Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients.

BACKGROUND: Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries. HYPOTHESIS: The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed. RESULTS: A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament. CONCLUSION: The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures.

Meniscal Ramp Lesions: What the Radiologist Needs to Know.

Meniscal ramp lesions are a special type of injury that affects the periphery of the posterior horn of the medial meniscus (PHMM) and/or its meniscocapsular attachments. They are strongly associated with acute and chronic anterior cruciate ligament (ACL) tears. These lesions have gained much prominence in recent years, due to a significant increase in their diagnosis and their important biomechanical involvement in the knee. It is known that their presence in ACL-deficient knees is related to instability and if they are not repaired during ACL reconstruction, they can ultimately cause the failure of the graft. Since this type of injury is often underdiagnosed due to its localization at the "blind" point of arthroscopic vision, it is crucial to make an accurate preoperative diagnosis of them with MRI. The objective of this article is to review the recent literature regarding meniscal ramp lesions and to summarize the anatomical, biomechanical and fundamentally diagnostic aspects, emphasizing the radiological findings described until now.

Simultaneous Clavicle Fracture and Acromioclavicular Joint Dislocation: Novel Surgical Technique: A Case Report.

CASE: A 41-year-old man sustained a midshaft clavicle fracture with associated type IV ipsilateral acromioclavicular joint (ACJ) dislocation. The clavicle was fixed with a locking plate and ACJ stabilized with a novel technique: 2 metal anchors with preloaded suture fixed at the coracoid process, looping the sutures over the clavicle, and passing through the plate holes without clavicle bone drilling. Excellent functional outcomes for range of motion, pain, and functional scores persisted 2 and a half years after surgery. CONCLUSION: The described surgical technique achieved exceptional short-term outcomes, sparing clavicle bone stock and allowing an early return to sports.

Late-Onset Recurrent Femoral Cyst Formation 10 Years after ACL Reconstruction: A Case Report and Literature Review.

Synovial fistula and cyst formation after anterior cruciate ligament (ACL) reconstruction is very unusual and almost always affects the tibia. Only 3 cases originating in the femur have been reported. We present a rare case of late-onset femoral cyst formation related to ACL reconstruction. Ten years after successful ACL reconstruction surgery, effusion and pain at the lateral aspect of the lateral femoral condyle appeared. Symptoms persisted despite initial percutaneous drainage and conservative treatment. Surgery was carried out, with drainage and graft-fixation pin device removal, with recurrent cyst formation after the intervention. Total recovery of the patient was achieved after carrying out revision surgery consisting in bone tunnel filling using autologous bone graft and occlusion of cortical bone defect with local fascial flap. The development of this unusual complication was related to lack of absorption of the fixation device, bone burn due to drilling, and persistent synovial fluid in the femoral bone tunnel, combined with the absence of bone ingrowth.

Two-Stage Anterior Cruciate Ligament Reconstruction Revision Surgery for Severe Bone Defects With Anterolateral Ligament Reconstruction Technique.

Anterior cruciate ligament revision surgery poses a number of specific difficulties. These include the lack of bone mass to enable effective fixation of the reconstruction, morbidity of the donor area when bone autograft is used to fill the tunnels, and absence of the semitendinosus and gracilis homolateral tendons in cases in which they have already been used in the primary surgical procedure. To address all these problems, we describe a 2-stage revision technique that uses bone allograft for tunnel filling and Achilles allograft for ligament reconstruction. In addition, the intervention includes an extra-articular phase in which the anterolateral ligament is reinforced to increase the rotational stability of the knee, thus improving the prognosis of operation.

Influencia del estatus profesional de los jugadores de fútbol en la frecuencia y gravedad de las lesiones: estudio piloto comparativo / Influence of the soccer players’ professional status on the frequency and severity of injuries: A comparative pilot study

Objetivo: El propósito del estudio es evaluar la frecuencia y la gravedad de las lesiones sufridas en un mismo equipo de fútbol durante 2 temporadas en 2 divisiones. Métodos: Estudio comparativo entre 2 estatus de fútbol profesional: Primera División (PD) y Segunda División (SD). La muestra consistió en jugadores profesionales de un mismo equipo cuyas lesiones se registraron prospectivamente durante las temporadas 2006-2007 (SD) y 2008-2009 (PD). Resultados: De las 101 lesiones registradas, 64 (63,4%) fueron consideradas leves, 26 (25,7%) moderadas y 11 (10,9%) graves. La incidencia de lesiones moderadas o graves durante el entrenamiento fue 3 veces mayor en la PD (3,36 vs 1,01; RR = 3,30), así como el total de lesiones durante el partido (52,82 vs 16,01; RR = 3,30). En cuanto a los días de baja, la incidencia fue mayor en PD, tanto en entrenamientos (60%) como en partidos (30%). El número de días perdidos por cada 1.000 h de exposición fue un 50% mayor en PD (129,60 vs 85,01 días/1.000 h de exposición). Conclusiones: Los resultados obtenidos muestran que en el fútbol español el estatus profesional puede ser un factor determinante de las lesiones. Además, estos resultados confirman el hecho de que el riesgo de lesión en el lugar de trabajo es considerablemente más alto en el fútbol profesional que en la mayoría de los demás sectores. Sería necesario que los clubes analizaran la importancia de desarrollar estrategias de prevención de lesiones y usaran recursos financieros para reducir el riesgo

Objective: The purpose of this study was to examine the frequency and severity of injuries sustained by members of a single soccer team over two seasons, when they played in the two divisions. Methods: Comparative study between two levels of professional soccer: the Spanish First Division (FD), and Second Division (SD). The original sample consisted of professional players of the same team whose injuries were prospectively recorded over the 2006-7 (SD) and 2008-9 (FD) seasons. Results: Of a total of 101 injuries registered, 64 (63.4%) were considered minor, 26 (25.7%) moderate, and 11 (10.9%) major. The incidence of moderate or major injuries during training was three times higher in FD (3.36 vs 1.01; RR = 3.30), as was the total number of injuries during match play (52.82 vs 16.01; RR = 3.30). As regards days lost, the incidence was higher in FD, in both training (60%) and matches (30%). The number of days lost per 1000 h exposure was 50% higher in FD (129.60 vs 85.01 days/1000 h exposure). Conclusions: The results show that in Spanish football, professional status may be a determining factor as regards injuries. These findings also confirm the fact that workplace injury risk is considerably higher in professional football than in most other sectors. It would therefore appear that clubs should take stock of the importance of developing injury prevention strategies, and use their financial resources to reduce the overall risk to clubs and players