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Kantrowitz DE, Colvin A. Comprehensive Clinical Examination of ACL Injuries. Clin Sports Med 2024; 43:311-330. [PMID: 38811112 DOI: 10.1016/j.csm.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
A comprehensive clinical examination of the potentially anterior cruciate ligament (ACL)-deficient knee should proceed as follows: inspection; palpation; range of motion; varus and valgus stress; neurovascular status; and finally provocative maneuvers. The Lachman, anterior drawer, Lever, and pivot shift tests are all greater than 90% specific for ACL pathology. Due to the relatively high coincidence of ACL injuries and those to the posterior cruciate ligament, posterolateral corner , posteromedial corner , and menisci, it is critical that the examiner perform provocative maneuvers to evaluate the integrity of these structures as well.
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Affiliation(s)
- David E Kantrowitz
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA.
| | - Alexis Colvin
- Department of Orthopedics, The Mount Sinai Hospital, 5 E 98th Street, 9th floor, New York, NY 10029, USA
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Heylen S, Braeckevelt T, Verdonk P, Krause M, Michielsen J. Diagnosing popliteofibular ligament injuries in anterior cruciate ligament-injured knees: A prospective magnetic resonance imaging study investigating the inter- and intraobserver reliability of identification of the popliteofibular ligament. J Exp Orthop 2024; 11:e12112. [PMID: 39055397 PMCID: PMC11269624 DOI: 10.1002/jeo2.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/24/2024] [Accepted: 07/01/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose The aim of our study was to investigate the intra- and interobserver reliability for the identification of the popliteofibular ligament (PFL) in magnetic resonance imaging (MRI) scans in patients with an anterior cruciate ligament (ACL) injury and ascertain the prevalence of PFL tears in ACL-injured knees without clinically high-grade posterolateral corner injury. Methods MRI readings were performed retrospectively by two surgeons on 84 patients who underwent ACL reconstruction in our department. The presence of the PFL on both sagittal and coronal images as well as the presence of PFL tears was noted. Readings were repeated 6 weeks later for one observer. The κ value was calculated to determine the intra- and interobserver reliability for identification of the PFL and the prevalence of PFL tears was ascertained. Results The PFL was visualized in 90.5%-91.7% of MRI scans. The intra- and interobserver reliability of visualizing the PFL on MRI had an κ value of 0.63 and 0.66 (substantially reliable), respectively. The intraobserver reliability for identification of PFL tears had an κ value of 0.26 (fair reliability). We found a 4.8% prevalence of PFL tears in ACL-injured knees. Conclusions There is substantially reliable intra- and interobserver reliability for the identification of the PFL on MRI scans but only fair reliability for the identification of PFL tears. A 4.8% prevalence of PFL tears in ACL-injured knees without clinically confirmed high-grade posterolateral corner injury can be observed in our series. Level of Evidence Level IV.
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Affiliation(s)
- Steven Heylen
- Department of Trauma and OrthopaedicsHeilig Hart Ziekenhuis LierLierBelgium
- Orthopaedic Research and Education FoundationOrthoClinic LierLierBelgium
- PhD Department, Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
| | - Thomas Braeckevelt
- Department of Trauma and OrthopaedicsHeilig Hart Ziekenhuis LierLierBelgium
| | - Peter Verdonk
- OrthoCA Orthopaedic CenterAntwerpBelgium
- Department of Orthopaedic SurgeryAntwerp University HospitalEdegemBelgium
| | - Matthias Krause
- Department of Trauma Surgery and OrthopaedicsUKEHamburgGermany
| | - Jozef Michielsen
- Department of Orthopaedic SurgeryAntwerp University HospitalEdegemBelgium
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Castro MO, Baptista DC, Afonso PD. Demystifying the "Dark Side of the Knee": An Update on Imaging of the Posterolateral Corner. Semin Musculoskelet Radiol 2024; 28:305-317. [PMID: 38768595 DOI: 10.1055/s-0044-1781431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
The posterolateral corner (PLC) of the knee is a complex anatomical-functional unit that includes ligamentous and tendinous structures that are crucial for joint stability. This review discusses the intricate anatomy, biomechanics, and imaging modalities, as well as the current challenges in diagnosing PLC injuries, with an emphasis on magnetic resonance imaging (MRI). Recognizing the normal MRI anatomy is critical in identifying abnormalities and guiding effective treatment strategies. Identification of the smaller structures of the PLC, traditionally difficult to depict on imaging, may not be necessary to diagnose a clinically significant PLC injury. Injuries to the PLC, often associated with cruciate ligament tears, should be promptly identified because failure to recognize them may result in persistent instability, secondary osteoarthritis, and cruciate graft failure.
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Affiliation(s)
- Miguel Oliveira Castro
- Radiology Department, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
- Lagoa Centro - Imagens Médicas, Lagoa, Portugal
| | - Diogo Correia Baptista
- Radiology Department, Instituto Português de Oncologia Francisco Gentil, Lisbon, Portugal
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
- Radiology Department, Hospital Particular da Madeira, Grupo HPA, Funchal, Portugal
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Limskul D, Buranapuntaruk T, Kuptniratsaikul S, Itthipanichpong T. Posterolateral Intra-/Extra-articular Tenodesis Technique: A Technique for Lateral Tenodesis of the Knee. Arthrosc Tech 2024; 13:102921. [PMID: 38690331 PMCID: PMC11056740 DOI: 10.1016/j.eats.2024.102921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/10/2023] [Indexed: 05/02/2024] Open
Abstract
Posterolateral tenodesis is necessary for restoring biomechanics in posterolateral instability of the knee. We propose a technique that provides the tenodesis effect to both intra- and extra-articular aspects of the knee. We call it the posterolateral intra-/extra-articular tenodesis technique, which is a technique for posterolateral reconstruction. This minimally invasive technique is particularly helpful in patients with high-grade posterolateral corner injury with the advantage of precise placement of the graft.
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Affiliation(s)
- Danaithep Limskul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | | | - Somsak Kuptniratsaikul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Thun Itthipanichpong
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
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Masoni V, Giustra F, Bosco F, Camarda L, Rovere G, Sciannameo V, Berchialla P, Massè A. Surgical treatment of popliteomeniscal fascicles tears is associated with better patient-reported outcome measures. A systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:9-20. [PMID: 37481735 PMCID: PMC10771597 DOI: 10.1007/s00590-023-03645-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE Popliteomeniscal fascicles (PMFs) are a component of the popliteal hiatus complex in the knee, and their injury primarily affects young athletes participating in sports activities involving twisting movements. The identification of PMFs tears presents a challenge, often accompanied by lateral pain and a locking sensation. The objective of this systematic review (SR) and meta-analysis is to enhance the suspicion and recognition of PMFs tears, aiming to facilitate the treatment of this condition, particularly in symptomatic young patients. METHODS A comprehensive search, focused on studies examining PMFs injuries and their treatment, was conducted in four databases, PubMed, Scopus, Embase, and Web of Science. The ROBINS-I tool was used to evaluate the risks of bias. The PRISMA flow diagram was used to conduct the research and select the included studies. A meta-analysis was conducted for the Lysholm score, the Tegner Activity Scale, and the subjective IKDC score. The present SR and meta-analysis was registered on PROSPERO. RESULTS Five clinical studies were included in the final analysis, comprising 96 patients. All the patients underwent a preoperative MRI assessment and a diagnostic arthroscopy to detect the PMFs tears, with a subsequent surgical procedure either open or arthroscopically performed. Surgery was associated with the resolution of symptoms. A statistically significant improvement in the Lysholm score (p: 0.0005) and the subjective IKDC score (p: 0.003) after the surgical procedure with respect to the preoperative evaluation was found. CONCLUSION This SR and meta-analysis showed a significant improvement in the Lysholm score and subjective IKDC score following surgery for PMFs tears. However, controversy persists regarding the optimal surgical approach, with current literature favoring arthroscopic procedures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Virginia Masoni
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
| | - Lawrence Camarda
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Veronica Sciannameo
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO, Via Zuretti 29, 10126, Turin, Italy
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Pruneski JA, Heyworth BE, Kocher MS, Tavabi N, Milewski MD, Kramer DE, Christino MA, Yen YM, Micheli LJ, Murray MM, Gilreath L, Kim A, Murray J, Kiapour AM. Prevalence and Predictors of Concomitant Meniscal and Ligamentous Injuries Associated With ACL Surgery: An Analysis of 20 Years of ACL Reconstruction at a Tertiary Care Children's Hospital. Am J Sports Med 2024; 52:77-86. [PMID: 38164668 DOI: 10.1177/03635465231205556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND There is an increasing rate of procedures being performed for concomitant injuries during anterior cruciate ligament (ACL) surgery. Few studies have examined risk factors for these associated injuries in young patients. HYPOTHESIS There are patient-related factors predictive of concomitant knee pathology that differ between age-based cohorts. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Natural language processing was used to extract clinical variables from available notes of patients undergoing ACL surgery between 2000 and 2020 at a single institution (5174 ACL surgeries; mean age, 17 ± 4 years; 53.1% female; accuracy, >98%). Patients were stratified to pediatric (5-13 years), adolescent (14-19 years), and young adult (20-35 years) cohorts. Logistic regression was used to determine predictors of concomitant injury to the menisci, medial collateral ligament (MCL), posterolateral corner (PLC), and posterior cruciate ligament (PCL). RESULTS Between 2000 and 2020, 54% of pediatric, 71% of adolescent, and 70% of adult patients had ≥1 concomitant soft tissue injury. In children and adolescents, increased age was consistently predictive of sustaining a concomitant injury (P < .02). Female children had increased odds of concomitant medial meniscal injury, while female adults had decreased odds (P≤ .046). Adolescent and adult female patients had decreased odds of concomitant lateral meniscal injury (P≤ .027). Female children had increased odds of injury to the MCL (P = .015), whereas female children and adolescents had decreased odds of PCL injury (P≤ .044). Adolescents undergoing revision ACL surgery had increased odds of meniscal injury (P≤ .001) and decreased odds of concomitant MCL injury (P = .028). Increased body mass index (BMI) was associated with increased odds of concomitant medial meniscal injury in all cohorts (P≤ .041), lateral meniscal injury in adults (P = .045), and PLC injury in children (P = .016). Contact injuries were associated with increased odds of MCL injury in adolescents (P = .017) and PLC injury in adolescents and adults (P < .014). CONCLUSION These findings support the hypothesis, as there were multiple factors that significantly affected the risk of concomitant injuries that differed between cohorts. Increased age, BMI, and contact injury history were generally associated with increased odds of sustaining a concomitant injury, whereas female sex and revision ACL surgery had mixed effects. Further studies are essential to investigate the sex-based differences in risk for concomitant injuries and to develop tailored treatment plans that minimize the risk of secondary ACL injury.
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Affiliation(s)
- James A Pruneski
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton E Heyworth
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mininder S Kocher
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nazgol Tavabi
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew D Milewski
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Dennis E Kramer
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa A Christino
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yi-Meng Yen
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lyle J Micheli
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Martha M Murray
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Leah Gilreath
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexander Kim
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph Murray
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ata M Kiapour
- Department of Orthopedic Surgery and Sports Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Investigation performed at Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Nagai K, Kamada K, Kay J, Hoshino Y, Matsushita T, Kuroda R, de Sa D. Clinical Outcomes After Anterior Cruciate Ligament Reconstruction in Patients With a Concomitant Segond Fracture: A Systematic Review. Am J Sports Med 2023; 51:525-533. [PMID: 34668790 DOI: 10.1177/03635465211045689] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The Segond fracture can be observed in patients with an anterior cruciate ligament (ACL) tear. It is unclear whether the Segond fracture affects clinical outcomes after ACL reconstruction. PURPOSE To investigate whether the presence of a concomitant Segond fracture affects clinical outcomes after ACL reconstruction and to compare clinical outcomes when a Segond fracture is repaired surgically or left unrepaired. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Three databases (PubMed, Embase, Cochrane Library) were searched in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines on July 27, 2020. Relevant studies regarding ACL injury with concomitant Segond fracture treated by primary ACL reconstruction were screened in duplicate. Data regarding patient characteristics and clinical outcomes were extracted. Descriptive data are presented, and a random-effects model was used to pool amenable data. RESULTS A total of 5 studies examining 2418 patients (987 female; 40.8%), mean age 25.4 years, were included in this study. There were 304 patients with a Segond fracture (mean age, 28.1 years; 35.9% female) and 2114 patients without a Segond fracture (mean age, 25.1 years; 41.5% female). Four studies directly compared outcomes between patients with an unrepaired Segond fracture and no Segond fracture. One study reported 12 patients who underwent ACL reconstruction and repair of a Segond fracture. Among 4 studies, 11 of 292 (3.8%) graft failures/revision surgeries were reported in the groups that had Segond fracture, whereas 145 of 2114 (6.9%) graft failures/revision surgeries were reported in groups that did not have Segond fracture. No significant difference was observed in the risk of graft failure between the 2 groups, with a pooled risk ratio of 0.59 (95% CI, 0.32-1.07; P = .08; I2 = 0%). No clinically significant differences were observed with regard to International Knee Document Committee score, Lysholm score, Tegner activity scale, and postoperative knee laxity between the group with Segond fracture and those without. CONCLUSION An unrepaired Segond fracture does not appear to have any significant negative effect on postoperative stability or risk of graft failure or revision surgery after ACL reconstruction. Future prospective studies may be warranted to confirm the finding that patients with combined ACL injury and Segond fracture may have outcomes comparable with those of ACL-injured patients without a Segond fracture when isolated ACL reconstruction is performed.
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Affiliation(s)
- Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kohei Kamada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Darren de Sa
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, Hamilton, Ontario, Canada
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Multiligament Knee Injuries in Young Athletes. Clin Sports Med 2022; 41:611-625. [DOI: 10.1016/j.csm.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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de Vries AJ, Brouwer RW, Veld RHIT, van der Wal WA, Reininga IHF, Hoogeslag RAG. Translation, Validity, and Reliability of the Dutch Anterior Cruciate Ligament-Quality of Life Questionnaire. Orthop J Sports Med 2022; 10:23259671221123297. [PMID: 36133928 PMCID: PMC9483972 DOI: 10.1177/23259671221123297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Anterior Cruciate Ligament-Quality of Life (ACL-QoL) questionnaire is a valid and reliable injury-specific instrument to assess the impact of an ACL rupture on the daily life of a patient. Purpose To translate the ACL-QoL into Dutch (ACL-QoL-NL) and to study its psychometric properties in patients with an ACL rupture. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods The original ACL-QoL questionnaire was translated from English to Dutch according to international guidelines. The study population consisted of 122 patients with a confirmed ACL rupture who completed the ACL-QoL-NL as well as 4 questionnaires: the International Knee Documentation Committee subjective score, Knee injury and Osteoarthritis Outcome Score, 36-item Short Form Health Survey, and Lysholm Knee Score. We determined the internal consistency, construct validity, and prevalence of floor and ceiling effects of the ACL-QoL-NL total score as well as its 5 subscales. To determine test-retest reliability, we analyzed the data of 68 patients who had a stable knee condition and who completed the ACL-QoL-NL a second time after a 2-week interval. Results The confirmatory factor analysis showed that the original structure of the ACL-QoL-NL was confirmed, except for 4 of 31 items. Internal consistency of the total scale and all 5 subscales was good. More than 75% of the predefined hypotheses on the correlations between the ACL-QoL-NL and the 4 questionnaires were met, indicating good construct validity. No significant floor or ceiling effects were observed. Test-retest reliability was good, and no systematic bias between test and retest was found. Standard error of measurement for the total score was 4.8 points out of 100, and the smallest detectable changes at the group and individual levels were 1.6 and 13.2 points, respectively. Conclusion The ACL-QoL-NL questionnaire was successfully translated from English to Dutch and demonstrated good internal consistency, validity, and reliability, with no presence of floor or ceiling effects.
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Affiliation(s)
- Astrid J de Vries
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | - Reinoud W Brouwer
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, the Netherlands
| | | | - Wybren A van der Wal
- Department of Orthopaedic Surgery, Gelderse Vallei Hospital, Ede, the Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Roy A G Hoogeslag
- Centre for Orthopaedic Surgery and Sports Medicine OCON, Hengelo, the Netherlands
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Varus stress MRI in the refined assessment of the posterolateral corner of the knee joint. Sci Rep 2022; 12:11858. [PMID: 35831396 PMCID: PMC9279472 DOI: 10.1038/s41598-022-15787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) is commonly used to assess traumatic and non-traumatic conditions of the knee. Due to its complex and variable anatomy, the posterolateral corner (PLC)—often referred to as the joint’s dark side—remains diagnostically challenging. We aimed to render the diagnostic evaluation of the PLC more functional by combining MRI, varus loading, and image post-processing in a model of graded PLC injury that used sequential transections of the lateral collateral ligament, popliteus tendon, popliteofibular ligament, and anterior cruciate ligament. Ten human cadaveric knee joint specimens underwent imaging in each condition as above, and both unloaded and loaded using an MR-compatible device that standardized loading (of 147 N) and position (at 30° flexion). Following manual segmentation, 3D joint models were used to computationally measure lateral joint space opening for each specimen, configuration, and condition, while manual measurements provided the reference standard. With more extensive ligament deficiency and loading, lateral joint spaces increased significantly. In conclusion, varus stress MRI allows comprehensive PLC evaluation concerning structural integrity and associated functional capacity. Beyond providing normative values of lateral compartment opening, this study has potential implications for diagnostic and surgical decision-making and treatment monitoring in PLC injuries.
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Sanghvi D, Srivastav A, Agrawal S, Nakshiwala V. The posterior oblique ligament in MRI of acute knee trauma. Skeletal Radiol 2022; 51:1063-1071. [PMID: 34626207 DOI: 10.1007/s00256-021-03930-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/21/2021] [Accepted: 10/03/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the posterior oblique ligament and assess incidence and patterns of injury to the ligament on MRI of acute knee trauma. SUBJECTS AND METHODS One hundred twenty-three MRI studies met the study criteria. For each case, the posterior oblique ligament was identified and scored as injured or normal. Incidence of proximal and distal posterior oblique ligament tears was calculated. Fisher's tests were employed to determine significance of association between tears of the posterior oblique ligament and components of the posteromedial corner and other capsuloligamentous structures of the knee. RESULTS The posterior oblique ligament was reliably identified as a distinct structure in 123 MRI scans that met the criteria and was consistently labeled as intact or torn. Posterior oblique ligament tear was seen in 61.7% of knee trauma with proximal injury in 56.5% and distal injury in 97.3% of positive cases. Posterior oblique ligament disruption was a part of multiligamentous injury in 94.7% of positive cases. Posterior oblique ligament injuries (n = 76) had an extremely significant relationship with oblique popliteal ligament tears (n = 27) (p = 0.0001), semimembranosus tendon insertion tears (n = 15) (p = 0.0005), and medial collateral ligament tears (n = 15) (p = 0.0005) and a highly significant association with medial meniscus tears (n = 68) (p = 0.0049) and posterior cruciate ligament tears (n = 12) (p = 0.0033). The association with anterior cruciate ligament tears (n = 53) was not significant. CONCLUSIONS The posterior oblique ligament is a distinct radiological entity consistently identified in acute trauma MRI. Disruptions of the distal posterior oblique ligament are frequent in complex knee injury, notably in association with oblique popliteal ligament, medial collateral ligament, and semimembranosus tendon tears.
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Hodel S, Hasler J, Fürnstahl P, Fucentese SF, Vlachopoulos L. Elongation Patterns of Posterolateral Corner Reconstruction Techniques: Results Using 3-Dimensional Weightbearing Computed Tomography Simulation. Orthop J Sports Med 2022; 10:23259671221090219. [PMID: 35464904 PMCID: PMC9019341 DOI: 10.1177/23259671221090219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background: The isometric characteristics of nonanatomic and anatomic posterolateral corner (PLC) reconstruction techniques under weightbearing conditions remain unclear. Purpose: To (1) simulate graft elongation patterns during knee flexion for 3 different PLC reconstruction techniques (Larson, Arciero, and LaPrade) and (2) compute the most isometric insertion points of the fibular collateral ligament (FCL) graft strands for each technique and report quantitative radiographic landmarks. Study Design: Descriptive laboratory study. Methods: The authors performed a 3-dimensional simulation of 10 healthy knees from 0° to 120° of flexion using weightbearing computed tomography (CT) scans. The simulation was used to calculate ligament length changes during knee flexion for the PLC reconstruction techniques of Larson (nonanatomic single-bundle fibular sling reconstruction), Arciero (anatomic reconstruction with additional popliteofibular ligament graft strand), and LaPrade (anatomic reconstruction with popliteofibular ligament graft strand and popliteus tendon graft strand). The most isometric femoral insertion points for the FCL graft strands were computed within a 10-mm radius around the lateral epicondyle (LE), using an automatic string generation algorithm (0 indicating perfect isometry). Radiographic landmarks for the most isometric points were reported. Results: Median graft lengthening during knee flexion was similar for the anterior graft strands of all 3 techniques. The posterior graft strands demonstrated significant differences, from lengthening for the Arciero (9.9 mm [range, 6.7 to 15.9 mm]) and LaPrade (10.2 mm [range, 4.1 to 19.7 mm]) techniques to shortening for the Larson technique (−17.1 mm [range, −9.3 to −22.3 mm]; P < .0010). The most isometric point for the FCL graft strands of all techniques was located at a median of 2.2 mm (range, −2.2 to 4.5 mm) posterior and 0.3 mm (range, −1.8 to 3.7 mm) distal to the LE. Conclusion: Overconstraint can be avoided by tensioning the posterior graft strands in the Larson technique in extension, and in the Arciero and LaPrade techniques at a minimum of 60° of knee flexion. The most isometric point was located posterodistal to the LE. Clinical Relevance: The described isometric behavior of nonanatomic and anatomic PLC reconstruction techniques can guide optimal surgical reconstruction and prevent graft lengthening and overconstraint of the lateral compartment in knee flexion. Repetitive graft lengthening has been found to be associated with graft failure, and overconstraint favors lateral compartment pressure and cartilage degeneration.
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Affiliation(s)
- Sandro Hodel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Julian Hasler
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro F. Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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13
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MR Imaging of the Knee Posterolateral and Posteromedial Corner Injuries. Magn Reson Imaging Clin N Am 2022; 30:215-226. [DOI: 10.1016/j.mric.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Lutz PM, Merkle M, Winkler PW, Geyer S, Herbst E, Braun S, Imhoff AB, Feucht MJ. Combined posterolateral knee reconstruction: ACL-based injuries perform better compared to PCL-based injuries. Knee Surg Sports Traumatol Arthrosc 2021; 29:3846-3853. [PMID: 33483769 PMCID: PMC8514347 DOI: 10.1007/s00167-020-06409-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare post-operative physical activity and return to work after combined posterolateral corner (PLC) reconstruction (PLC-R) in anterior cruciate ligament (ACL)- or posterior cruciate ligament (PCL)-based injuries. METHODS Patients aged > 18 years undergoing PLC-R using the Larson technique combined with either ACL or PCL reconstruction were included. Outcome was evaluated retrospectively after a minimum follow-up of 24 months using Tegner Activity Scale, Activity Rating Scale (ARS), Knee Injury and Osteoarthritis Outcome Score (KOOS), work intensity according to REFA classification, and a questionnaire about type of occupation and time to return to work. RESULTS A total of 32 patients (11 ACL-based injuries and 21 PCL-based injuries) were included. Mean follow-up was 56 ± 26 months in the ACL-based injury group and 59 ± 24 months in the PCL-based injury group. All patients in the ACL-based injury group and 91% of patients in the PCL-based injury group returned to sports activities. Comparing pre- and post-operative values, a significant deterioration of the Tegner Activity Scale and ARS was observed in the PCL-based injury group, whereas no significant change was observed in the ACL-based injury group. KOOS subscales were generally higher in the ACL-based injury with significant differences in the subscale sports and recreational activities. Patients with ACL-based injuries returned to work significantly earlier compared to patients with PCL-based injuries (11 ± 4 weeks vs. 21 ± 10 weeks, p < 0.05). CONCLUSION High rates of return to sports and work can be expected after combined PLC-R in both ACL- and PCL-based injuries. However, deterioration of sports ability must be expected in PCL-based injuries. ACL-based injuries led to superior patient-reported outcomes and an earlier return to work, as compared to PCL-based injuries. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Patricia M Lutz
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Merkle
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Philipp W Winkler
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephanie Geyer
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Westfalian-Wilhelms University Muenster, Muenster, Germany
| | - Sepp Braun
- Gelenkpunkt - Sports- and Traumasurgery Innsbruck, Innsbruck, Austria.,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Private University for Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - Andreas B Imhoff
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Matthias J Feucht
- Department for Orthopedic Sports Medicine, Technical University Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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15
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Suh D, Chang MJ, Park HJ, Chang CB, Kang SB. Assessment of Anterolateral Ligament of the Knee After Primary Versus Revision Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2021; 9:23259671211026237. [PMID: 34676268 PMCID: PMC8524717 DOI: 10.1177/23259671211026237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 02/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background: The anterolateral ligament of the knee (ALL) is a component of the lateral
complex that stabilizes the structure against rotational force and may be
associated with the outcome of anterior cruciate ligament (ACL)
reconstruction (ACLR). Purpose: To (1) find whether the visibility of the structure of the ALL is different
in primary and revision ACLR groups, (2) determine whether the abnormal
findings of the ALL structure on magnetic resonance imaging (MRI) scans are
associated with type of trauma in ACL injury and mode of graft failure, and
(3) determine whether there are differences in knee functional scores
between patients with or without abnormal findings of the ALL structure on
MRI scans in primary and revision ACLR groups. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 40 patients who underwent primary ACLR and
39 patients who underwent revision ACLR. Conventional MRI (1.5-T) scans
taken before primary or revision ACLR were obtained and analyzed for
visibility of the ALL, frequency and degree of injury of the ALL, and ALL
signal anomalies. We also evaluated 1-year postoperative functional knee
scores using the subjective International Knee Documentation Committee and
Lysholm scores. Results: Visibility of the ALL was better in the primary ACLR group than the revision
ACLR group (38% vs 14%; P = .041). The primary ACLR group
showed a lower degree of injury across the femoral, meniscal, and tibial
attachment sites than did the revision ACLR group (30% vs 13%, 41% vs 8%,
and 62% vs 26%, respectively). Relative signal anomaly of the ALL was more
frequent in the case of contact versus noncontact trauma of the ACL (85% vs
15%; P = .035), while absolute signal anomaly was equally
observed between cases of contact and noncontact trauma in the primary ACLR
group (50% vs 50%). No association was observed between ALL signal anomalies
and 1-year postoperative functional knee scores. Conclusion: The revision ACLR group offered less visibility and showed a tendency for
more frequent, higher degree of injury to the structure of the ALL.
Regardless of observational differences between the 2 groups, no definite
relevance was observed between the image and the functional outcome. For the
assessment of the ALL, routinely performed conventional MRI alone is
insufficient to make a clinical decision.
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Affiliation(s)
- Dongwhan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, Catholic University of Korea, Daejeon, Republic of Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Keyhani S, Movahedinia M, Soleymanha M, Verdonk R, Kazemi M, Qoreishy M. Repair of popliteomeniscal fascicles tear using a posterior transseptal portal fixes hypermobile lateral meniscus. J Exp Orthop 2021; 8:93. [PMID: 34676494 PMCID: PMC8531177 DOI: 10.1186/s40634-021-00412-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE This study investigates the effects of the all-inside repair of posterosuperior popliteomeniscal fascicle (PMF) on lateral meniscus stabilization using a posterior arthroscopic approach. METHODS Between 2015 and 2018, 17 patients with hypermobile lateral meniscus (HLM) underwent posterior knee arthroscopy for PMF repair. The all-inside repair was performed through posteromedial transseptal and posterolateral portals using a suture hook technique. Patients were clinically assessed based on IKDC and Lysholm scores. RESULTS Both IKDC and Lysholm scores improved significantly after an average follow-up of 3.5 years (P < 0.001). No patients underwent reoperation, and no complications associated with posterior knee arthroscopy were reported. CONCLUSION The all-inside suture hook technique using posterolateral and posteromedial transseptal portals fixes HLM with excellent IKDC and Lysholm scores. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Sohrab Keyhani
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran.
| | - Mohammad Movahedinia
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
| | | | - Rene Verdonk
- Department of Orthopedics and Traumatology, Gent University, Ghent, Belgium
| | - Morteza Kazemi
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
| | - Mohamad Qoreishy
- Bone Joint and Related Tissues Research Center, Akhtar Orthopedic Hospital, Shahid Beheshti University of Medical Sciences, Sharifi manesh street, Shariati street, Tehran, Iran
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17
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D'Addona A, Izzo A, Di Vico G, Rosa D, Maffulli N. The popliteomeniscal fascicles: from diagnosis to surgical repair: a systematic review of current literature. J Orthop Surg Res 2021; 16:148. [PMID: 33610180 PMCID: PMC7896406 DOI: 10.1186/s13018-021-02290-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/10/2021] [Indexed: 02/07/2023] Open
Abstract
Background Popliteomeniscal fascicles (PMF) are considered the posterolateral meniscocapsular extensions which connect the lateral meniscus to the edge of the tibia. PMFs disruption leads to hypermobility of the lateral meniscus with pain and locking sensation. Recognition and treatment of PMFs tear remain very challenging. The aim of this systematic review is to collect and analyse the articles concerning popliteomeniscal fascicle disruption from diagnosis to surgical approach. Methods PubMed, Scopus, Web of Science and EMBASE were searched. Various combinations of the keywords “Popliteomeniscal Fascicles”, “Lateral Meniscus”, “Popliteal Hiatus”, “Posterolateral Corner”, “Tear” and “Surgical Repair” were used. The original literature search identified a total of 85 articles comprising of duplicates. The PRISMA guidilines were followed. Studies in English language and published in peer-reviewed journals were included. Articles with level of evidence I to IV were included Results A total of three articles were included in the qualitative analysis. All the articles included are retrospective case series, with a level of evidence IV. Studies concerning patients with pre-operative imaging MRI and clinical assessment, reporting surgical technique and clinical outcomes assessed by physical examination and/or subjective evaluation scales were analysed. Conclusions MRI and the Figure-4 test allow to assess PMF tears pre-operatively. Arthroscopic evaluation constitutes the gold standard to confirm the diagnosis. Although surgery is considered resolutive for symptoms, there is still controversy about the most appropriate technique. Further higher quality studies are required.
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Affiliation(s)
- Alessio D'Addona
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy. .,Humanitas Clinical and Research Center-IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, MI, Italy.
| | - Andrea Izzo
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy
| | - Giovanni Di Vico
- Department of Orthopaedics and Trauma Surgery, Clinica San Michele, Maddaloni, CE, Italy
| | - Donato Rosa
- A.O.U. Federico II, Department of Public Health, Section of Orthopaedics and Trauma Surgery, Via S. Pansini 5, 80131, Naples, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Mile End Hospital, Barts and The London School of Medicine and Dentistry, 275 Bancroft Road, London, E1 4DG, UK
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18
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Goto K, Duthon V, Menetrey J. An isolated Posterolateral corner injury with rotational instability and hypermobile lateral meniscus: a novel entity. J Exp Orthop 2020; 7:95. [PMID: 33259028 PMCID: PMC7708576 DOI: 10.1186/s40634-020-00313-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
Purpose Although complete tear of the knee posterolateral corner (PLC) commonly occurs in combination with other knee ligamentous injuries, the incidence of isolated PLC injury was reported only 28% and overlooked in many cases. Nevertheless, an isolated PLC injury does not only provoke posterolateral instability, but also may be associated to hypermobile lateral meniscus. This study aims at showing the characteristics of isolated PLC injuries and to alert potential overlooked cases by describing their arthroscopic findings and clinical characteristics. Methods Seventy-one patients with a clinically proven isolated PLC injury who underwent knee arthroscopy were included in this study. Pre-operative symptoms and clinical signs at examination were recorded: Pain at the posterolateral aspect, feelings of instability, catching, locking; and for clinical signs: McMurray test, varus stress test in extension and at 30° of flexion, posterolateral drawer test at 30° and 80°, dial test at 30° and 80° of flexion. In terms of arthroscopic findings, systematic meniscal stability was performed to evaluate the presence of hypermobile lateral meniscus, “lateral drive through test” was also recorded in all cases. Results Positive Lateral Drive through test was found in 69 patients (95.8%). Hypermobile lateral meniscus was seen in all patients. Conclusions Hyper mobile lateral meniscus was concomitant with all isolated PLC injuries in our case series. As the typical arthroscopic characteristic, lateral drive through test positive were seen in 95.8%. In order to prevent overlooking this concomitant pathology, meticulous arthroscopic observation is crucial. Level of evidence Level IV.
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Affiliation(s)
- Kazumi Goto
- Centre for Sports Medicine and Exercise, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Chemin Thury 7 A, 1206, Geneve, Switzerland
| | - Victoria Duthon
- Centre for Sports Medicine and Exercise, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Chemin Thury 7 A, 1206, Geneve, Switzerland
| | - Jacques Menetrey
- Centre for Sports Medicine and Exercise, Swiss Olympic Medical Center, Hirslanden Clinique La Colline, Chemin Thury 7 A, 1206, Geneve, Switzerland. .,University Hospital of Geneva, Geneva, Switzerland.
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Concomitant Posterolateral Corner Injuries in Skeletally Immature Patients With Acute Anterior Cruciate Ligament Injuries. J Pediatr Orthop 2020; 40:271-276. [PMID: 32501906 DOI: 10.1097/bpo.0000000000001450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Missed posterolateral corner (PLC) injuries are a known cause of anterior cruciate ligament reconstruction (ACL) failure in the adult population. Failed ACL reconstruction causes significant morbidity in the skeletally immature pediatric population. There is little literature on the character and potential significance of PLC injuries in skeletally immature patients. METHODS Magnetic resonance imaging studies of the knee at a tertiary care children's hospital for patients who underwent an ACL reconstruction without PLC surgery were retrospectively reviewed. Demographic variables were obtained through chart review, and magnetic resonance imaging studies were evaluated for PLC (popliteus, fibular collateral ligament, popliteofibular ligament, and arcuate ligament) injury, and ACL, medial collateral ligament (MCL), bone bruise, fracture, and meniscal pathology by an experienced pediatric musculoskeletal radiologist. RESULTS A total of 50 patients with a mean age at 13.3 years at injury were analyzed. PLC injuries were found in 26 patients (52%), with 7 patients (14%) having a complete tear of a component of the PLC. There was no association between sex (P=0.35), Segond fracture (P=0.09), meniscus injury (P=0.92), or MCL injury (P=0.24) with the risk of PLC injury. There was an association between patient age and PLC injury (P=0.02). For each additional year of age, the odds of PLC injury increased by 1.8 times (odds ratio, 1.8; 95% confidence interval, 1.4-2.2). There was no association between PLC injury and ACL graft failure (P=0.19). CONCLUSIONS Missed PLC injuries are a significant source of morbidity and poor clinical outcomes in the management of concomitant ACL injuries in adults. This study demonstrates the prevalence of PLC injuries in the setting of concomitant ACL injuries in the unique skeletally immature patient population. Incomplete PLC injuries are relatively common. Complete PLC injuries are relatively uncommon. PLC injury was more common in older patients. No other concomitant injury predicted the likelihood of PLC injury. Further research is needed regarding the risk of ACL reconstruction failure from associated PLC injury and the indications for PLC reconstruction in skeletally immature patients. LEVEL OF EVIDENCE Level IV-diagnostic study.
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20
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Ruptur des M. soleus als Begleitverletzung einer akuten vorderen Kreuzbandruptur. ARTHROSKOPIE 2020. [DOI: 10.1007/s00142-020-00370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungDie Ruptur des vorderen Kreuzbands (VKB) ist eine häufige Verletzung des Kniegelenks und geht oftmals mit Begleitverletzungen einher. Diese können intra- und extraartikuläre Strukturen betreffen. Die Entscheidung zur konservativen oder operativen Versorgung der VKB-Ruptur muss patientenorientiert und unter Beachtung der Begleitverletzungen erfolgen. Der hier vorliegende Fall beschreibt eine 30-jährige Patientin, die sich nach dem Absprung von einer Kletterwand bei der Landung das linke Knie verletzt hat. Die klinische Untersuchung ergab zum positiven Lachman-Test zusätzlich einen Druckschmerz im Bereich des Ursprungs des M. soleus. Die bildgebende Diagnostik mittels Magnetresonanztomographie (MRT) bestätigte die VKB-Ruptur und zeigte eine begleitende Ruptur des M. soleus im Bereich des Ursprungs am Fibulakopf. Nach der operativen Therapie der VKB-Ruptur und konservativer Behandlung der Muskelläsion zeigte die Patientin einen beschwerdefreien Verlauf ohne Instabilitätsgefühl, Bewegungseinschränkung oder Kraftgradminderung bei einem Follow-up bis 6 Monate nach der Operation. Diese seltene Verletzung unterstreicht die protektive Aufgabe des M. soleus bei einbeinigen Landungen und die Wichtigkeit, diesen Muskel im diagnostischen Algorithmus zu berücksichtigen.
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21
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Large variability exists in the management of posterolateral corner injuries in the global surgical community. Knee Surg Sports Traumatol Arthrosc 2020; 28:2116-2123. [PMID: 32239270 DOI: 10.1007/s00167-020-05922-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 02/24/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The management of posterolateral corner (PLC) injuries has significantly evolved over the past 2 decades. The purpose of this study was to determine the current worldview of key concepts on the diagnosis, treatment strategy, and rehabilitation for patients presenting with PLC injuries. METHODS A 12-question multiple-choice online survey was designed to address key questions in the diagnosis, treatment, and rehabilitation of PLC injuries. The survey was distributed to the most important international sports medicine societies worldwide. Clinical agreement was defined as > 80% of agreement in responses and general agreement was defined as > 60% of agreement in responses. RESULTS 975 surgeons completed the survey with 49% from Europe, 21% from North America, 12% from Latin America, 12% from Asia, and smaller percentages from Africa and Oceania. Less than 14% of respondents manage more than ten PCL injuries yearly. Clinical agreement of > 80% was only evident in the use of MRI in the diagnosis of PLC injury. Responses for surgical treatment were split between isometric fibular-based reconstruction techniques and anatomically based fibular and tibial-based reconstructions. A general agreement of > 60% was present for the use of a post-operative brace in the early rehabilitation. CONCLUSION In the global surgical community, there remains a significant variability in the diagnosis, treatment, and postoperative management of PLC injuries. The number of PLC injuries treated yearly by most surgeons remains low. As global clinical consensus for PLC remains elusive, societies will need to play an important role in the dissemination of evidence-based practices for PLC injuries. LEVEL OF EVIDENCE IV.
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22
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Shekari I, Shekarchi B, Abbasian M, Minator Sajjadi M, Momeni Moghaddam A, Kazemi SM. Predictive Factors Associated with Anterolateral Ligament Injury in the Patients with Anterior Cruciate Ligament Tear. Indian J Orthop 2020; 54:655-664. [PMID: 32850030 PMCID: PMC7429582 DOI: 10.1007/s43465-020-00159-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The earlier studies did not assess the associated factors of anterolateral ligament injury, comprehensively. We sought to evaluate the independent predictive factors of anterolateral ligament injury in the patients with anterior cruciate ligament tear. Ultrasound scan has an emerging role in the diagnosis of anterolateral ligament injury. MATERIALS AND METHODS We included 198 patients with anterior cruciate ligament tear in this study. All the patients underwent knee ultrasound scan to diagnose the anterolateral ligament injury. The potential predictive factors of anterolateral ligament injury were compared between the patients with anterolateral ligament injury and the patients with the intact anterolateral ligament. RESULTS In all the patients, the anterolateral ligament was seen in the tibial and femoral portions using the ultrasound scan. One hundred and ten patients (55.6%) had anterolateral ligament injury and the anterolateral ligament was intact in 88 patients (44.4%). The lateral collateral ligament injury was significantly associated with the anterolateral ligament injury (p < 0.001). In addition, the iliotibial band injury had a significant relationship with the anterolateral ligament injury (p = 0.001). An increased lateral tibial slope was significantly associated with the anterolateral ligament injury (p = 0.031). Furthermore, the bone contusion of the lateral femoral condyle had a significant relationship with the anterolateral ligament injury (p = 0.004). CONCLUSION The independent predictors of anterolateral ligament injury included the lateral collateral ligament injury, iliotibial band injury, bone contusion of the lateral femoral condyle, and an increased lateral tibial slope.
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Affiliation(s)
- Iraj Shekari
- grid.411259.a0000 0000 9286 0323Radiology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Babak Shekarchi
- grid.411259.a0000 0000 9286 0323Department of Radiology, AJA University of Medical Sciences, Etemadzadeh Street, Fatemi Avenue, Tehran, 1411718541 Iran
| | - Mohammadreza Abbasian
- grid.411600.2Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amin Momeni Moghaddam
- grid.411600.2Department of Radiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyed Morteza Kazemi
- grid.411600.2Department of Orthopedic Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Taljanovic MS, Chang EY, Ha AS, Bartolotta RJ, Bucknor M, Chen KC, Gorbachova T, Khurana B, Klitzke AK, Lee KS, Mooar PA, Nguyen JC, Ross AB, Shih RD, Singer AD, Smith SE, Thomas JM, Yost WJ, Kransdorf MJ. ACR Appropriateness Criteria® Acute Trauma to the Knee. J Am Coll Radiol 2020; 17:S12-S25. [PMID: 32370956 DOI: 10.1016/j.jacr.2020.01.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/20/2022]
Abstract
Acute trauma to the knee is a common presentation seen in the emergency department. After a routine clinical examination, imaging is frequently performed to facilitate the diagnosis and almost always starts with radiographs. If clinically indicated, advanced cross-sectional imaging may then be performed for further evaluation. CT is often performed for preoperative planning of the complex tibial plateau and distal femur fractures. Currently, MRI is the study of choice for evaluation of bone marrow, internal derangements, and other soft-tissue injuries about the knee joint. In patients with knee dislocations, MR angiography may be performed simultaneously with MRI for evaluation of internal derangements and vascular injuries with less morbidity compared to conventional angiography. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Eric Y Chang
- Panel Chair, VA San Diego Healthcare System, San Diego, California
| | - Alice S Ha
- Panel Vice-Chair, University of Washington, Seattle, Washington
| | | | - Matthew Bucknor
- University of California San Francisco, San Francisco, California
| | - Karen C Chen
- VA San Diego Healthcare System, San Diego, California
| | | | | | - Alan K Klitzke
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Kenneth S Lee
- University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Pekka A Mooar
- Temple University Hospital, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Jie C Nguyen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Andrew B Ross
- University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin
| | - Richard D Shih
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida; American College of Emergency Physicians
| | - Adam D Singer
- Emory University School of Medicine, Atlanta, Georgia
| | - Stacy E Smith
- Brigham & Women's Hospital & Harvard Medical School, Boston, Massachusetts
| | - Jonelle M Thomas
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - William J Yost
- UnityPoint Health, Des Moines, Iowa; American College of Physicians
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Abstract
PURPOSE OF REVIEW The importance of the posterolateral corner (PLC) with respect to knee stability, particularly in the setting of anterior cruciate ligament (ACL) deficiency, has become more apparent in recent years. The purposes of this article are to review the current concepts of PLC injuries and to address their role in the ACL-deficient and ACL-reconstructed knee. RECENT FINDINGS Recent literature demonstrates that a single staged, combined reconstruction is optimal. Studies further provide more thorough insight into avoidance of tunnel collision during the multiligament reconstruction. In total, reconstruction procedures have demonstrated successful outcomes in over 90% of patients. In summary, we report that in the setting of suspected concomitant PLC and ACL injury, it is essential to address both injuries; appreciating the local anatomy, diagnostic modalities, and surgical techniques are each crucial to achieving desirable clinical outcomes.
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Lee SY, Choi YJ, Park HJ, Kook SH, Kang KA, Kim MS, Kwon HJ, Ahn JH. Types of posterolateral corner injury associated with both bundle and selective-bundle ACL tears. Acta Radiol 2019; 60:284185119842833. [PMID: 31042067 DOI: 10.1177/0284185119842833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is unknown whether a selective-bundle tear of the anterior cruciate ligament (ACL) shows a different prevalence of posterolateral corner (PLC) injury than a both-bundle tear. PURPOSE The prevalence of injury of PLC stabilizer in relation to the type of combined ACL tear (both-bundle and selective-bundle tears) has been investigated. MATERIAL AND METHODS This retrospective study included 94 patients who were diagnosed with an ACL tear after knee joint magnetic resonance imaging and underwent arthroscopic surgery. We compared the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear. We used Fischer exact tests to compare the prevalence of each lesion in relation to the type of ACL injury and the type of selective-bundle tear. RESULTS Both-bundle tears occurred in 55 cases (56%) and selective-bundle tears in 39 cases (44%). The most common PLC injury with an ACL tear was inferior popliteomeniscal fascicle (PMF) injury, followed by superior PMF injury. The prevalence of each PLC injury was higher for both-bundle tears than selective-bundle tears, with the exception of popliteus tendon injury diagnosed by reader 1 (P.H.J). However, these differences were statistically significant for superior PMF injury only ( p < 0.05). The prevalence of PLC injury was unrelated to the type of selective-bundle tear (anteromedial vs posterolateral). CONCLUSION Superior PMF injury is more common in both-bundle tears than selective-bundle tears. There is no statistically significant difference in the prevalence of PLC injury between both-bundle tears and selective-bundle tears.
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Affiliation(s)
- So Yeon Lee
- 1 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon Jung Choi
- 1 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Park
- 1 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Shin Ho Kook
- 1 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyung A Kang
- 1 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Mi Sung Kim
- 1 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Heon Ju Kwon
- 1 Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Hwan Ahn
- 2 Department of Orthopaedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Bone Bruises Associated with Anterior Cruciate Ligament Injury as Indicators of Injury Mechanism: A Systematic Review. Sports Med 2019; 49:453-462. [DOI: 10.1007/s40279-019-01060-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Temponi EF, Saithna A, de Carvalho LH, Teixeira BP, Sonnery-Cottet B. Nonoperative Treatment for Partial Ruptures of the Lateral Collateral Ligament Occurring in Combination With Complete Ruptures of the Anterolateral Ligament: A Common Injury Pattern in Brazilian Jiu-Jitsu Athletes With Acute Knee Injury. Orthop J Sports Med 2019; 7:2325967118822450. [PMID: 30719481 PMCID: PMC6348520 DOI: 10.1177/2325967118822450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Combined partial lateral collateral and complete anterolateral ligament
(PLCCALL) injuries are a specific injury pattern seen in Brazilian jiu-jitsu
(BJJ) because of the knee varus-flexion mechanism that frequently occurs
during grappling. Purpose/Hypothesis: The purpose of this study was to evaluate the incidence of this injury
pattern in a series of BJJ athletes with an acute knee injury and to
evaluate clinical and functional outcomes after nonoperative management at a
minimum follow-up of 1 year. Our hypotheses were that PLCCALL injuries are
common in BJJ and that nonoperative treatment is associated with excellent
clinical outcomes and return to the preinjury level of sport. Study Design: Case series; Level of evidence, 4. Methods: All BJJ athletes who presented with an acute knee injury between July 2013
and June 2017 and who underwent magnetic resonance imaging (MRI) of the knee
were included. A specific emphasis was placed on identifying those whose
imaging demonstrated PLCCALL injury. Clinical evaluation included physical
examination as well as Lysholm and International Knee Documentation
Committee (IKDC) scores. Results: Of the 27 patients analyzed, 7 (25.9%) had MRI-proven PLCCALL injuries. The
mean follow-up after nonoperative management was 41.3 months. The mean IKDC
and Lysholm scores were 94 and 92 before the injury, 26 and 36 at the
initial assessment after the injury, and 83 and 78 at 12-month follow-up,
respectively (P < .00001). All 7 patients had returned
to their preinjury level of sports by the 12-month follow-up. The mean time
between injury and return to competition level was 4.7 months (range, 4-6
months). Conclusion: PLCCALL injury is a specific but infrequent injury pattern in BJJ. The
prognosis of this injury after nonoperative treatment appears to be
excellent. Improved functional scores (IKDC and Lysholm) and changes on MRI
demonstrated that the anterolateral ligament has intrinsic healing
potential, as the images showed complete healing of the previously
documented rupture of the anterolateral ligament from its proximal
attachment.
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Affiliation(s)
| | - Adnan Saithna
- Renacres Hospital, Ormskirk, Lancashire, UK.,School of Science and Technology, Nottingham Trent University, Clifton Campus, East Midlands, UK
| | | | | | - Bertrand Sonnery-Cottet
- Centre Orthopedic Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
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Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression. Knee Surg Sports Traumatol Arthrosc 2019; 27:44-59. [PMID: 29869683 PMCID: PMC6510815 DOI: 10.1007/s00167-018-4993-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/30/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE During anterior cruciate ligament (ACL) injury, the large external forces responsible for ligament rupture cause a violent impact between tibial and femoral articular cartilage, which is transferred to bone resulting in bone bruise detectable at MRI. Several aspects remain controversial and await evidence on how this MRI finding should be managed while addressing the ligament lesion. Thus, the aim of the present review was to document the evidence of all available literature on the role of bone bruise associated with ACL lesions. METHODS A systematic review of the literature was performed on bone bruise associated with ACL injury. The search was conducted in September 2017 on three medical electronic databases: PubMed, Web of Science, and the Cochrane Collaboration. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used. Relevant articles were studied to investigate three main aspects: prevalence and progression of bone bruise associated with ACL lesions, its impact on the knee in terms of lesion severity and joint degeneration progression over time and, finally, the influence of bone bruise on patient prognosis in terms of clinical outcome. RESULTS The search identified 415 records and, after an initial screening according to the inclusion/exclusion criteria, 83 papers were used for analysis, involving a total of 10,047 patients. Bone bruise has a high prevalence (78% in the most recent papers), with distinct patterns related to the mechanism of injury. This MRI finding is detectable only in a minority of cases the first few months after trauma, but its presence and persistence have been correlated to a more severe joint damage that may affect the degenerative progression of the entire joint, with recent evidence suggesting possible effects on long-term clinical outcome. CONCLUSION This systematic review of the literature documented a growing interest on bone bruise associated with ACL injury, highlighting aspects which could provide to orthopaedic surgeons evidence-based suggestions in terms of clinical relevance when dealing with patients affected by bone bruise following ACL injury. However, prospective long-term studies are needed to better understand the natural history of bone bruise, identifying prognostic factors and targets of specific treatments that should be developed in light of the overall joint derangements accompanying ACL lesions. LEVELS OF EVIDENCE IV, Systematic review of level I-IV studies.
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An Update and Comprehensive Review of the Posterolateral Corner of the Knee. Radiol Clin North Am 2018; 56:935-951. [DOI: 10.1016/j.rcl.2018.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Filli L, Rosskopf AB, Sutter R, Fucentese SF, Pfirrmann CW. MRI Predictors of Posterolateral Corner Instability: A Decision Tree Analysis of Patients with Acute Anterior Cruciate Ligament Tear. Radiology 2018; 289:170-180. [DOI: 10.1148/radiol.2018180194] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lukas Filli
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
| | - Andrea B. Rosskopf
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
| | - Reto Sutter
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
| | - Sandro F. Fucentese
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
| | - Christian W.A. Pfirrmann
- From the Departments of Radiology (L.F., A.B.R., R.S., C.W.A.P.) and Orthopedics (S.F.F.), Balgrist University Hospital, Forchstrasse 340, CH-8008 Zurich, Switzerland; and Faculty of Medicine, University of Zurich, Zurich, Switzerland (L.F., A.B.R., R.S., S.F.F., C.W.A.P.)
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Zappia M, Reginelli A, Chianca V, Carfora M, Di Pietto F, Iannella G, Mariani PP, Di Salvatore M, Bartollino S, Maggialetti N, Cappabianca S, Brunese L. MRI of popliteo-meniscal fasciculi of the knee: a pictorial review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:7-17. [PMID: 29350634 PMCID: PMC6179070 DOI: 10.23750/abm.v89i1-s.7007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 01/10/2018] [Indexed: 01/13/2023]
Abstract
The popliteomeniscal fascicules (PMFs) provide the attachment of the lateral meniscus to the popliteus musculotendinous region, forming the floor and the roof the popliteal hiatus. In the second half of 1900's, some anatomic studies claim the important function of the PMF as stabilizers of the lateral meniscus; these anatomical structures work in conjunction with the popliteus musculotendinous unit to prevent excessive lateral meniscal movement and possible meniscus subluxation. A correct diagnosis of the PMFs pathology is crucial to establish the suitable surgical treatment for each patient. MRI is a well-established imaging technique in the musculoskeletal system and the frequency of recognition of normal PMF in the normal knees is high in almost all MRI studies. At day, the gold standard for diagnosis is the arthroscopic evaluation that allows the direct visualization of the popliteo-meniscal ligaments at popliteal hiatus and evaluation of lateral meniscal movements. For this reason if unstable condition of meniscus was suspected, arthroscopic observation with probing into the popliteo-meniscal fascicle area is essential for the identification of the fascicle tears. Despite many treatments have being proposed in literature since now there is high recurrence of knee locking after repair and it is fundamental to develop new surgical techniques in order to achieve better outcome.
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