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Knee ligamentous tears

Levi Reina Fernandes, Herve Ouanezar, Adnan Saithna, Bertrand Sonnery-Cottet
The Segond fracture (SF) is considered pathognomonic of an anterior cruciate ligament (ACL) tear. However, the anatomy of the soft-tissue attachments responsible for the avulsion of SFs has been a cause of controversy. A 31-year-old male patient presented with an injury to his right knee that resulted in ACL tear and a SF. Open SF fixation and arthroscopic ACL reconstruction were performed. The anatomical dissection demonstrated that the avulsion of SFs had occurred because of the tibial attachment of the anterolateral ligament (ALL) with an intact Iliotibial band...
March 20, 2018: BMJ Case Reports
Joseph T Gamboa, Edward C Shin, Neil P Pathare, Patrick J McGahan, James L Chen
Anterior cruciate ligament (ACL) tears are an unfortunate and devastating injury in the athletic patient. Surgical reconstruction of the ACL with a taut graft construct is necessary to restore knee stability and help expedite the patient's return to an active lifestyle. Arthroscopy-assisted ACL reconstruction can be a technically involved procedure, where strong fixation limits graft motion to allow sufficient healing within the tibial and femoral tunnels at the bone-tendon interfaces. Loss of tension in a graft can cause symptomatic anterior or rotatory instability and potential retear of the ACL graft...
February 2018: Arthroscopy Techniques
Etienne Cavaignac, Gregoire Laumond, Nicolas Reina, Karine Wytrykowski, Jérôme Murgier, Marie Faruch, Philippe Chiron
Ultrasonography (US) is a nonirradiating, low-cost, real-time imaging modality that has very good spatial resolution. US can be used to view the anterolateral ligament (ALL) and injuries to the ALL. Several authors have sought to analyze the anterolateral aspect of the knee using US with varying luck. All of them analyzed the ALL statically only. The goal of this Technical Note is to describe in detail the technique that we use to analyze the anterolateral aspect of the knee in patients with an anterior cruciate ligament tear...
January 2018: Arthroscopy Techniques
William Craddock, Troy Smithers, Craig Harris, William du Moulin, Robert Molnar
BACKGROUND: Posterior cruciate ligament (PCL) injuries of the knee are common and sometimes difficult to diagnose. Magnetic resonance imaging (MRI), performed using standard orthogonal plane views, is the investigation of choice. It can be particularly difficult to differentiate acute partial and complete tears and identify elongation of chronic healed tears. The aim of the paper is to describe a new method of positioning the patient with the knee flexed at 90°, allowing the PCL to be visualised in a position of greatest length and tension which may assist in differentiating and identifying these injuries...
March 14, 2018: Knee
Jia-Ping Pan, Xu-Can Wang, Ming-Hong Huang
OBJECTIVE: To investigate the characteristics and clinical treatment of avulsion fracture of the lateral edge of tibial plateau(segond fracture) in knee joint injuries. METHODS: From January 2011 and December 2015, 29 patients with Segond fracture were treated with minimally invasive arthroscopy technology in intra-articular injuries combined with double anchor nail fixation in avulsion fracture of the lateral edge of tibial plateau, including 17 males and 12 females with an average age of 41 years old ranging from 27 to 62 years old...
February 25, 2018: Zhongguo Gu Shang, China Journal of Orthopaedics and Traumatology
Andres Kroker, Jennifer L Bhatla, Carolyn A Emery, Sarah L Manske, Steven K Boyd
Anterior cruciate ligament (ACL) tears are a common sports-related knee injury that increases the risk of developing post-traumatic osteoarthritis (OA). During OA progression bone microarchitecture changes in the affected knee, however, little is known about bone microarchitecture in knees with early stage OA. The purpose of this study is to investigate in a cohort of females predisposed to develop OA how bone microarchitecture in ACL reconstructed knees differs from uninjured contralateral knees as well as healthy control knees and how this relates to early changes in OA...
March 8, 2018: Bone
Jisook Yi, Young Han Lee, Ho-Taek Song, Jin-Suck Suh
Objective: To evaluate the feasibility of synthetic magnetic resonance imaging (MRI) compared to conventional MRI for the diagnosis of internal derangements of the knee at 3T. Materials and Methods: Following Institutional Review Board approval, image sets of conventional and synthetic MRI in 39 patients were included. Two musculoskeletal radiologists compared the image sets and qualitatively analyzed the images. Subjective image quality was assessed using a four-grade scale...
March 2018: Korean Journal of Radiology: Official Journal of the Korean Radiological Society
Volker Musahl, Elmar Herbst, Jeremy M Burnham, Freddie H Fu
The anterolateral structures of the knee have recently garnered considerable interest regarding their role in rotatory knee instability related to anterior cruciate ligament tears. Isolated anterior cruciate ligament reconstruction may not always restore rotatory stability of the knee. In these patients, additional procedures, such as lateral reconstruction or tenodesis, may be indicated. The anatomy of the anterolateral structures of the knee has been well described. Histologic and anatomic studies have reported conflicting findings regarding the presence of a discrete ligament...
March 6, 2018: Journal of the American Academy of Orthopaedic Surgeons
Robert E Boykin
Patients with radiographic evidence of femoroacetabular impingement and decreased hip internal rotation have a higher rate of anterior cruciate ligament (ACL) tears. Limited internal rotation of the hip increases strain and potentially resultant fatigue failure of the ACL. Although causation has not been proven, a better understanding of the lower extremity kinetic chain may allow improved ACL prevention strategies through measures (operative or nonoperative) to improve rotation of the hip.
March 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Berkcan Akpinar, Eric Thorhauer, James J Irrgang, Scott Tashman, Freddie H Fu, William J Anderst
BACKGROUND: Limited in vivo kinematic information exists on managing meniscal injury during anterior cruciate ligament reconstruction (ACLR). HYPOTHESIS: Isolated anatomic ACLR restores knee kinematics, whereas ACLR in the presence of medial meniscal injury is associated with altered long-term knee kinematics. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From March 2011 to December 2012, 49 of 57 participants in a clinical trial underwent anatomic ACLR with successful kinematic testing at 24 months after ACLR...
March 1, 2018: American Journal of Sports Medicine
Mark Phillips, Erik Rönnblad, Love Lopez-Rengstig, Eleonor Svantesson, Anders Stålman, Kalle Eriksson, Olufemi R Ayeni, Kristian Samuelsson
PURPOSE: To compare Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol-5D (EQ-5D) subscale scores at 2-year follow-up for patients with primary isolated ACL reconstruction with patients undergoing ACL reconstruction and simultaneous meniscal treatment in terms of either resection or repair in the Swedish National Knee Ligament Register (SNKLR). METHODS: All ACL reconstruction patients within the SNKLR at 2-year follow-up were reviewed. The KOOS and EQ-5D subscales were assessed in four distinct patient groups: isolated ACL reconstruction, ACL reconstruction + medial meniscus resection, ACL reconstruction + lateral meniscus resection, ACL reconstruction + medial meniscus repair, and ACL reconstruction + lateral meniscus repair...
February 28, 2018: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Neil S Kumar, Cory Edgar, Tiahna Spencer, James K Ware, Dale N Reed, Mark P Cote, Robert A Arciero
Separation of the posteromedial meniscocapsular junction (PMC) is a unique injury seen in patients with disruption of the anterior cruciate ligament. PMC tears may go unrecognized despite preoperative magnetic resonance imaging and diagnostic arthroscopy of the medial compartment. Unrepaired lesions may lead to persistent laxity of the knee after anterior cruciate ligament reconstruction. Inside-out repair techniques risk iatrogenic injury to the articular cartilage during needle passage and require dissection of the posteromedial knee for suture retrieval...
August 2017: Arthroscopy Techniques
Kyoung Ho Yoon, Jung Suk Kim, Soo Yeon Park, Sang Eon Park
PURPOSE: To determine the prevalence of Segond fractures using computed tomography (CT) and to investigate the effects of Segond fractures on the outcomes of primary anterior cruciate ligament (ACL) reconstruction for isolated ACL injuries. METHODS: Between January 2010 and July 2015, we retrospectively evaluated 383 patients who underwent primary ACL reconstruction, who underwent CT scans immediately after surgery, and who were available at 2 years of follow-up...
February 24, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Julio Brandao Guimaraes, Luca Facchetti, Benedikt J Schwaiger, Alexandra S Gersing, Xiaojuan Li, Thomas M Link
OBJECTIVES: To assess (i) normal imaging anatomy of the popliteomeniscal fascicles, (ii) prevalence and natural evolution of popliteomeniscal fascicle tears (PMFT) in subjects with traumatic anterior cruciate ligament (ACL) tears over 2 years and (iii) compare knee cartilage degeneration in subjects with and without PMFT longitudinally. METHODS: 57 subjects with ACL tears were screened for PMFT. Morphological (high-resolution 3D fast spin-echo) and compositional (T1ρ and T2 mapping) MR imaging was performed prior to and 2 years after ACL reconstruction...
February 23, 2018: European Radiology
Mark E Cinque, Jorge Chahla, Justin J Mitchell, Gilbert Moatshe, Jonas Pogorzelski, Colin P Murphy, Nicholas I Kennedy, Jonathan A Godin, Robert F LaPrade
Background: Meniscal and chondral lesions are commonly associated with anterior cruciate ligament (ACL) tears, and these lesions may play a role in patient outcomes after ACL reconstruction. Purpose: To determine the effects of the presence and location of meniscal and chondral lesions at the time of ACL reconstruction on patient-reported outcomes at a minimum 2-year follow-up. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with no prior knee surgery who underwent primary ACL reconstruction by a single surgeon between 2010 and 2014 were included in this study...
February 2018: Orthopaedic Journal of Sports Medicine
Jeffrey T Johnston, Bert R Mandelbaum, David Schub, Scott A Rodeo, Matthew J Matava, Holly J Silvers, Brian J Cole, Neil S ElAttrache, Tim R McAdams, Robert H Brophy
BACKGROUND: Anterior cruciate ligament (ACL) injuries are prevalent in contact sports that feature cutting and pivoting, such as American football. These injuries typically require surgical treatment, can result in significant missed time from competition, and may have deleterious long-term effects on an athlete's playing career and health. While the majority of ACL tears in other sports have been shown to occur from a noncontact mechanism, it stands to reason that a significant number of ACL tears in American football would occur after contact, given the nature of the sport...
February 1, 2018: American Journal of Sports Medicine
Kazuhisa Hatayama, Masanori Terauchi, Kenichi Saito, Jun Aoki, Satoshi Nonaka, Hiroshi Higuchi
PURPOSE: To prospectively evaluate the sensitivity and specificity of magnetic resonance imaging (MRI) for diagnosing ramp lesions, to compare them between 1.5- and 3-T MRI, and to evaluate whether bone contusion of the posterior lip of the medial tibial plateau was associated with ramp lesions. METHODS: For 155 knees that underwent primary ACL reconstruction, we prospectively examined for ramp lesions and medial meniscal body tears on MRI. MRI diagnosis of ramp lesions required high signal irregularity of the capsular margin or separation in the meniscocapsular junction of the medial meniscus posterior horn on sagittal images...
February 15, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
Innocent Ouko, James Kigera, Kevin Ongeti, Anne Pulei
PURPOSE: Meniscal tears are common in Kenya, with prevalence rates ranging from 45 to 78% of intracapsular knee pathology. Diagnosis of these injuries relies on the use of both clinical signs and symptoms as well as radiological investigations. In a few instances, radiological detection could be difficult, partly because of variant attachment patterns of the medial meniscal anterior horn. Some of these unusual attachments of the anterior horn of the medial meniscus could even be mistaken for meniscal tears...
February 16, 2018: International Orthopaedics
Brian Grawe, Amanda J Schroeder, Rafael Kakazu, Malynda S Messer
The lateral collateral ligament is the primary varus stabilizer of the tibiofemoral joint. Diagnosing an injury to this ligament can be challenging in the setting of multiligamentous trauma; however, failure to recognize these injuries can result in instability of the knee and unsatisfactory outcomes after cruciate ligament reconstruction. Recent literature exploring the anatomy and biomechanics of the lateral collateral ligament has enhanced our understanding and improved diagnosis and management of these injuries...
March 15, 2018: Journal of the American Academy of Orthopaedic Surgeons
Santiago Pache, Zachary S Aman, Mitchell Kennedy, Gilberto Yoshinobu Nakama, Gilbert Moatshe, Connor Ziegler, Robert F LaPrade
The posterior cruciate ligament (PCL) is the largest and strongest ligament in the human knee, and the primary posterior stabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCL injuries are typically combined with other ligamentous, meniscal and chondral injuries. Stress radiography has become an important and validated objective measure in surgical decision making and post-operative assessment. Isolated grade I or II PCL injuries can usually be treated non-operatively...
January 2018: Archives of Bone and Joint Surgery
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