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
Michael Schlumberger, Philipp Schuster, Martin Eichinger, Philipp Mayer, Raul Mayr, Micha Immendörfer, Jörg Richter
PURPOSE: To analyse 1000 consecutive patients, treated with isolated or combined posterior cruciate ligament (PCL) reconstruction in a single centre according to the epidemiological factors and differences in injury patterns depending on the activity during trauma. METHODS: Between 2004 and 2019, one thousand isolated and combined PCL reconstructions were performed. The medical charts and surgical reports of all patients were analysed regarding epidemiological factors...
March 10, 2020: Knee Surgery, Sports Traumatology, Arthroscopy: Official Journal of the ESSKA
Kristofer E Chenard, Laith M Jazrawi, Michael J Alaia
Injuries to the posterolateral corner of the knee are rare but significant injuries that occur most commonly in the context of a multiligamentous knee injury. The structures of the posterolateral corner serve as a primary restraint to varus and external rotation and as a secondary restraint to posterior translation. Contemporary reconstructive techniques focus on anatomic restoration of function of the posterolateral corner and excellent long-term results have been demonstrated.
2020: Bulletin of the Hospital for Joint Diseases
Surya Gandham, Graham Millward, Andrew P Molloy, Lyndon W Mason
AIM: The aim of this study was to determine the most appropriate approaches for fixation of each type and fragment of posterior malleolar fractures. MATERIALS AND METHODS: A retrospective analysis of a prospectively collected database was performed on 141 posterior malleolar fractures. On the CT scan axial slice, a clock face was drawn using the posterolateral corner of the tibia as the centre and the Achilles tendon as the 6 o'clock axis. A box was then drawn from the fracture plane, with 90-degree lines corresponding to the medial perpendicular line (MPL) and lateral perpendicular line (LPL) extremity of the fracture and a central perpendicular line (CPL) (i...
June 2020: Foot
Paulo Victor Partezani Helito, Stijn Bartholomeeusen, Steven Claes, Marcelo Bordalo Rodrigues, Camilo Partezani Helito
PURPOSE: To evaluate the magnetic resonance imaging (MRI) characteristics of Segond fractures, including the structures attached to the avulsed fragment, the integrity of anterolateral ligament (ALL) and iliotibial band (ITB), and fragment size and location. METHODS: This was a retrospective, cross-sectional study with MRI scans from 2016 to 2019 with the term "Segond" in the reports, signs of acute trauma, and a bony anterolateral tibial avulsion (Segond) fracture...
June 2020: Arthroscopy: the Journal of Arthroscopic & related Surgery
Christopher D Markeson, Ryan M Renacci, Roger J Bartolotta
No abstract text is available yet for this article.
January 27, 2020: Journal of Emergency Medicine
Guillaume Sigonney, Shahnaz Klouche, Virgile Chevance, Thomas Bauer, Benoit Rousselin, Olivia Judet, Philippe Hardy
INTRODUCTION: In anterior cruciate ligament (ACL) tear, passive spontaneous anterior tibial subluxation (ATS), with respect to the femur, is sometimes observed on MRI. In a case-control study, ATS>3.5mm showed 100% specificity (±3.6, 95% CI) for complete ACL tear. The aim of the present study was to assess the relation between ATS on MRI and associated lesions in complete ACL tear. The study hypothesis was that associated lesions are a risk factor for ATS. MATERIAL AND METHODS: A retrospective study included patients operated on for complete ACL tear between 2010 and 2015...
January 23, 2020: Orthopaedics & Traumatology, Surgery & Research: OTSR
Ping Liu, Xi Gong, Jiahao Zhang, Yingfang Ao
PURPOSE: To assess the role of anatomic reconstruction of the posterolateral corner (PLC) of the knee arthroscopically in cadaveric knees with simulated isolated grade III posterolateral instability. METHODS: A total of 12 nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10-Nm varus moment, 5-Nm external and internal rotation torques, and 134-N posterior tibial load at 0°, 15°, 30°, 60°, and 90° of knee flexion (0° for varus loading only)...
January 21, 2020: Arthroscopy: the Journal of Arthroscopic & related Surgery
Tatsuya Jitsuishi, Seiichiro Hirono, Tatsuya Yamamoto, Keiko Kitajo, Yasuo Iwadate, Atsushi Yamaguchi
The vertical occipital fasciculus (VOF) is an association fiber tract coursing vertically at the posterolateral corner of the brain. It is re-evaluated as a major fiber tract to link the dorsal and ventral visual stream. Although previous tractography studies showed the VOF's cortical projections fall in the dorsal and ventral visual areas, the post-mortem dissection study for the validation remains limited. First, to validate the previous tractography data, we here performed the white matter dissection in post-mortem brains and demonstrated the VOF's fiber bundles coursing between the V3A/B areas and the posterior fusiform gyrus...
January 21, 2020: Scientific Reports
Addison Wood, Morgan Boren, Taylor Dodgen, Russell Wagner, Rita M Patterson
BACKGROUND: The function of the popliteus muscle is largely treated as a static stabilizer and has a lack of basic muscular architectural data to enable study of its dynamic function. A large volume of literature supports its static function and the essential need for reconstruction in the posterolateral knee when injured to restore knee stability. HYPOTHESIS/PURPOSE: We hypothesize that the popliteus muscle is more significant as a dynamic presence in the knee...
January 15, 2020: Knee
Eleonor Svantesson, Eric Hamrin Senorski, Frida Kristiansson, Eduard Alentorn-Geli, Olof Westin, Kristian Samuelsson
BACKGROUND: Anterior cruciate ligament (ACL) revision surgery has been associated with inferior outcome compared with primary ACL reconstruction. However, this has rarely been investigated in a consecutive cohort limited to patients that have undergone both primary and revision ACL reconstruction. This study aimed to assess differences in outcome and concomitant injuries between primary and revision ACL reconstruction in such a cohort, and to identify predictors of the patient-reported outcome after ACL revision...
January 10, 2020: Journal of Orthopaedic Surgery and Research
Dennis E Kramer, Patricia E Miller, Iman K Berrahou, Yi-Meng Yen, Benton E Heyworth
BACKGROUND: The majority of research on medial (MCL) and lateral (LCL) collateral ligament injuries has focused on adults and combined collateral/cruciate injuries. The purpose of this study was to determine characteristics associated with isolated collateral ligament injuries in adolescents, and assess timing for return to sports. METHODS: Electronic medical records were queried to identify patients aged below 17 years who sustained a magnetic resonance imaging-confirmed isolated MCL or LCL injury over an 8-year period...
February 2020: Journal of Pediatric Orthopedics
Benjamin Freychet, Nicholas I Kennedy, Thomas L Sanders, Nathan M Levy, Devin P Leland, Aaron J Krych, Michael J Stuart, Bruce A Levy
PURPOSE: Posterolateral corner (PLC) injuries commonly occur in the setting of a dislocated knee and often require multiple procedures due to concomitant vascular, nerve, and soft tissue involvement. Debate persists regarding single vs staged surgery. The purpose of this study was to compare knee function after single and staged surgery for PLC injury. METHODS: Patients who underwent surgery for a PLC injury (KD I, IIIL, IV) with minimum follow-up of 2 years were included...
January 7, 2020: Knee Surgery, Sports Traumatology, Arthroscopy
Sachin Ramchandra Tapasvi, Anshu Shekhar, Shantanu Sudhakar Patil
The posterolateral corner of the knee is composed of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament, which provide varus and rotational stability to the knee. An anatomic technique reconstructs these structures through 2 femoral sockets and 1 tibial and 1 fibular tunnel. This reconstruction can be performed using a peroneus longus autograft that is prepared as a Y construct. The peroneus longus autograft is preferred because it provides adequate length and diameter for the entire reconstruction...
December 2019: Arthroscopy Techniques
Takehiko Sugita, Nobuyuki Itaya, Toshimi Aizawa, Masayuki Kamimura, Atsushi Takahashi, Naohisa Miyatake
We orthopaedic surgeons are not familiar with the popliteus bursa. It is defined as the expansion in the synovial membrane of the posterolateral part of the knee that lies between the lateral meniscus and the tendon of the popliteus muscle. The popliteus bursa extends approximately 1 cm distal to the joint line and has 4 borders; the medial border is the peripheral margin of the lateral meniscus, the lateral border is the popliteus tendon, and the superior and inferior borders are formed by 2 fascicles. We very rarely observe cystic lesions that expand more distally, such as pigmented villonodular synovitis (PVNS) and synovial osteochondromatosis...
December 2019: Arthroscopy Techniques
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