Munish Sood, Vikas Kulshrestha, Julie Sachdeva, Amresh Ghai, Ajaydeep Sud, Shalender Singh
Backgroud: Anterior cruciate ligament reconstruction (ACLR) remains the gold standard treatment for anterior cruciate ligament (ACL) injury. However, a good functional outcome even after a successful surgery depends on multiple factors. It has been observed that certain patients with a chronic ACL injury demonstrate knee instability voluntarily. The authors observed that these patients might not perform well even after a successful surgery. This study aims to assess the outcome after ACL and other ligament reconstruction in patients with voluntary knee instability...
September 2020: Clinics in Orthopedic Surgery
Yang Yang, Xiaoxiao Zhou, Houlin Ji, Xiaobo Zhou, Linchao Ye, Mengqin Zhang
BACKGROUND: Posterolateral tibial plateau fractures (PTPF) remain a challenge for orthopedics surgeons because the special anatomical structures of the posterolateral corner of knee joint including the fibular head, the lateral collateral ligament, and the peroneal nerve, which impedes the exposure of the fracture fragments and need irregular implants to get a stable fixation. The purpose of present study was to introduce a new articular fracture fragments restoration technique for three patterns of PTPF and investigate the relationship between associated soft injuries and fracture patterns...
September 3, 2020: Journal of Orthopaedic Surgery and Research
Harmen D Vermeijden, Jelle P van der List, Gregory S DiFelice
Injuries to the lateral collateral ligament (LCL) most commonly occur with concomitant cruciate ligament tears. Over the past decade, there has been increased interest in anatomic reconstruction of the posterolateral corner (PLC). Not much attention has been paid to anatomic primary LCL repair given the historically high failure rates of primary repair of lateral sided knee ligaments, but better outcomes can now be expected because of recent developments in additional suture augmentation. The purpose of this Technical Note is to describe the surgical technique of primary distal LCL repair using suture augmentation...
August 2020: Arthroscopy Techniques
K Kurtys, B Gonera, Ł Olewnik, P Karauda, R Shane Tubbs, M Polguj
BACKGROUND: The fibular collateral ligament is a permanent and extracapsular ligament of the knee joint. It is located on the lateral aspect of the knee and extends from the lateral epicondyle of the femur to the lateral surface of the head of the fibula. As one of the main knee joint ligaments it is a stabilizer of the posterolateral corner of the knee and resists varus stress. The case report displays the bifurcated variant of the fibular collateral ligament. The aim of this study is to determine which of those bands should be considered dominant...
August 13, 2020: Folia Morphologica (Warsz)
Evan W James, Isabel Wolfe, Robert G Marx
Knee dislocations leading to multiligament knee injuries are associated with a wide variety of bony, ligamentous, soft tissue, and neurovascular injury patterns. Numerous management strategies have been proposed including nonoperative treatment and surgical repair or reconstruction. In recent years, an emphasis has been placed on anatomic repair and reconstruction principles, which have shown superior outcomes compared with older techniques. However, despite these advances, clinical outcomes continue to vary widely, with many patients experiencing chronic pain, stiffness, loss of range of motion, instability, and failure to return to work or sports...
September 2020: Sports Medicine and Arthroscopy Review
James P Stannard, James T Stannard, James L Cook
A knee dislocation that involves at least 2 of the 4 major ligament groups-such as the anterior cruciate ligament, the posterior cruciate ligament, or the posterolateral corner-is a catastrophic event for an athlete or trauma patient. Careful evaluation of these patients is needed to avoid disastrous outcomes. Surgeons must be cognizant of a number of key treatment concerns-such as tunnel crowding, controversies over graft fixation methods, and sparsity of level I clinical data-to make proper ligament repair decisions...
September 2020: Sports Medicine and Arthroscopy Review
Hong Lee Terry Teo, Ke Xin Magneline Ang, Sir Young James Loh
BACKGROUND: This is an experimental study conducted to assess whether the fibular head is a reliable reference point to identify the position of the common peroneal nerve at the posterolateral corner of the knee. MATERIALS AND METHODS: Twelve cadaveric knees were dissected through the lateral approach. The common peroneal nerve was identified and traced. The location where the common peroneal nerve crossed the posterior border of the biceps femoris and the posterior border of the fibular neck were designated as points B and N, respectively...
May 24, 2020: Knee Surgery & related Research
Stuart D Kinsella, Sean M Rider, Matthew S Fury, Frances A Tepolt, Kirsten Ecklund, Mininder S Kocher
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...
July 2020: Journal of Pediatric Orthopedics
David J Cinats, Trevor Stone
Comminuted proximal fibula fractures or arcuate fractures (OTA/AO 4F1B fractures), can defunction the posterolateral corner and result in posterolateral knee instability. Ongoing posterolateral knee instability can limit function, cause significant pain, and lead to early knee arthrosis. The anatomy of the posterolateral corner and proximal fibula limit the options for repair of this injury. The ideal method for osteosynthesis of these injuries has not been established. The goals of treatment include reconstitution of posterolateral stability, restoration of the anatomic relationship of posterolateral corner structures, and restoration of bone stock that would permit future reconstruction...
May 27, 2020: Journal of Orthopaedic Trauma
Andreas Weiler, Karl-Heinz Frosch, Clemens Gwinner, Michael J Strobel, Philipp Lobenhoffer
PURPOSE: There has been a recent resurgence in interest in posterolateral instabilities of the knee joint. As this terminology comprises a large variety of pathologies, confusion and ambiguity in communication between surgeons and allied health professionals are generated. Consequently, accurate classification criteria are required to account for thorough preoperative diagnostics, surgical decision-making, and a standardized scientific documentation of injury severity. METHODS: A working group of five knee surgeons, who retrospect more than 2000 reconstructions of the posterolateral corner (PLC) at the minimum, was founded...
May 27, 2020: Knee Surgery, Sports Traumatology, Arthroscopy
Kuldeep Bansal, Pratyush Shahi, Anil K Jain, Ish K Dhammi, Saurabh Kumar
We report the case of a six-year-old male child with progressive pain and swelling of the right shoulder for six months. On examination, there was a 7x7 cm globular, tender swelling with firm consistency over the posterolateral corner of the right shoulder. Radiographs showed an expansile lytic lesion in the acromion process of the scapula. Biopsy showed lobules of hypocellular cartilage separated by fibroconnective stroma suggestive of an enchondroma. Extended curettage and fibular bone grafting of the lesion was done...
April 11, 2020: Curēus
Steven Garcia, Nirav K Pandya
PURPOSE OF REVIEW: With an increase in high-demand sporting activity, the rate of pediatric and adolescent anterior cruciate ligament (ACL) reconstruction is increasing. Yet, the failure rates after reconstruction are much higher than the adult population. The purpose of this paper is to understand failure rates, reasons for graft failure, and strategies for successful revision surgery. RECENT FINDINGS: A complete understanding of the failure etiology is essential for the clinician treating this population prior to revision...
June 2020: Current Reviews in Musculoskeletal Medicine
Praveen Sodavarapu, Deepak Kumar, Aditya Guduru, Pratik M Rathod
We present an unusual and complex case of a 16-year-old adolescent male who injured his right knee and sustained combined avulsion injuries of posterior cruciate ligament (PCL) at the tibial insertion site, iliotibial band at lateral tibial condyle, and lateral collateral ligament (LCL) at femoral insertion site akin to osteoligamentous posterolateral corner injury. Anatomical reduction of the femoral LCL avulsion fragment was performed and fixed with a two 4-mm partially threaded cancellous screw. Iliotibial band avulsion was buttressed using Ellis t-plate and fixed with two 4-mm partially threaded cancellous screws...
April 4, 2020: Curēus
Tobias C Drenck, Achim Preiss, Christoph Domnick, Mirco Herbort, Jannik Frings, Ralph Akoto, Matthias Krause, Karl-Heinz Frosch
PURPOSE: This study aimed to compare the biomechanical properties of the popliteus bypass against the Larson technique for the reconstruction of a combined posterolateral corner and posterior cruciate ligament injury. METHODS: In 18 human cadaver knees, the kinematics for 134 N posterior loads, 10 Nm varus loads, and 5 Nm external rotational loads in 0°, 20°, 30°, 60,° and 90° of knee flexion were measured using a robotic and optical tracking system. The (1) posterior cruciate ligament, (2) meniscofibular/-tibial fibers, (3) popliteofibular ligament (PFL), (4) popliteotibial fascicle, (5) popliteus tendon, and (6) lateral collateral ligament were cut, and the measurements were repeated...
May 5, 2020: Knee Surgery, Sports Traumatology, Arthroscopy
Robert F LaPrade, Lars Engebretsen
Two decades ago, it was not uncommon to call the posterolateral corner of the knee the "dark side of the knee." This was because there were few quantitative anatomic data, no anatomic-based reconstructions, and a high rate of clinical outcome failures. Most nonanatomic posterolateral reconstruction procedures at the time commonly resulted in significant recurrent increases in varus gapping and significant overconstraint in external rotation. Postoperative protocols for treating these injuries were designed to often either cast or immobilize the operative knee for 2 to 6 weeks, which resulted in a higher incidence of arthrofibrosis...
May 2020: Arthroscopy
Carl K Schillhammer
The negative consequences of neglected posterolateral corner injury (PLC) have led to numerous advancements in the understanding and treatment of these injuries. As anatomic, biomechanical, and clinical knowledge of PLC injury continues to progress, finding the balance between re-creating native anatomy and safely performing PLC reconstruction continues to provide challenges to surgeons managing this complex constellation of injuries.
May 2020: Arthroscopy
Jimmy Wui Guan Ng, Yulanda Myint, Fazal M Ali
Up to 18% of multiligament knee injuries (MLKI) have an associated vascular injury.All MLKI should be assessed using the ankle brachial pressure index (ABPI) with selective arteriography if ABPI is < 0.9.An ischaemic limb following knee dislocation must be taken to the operating theatre immediately for stabilization and re-vascularization.Partial common peroneal nerve (CPN) injury following MLKI has better recovery than complete palsy.Posterior tibial tendon transfer is offered to patients with complete CPN palsy if there is no recovery at six months...
March 2020: EFORT open reviews
Jorge Chahla, Brady T Williams, Robert F LaPrade
Historically described as the "dark side of the knee," the posterolateral corner of the knee has been a significant focus of anatomic, biomechanical, and clinical outcomes research due to poor treatment outcomes for these injuries before improvements over the past 2 decades. These research efforts have resulted in significant improvements in the understanding, diagnosis, and surgical treatment of these injuries. Perhaps most importantly, improved understanding of the anatomy and biomechanics has led to the development of anatomic-based reconstructions, which have been subsequently validated with both biomechanical and clinical outcomes...
April 2020: Arthroscopy
Pablo Eduardo Gelber, Justin Drager, Bhargavi Maheshwer, Manuel Leyes, Björn Barenius, James Robinson, Nicolas Pujol, Thomas Tischer, Fabrizio Margheritini, Brett Fritsch, Karl-Heinz Frosh, Jorge Chahla
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...
April 1, 2020: Knee Surgery, Sports Traumatology, Arthroscopy
Konstantinos Natsis, Theofilos Karasavvidis, Dimitris Kola, Stavros Papadopoulos, Trifon Totlis
PURPOSE: The present study is a systematic review of a relatively unknown structure of the posterolateral corner of the knee, the meniscofibular ligament (MFL), aiming at summarizing and broadening current scientific knowledge regarding this ligament anatomy, function, imaging and injury. MATERIALS AND METHODS: A systematic review was performed according to the PRISMA guidelines. Medline (PubMed) and Cochrane Library databases were reviewed for every kind of study reporting on the MFL through December 2019...
March 29, 2020: Surgical and Radiologic Anatomy: SRA
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