The Wii Knee

The first entry today is a BMJ Case Report released in June 2009 regarding medial meniscal tear injury whilst playing on the Nintendo Wii.

Almedghiol SM, Shablahidis O, Rennie W, Ashford R. Wii knee revisited: meniscal injury from 10-pin bowling. BMJ Case Reports 2009; doi:10.1136/bcr.11.2008.1189

A 23 year old woman presented to the orthopaedic clinic with right knee pain, sustained whilst playing bowling on the Wii. Meniscus tear is one of the most common injuries of the knee, cuased by axial loading and rotational force. The knee became swollen immediately after the incident although the patient was able to go about her normal business in the aftermath. She presented three months later with pain and tenderness over the medial aspect of her knee. On examination there was a mild effusion of the right knee with tenderness along the joint line and a full range of motion maintained. What made this case un-usual was that usually meniscal tears are caused by contact sports injuries whislt this was an example of a 'non-contact' event. Investigation is MRI scan and treatment can be either medical, surgical or conservative. This case provides a worthy reminder that serious injuries can be caused by these games and people should take care!

Examination of the Knee: Revision
Inspect for muscle wasting, swelling, deformity, loss of full extension.
Feel for any effusion, patella and joint line.
Move to flexion and extension.
Function test collateral ligaments, and cruciate ligaments (anterior and posterior Drawer tes.
Further details on examination of the knee is in the ARC Musculoskeletal Assessment for Medical Students DVD.

The medical news making the headlines this week was regarding the postcode lottery for patients being given weight loss surgery.

Kmietowicz Z. Postcode lottery persists over weight loss surgery despite NICE guidance
22 January 2010, BMJ 2010;340:c427

Reports said that sometimes in the same hospitals patients with BMIs of greater than 60 were not being offered surgery whilst patients with a BMI of less than 40 from a different postcode were receiving bariatric surgery. The issue here does represent a somewhat ethical dilemma as to delivering equality of healthcare. Surgeons have reportedly said that there is no evidence to support the use of surgery in treating the most seriously ill, but it is cost-effective providing surgery, as consts of the operation will be re-couped within 3 years of the operation from money saved by obesity management. A quote: "In the UK an estimated 1 million people meet the NICE critria for obesity surgery and of this number around 240,000 have expressed interest in the surgery, yet only 4300 weight loss operations were carried out in 2009". The surgeons are calling for a long-term strategy that ensures all patients have equal access to equal access to treatment from appropriately equipped centres.