Kanit Sananpanich, Artit Boonyalapa, Jirachart Kraisarin, Nuttaya Pattamapaspong
INTRODUCTION: Vascularized proximal fibular epiphyseal transfer is a reconstruction method for joints and growing bones. The authors investigated the vascular supply of the proximal fibula, including skin perforators, for suitability in creating an osteocutaneous flap. METHODS: Twenty fresh cadaveric knees were studied using computed tomographic angiography combined with anatomical dissection. Three-dimensional angiography was used to develop an overview, and multiplanar two-dimension angiography was used for detailed data collection...
October 12, 2020: Surgical and Radiologic Anatomy: SRA
Kathryn J Stevens, Omar M Albtoush, Amelie M Lutz
OBJECTIVE: This study aimed to evaluate injury patterns associated with Stieda avulsion fractures of the medial femoral condyle at the attachment of the proximal MCL. MATERIALS AND METHODS: Knee radiographs and MRI scans of 11 patients with Stieda fractures were evaluated by two fellowship-trained MSK radiologists for fracture origin, integrity of the deep and superficial components of the MCL, medial retinacular structures, posterior oblique ligament, other ligamentous injuries, meniscal tears, and osteochondral injuries...
October 9, 2020: Skeletal Radiology
Przemysław A Pękala, Mitchell R Mann, Jakub R Pękala, Krzysztof A Tomaszewski, Robert F LaPrade
BACKGROUND: The popliteofibular ligament (PFL) is a static stabilizer of the posterolateral corner of the knee, preventing varus angulation, tibial rotation, and posterior translation. The PFL is anatomically variable, and there is no current review that outlines its prevalence rate and morphological variations. PURPOSE: To investigate the anatomic prevalence and morphological qualities of the PFL in various global patient populations via a meta-analysis of relevant literature involving both cadaveric dissections and patient-based research using magnetic resonance imaging (MRI) scans...
October 5, 2020: American Journal of Sports Medicine
Túlio Vinícius de Oliveira Campos, Marcelo Nacif Moraes, Marco Antônio Percope de Andrade, Robert C Schenck, Simon T Donell
Knee dislocations associated with ipsilateral tibial shaft fracture represent one of the most challenging injuries in trauma surgery. This injury occurs in only 2% of all tibial fractures in several series. With the use of intramedullary nail (IMN) of the tibia, current practice paraments suggest that transtibial tunnels should be avoided and ligamentous knee surgery be delayed until healing of the shaft fracture occurs. We report a novel case which was successfully managed by delayed IMN and multiligamentous transtibial posterior cruciate ligament (PCL) and posterolateral corner (PLC) autograft reconstructions...
July 2020: Surgery Journal
J W Ng, A R Ahmad, G N Solayar
Introduction: This study was conducted to evaluate the demographics, causes and outcomes of patients who underwent Posterior Cruciate Ligament (PCL) reconstruction and/or Posterolateral Corner (PLC) reconstruction performed at our institution over the last three years. Sub-analysis was performed to assess the impact of delay from injury to surgery and how this affected outcomes. Material and Methods: From an initial number of 10 patients, seven were contactable and available for analysis...
July 2020: Malaysian Orthopaedic Journal
Sebastian Weiss, Matthias Krause, Karl-Heinz Frosch
INTRODUCTION: Injuries of the posterolateral corner (PLC) of the knee lead to chronic lateral and external rotational instability and are often associated with PCL injuries. Numerous surgical techniques for repair and reconstruction of the PLC are established. Recently, several arthroscopic techniques have been published in order to address different degrees of PLC injuries through reconstruction of one or more functional structures. The purpose of this systematic review is to give an overview about arthroscopic techniques of posterolateral corner reconstructions and to evaluate their safeness...
September 21, 2020: Archives of Orthopaedic and Trauma Surgery
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
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