1
|
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.
Collapse
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
| |
Collapse
|
2
|
Völlner F, Herl F, Greimel F, Benditz A, Renkawitz T, Grifka J, Craiovan B, Weber M. The effects of soft tissue lateral release on the stability of the ligament complex of the knee. Arch Orthop Trauma Surg 2020; 140:933-940. [PMID: 32232619 PMCID: PMC7295728 DOI: 10.1007/s00402-020-03422-6] [Citation(s) in RCA: 4] [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: 12/19/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Valgus deformity presents a particular challenge in total knee arthroplasty. This condition regularly leads to contractures of the lateral capsular ligament complex and to overstretching of the medial ligamentous complex. Reconstruction of the knee joint kinematics and anatomy often requires lateral release. However, data on how such release weakens the stability of the knee are missing in the literature. This study investigated the effects of sequential lateral release on the collateral stability of the ligament complex of the knee in vitro. METHODS Ten knee prostheses were implanted in 10 healthy cadaveric knee joints using a navigation device. Soft tissue lateral release consisted of five release steps, and stiffness and stability were determined at 0, 30, 60 and 90° flexion after each step. RESULTS Soft tissue lateral release increasingly weakened the ligament complex of the lateral compartment. Because of the large muscular parts, the release of the iliotibial band and the M. popliteus had little effect on the stability of the lateral and medial compartment, but release of the lateral ligament significantly decreased the stability in the lateral compartment over the entire range of motion. Stability in the medial compartment was hardly affected. Conversely, further release of the posterolateral capsule and the posterior cruciate ligament led to the loss of stability in the lateral compartment only in deep flexion, whereas stability decreased significantly in the medial compartment. CONCLUSION Our study shows for the first time the association between sequential lateral release and stability of the ligamentous complex of the knee. To maintain the stability, knee surgeons should avoid releasing the entire lateral collateral ligament, which would significantly decrease stability in the lateral compartment.
Collapse
Affiliation(s)
- Florian Völlner
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Florian Herl
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Felix Greimel
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Tobias Renkawitz
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Benjamin Craiovan
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| | - Markus Weber
- Department of Orthopaedic Surgery, Regensburg University Medical Centre, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077 Bad Abbach, Germany
| |
Collapse
|
3
|
Matar HE, Farrar NG. Snapping Biceps Femoris: clinical demonstration and operative technique. Ann R Coll Surg Engl 2018; 100:e59-e61. [PMID: 29364023 PMCID: PMC5930108 DOI: 10.1308/rcsann.2018.0007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2017] [Indexed: 01/13/2023] Open
Abstract
Snapping biceps femoris syndrome has been reported in the literature in a handful of case reports but not yet with a demonstration of clinical examination and intraoperative findings. We present an educational clinical video of snapping biceps femoris with intraoperative demonstration of findings and surgical repair.
Collapse
Affiliation(s)
- HE Matar
- Mid Cheshire Hospitals NHS Foundation Trust, UK
| | - NG Farrar
- Mid Cheshire Hospitals NHS Foundation Trust, UK
| |
Collapse
|
4
|
Freimoser F, Grechenig S, Ofenhitzer A, Bakota B, Staresinic M, Pfeifer CG. Anatomical and radiological evaluation of less invasive stabilisation system (LISS) in correlation with knee lateral collateral ligament insertion. Injury 2017; 48 Suppl 5:S56-S60. [PMID: 29122124 DOI: 10.1016/s0020-1383(17)30741-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The Less Invasive Stabilisation System (LISS) is an angle-stable plate that enables treatment of distal femoral comminuted and periprosthetic fracture. As it is placed through a minimally-invasive lateral approach, lateral knee pain is a commonly described symptom after its application. This study investigates knee lateral collateral ligament (LCL) iatrogenic injury during LISS plate fixation. A cadaver study was performed and a retrospective radiological investigation with the analysis of its clinical application was conducted to evaluate possible knee LCL damage. METHODS The cadaver study included 13 human lower extremities, treated with LISS. After application, lateral knee side was dissected, implants were removed and distances between the drill holes and LCL origin were measured. In the retrospective radiological evaluation, postoperative X-rays for patients treated with distal femoral LISS plate in the University Hospital Regensburg, Germany from January 2010 to December 2015 were examined. Following a protocol described by Pietrini et al., the LCL origin on postoperative X-rays was calculated, both in lateral and anterior-posterior (AP) view, and distances between the plate and its closest locking screw to the LCL origin were measured. RESULTS In the cadaver study, the mean distance between the closest drilling hole and the ligament origin was 14.0mm (range 9-21mm; SD 3.8mm). Twenty-two patients matched the inclusion criteria for the retrospective radiological study. In lateral view, the mean distance between the origin and the closest locking screw was 6.3mm (range 0-16.4mm; SD 4.7mm); the mean distance between the origin and the plate was 3.1mm (range 0-13.9mm; SD 4.1mm). In AP view, the mean distance between LCL origin and the nearest screw was 2.4mm (range 0-7.6mm; SD 2.4mm). The mean distance between the origin and the most distal locking screw was 9.2mm (range 0-17.5mm; SD 4.0mm). DISCUSSION The LISS is a safe option to treat distal femoral fractures in respect to the LCL. Due to close proximity, the LCL might be harmed; therefore, lateral knee pain or lateral instability after implantation should be assessed in further treatment.
Collapse
Affiliation(s)
- Florian Freimoser
- Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany
| | - Stephan Grechenig
- Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany
| | - Anna Ofenhitzer
- Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany
| | - Bore Bakota
- Trauma and Orthopaedic Surgery department, Brighton and Sussex University Hospital, NHS Trust, UK
| | - Mario Staresinic
- Trauma and Orthopaedic Clinic, University Hospital Merkur, Zagreb, Croatia
| | - Christian G Pfeifer
- Department of Trauma and Orthopaedic Surgery, University Medical Centre Regensburg, Germany.
| |
Collapse
|
5
|
Temponi EF, de Carvalho Júnior LH, Saithna A, Thaunat M, Sonnery-Cottet B. Incidence and MRI characterization of the spectrum of posterolateral corner injuries occurring in association with ACL rupture. Skeletal Radiol 2017; 46:1063-1070. [PMID: 28424850 DOI: 10.1007/s00256-017-2649-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 03/25/2017] [Accepted: 03/30/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the incidence and MRI characteristics of the spectrum of posterolateral corner (PLC) injuries occurring in association with anterior cruciate ligament (ACL) rupture. MATERIALS AND METHODS We carried out a level IV, retrospective case series study. All patients clinically diagnosed with an ACL rupture between July 2015 and June 2016 who underwent MRI of the knee were included in the study. In addition to standard MRI knee reporting, emphasis was placed on identifying injury to the PLC and a description of involvement of these structures by two musculoskeletal radiologists. Association with PLC involvement was sought with concomitant injuries using correlation analysis and logistic regression. RESULTS One hundred sixty-two patients with MRI following ACL rupture were evaluated. Thirty-two patients (19.7%) had an injury to at least one structure of the PLC, including the inferior popliteomeniscal fascicle (n = 28), arcuate ligament (n = 20), popliteus tendon (n = 20), superior popliteomeniscal fascicle (n = 18), lateral collateral ligament (n = 8), popliteofibular ligament (n = 7), biceps tendon (n = 4), iliotibial band (n = 3), and fabellofibular ligament (n = 1). Seventy-five percent of all patients with combined ACL and PLC injuries had bone contusions involving the lateral compartment of the knee. The presence of these contusions strongly correlated with superior popliteomeniscal fascicle lesions (p < 0.05). There was no correlation between injuries to other structures of the PLC and other intra-articular lesions. CONCLUSION Missed injuries of the PLC lead to considerable morbidity. The relevance of this study is to highlight that these injuries occur more frequently than previously described and that an appropriate index of suspicion, clinical examination, and MRI are all required to reduce the risk of missed diagnoses. The results of this study support previous suggestions that the rate of concomitant PLC injury in the ACL-deficient knee is under-reported. The rate of combined injuries in this series was 19.7%. The key message of this paper is that PLC injury is common in the presence of ACL injury and should be sought both clinically and radiologically.
Collapse
Affiliation(s)
- Eduardo Frois Temponi
- Hospital Madre Teresa, Avenida Raja Gabáglia, 1002, Belo Horizonte, 30441-070, Minas Gerais, Brazil.
| | - Lúcio Honório de Carvalho Júnior
- Hospital Madre Teresa, Avenida Raja Gabáglia, 1002, Belo Horizonte, 30441-070, Minas Gerais, Brazil.,Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adnan Saithna
- Southport and Ormskirk Hospitals, Southport, UK.,Department of Clinical Engineering, University of Liverpool, Liverpool, UK
| | - Mathieu Thaunat
- Centre Orthopedic Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedic Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, Lyon, France
| |
Collapse
|
6
|
Huang H, Li J, Tang X. [Classification, diagnosis, and treatment system of posteromedial structure and posterolateral corner injury in knee dislocation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:614-619. [PMID: 29798553 PMCID: PMC8498247 DOI: 10.7507/1002-1892.201611139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/30/2017] [Indexed: 02/05/2023]
Abstract
Objective To review the research progress of diagnosis and treatment system for knee dislocation (KD) based on the stage and classification of posteromedial structure and posterolateral corner injury, so as to provide guidance for clinical work. Methods The relevant literature on the classification, diagnosis and treatment was extensively reviewed. Results At present, the criterion of the stage and classification of KD mainly include classification based on the size of the injury energy, Kennedy classification, and the improved Schenck classification, but they are not perfect because of no stage and classification of multiple ligament injury and no standardized treatment of different injuries. Hua Xi Knee Dislocation and Multiple Ligament Injury (HX-KDMLI) has optimum plan for injury treatment of posteromedial structure and posterolateral corner injury in KD based on stage and classification. Conclusion At present, there is no unified opinion on stages and classifications of the posteromedial structure and posterolateral corner injury in KD as well as on diagnosis and treatment. HX-KDMLI has certain feasibility for the stage and classification of the posteromedial structure and posterolateral corner injury in KD, to a certain extent, it can be used as reference for the diagnosis and treatment of KD.
Collapse
Affiliation(s)
- Huaqiang Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Jian Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xin Tang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
| |
Collapse
|