Preoperative MRI for the Multiligament Knee Injury: What the Surgeon Needs to Know

Reverse Ramp Lesion Repair in Patients With Meniscotibial Ligament Avulsion Injury: The Hidden AMRI

Lesions of the meniscocapsular junction and the meniscotibial ligament (MTL) of the posterior horn of the medial meniscus are common with knee ligamentous injuries and associated with residual rotational instability if left untreated. MTL avulsion from its tibial attachment has never been described among different types of meniscocapsular disruptions so far. Both diagnosis and treatment of such an injury can be challenging. This article describes a detailed technique and proposes an algorithm to appropriate management of this rare injury.

Cruciate and Collateral Ligaments: 2-Dimensional and 3-Dimensional MR Imaging-Aid to Knee Preservation Surgery

Being a major load-bearing and dynamic functional joint of the body, the knee joint is prone to injuries to the menisci and ligaments. Injury to one or more of these structures leads to accelerated or premature osteoarthritis and chronic debilitation. The estimated cost of these injuries in terms of diagnosis, treatment, rehabilitation, and person-hours lost amounts to over a billion dollars annually. Understanding the relevant anatomy of knee cruciate and collateral ligaments, their biomechanical functional role, and imaging considerations are essential to assist multi-disciplinary communications and timely patient treatments for improved management. MRI is considered the gold standard over other imaging modalities like X-ray, ultrasound (US), and Computed Tomography (CT) for diagnosing and assessing such injuries. High-resolution 2D and 3D MRI are considerably helpful in planning for knee preservation surgery, and this article reviews the role of such imaging as a valuable aid to knee preservation surgery in pre-and post-operative states. Relevant arthroscopy correlations have been illustrated.

The value of magnetic resonance imaging in the preoperative diagnosis of tibial plateau fractures: a systematic literature review

Purpose

The outcome of a tibial plateau fracture (TPF) depends on the fracture reduction achieved and the extent of soft-tissue lesions, including lesions in the ligaments, cartilage, and menisci. Sub-optimal treatment can result in poor knee function and osteoarthritis. Preoperative planning is primarily based on conventional X-ray and computed tomography (CT), which are unsuitable for diagnosing soft-tissue lesions. Magnetic resonance imaging (MRI) is not routinely performed. To date, no literature exists that clearly states the indications for preoperative MRI. This systematic review aimed to determine the frequency of soft-tissue lesions in TPFs, the association between fracture type and soft-tissue lesions, and the types of cases for which MRI is indicated.

Methods

A systematic review of the literature was based on articles located in PubMed/MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL), supplemented by searching the included articles’ reference lists and the ePublication lists of leading orthopedic and trauma journals.

Results

A total of 1138 studies were retrieved. Of these, 18 met the eligibility criteria and included a total of 877 patients. The proportion of total soft-tissue lesions was 93.0%. The proportions of soft-tissue lesions were as follows: medial collateral ligament 20.7%, lateral collateral ligament 22.9%, anterior cruciate ligament 36.8%, posterior cruciate ligament 14.8%, lateral meniscus 48.9%, and medial meniscus 24.5%. A weak association was found between increasing frequency of LCL and ACL lesions and an increase in fracture type according to Schatzker's classification. No standard algorithm for MRI scans of TPFs was found.

Conclusion

At least one ligament or meniscal lesion is present in 93.0% of TPF cases. More studies with higher levels of evidence are needed to find out in which particular cases MRI adds value. However, MRI is recommended, at least in young patients and cases of high-energy trauma.

Observation on the Effect of Rehabilitative Physical Training on Ice and Snow Sports Injury under Ultrasound Examination

In order to solve the problem of rehabilitative physical training on ice and snow sports injuries, the author proposed an observation method using ultrasonography to be proposed. This method selects patients with anterior talofibular ligament injury treated in a hospital, forty-nine patients who did not undergo conventional rehabilitation under the surveillance of sports medicine ultrasound were set as the control group, a total of 49 patients with anterior talofibular ligament injury who underwent rehabilitation treatment under the monitoring of sports medicine ultrasound were selected as the experimental group, and the clinical efficacy of the two groups of patients was retrospectively analyzed, in order to discuss the application value of sports medicine ultrasound in the rehabilitation of anterior talofibular ligament injury. The results showed that comparing the rehabilitation effect, ankle function score, and daily living ability of the two groups of patients, the experimental group was better than the control group. Comparing the thickness of ligament and effusion between the two groups, the experimental group was also better than the control group, and the difference was statistically significant (P < 0.05). Ultrasound medical examination can help doctors to effectively judge the degree of injury and recovery of patients, and doctors can adjust the treatment plan in time according to the examination results and formulate an effective rehabilitation plan, which can greatly shorten the recovery time of patients, improve the treatment effect, promote the functional recovery of the ankle joint, and reduce the occurrence of complications.

An Evidence-Based Approach to Multi-Ligamentous Knee Injuries

Multi ligament knee injuries (MLKIs) are highly complex injuries with associated complications and often present with difficult management strategies. MLKIs may affect the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (or posteromedial corner (PMC)), and lateral collateral ligament (or posterolateral corner (PLC)) in addition to other structures including the menisci, common peroneal nerve, and popliteal artery. MLKIs are highly associated with the male sex and are commonly seen in high-velocity motor vehicle accidents and low-velocity sports injuries. Given the multiple planes of movement in the knee and various primary and secondary stabilizers throughout those planes, there is great heterogeneity in an injury pattern and most involve the ACL and PCL. Initial evaluation of this injury includes assessment of lower extremity sensation, distal pulses, and ankle-brachial index (ABI). If vascular compromise is suspected, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are indicated to evaluate the vasculature. As opposed to CTA, MRA offers visualization of the soft-tissue structures that are commonly damaged in MLKIs. Initial management typically includes closed reduction of the knee with subsequent external fixation. Classification systems guide initial assessments; however, further management is unclear and leads the surgical team to decide the best, individualized management option for each patient. As a result, optimal surgical and postoperative treatment options remain complicated, and clinical outcomes remain difficult to predict. The purpose of this review is to consolidate the most up-to-date practices of the diagnostic workup, management, and treatment of MLKIs.

[Short-term effectiveness of one-stage anterior and posterior cruciate ligaments and posterolateral complex reconstruction combined with medial collateral ligament repair for KD- knee dislocation]

OBJECTIVE

To investigate the short-term effectiveness of one-stage anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posterolateral complex (PLC) reconstruction combined with medial collateral ligament repair for KD-Ⅳ knee dislocation.

METHODS

Between January 2018 and June 2020, 9 patients with KD-Ⅳ knee dislocation were treated. Of 9 cases, 7 were male and 2 were female with an average age of 32.3 years (range, 23-43 years). The knee dislocation was caused by falling from height in 6 cases and traffic accident in 3 cases. The injury located at left knee in 2 cases and right knee in 7 cases. The time from injury to operation was 14-24 days, with an average of 19 days. The preoperative International Knee Joint Documentation Committee (IKDC) score was 45.6±4.2, Lysholm score was 42.4±7.0, and the knee joint active flexion range of motion was (75.2±12.3)°. The posterior drawer test, pivot-shift test, Dial test, and 0° valgus stress test were all positive. Under arthroscopy, PCL was reconstructed with the autologous tendons, ACL with allogeneic Achilles tendon, PLC with the allogeneic anterior tibial tendon by Larson enhanced reconstruction method, and MCL was repaired with anchor or simple suture.

RESULTS

The operation time was 2-3 hours (mean, 2.5 hours). All incisions healed by first intention after operation. All patients were followed up12-25 months (mean, 16.1 months). After operation, 2 cases developed knee flexion disorder and pain, and 1 case had knee joint stiffness. At last follow-up, the IKDC score was 76.9±7.4, the Lysholm score was 81.6±6.4, and the knee active flexion range of motion was (122.9±7.2)°, all of which significantly improved when compared with preoperative ones ( P<0.05). During follow-up, there was no failure of the grafts. At last follow-up, there were significant differences in the posterior drawer test, pivot-shift test, Dial test, and 0° valgus stress test between pre- and post-operation ( P<0.05). The imaging review showed that the positions of the bone tunnels were satisfactory, the reconstructed ACL, PCL, and PLC structures were continuous, and MCL insertions were restored.

CONCLUSION

One-stage ACL, PCL, and PLC reconstruction combined with MCL repair to treat KD-Ⅳ knee dislocation can effectively restore knee joint stability, improve joint laxity, and improve joint movement.