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Knee anatomy and injury

Anand Kaul, Sunil Manjila, Jonathan P Miller
: Isadore Max Tarlov (1905-1977) is primarily remembered for his 1938 description of the eponymous perineural "Tarlov cyst." However, during his long career as a neurosurgeon and researcher, he was responsible for many other observations and inventions that influenced the development of neurosurgery in the 20th century. While studying at Johns Hopkins Medical School he was acquainted with Walter Dandy, and he became the first resident to study under Wilder Penfield at the newly formed Montreal Neurological Institute...
November 2016: Neurosurgery
Timothy I Alves, Gandikota Girish, Monica Kalume Brigido, Jon A Jacobson
Pain and other disorders of the knee are a common presenting complaint in the ambulatory setting. Although the cornerstones of imaging evaluation of the knee are radiographs and magnetic resonance (MR) imaging, ultrasonography (US) is less expensive than MR imaging, easily available, and of comparable accuracy in the evaluation of certain pathologic conditions of the knee. The benefits of US include portability, low cost, high spatial resolution, dynamic imaging, and ability to guide percutaneous interventions when indicated...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
M Cody O'Dell, Diego Jaramillo, Laura Bancroft, Laura Varich, Gregory Logsdon, Sabah Servaes
With increasing participation and intensity of training in youth sports in the United States, the incidence of sports-related injuries is increasing, and the types of injuries are shifting. In this article, the authors review sports injuries of the lower extremity, including both acute and overuse injuries, that are common in or specific to the pediatric population. Common traumatic injuries that occur in individuals of all ages (eg, tears of the acetabular labrum and anterior cruciate ligament) are not addressed, although these occur routinely in pediatric sports...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Humberto G Rosas
Although rare, posterolateral corner (PLC) injuries can result in sustained instability and failed cruciate ligament reconstruction if they are not diagnosed. The anatomy of the PLC was once thought to be perplexing and esoteric-in part because of the varying nomenclature applied to this region in the literature, which added unnecessary complexity. More recently, three major structures have been described as the primary stabilizers of the PLC on the basis of biomechanical study findings: the lateral collateral ligament, popliteus tendon, and popliteofibular ligament...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Ali M Naraghi, Lawrence M White
Acute knee injuries are a common source of morbidity in athletes and if overlooked may result in chronic functional impairment. Magnetic resonance (MR) imaging of the knee has become the most commonly performed musculoskeletal MR examination and is an indispensable tool in the appropriate management of the injured athlete. Meniscal and ligamentous tearing are the most frequent indications for surgical intervention in sports injuries and an understanding of the anatomy, biomechanics, mechanisms of injury, and patterns of injury are all critical to accurate diagnosis and appropriate management...
October 2016: Radiology
Blaine T Manning, Rachel M Frank, Nathan G Wetters, Bernard R Bach, Aaron G Rosenberg, Brett R Levine
Knee-related complaints are among the most commonly encountered conditions by orthopaedic surgeons. Knee pathology varies widely and includes arthritis, deformities, fractures, infections, neuromuscular disorders, oncologic diseases, and soft-tissue injury. While nonoperative treatment modalities (activity modification, medications, injections, and physical therapy) are typically used as primary interventions, surgical treatment may ultimately become necessary. The purpose of this review is to discuss the most common open approaches to the knee, with an emphasis on surgically relevant anatomy for each approach...
September 2016: Bulletin of the Hospital for Joint Diseases
S F DeFroda, J A Gil, C T Born
PURPOSE: Fractures of the lower extremity, particularly of the femur and acetabulum, may be difficult to immobilize with splinting alone. These injuries may be best stabilized with the application of various types of skeletal traction. Often, traction is applied percutaneously in an emergent setting, making the knowledge of both superficial and deep anatomy crucial to successful placement. METHODS: Review was performed via PubMed search as well as referencing the Orthopaedic literature...
July 23, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Bryan T H Koh, Andrew A Sayampanathan, Hamid Rahmatullah Bin Abd Razak, Hwei Chi Chong, Hwee-Chye Andrew Tan
BACKGROUND: An anterior cruciate ligament (ACL) graft rupture or a primary ACL injury in the contralateral knee is one of the greatest concerns of patients following primary anterior cruciate ligament reconstruction (ACLR). Our study describes the epidemiology and presence of concomitant meniscal injuries of patients with a graft rupture following primary ACLR or a primary rupture of the contralateral ACL following primary ACLR of the ipsilateral knee. METHODS: We reviewed the medical records of 42 patients who underwent a second ACLR...
June 2016: Annals of Translational Medicine
Mélanie L Beaulieu, Grace E Carey, Stephen H Schlecht, Edward M Wojtys, James A Ashton-Miller
BACKGROUND: Most ruptures of the native anterior cruciate ligament (ACL) and ACL graft occur at, or near, the femoral enthesis, with the posterolateral fibers of the native ligament being especially vulnerable during pivot landings. Characterizing the anatomy of the ACL femoral enthesis may help us explain injury patterns which, in turn, could help guide injury prevention efforts. It may also lead to improved anatomic reconstruction techniques given that the goal of such techniques is to replicate the knee's normal anatomy...
December 2016: Journal of Experimental Orthopaedics
Soo Yeon Kim, Phuong Uyen Le, Boleslav Kosharskyy, Alan D Kaye, Naum Shaparin, Sherry A Downie
Genicular nerve radiofrequency ablation (RFA) has recently gained popularity as an intervention for chronic knee pain in patients who have failed other conservative or surgical treatments. Long-term efficacy and adverse events are still largely unknown. Under fluoroscopic guidance, thermal RFA targets the lateral superior, medial superior, and medial inferior genicular nerves, which run in close proximity to the genicular arteries that play a crucial role in supplying the distal femur, knee joint, meniscus, and patella...
July 2016: Pain Physician
Benjamin C Marchi, Ellen M Arruda
The mechanical behaviors of biological soft tissues are challenging to describe abstractly, with each individual tissue potentially characterized by its own unique nonlinear, anisotropic, and viscoelastic properties. These complexities are exacerbated by patient to patient variability, both mechanically and anatomically, and by inherent constitutive heterogeneity. Despite these challenges, computational models of whole knee biomechanics can be instrumental in describing the onset and progression of injury and disease...
July 8, 2016: Biomechanics and Modeling in Mechanobiology
Masakazu Ishikawa, Nobuo Adachi, Masahiro Yoshikawa, Atsuo Nakamae, Tomoyuki Nakasa, Yasunari Ikuta, Seiju Hayashi, Masataka Deie, Mitsuo Ochi
BACKGROUND: Osteochondritis dissecans (OCD) of the knee is a disorder in juveniles and young adults; however, its etiology still remains unclear. For OCD at the medial femoral condyle (MFC), it is sometimes observed that the lesion has a connection with fibers of the posterior cruciate ligament (PCL). Although this could be important information related to the etiology of MFC OCD, there is no report examining an association between the MFC OCD and the PCL anatomy. PURPOSE: To investigate the anatomic features of knees associated with MFC OCD, focusing especially on the femoral attachment of the PCL, and to compare them with knees associated with lateral femoral condyle (LFC) OCD and non-OCD lesions...
May 2016: Orthopaedic Journal of Sports Medicine
Aashay L Kekatpure, Iman Widya Aminata, In-Ho Jeon, In-Hyeok Rhyou, Hyun-Joo Lee, Jae-Myeung Chun
BACKGROUND: Ligamentous injury associated with isolated coronoid fracture had been sparingly reported. Concealed or unclear fractures and ligamentous or articular cartilage lesions are promptly acknowledged by magnetic resonance imaging (MRI) but cannot be entirely pictured in regular radiological assessments. In isolated coronoid fracture, the fragment size is very small and due to the complex anatomy surrounding the coronoid radiographic imaging may not be sufficient. The purpose of this study was to evaluate the incidence of combined osteochondral and ligamentous injuries by magnetic resonance imaging (MRI) in 24 patients with an isolated coronoid fracture...
May 2016: Indian Journal of Orthopaedics
Hiroyasu Ogawa, Kazu Matsumoto, Yoshiki Ito, Kenji Kawashima, Iori Takigami, Haruhiko Akiyama
Popliteal artery injury in total knee arthroplasty (TKA) is rare but a devastating complication with consequence from transient bleeding to death. We report a case of 83-yearold woman suffering from an unusual early postoperative indirect popliteal artery transection in revision TKA for an infected knee. This injury was triggered by surgical correction of stiffened and distorted soft tissue, which resulted in excessive tensioning and eventual indirect transection of the artery. To avoid this devastating complication, early elimination of infection concomitant with perioperative maintenance of the normal anatomy of the knee is important...
June 2016: Bulletin of the Hospital for Joint Diseases
Bertrand Sonnery-Cottet, Nuno Camelo Barbosa, Sanesh Tuteja, Matt Daggett, Charles Kajetanek, Mathieu Thaunat
Recent evidence on the anatomy, function, and biomechanical properties of the anterolateral ligament has led to the recognition of the importance of this structure in the rotational control of the knee. This article describes a technique that allows for minimally invasive anterolateral ligament reconstruction as a complement to most techniques of anterior cruciate ligament reconstruction. A gracilis tendon autograft is harvested and prepared in a double-strand, inverted V-shaped graft. The graft is percutaneously placed through a femoral stab incision, and each strand is then passed deep to the iliotibial band, emerging through each tibial stab incision...
February 2016: Arthroscopy Techniques
Henning Madry, Lars Goebel, Alexander Hoffmann, Klaus Dück, Torsten Gerich, Romain Seil, Thomas Tschernig, Dietrich Pape
PURPOSE: To give an overview of the basic knowledge of the functional surgical anatomy of the proximal lower leg and the popliteal region relevant to medial high tibial osteotomy (HTO) as key anatomical structures in spatial relation to the popliteal region and the proximal tibiofibular joint are usually not directly visible and thus escape a direct inspection. METHODS: The surgical anatomy of the human proximal lower leg and its relevance for HTO are illustrated with a special emphasis on the individual steps of the operation involving creation of the osteotomy planes and plate fixation...
May 28, 2016: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Jorge Chahla, Gilbert Moatshe, Chase S Dean, Robert F LaPrade
Injuries to the posterolateral corner (PLC) comprise a significant portion of knee ligament injuries. A high index of suspicion is necessary when evaluating the injured knee to detect these sometimes occult injuries. Moreover, a thorough physical examination and a comprehensive review of radiographic studies are necessary to identify these injuries. In this sense, stress radiographs can help to objectively determine the extent of these lesions. Non-operative and operative treatment options have been reported depending on the extent of the injury...
April 2016: Archives of Bone and Joint Surgery
K Thiele, P von Roth, T Pfitzner, B Preininger, C Perka
Quadriceps tendon injuries and insufficiencies in total knee arthroplasty are rare, but are followed by a devastating complication that left untreated leads to a complete loss of function of the knee. This review article summarizes the functional anatomy, risk factors, and the prevalence and diagnosis of quadriceps tendon injuries, in addition to the possible management options for partial and complete ruptures. The treatment options are adapted according to the extent of the loss of function (partial, complete) and the duration of the injury (acute vs chronic)...
May 2016: Der Orthopäde
F Lapègue, N Sans, C Brun, S Bakouche, N Brucher, Z Cambon, H Chiavassa, A Larbi, M Faruch
Fat is not just used by the body as bulk tissue. In addition to its role in storing energy and regulating hormone action, fat is used in some parts of the body for its mechanical properties. The anatomy of anterior knee fat is more complex than it appears at first sight and is capable of withstanding considerable compressive and shear stress. Specific lesions occur when such mechanical stress exceeds the physiological limits and are yet little known. Superficial fat can be the site of either acute injury by closed degloving called the Morel-Lavallée lesion or chronic injury, when subject to repeat excessive shear forces, due to more complex and less well-defined disruptions that result in pseudo-bursitis...
July 2016: Diagnostic and Interventional Imaging
Justin W Arner, James N Irvine, Liying Zheng, Tom Gale, Eric Thorhauer, Margaret Hankins, Ermias Abebe, Scott Tashman, Xudong Zhang, Christopher D Harner
BACKGROUND: Anterior cruciate ligament (ACL) injury increases the risk of meniscus and articular cartilage damage, but the causes are not well understood. Previous in vitro studies were static, required extensive knee dissection, and likely altered meniscal and cartilage contact due to the insertion of pressure sensing devices. HYPOTHESIS: ACL deficiency will lead to increased translation of the lateral meniscus and increased deformation of the medial meniscus as well as alter cartilage contact location, strain, and area...
April 2016: Orthopaedic Journal of Sports Medicine
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