ABSTRACT
Background: Knee is one of the major joints involved in kinesis. With increasing involvement in sports related activities especially in young people, Trauma related knee pathologies have increased. An accurate diagnosis regarding the type and extent of injuries is essential for early operative as well as non-operative treatment. Methods:This prospective study included total of 82 cases. The patients were referred to the department of Radiodiagnosis from indoor and outdoor departments of Guru Nanak Dev Hospital, Amritsar with suspicion of internal derangement of the knee and with history of knee trauma.Results:The most common age group involved was young males between 15-34 years. In all age groups most of the patients were males. Most common ligament to be injured was Anterior Cruciate Ligament (ACL). Partial tears were more common than complete tears. Posterior Cruciate Ligament (PCL) tears were less common. Medial Collateral Ligament (MCL) tears outnumbered Lateral Collateral Ligament (LCL) tears and grade 2 tears were more common in both. Among the meniscal injuries Medial Meniscus (MM) tears were more common than LM and grade 3 signal was more common in both. Most of the patellar retinaculum injuries were associated with Anterior Cruciate Ligament ACL tears.Conclusions:Post-traumatic pre-arthroscopic MR imaging evaluation has proved to be cost-effective. MRI is an accurate imaging modality complementing the clinical evaluation and providing a global intra-articular and extra-articular assessment of the knee.
ABSTRACT
El ligamento colateral lateral (LCL), que forma parte de los estabilizadores de la rodilla, constituye una estructura importante dentro del complejo posterolateral de la misma (CPL), que restringe al varo, en los ángulos de flexión de esta, especialmente a los 30°, además de controlar la rotación externa. Son infrecuentes las lesiones que afectan a este complejo, etiológicamente entre el 50- 90% se asocian a otras lesiones ligamentosas con predominio del 60% de daño del ligamento cruzado posterior. La técnica de Larson se basa en la reconstrucción del LCL y del complejo poplíteo, utilizando una inserción proximal única en el epicóndilo femoral. Presentamos el caso de un paciente masculino de 28 años de edad, sin antecedentes clínicos, que acude debido a un varo forzado de la extremidad mientras realizaba actividad deportiva y tras recibir impacto directo en la región lateral interna de pantorrilla derecha, posterior a lo cual presenta dolor a los movimientos pasivos e imposibilidad a la deambulación. Además, presenta equimosis, edema, escoriaciones superficiales en cara lateral externa y dolor a la digitopresión en trayecto de ligamento colateral externo. A maniobras de exploración de rodilla: signo de bostezo en varo positivo, cepillado rotuliano positivo, hiperpresión de rotula positivo, limitación funcional a la flexión y extensión de la articulación. Esta técnica, Larson modificada, resulta como una de las más prometedoras por sus varias características, como la menos exigente y al mismo tiempo brindando resultados alentadores. Este procedimiento se fundamenta en la reconstrucción del LCL y del tendón poplíteo (TP) en conjunto, resumiéndose así la reconstrucción del Ligamento Poplíteo Peroneo (LPP) como estabilizador estático del TP, con su inserción a nivel de la cabeza del peroné en conjunto con la del LCL y la restitución de ambas inserciones en el epicóndilo femoral, tomando en cuenta la morfología del peroné y los ángulos de movimientos de la rodilla.
The lateral collateral ligament (LCL), which is part of the knee stabilizers, constitutes an important structure within the posterolateral complex of the same (CPL), which restricts the varus, in the flexion angles of this, especially at 30°, in addition to controlling external rotation. Lesions that affect this complex are infrequent, etiologically between 50-90% are associated with other ligamentous injuries with a predominance of 60% damage to the posterior cruciate ligament. The Larson technique is based on the reconstruction of the LCL and the popliteal complex, using a single proximal insertion in the femoral epicondyle. We present the case of a 28-year-old male patient, with no medical history, who attended due to a forced varus of the limb while performing sports activity and after receiving a direct impact on the internal lateral region of the right calf, after which he presented pain to passive movements and inability to ambulation. In addition, he presents ecchymosis, edema, superficial abrasions on the external lateral aspect and pain on acupressure in the course of the external collateral ligament. A knee examination maneuvers: positive varus yawn sign, positive patellar brushing, positive patella hyperpressure, functional limitation to flexion and extension of the joint. This modified Larson technique turns out to be one of the most promising due to its various characteristics, as the least demanding and at the same time providing encouraging results. This procedure is based on the reconstruction of the LCL and the popliteal tendon (PT) as a whole, thus summarizing the reconstruction of the Peroneal Popliteal Ligament (LPP) as a static stabilizer of the PT, with its insertion at the level of the head of the fibula in conjunction with the of the LCL and the restitution of both attachments in the femoral epicondyle, taking into account the morphology of the fibula and the angles of movement of the knee.
Subject(s)
Male , Adult , Surgical Procedures, Operative , Medial Collateral Ligament, Knee , Ulnar Collateral Ligament Reconstruction , Anatomy , KneeABSTRACT
Results: The most important factors related to PMRI of the elbow joint are lateral collateral ligament complex (LCLC) lesion, posterior bundle of the medial collateral ligament complex (MCLC) lesion, and anteromedial coronoid fracture. Clinical physical examination include varus and valgus stress test of the elbow joint. X-ray examination, computed tomography, particularly three-dimensional reconstruction, are particularly useful to diagnose the fracture. Also MRI, arthroscopy, and dynamic ultrasound can assistantly evaluate the affiliated injury of the parenchyma. It is important to repair and reconstruct LCLC and MCLC and fix coronoid process fracture for recovering stability of the elbow joint. There are such ways to repair ligament injury as in situ repairation and functional reconstruction, which include direct suturation, borehole repairation, wire anchor repairation, and transplantation repairation etc. The methods for fixation of coronal fracture include screw fixation, plate fixation, unabsorbable suture fixation, and arthroscopy technology.
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OBJECTIVE: To evaluate the prevalence of deltoid ligament and distal tibiofibular syndesmosis injury on 3T magnetic resonance imaging (MRI) in patients with chronic lateral ankle instability (CLAI). MATERIALS AND METHODS: Fifty patients (mean age, 35 years) who had undergone preoperative 3T MRI and surgical treatment for CLAI were enrolled. The prevalence of deltoid ligament and syndesmosis injury were assessed. The complexity of lateral collateral ligament complex (LCLC) injury was correlated with prevalence of deltoid or syndesmosis injuries. The diagnostic accuracy of ankle ligament imaging at 3T MRI was analyzed using arthroscopy as a reference standard. RESULTS: On MRI, deltoid ligament injury was identified in 18 (36%) patients as follows: superficial ligament alone, 9 (50%); deep ligament alone 2 (11%); and both ligaments 7 (39%). Syndesmosis abnormality was found in 21 (42%) patients as follows: anterior inferior tibiofibular ligament (AITFL) alone, 19 (90%); and AITFL and interosseous ligament, 2 (10%). There was no correlation between LCLC injury complexity and the prevalence of an accompanying deltoid or syndesmosis injury on both MRI and arthroscopic findings. MRI sensitivity and specificity for detection of deltoid ligament injury were 84% and 93.5%, and those for detection of syndesmosis injury were 91% and 100%, respectively. CONCLUSION: Deltoid ligament or syndesmosis injuries were common in patients undergoing surgery for CLAI, regardless of the LCLC injury complexity. 3T MRI is helpful for the detection of all types of ankle ligament injury. Therefore, careful interpretation of pre-operative MRI is essential.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Ankle Injuries/pathology , Ankle Joint/diagnostic imaging , Arthroscopy , Chronic Disease , Joint Instability/pathology , Ligaments, Articular/pathology , Magnetic Resonance ImagingABSTRACT
BACKGROUND: Unstable simple elbow dislocation (USED) repair is challenged by the maintenance of joint reduction; hence, primary repair or reconstruction of disrupted ligaments is required to maintain the congruency and allow early motion of the elbow. We evaluated the effectiveness and the outcome of lateral collateral ligament (LCL) complex repair with additional medial collateral ligament (MCL) repair in cases of USED. METHODS: We retrospectively reviewed 21 cases of diagnosed USED without fractures around the elbow that were treated with primary ligament repair. In all cases, anatomical repair of LCL complex with or without common extensor origin was performed using suture anchor and the bone tunnel method. Next, the instability and congruency of elbow for a full range of motion were evaluated under the image intensifier. MCL was repaired only if unstable or incongruent elbow was observed. Clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and radiographic outcomes on last follow-up images. RESULTS: All cases achieved a stable elbow on radiographic and clinical results. LCL complex repair alone was sufficient to obtain the stable elbow in 17 of 21 cases. Four cases required additional MCL repair after restoration of the LCL complex. The overall mean MEPS was 91 (range, 70 to 100): excellent in 12 cases, good in 7 cases, and fair in 2 cases. All 17 cases with LCL complex repair only and 2 of 4 cases with additional MCL repair had excellent or good results by MEPS. CONCLUSIONS: USED requires surgical treatment to achieve a congruent and stable joint. If the repair of lateral stabilizer such as LCL complex acquires enough joint stability to maintain a full range of motion, it may not be necessary to repair the medial stabilizer in all cases of USED.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Collateral Ligaments/surgery , Joint Dislocations/complications , Elbow Joint/injuries , Joint Instability/complications , Orthopedic Procedures/methods , Range of Motion, Articular , Retrospective StudiesABSTRACT
Objective To obtain kinematic and kinetic parameters of the ankle joint from young man with ankle lateral collateral ligament (LCL) injury during walking, and to investigate the biomechanical characteristics of gaits by these ankle-injured patients. Methods Qualysis MCU500 3D image capture system and Kistler 3D force platform were used to test synchronously the gait of 15 patients with LCL injury and 15 healthy young men. Results For patients with LCL injury, the vertical component of ground reaction force (GRF) changed smoothly, and the posterior anterior component of GRF and the medial-lateral component of GRF were larger than that of healthy young men during anterior-middle support phase and during 60% anterior support phase, respectively. The moment of ankle joint plantar flexion in patients with LCL injury and in healthy young men was similar. The largest ecstrophy and extorsion moment of the ankle joint was found at the injured side of patients with LCL injury, with the largest output power in the sound limb of them. Conclusions The stability of the ankle joint in patient with LCL injury was decreased, with abnormal gait appeared during walking. The sound limb had to compensate the injured limb to reduce the load on the injured limb by switching quickly to the phase of vertical support at the moment of heel-striking. This study provides theoretical references for both the prevention and treatment of ankle joint injury in clinic and rehabilitation training.
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PURPOSE: The biceps femoris tendon (BFT) and lateral collateral ligament (LCL) in the knee were formerly known to form a conjoined tendon at the fibular attachment site. However, the BFT and LCL are attached into the fibular head in various patterns. We classified insertion patterns of the BFT and LCL using MR imaging, and analyzed whether the LCL attaches to the fibular head or not. MATERIALS AND METHODS: A total of 494 consecutive knee MRIs of 470 patients taken between July 2012 and December 2012 were retrospectively reviewed. There were 224 males and 246 females, and patient age varied from 10 to 88 (mean, 48.6). The exclusion criteria were previous surgery and poor image quality. Using 3T fat-suppressed proton density-weighted axial images, the fibular insertion patterns of the BFT and LCL were classified into following types: type I (the LCL passes between the anterior arm and direct arm of the BFT's long head), type II (the LCL joins with anterior arm of the long head of the BFT), type III (the BFT and LCL join to form a conjoined tendon), type IV (the LCL passes laterally around the anterior margin of the BFT), and type V (the LCL passes posteriorly to the direct arm of the BFT's long head). RESULTS: Among the 494 cases of the knee MRI, there were 433 (87.65%) type I cases, 21 (4.25%) type II cases, 2 (0.4%) type III cases, 16 (3.23%) type IV cases, and 22 (4.45%) type V cases. There were 26 cases (5.26%) in which the LCL and BFT were not attached into the fibular head. CONCLUSION: The fibular attachment pattern of the BFT and LCL shows diverse types in MR imaging. The LCL does not adhere to the head in some patients.
Subject(s)
Female , Humans , Male , Arm , Head , Knee , Lateral Ligament, Ankle , Magnetic Resonance Imaging , Protons , Retrospective Studies , TendonsABSTRACT
Anteromedial force to the knee in an extended position can cause an avulsion fracture of the proximal fibula with combined injuries to the posterolateral ligaments. Avulsion fractures of the proximal fibula are rare and current management of these fractures is based on few descriptions in literature. Various surgical methods of fixation for these fractures have been reported, but there is still no standard treatment modality. Anatomic reduction of these fractures is technically difficult, and failure of reduction may cause posterolateral instability, secondary arthritis and other complications. We present our experience with two such cases of comminuted avulsion fractures of the proximal fibular with posterolateral ligament ruptures surgically fixated with a locking compression hook plate and non absorbable sutures.
Subject(s)
Arthritis , Collateral Ligaments , Fibula , Knee , Ligaments , Rupture , SuturesABSTRACT
Calcification most frequently occurs in the rotator cuff insertion of the shoulder. However, calcification is known to develop in any joint, including the hip, knee, wrist and elbow. Around the knee joint, it usually occurs in the areas such as the quadriceps femoris muscle, the popliteus muscle and the medial collateral ligament with a history of trauma. But the occurrence of calcification in the lateral collateral ligament is very rare. We herein report on one case of the calcification that developed in the lateral collateral ligament, and this was treated by excision of the calcified materials and repair of the ligament. We also present the magnetic resonance imaging findings of this case.
Subject(s)
Collateral Ligaments , Elbow , Hip , Joints , Knee , Knee Joint , Ligaments , Magnetic Resonance Imaging , Muscles , Quadriceps Muscle , Rotator Cuff , Shoulder , WristABSTRACT
Dislocations of the interphalangeal joint of the great toe that are irreducible are very rare. Invagination of the plantar plate or the sesamoid bone into the IP joint, which prevents reduction. To our knowledge, however, dislocations of the IP joint of the great toe that were irreducible because of lateral collateral ligament entrapment, not invagination of the plantar plate or the sesamoid bone, have not been reported by any English literature. We report a 29-year-old ballet dancer who sustained an irreducible dislocation of the interphalangeal joint of the great toe owing to lateral collateral ligament entrapment.
Subject(s)
Adult , Humans , Collateral Ligaments , Joint Dislocations , Joints , Sesamoid Bones , ToesABSTRACT
The anterior cruciate ligament (ACL) and the posterolateral structures are functionally important structures that assist with the stability of the knee joint. Sport-related injuries to these structures and reconstructive surgery are becoming more frequent. However, the anatomic characteristics and the relationship between these structures are not well understood. We measured the morphological characteristics of the posterolateral structures of the knee and the ACL, and we identified the anatomic relationship between the center of the femoral attachment area of the ACL and other femoral structures. We dissected 34 cadaveric knees with no signs of previous surgery, knee abnormality, or disease. The lateral collateral ligament (LCL) and the popliteus tendon (PLT) were present in all knees, although the popliteofibular ligament (PFL) was not present in 20.6% of knees. The mean length of the LCL was 51.99 mm and differed significantly between men and women (P<0.05). The mean length of the PLT was 21.59 mm, and the mean length of the PFL was 18.49 mm. In 67.7% of knees, the PLT was attached to the inferior aspect of the femoral attachment of the LCL, and the femoral attachment of the PLT was covered by the bundle of the LCL. The ACL was distinguished into anteromedial (AM) and posterolateral (PL) bundles in all knees. The mean lengths of the AM and PM bundles were 22.14 mm and 15.98 mm, respectively. The measured lengths in each bundle differed significantly between men and women (P<0.05). The mean distance between the center of the femoral attachment area of the ACL and the intercondylar line was 8.36 mm in the AM bundle, 15.98 mm in the PL bundle, and 10.96 mm in the entire ACL. The mean distance between the center of the femoral attachment area of the ACL and the medial border of the lateral condyle was 8.14 mm in the AM bundle, 7.36 mm in the PL bundle, and 8.45 mm in the entire ACL.
Subject(s)
Female , Humans , Male , Anterior Cruciate Ligament , Cadaver , Collateral Ligaments , Knee , Knee Joint , Ligaments , TendonsABSTRACT
Combined rupture of the medial collateral ligament, medial meniscus, and anterior cruciate ligament is common. Since O Donoghue described this combined injury in 1950, it has been referred to as O Donoghue's triad. But the rupture of the patellar tendon is a relatively uncommon form of injury, particularly in a young, well-conditioned athlete. Baker (1980) presented a case of O' Donoghue' s triad with a rupture of the patellar tendon. We present an unusual case of patellar tendon rupture associated with rupture of anterior cruciate ligament, medial collateral ligament, lateral collateral ligament and lateral meniscus. This case differs from Baker's case and has not yet been reported in the literature. The senior author performed arthroscopic partial menisectomy, patellar tendon repair by Matava's method and arthroscopic anterior cruciate ligament reconstruction, using the autogenous bone-patellar tendon-bone graft from the controlateral knee. The clinical results were good, and as far as the authors have reviewed, no report has been published about this rare injury. So we report this case with a review of the literature.
Subject(s)
Humans , Anterior Cruciate Ligament Reconstruction , Anterior Cruciate Ligament , Athletes , Bone-Patellar Tendon-Bone Grafts , Collateral Ligaments , Knee , Lateral Ligament, Ankle , Menisci, Tibial , Patellar Ligament , RuptureABSTRACT
The ankle is one of the most common site of ligamentous injury. The incidence of the injury is increasing in these days, probably due to prevailing leisure and sports. Lateral collateral ligament is more susceptible to injury than medial because of anatomical and biomechanical difference. There was a tendency to treat the ankle ligamentous injury with conservative method, but because of the problem of chronic and recurrent ankle instability and injury, operative method is necessary in certain patients. We have experienced of 14 cases of surgical treatment of the lateral ligaments, excluding the associated fracture, from March 1983 to February 1986, in Koryo General Hospital. Among 14 cases, the acute injury, which were treated with primary repair, were 9 cases and the chronic cases, which with modified Watson-Jones method, were 5. The average follow up period was 1 year and 2 months. The results are as follows : 1. The male and female ratio, was 9 to 5 and peak incidence was 3rd and 4th decade. 2. The cause of injury was mainly slip down (9 cases) and sports injury(4 cases). 3. There was no correlation between the degree of the ligament rupture and talar tilt. 4. When the talar tilt is above 10, it may cause ankle instability. 5. The clinical results are both satisfactory in acute and chronic cases, but in chronic cases, some degenerative changes began to appear in 2 cases. 6. C.P.M.(Continuous Passive Motion) and Air Cast have much advantages in postoperative care.