction cause this progression after 5 years? Did well for 4.5 years. Infection workup negative.
@PeltMD @jointdocShields @CenterRotation @NaanDerthaal @tdd340 @ChrisGraysonMD1
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@generalorthomd @PeltMD @jointdocShields @CenterRotation @NaanDerthaal @tdd340 @ChrisGraysonMD1 I think the slope on the tibia was too steep as well which would add to the loose knee flexion gap. I politely disagree that this was a well positioned implant. I am betting that this was not done with a 🤖
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@SurfOrthoMD @PeltMD @jointdocShields @CenterRotation @NaanDerthaal @tdd340 @ChrisGraysonMD1 You, sir, are correct. Needed a CCK. It was the nastiest uni conversion I’ve done.
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@generalorthomd Damn man. Sorry you had to deal with that. This makes me angry. Good argument for 10-year term limits on PDs.
Richfield, OH 🇺🇸 English
6 years ago, 9 months before residency graduation, baby girl arrived!
My pathetic residency director tried to suspend me for missing 7 morning didactic sessions (to take older children to school) after the birth.
I argued this was a blatant FMLA violation. He persisted. 🧵
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@generalorthomd This is what happens when you try to get into a competitive subspecialty with “the match”. Residency programs have all of the power over trainees and they know it. In any other field this would be anti-trust and labor abuse
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@MichaelAlaiaMD @jointdocShields @generalorthomd I don’t understand why someone would do this in leu of an osteotomy
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@jointdocShields @generalorthomd Don’t be haters until you have data showing it’s not safe or effective. Multiple papers out from reputable surgeons showing 85 percent retention rate and high patient satisfaction at 5 years.
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Who thinks this is a good idea for medial compartment knee OA, and who would consider using?
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@jointdocShields Metal moving against metal?
Eccentric cyclical loading of plate and screws for infinity?
A prominent implant with limited soft tissue coverage?
What COULD go wrong? This is a true competitor against the reverse total hip in the “worst ideas ever” competition.
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@MichaelAlaiaMD @MDMillerMDUVA @BruceALevyMD @H2O_SportsMD The media have been out of control this year with the narratives of these major injuries. If the public develops these false expectations of severity of inj and likelyhood of RTS, we should not be surprised that we will continue to have worsening medlegal issues with athletes
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Disclaimer - I love nick Chubb. For the knee to hit a 90 degree angle like that, the ACL and/or PCL would likely have to stretch - SIGNIFICANTLY. (Past point of no return) @MDMillerMDUVA @BruceALevyMD @H2O_SportsMD espn.com/nfl/story/_/id…
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@Stephania_ESPN ~50% return to NFL after multi-ligament knee injury. Chubb already defied the odds from his first knee injury in college. A revision multi-ligament is truly career threatening…not even to mention limb threatening.
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@Patelladoc A RFO is a procedure that is “bigger” for the patient than the surgeon. The surgery is relatively easy to perform but the rehab for the patients is a rough go.
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@SurfOrthoMD It’s a big operation
TTO compensates very well with less risk. Dial it in
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Can’t fix this with a trochleoplasty. Very flat trochlea. Has lateral PF arthritis. Young patient. Scheduled for AMTTO and MQTFLR
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@generalorthomd @waitwtf1 Right on @generalorthomd. We wonder why mental health issues in youth sports are so prevalent. In this age group sports should be a fun social and physical exercise. Putting this much pressure on kids to be mini-professionals is ridiculous.
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@waitwtf1 Why do 9 year olds need to a playbook that requires that much repetition to "get right?" They don't.
I've been the team doctor, am a board certified orthopedic surgeon, and played in the NFL. I understand this world better than most.
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Yes. Have you stayed for practices? They aren’t hitting every day that week. There’s usually only one or two days that they’re even in pads. They’re learning plays, routes & techniques as well as conditioning during that hour each day. Those things take repetition to get right.
Very General Orthopaedist@generalorthomd
My 9 year old has football practice every evening after school from 630-730. Is this normal? It shouldn’t be. There is ZERO value in that volume of practice for a 9 year old. It’s likely detrimental to their school/family life, not to mention burning them out on football.
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Great to see a fellow Floridian become women’s world champ! Great one @Caroline_Marks3! Definitely more great things to come 🏄♂️ 🥇
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@Patelladoc What are your thoughts of rotational DFOs for patients with “excess” hip ante-torsion/version in the setting of PF instability such as this?
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Can anyone answer the question... One potential treatment method is the use of a "Cross brace" to bring the torn ends of a ruptured ACL in closer proximity for healing. But does flexing the knee to 90° really do that?
Cian O Brien@cianobriain
How long have we been around as a species? Would an ACL tear be a death sentence? Highly unlikely. We have overestimated the efficacy of many interventions including surgery e.g. Mosely 2002 placebo surgery. Orgel’s 2nd rule - “Evolution is smarter than you”
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@Hewett1Tim I will answer your question with another question. If you just had an ACL tear, with a painful knee effusion, how compliant are you going to be if instructed to be immobilized to 90 degrees for 4 weeks? How much extension does that patient loose? Rhetorical of course :)
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Ian Al’Khafaji ری ٹویٹ کیا
EXCITING NEWS! 📢 Dr. Kyle Martin will be on the #TedxStCloud stage on October 12! Tickets & more information about the event can be found here ➡️ tedxstcloud.com
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