ACL tear and varus knee

BACKGROUND: A hamstring autograft is commonly used in anterior cruciate ligament (ACL) reconstruction (ACLR); however, there is evidence to suggest that the tendons harvested may contribute to medial knee instability. HYPOTHESIS: We tested the hypothesis that the gracilis (G) and semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury...

PURPOSE: The purpose of the present study was to determine, in vivo, the effect of different types of meniscectomy on an ACL-deficient knee. METHODS: Using a computer-assisted navigation system, 56 consecutive patients (45 men and 11 women) were subjected to a biomechanical testing with Lachman test (AP30), drawer test (AP90), internal/external rotation test, varus/valgus rotation test and pivot-shift test. The patients were divided into three groups according to the status of the medial meniscus...

PURPOSE: To investigate the patterns of medial meniscus (MM) tears in patients with varus knee osteoarthritis who underwent total knee arthroplasty and analyze the factors that could affect MM tears. MATERIALS AND METHODS: The patients (365 knees, 268 patients) were classified into three groups; group I with MM posterior horn (PH) tear only; group II with MM root tear only; and group III with MMPH plus root tear. The following factors were evaluated: age, gender, body mass index, varus deviation of the mechanical axis, medial proximal tibial angle, posterior tibial slope (PTS), and anterior cruciate ligament (ACL) integrity (normal, degeneration, and tear or absence)...

BACKGROUND: Biomechanical studies indicate that the tibia shifts medially and has a more valgus orientation in the anterior cruciate ligament (ACL)-deficient knee. However, it is not known whether these differences can be detected on standing radiographs. PURPOSE: To determine whether medial subluxation and more changes in coronal alignment of the tibia are detectable in both weightbearing radiographs and a cadaveric model simulating quiet standing. STUDY DESIGN: Case series; Level of evidence, 4, and Descriptive laboratory study...

BACKGROUND: To identify and characterize the concomitant ligamentous and meniscal injuries in floating knee. METHODS: A total of 37 cases of floating knee were enrolled. Arthroscopic or open surgical examination of the knee, Lachman test, posterior drawer's test, and varus and valgus stress tests under anesthesia were carried out to determine the incidence of knee injury. RESULTS: Through arthroscopic and open surgical examinations, a medial meniscal tear was detected in 14 (37...

Posterolateral instability (PLI) is common with posterior cruciate ligament tears, is less common with anterior cruciate ligament tears, and isolated PLI is rare. There are varying degrees of PLI with respect to pathologic external tibial rotation and varus laxity. Surgical treatment of PLI must address all components of the PLI (popliteus tendon, popliteofibular ligament, lateral collateral ligament, and the lateral-posterolateral capsule), the abnormal planes of motion, as well as other structural injuries...

The purpose of this report was to describe the surgical technique for and outcomes after a modified physeal-sparing posterolateral corner reconstruction in a 12-year-old skeletally immature male with a mid-substance fibular collateral ligament tear, a proximal posterior tibiofibular ligament tear, and an anterior cruciate ligament avulsion fracture of the medial tibial eminence. A modified physeal-sparing posterolateral corner reconstruction was used to provide a near-anatomic reconstruction of the fibular collateral ligament and proximal posterior tibiofibular ligament...

BACKGROUND: There is controversy regarding the functional role of the posterolateral (PL) bundle of the anterior cruciate ligament (ACL). PURPOSE: To evaluate the in vivo function of the PL and anteromedial (AM) bundles of the ACL during anatomic double-bundle (DB) ACL reconstruction for acute, isolated ACL tears utilizing a computer navigation system to track intraoperative knee kinematics. STUDY DESIGN: Controlled laboratory study. METHODS: Fifteen patients with acute, isolated ACL tears who underwent anatomic DB ACL reconstruction formed the sample for this study...

PURPOSE: The aim of this prospective study was to determine the clinical value of lateral radiographs and corresponding MRI scans in the preoperative evaluation of the functional integrity of the anterior cruciate ligament (ACL) in a consecutive series of 78 patients (93 knees) with medial compartment osteoarthritis. METHODS: All knees received standardised radiographs and MRI imagery. The wear pattern on the lateral radiograph was described based on a modified Keyes classification...

BACKGROUND: A consensus on the treatment of combined anterior cruciate ligament (ACL) and posterolateral corner (PLC) injuries is still lacking. PURPOSE: To review the available literature on the management of these combined lesions to investigate the influence that injuries of knee posterolateral structures play in the outcome of an ACL lesion. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A comprehensive search was performed on PubMed, Medline, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "posterolateral corner," "plc," "posterolateral instability," "posterolateral injury," "anterior cruciate ligament," and "acl...

Women tear their Anterior Cruciate Ligament (ACL) 2-8 times more frequently than men. Frontal plane knee motion can produce a pathological load in the ACL. During a state of fatigue the muscles surrounding the knee joint may lose the ability to protect the joint during sudden deceleration while landing. The purpose of this study was to investigate the effects of fatigue and gender on frontal plane knee motion, EMG amplitudes, and GRF magnitudes during drop- jump landing. Pretest-posttest comparison group design was used...

BACKGROUND: Concomitant knee injury is a common finding in femoral fractures but can be easily missed during early management of the initial trauma. Degrees of damage to the articular structures vary considerably; from only a mild effusion to complete ligamentous and meniscal tears. Since previous reports were mostly from developed societies, this study was designed to look into characteristics of associated knee injury in a sample from Iran, to represent a developing country perspective...

BACKGROUND: Failed ACL reconstruction frequently is accompanied by irreparable medial meniscal tear and/or visible osteoarthritis (OA) in the medial tibiofemoral joint. Thus, assessment for the presence of varus malalignment is important in caring for patients in whom revision ACL reconstruction is considered. QUESTIONS/PURPOSES: We determined whether patients undergoing revision ACL reconstruction (1) have more frequent varus malalignment coupled with more severe degrees of medial meniscal injury and/or medial tibiofemoral OA, and (2) would meet potential indications for high tibial osteotomy more frequently than patients undergoing primary ACL reconstruction...

PURPOSE: To investigate the association between varus alignment and post-traumatic osteoarthritis (OA) after an anterior cruciate ligament (ACL) injury. METHODS: One hundred subjects with an acute complete ACL tear were followed for 15 years. Anterior-posterior radiographs of the tibiofemoral joint were obtained with a knee flexion of 20°, and the patellofemoral joint was examined with skyline view at 50° knee flexion. Joint space narrowing and osteophytes were graded in the tibiofemoral and patellofemoral joints in the injured (ACL) and uninjured knee according to the radiographic atlas of the Osteoarthritis Research Society International...

Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascular assessment and treatment should be done to avoid critical complications...

BACKGROUND: Tears of the medial meniscus posterior horn attachment (PHA) occur clinically, and an anterior cruciate ligament (ACL)-deficient knee may be more vulnerable to this injury. HYPOTHESIS: The PHA forces from applied knee loadings will increase after removal of the ACL. STUDY DESIGN: Controlled laboratory study. METHODS: A cap of bone containing the medial meniscus PHA was attached to a load cell that measured PHA tensile force...

Marginal fractures of the medial tibial plateau have been reported in the literature as a secondary type of Segond fracture. Some reports described this entity in the setting of combined injuries such as root avulsions of the medial meniscus, complete disruption of the posterior cruciate ligament (PCL), partial tear of the anterior cruciate ligament (ACL), and tears of the medial meniscus and medial collateral ligament. It has been postulated that medial marginal fractures are secondary to compression of the medial aspect of the femoral condyle and tibial plateau with a corresponding posterolateral corner injury...

BACKGROUND: Few studies have reported the outcomes of surgical treatment of an acute grade-III posterolateral knee injury. Our purpose was to report the objective stability and subjective outcomes for a prospective series of patients with an acute grade-III posterolateral knee injury treated with anatomic repair and/or reconstruction of all injured structures. METHODS: A prospective study of all patients with a grade-III posterolateral knee injury treated with an anatomic repair and/or reconstruction within six weeks of injury was initiated in May 2005...

The purposes of the present study were to examine the frequency and characteristics of root tears of the medial meniscus associated with ligament injuries of the knee and to evaluate the effectiveness of pull-out repair for restoring meniscus function. We retrospectively analyzed the 9 patients (10 knees) with posterior root tears of the medial meniscus and ligament injuries of the knee treated between August 2004 and February 2007. All the patients were male, with average age of 29.8 years, and the mean follow-up period was 29...

Four patients, aged 37-50 years, with chronic anterior cruciate ligament (ACL) deficiency, medial compartment osteoarthritis and varus deformity, underwent simultaneous arthroscopic ACL reconstruction and opening wedge high tibial osteotomy using the TomoFix fixation device and hydroxyapatite wedges. The simultaneous procedure allowed our patients to perform a full weight-bearing exercise at 4 weeks after surgery. At device removal and concomitant second-look arthroscopy, all patients had either a cyclops-like lesion or partial tears at the point of contact between the reconstructed ACL and intercondylar notch...