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Multiligament knee

Vikram Arun Mhaskar, Jitendra Mahehswari, Manjeet Sansanwal
Anterior cruciate ligament (ACL) femoral avulsions are a rare entity mainly seen in children. We describe a unique case of a bony ACL avulsion with a medial collateral ligament (MCL) and lateral meniscus (LM) tear in a 37-year-old patient who sustained a two-wheeler accident. The ACL femoral avulsion was fixed arthroscopically using a Knee Scorpion and a FiberTape fixed over a suture disc on the lateral cortex. The MCL was repaired with an internal brace using a FiberTape and two SwiveLocks and the torn LM was repaired using all-inside sutures...
March 18, 2019: Knee Surgery & related Research
Bruce A Levy, Benjamin Freychet
No abstract text is available yet for this article.
April 2019: Clinics in Sports Medicine
John Dabis, Adrian Wilson
The internal brace is a ligament repair bridging concept using braided ultra-high-molecular-weight polyethylene suture tape and knotless bone anchors to reinforce ligament strength to allow early mobilization during early-phase healing. This concept can be used in the management of anterior cruciate ligament, posterior cruciate ligament, anterolateral ligament, medial collateral ligament, posteromedial corner, and posterolateral corner injuries. Ligament reinforcement is a concept in which a graft is reinforced and can be used in all aspects of knee ligament reconstruction...
April 2019: Clinics in Sports Medicine
Thomas Neri, Darli Myat, Aaron Beach, David Anthony Parker
Multiligament knee injuries remain a challenge for the treating surgeon and little is known about the injury patterns and factors determining clinical and gait outcomes after multiligament knee reconstruction (MLKR). This article aims to identify specificities of this complex injury, in terms of demographics, mechanisms of injury, injury pattern, and associated lesions. The time frame between injury and surgery and distribution of repair versus reconstruction procedures have been analyzed. This study reports functional and clinical outcomes, providing an overview of expected results...
April 2019: Clinics in Sports Medicine
Nicholas A Trasolini, Adam Lindsay, Aaron Gipsman, George F Rick Hatch
The multiple ligament injured knee is a complex biomechanical environment. When primary stabilizers fail, secondary stabilizers have an increased role. In addition, loss of primary restraints puts undue stress on the remaining intact structures of the knee. Treatment of these injuries requires accurate diagnosis of all injured structures, and careful consideration of repairs and reconstructions that restore the synergistic stability of all ligaments in the knee.
April 2019: Clinics in Sports Medicine
Graeme Matthewson, Adam Kwapisz, Treny Sasyniuk, Peter MacDonald
In this review, we explore the epidemiology and mechanism of multiligament knee injuries (knee dislocation) and their complications, focusing on the morbidity and mortality associated with concomitant vascular injuries. We discuss the various diagnostic and treatment algorithms in use today and finish the report with a brief case example to outline these principles.
April 2019: Clinics in Sports Medicine
Christoph Kittl, Deborah K Becker, Michael J Raschke, Marcus Müller, Guido Wierer, Christoph Domnick, Johannes Glasbrenner, Philipp Michel, Mirco Herbort
BACKGROUND: Little is known about the dynamic restraints of the semimembranosus muscle (SM). PURPOSE AND HYPOTHESIS: The goal of the present study was to elucidate the role of (1) passive and (2) active restraints to medial-side instability and to analyze (3) the corresponding tightening of the posteromedial structures by loading the SM. It was hypothesized that points 1 to 3 will significantly restrain medial knee instability. This will aid in understanding the synergistic effect of the semimembranosus corner...
March 2019: American Journal of Sports Medicine
Jack Porrino, Annie Wang, Kimia Kani, Christopher Y Kweon, Albert Gee
The multiligament knee injury is devastating and potentially limb threatening. Preoperative magnetic resonance imaging for the evaluation of the multiligament knee injury is an invaluable clinical tool, and when the radiologist is familiar with how certain injury patterns influence management, optimal outcomes can be achieved. We provide a detailed description of the relationship between salient imaging features of the multiligament knee injury, focusing on the preoperative magnetic resonance imaging, and their influence on clinical decision-making...
February 10, 2019: Current Problems in Diagnostic Radiology
Jayson Lian, Neel K Patel, Michael Nickoli, Ravi Vaswani, James J Irrgang, Bryson P Lesniak, Volker Musah
The objective was to report the effect of obesity, utilizing a body mass index (BMI) threshold of 35 kg/m2 , on outcomes and complications of multiple ligament knee injury (MLKI). It was hypothesized that obese patients would have longer intraoperative times and hospital length of stay, greater estimated blood loss, and higher rates of wound infection requiring irrigation and debridement (I&D) and revision ligament surgery. A retrospective review was performed on 143 individuals who underwent surgery for an MLKI between 2011 and 2018 at a single academic center...
March 1, 2019: Journal of Knee Surgery
Giovanni Vicenti, Giuseppe Solarino, Massimiliano Carrozzo, Silvana De Giorgi, Lorenzo Moretti, Angelo De Crescenzo, Biagio Moretti
PURPOSE: The purpose of this systematic review was to address the treatment of multiligament knee injuries in three major aspects, specifically (1) surgical versus nonoperative treatment, (2) repair versus reconstruction of injured ligamentous structures, and (3) early versus late surgery of damaged ligaments. METHODS: Two independent reviewers performed a search on PubMed from 1966 to March 2016 using Levy's review as a starting-point, and the same terms "knee dislocation," "multiple ligament-injured knee," and "multiligament knee reconstruction...
February 15, 2019: Injury
Elaine C Schmidt, Matthew Chin, Julien T Aoyama, Theodore J Ganley, Kevin G Shea, Michael W Hast
Background: Although anterior cruciate ligament (ACL) tears have received the most attention, the medial collateral ligament (MCL) is thought to be the most commonly injured knee ligament overall. The lateral collateral ligament (LCL) and posterior collateral ligament (PCL) are less frequently compromised but can be involved in severe multiligament injuries. The paucity of information on the native properties of these ligaments in the pediatric population hinders the overall optimization of treatment for these injuries...
February 2019: Orthopaedic Journal of Sports Medicine
Eric X Jiang, Moneer M Abouljoud, Joshua S Everhart, Alex C DiBartola, Christopher C Kaeding, Robert A Magnussen, David C Flanigan
PURPOSE: To systematically review the literature to determine what clinical factors influence patient outcomes after meniscal root repairs. METHODS: A systematic review of multiple databases was performed. The inclusion criteria included English language, studies evaluating clinical and/or radiographic factors related to meniscal root repair outcomes, medial or lateral posterior root repairs, and human studies. The exclusion criteria included meniscectomy studies, meniscal body studies, technique descriptions, studies reporting only failure rate of meniscal repairs, multiligament repairs, abstracts, controlled laboratory studies, meta-analyses, and systematic reviews...
February 13, 2019: Knee
Tsuneari Takahashi, Tomohiro Matsumura, Kazuaki Ishihara, Shuhei Hiyama, Katsushi Takeshita
Knee dislocation with concomitant multiligament injury is a rare and devastating injury. We report the successful repair of a rare case of open knee dislocation with concomitant multiligament injury and patellar tendon rupture of an 18-year-old male due to a motorcycle accident. The patient presented with an open wound running parallel to the knee joint line and patellar tendon rupture with full exposure of the cartilage of the distal femur. Staged surgical management including the application of a ring-type external fixator with a hinged joint, lateral collateral ligament repair, medial collateral ligament reconstruction using autogenous hamstring tendon, and joint release was performed...
2019: SAGE Open Medical Case Reports
Nicolas Tardy, Caroline Mouton, Philippe Boisrenoult, Daniel Theisen, Philippe Beaufils, Romain Seil
The original article can be found online.
January 20, 2019: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Christian Owesen, Jan-Harald Røtterud, Lars Engebretsen, Asbjørn Årøen
Background: The outcomes after posterior cruciate ligament reconstruction (PCLR) have been shown to be inferior to those of anterior cruciate ligament reconstruction. There is a lack of knowledge regarding prognostic factors of PCLR outcomes. Purpose: To explore the effect of injury mechanism and concomitant ligament injuries on patient-reported outcomes at 2-year follow-up after PCLR. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 373 patients who underwent primary PCLR and who were registered in the Norwegian Knee Ligament Registry were included...
December 2018: Orthopaedic Journal of Sports Medicine
A Ateschrang, M D Ahrend, S Ahmad, D Körner, T Stein, M Yesil, U Stöckle, A J Schreiner
OBJECTIVE: Simultaneous arthroscopic reconstruction of the anterior and/or posterior cruciate ligament (ACL/PCL) using the GraftLink® system (Arthrex) to obtain stable treatment and good functional results. The transplant is protected by the safety belt like biomechanical GraftLink® principle, which is used to secure the intraoperatively obtained stability in the long term. INDICATIONS: ACL, PCL, or combined cruciate ligament rupture, especially multiligament injuries...
February 2019: Operative Orthopädie und Traumatologie
Philip L Wilson, Charles W Wyatt, Jose Romero, Meagan J Sabatino, Henry B Ellis
Background: Despite the increasing incidence of sports-related knee injuries in youth athletes, few studies have reported on the diagnosis and treatment of pediatric and adolescent meniscal root injuries. Purpose: To describe traumatic posterior meniscal root injuries in a pediatric and adolescent population and compare the presentation of meniscal root injuries versus that of nonroot injuries. Study Design: Cohort study; Level of evidence, 3...
November 2018: Orthopaedic Journal of Sports Medicine
A Achtnich, A Schmitt, P Forkel, A B Imhoff, K Beitzel
OBJECTIVE: The aim of arthroscopic bracing of the posterior cruciate ligament (PCL) is to restore anatomic and biomechanic function in acute PCL tears. Therefore, primary augmentation of the PCL by using a stable suturing system is used. INDICATIONS: Acute tears of the PCL, femoral avulsions, isolated or combined in cases of multiligament injuries (knee dislocations of Schenk types II-IV). CONTRAINDICATIONS: Chronic instabilities of the PCL, infection of the knee joint...
November 26, 2018: Operative Orthopädie und Traumatologie
Brian M Devitt, Ruchith Dissanayake, Joseph Clair, Richard J Napier, Tabitha J Porter, Julian A Feller, Kate E Webster
Background: Although isolated posterior cruciate ligament reconstruction (PCLR) has become a more frequently performed procedure, reports of functional outcomes and return-to-sport (RTS) rates to support its use are still limited. Purpose: To systematically review the literature to determine the rates of RTS and the functional outcomes of patients after isolated PCLR. Study Design: Systematic review: Level of evidence, 4. Methods: Two reviewers independently searched 5 databases for patient-based clinical studies with a minimum 2-year follow-up that analyzed functional outcome and RTS following isolated PCLR...
October 2018: Orthopaedic Journal of Sports Medicine
Eric Hamrin Senorski, David Sundemo, Eleonor Svantesson, Ninni Sernert, Jüri-Toomas Kartus, Jón Karlsson, Kristian Samuelsson
PURPOSE: To determine preoperative predictors of long-term acceptable knee function and the development of osteoarthritis (OA) in long-term follow-up after anterior cruciate ligament (ACL) reconstruction. METHODS: This study is a long-term follow-up of 2 previous randomized controlled trials that included 193 patients who underwent unilateral ACL reconstruction with ipsilateral hamstring tendon or patellar tendon autografts. Patients who suffered multiligament injuries, major meniscal injuries, chondral lesions requiring surgical treatment, or had a previous ACL reconstruction were excluded...
October 6, 2018: Arthroscopy: the Journal of Arthroscopic & related Surgery
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