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At least 235 records · Page 13Linked to original sources
PubMed2003

Combined anterior and posterior cruciate and medial collateral ligament injury: nonsurgical and delayed surgical treatment.

A detailed history, thorough examination, and a high index of suspicion for associated injuries together are the cornerstone for diagnosing and treating a knee with multiple ligament injuries. Acute surgery in patients with combined ligament injuries of the knee can lead to stiffness, primarily with medial-side injuries. Knee dislocations with lateral-side injuries require acute repair to achieve a good long-term result. All knee dislocations should not be grouped together because of the difference in healing potential between medial- and lateral-side injuries. Patients likely prefer a knee that is mildly lax but functional with full range of motion as opposed to a stiff, painful, stable knee. Treatment is based on the individual healing potential of the injured structures and the natural history of these injuries, along with the following principles: (1) medial-side injuries can heal with proper nonsurgical treatment; (2) posterior cruciate ligament (PCL) tears with grade II laxity or less can heal with similar long-term results as PCL tears with grade I laxity; therefore, surgery may not be indicated. As surgical techniques are developed and improved upon, a more aggressive approach to PCL reconstruction may be warranted; (3) PCL laxity greater than grade II and a soft end point should be considered for semiacute reconstruction; and (4) anterior cruciate ligament injuries in combination with medial collateral ligament and/or PCL injury can initially be treated nonsurgically and reconstructed later as dictated by patient symptoms and activity level.

Anterior Cruciate Ligament Injuries↗
PubMed1996

Patellar dislocation after total knee arthroplasty.

BACKGROUND: Patellar problem is an important cause of nonseptic failure of the current condylar design of total knee arthroplasties. Patellar dislocation after total knee arthroplasty is infrequent but can cause disabling symptoms. METHODS: From March, '84 to July, '92, 1652 total knee arthroplasties were performed at this Hospital. Of these 1100 knees in 978 patients were available to be followed up regularly at the Outpatient Department. Eleven cases of patellar dislocation after total knee arthroplasty were encountered during follow-up. Among these patients, nine patients had received operation at this Hospital; the other two patients had been referred here by the other hospitals. All 11 patients had been treated with surgical methods: proximal realignment of the quadriceps alone in 6 knees, lateral retinacular release combined with revision of the malaligned components in 2 knees, combined proximal and distal realignment in 2 knees and patellar tendon transfer in 1 knee. RESULTS: After an average follow-up of 21.8 months, from April, '84 to April, '93, there was one redislocation, unfortunately caused by trauma. Using the average knee rating scale of the Hospital for Special Surgery, New York, USA, the results of 90.5 were satisfactory and encouraging. CONCLUSIONS: Patellar dislocation after total knee arthroplasty can cause disabling symptoms, including pain, weakness, limited range of motion, extension lag and difficulty when climbing up or down stairs. The cause of patellar dislocation after total knee arthroplasty was error in surgical technique in this series. Revision of the component should be performed in those with malaligned component. Proximal realignment is recommended in those with quadriceps imbalance. Distal realignment is recommended only when proximal realignment alone has failed to restore proper patellar tracking, this should be carried out with great caution due to the potential for serious complications.

Aged↗
PubMed2005

Initial evaluation of the acute and chronic multiple ligament injured knee.

Despite the recent focus on the limited use of urgent arteriograms in the evaluation of acute knee dislocations, physical examination remains the cornerstone of assessment. Several clinical scenarios dictate an orthopedic emergency: vascular disruption, open wound, compartment syndrome, or an irreducible joint/dimple sign. In the acute setting, every attempt should be made to rule out associated injuries and the need for intervention. The multiple ligament knee injury or knee dislocation is a complex dilemma that requires close attention. Concomitant injuries about the knee often arise and must be addressed prior to ligamentous repair, and therefore the orthopedic surgeon must maintain a high index of suspicion for associated injuries in the evaluation of a multiple ligament knee injury.

Diagnosis, Differential↗
PubMedDate not supplied

Congenital dislocation of the knee in Ibadan, Nigeria.

Between January 1996 and December 2001, 41 congenital dislocations of the knee joints (30 patients) were reduced with closed methods by immediate reduction without anaesthesia and serial casting in plaster of Paris immobilization for a period of six to eight weeks. The patients' age ranged from the age of one week to four weeks with a male to female ratio of 1.5:1. The right knee was involved in 46.65% the left in 16.6% and bilateral involvement in 36.65% of patients. Routine check of the hip did not reveal any patient with hip instability. All the patients followed up after 2 years showed excellent results. We conclude that congenital knee dislocation when discovered early and without any other congenital malformation can be managed conservatively with excellent results.

Age Distribution↗
PubMed2005

Knee stability after articulated external fixation.

BACKGROUND: Articulated external fixation has been proposed as a method to protect ligament reconstructions while allowing aggressive and early postoperative rehabilitation after knee dislocation. However, the ability of these fixators to protect and stabilize the knee joint has not been clearly determined. HYPOTHESIS: Articulated external fixation can reduce anteroposterior translation in the cruciate-deficient knee and reduce cruciate ligament strain in cases of intact or reconstructed ligaments. STUDY DESIGN: Controlled laboratory study. METHODS: Knee stability was assessed by 3 standard clinical stability tests (Lachman, anterior drawer, and posterior drawer) on 7 human cadaveric lower extremities. Instrumented forces of 100 N were applied to the tibia to measure cruciate ligament forces and tibiofemoral displacement in intact and cruciate-deficient specimens with and without articulated external fixation to determine the degree to which a fixator can protect cruciate ligaments and stabilize the knee. Articulated external fixation was applied using monolateral and bilateral fixators to comparatively analyze the effectiveness of each construct. Statistical analysis was performed using 2-tailed, paired Student t tests. RESULTS: Application of the monolateral articulated external fixator to specimens with intact ligaments significantly reduced cruciate ligament forces by 1.0 N (P = .011), 1.7 N (P = .046), and 1.4 N (P = .009) for Lachman, anterior drawer, and posterior drawer tests, respectively. In the cruciate ligament-deficient knees, the application of a monolateral fixator significantly reduced tibiofemoral translation by 49%, 70%, and 46% for Lachman, anterior drawer, and posterior drawer tests, respectively. No significant differences between the monolateral and bilateral fixator frames, in terms of ligament protection and joint stabilization, were observed. CONCLUSION AND CLINICAL RELEVANCE: Articulated external fixation of the knee can reduce stress in the cruciate ligaments after multiligament reconstructions and can decrease anteroposterior translation in the cruciate-deficient knee.

Aged↗
PubMed1980

[Dislocations of the knee joint].

UNLABELLED: Tibial dislocation in the knee joint with an incidence of 0.2--3% is a rare event but inevitably bears severe consequences. From 1970--1978 we observed 7 cases. Most frequently there was a complex instability of the joint, accompanied by blood vessel and nerve lesions in 5 cases. THERAPY: Early suture or reinsertion of ligament rupture. Strict priority of blood vessel injuries. Conservative treatment results in poor functional results with necessity of secondary reconstructive procedures. Interdisciplinary cooperation is of crucial value in these injuries.

Humans↗
PubMed1993

Congenital dislocation of the knee. Its pathologic features and treatment.

Arthrograms and operative findings of 19 patients with 26 congenital dislocations of the knee (CDK) were reviewed to clarify the pathologic features, methods of treatment, and the optimum treatment for the patient with multiple joint deformities. The fundamental pathologic features in CDK involved a shortening of the quadriceps femoris tendon, a tight anterior articular capsule, and hypoplasia of the suprapatellar bursa. Valgus deformity of the knee, which was observed in half of the patients, was caused by the fragility of the medial components of the knee. This fragility was attributable to the forward displacement of the tibial insertion of the medial components. Arthrograms served as effective indicators when evaluating the pathologic features and determining the applicability of surgical therapy. There were limits to conservative therapy that were dependent on the extent of the pathologic changes. In extremely refractory patients with arthrogryposis multiplex congenita (AMC), an elimination of genu recurvatum and an improved range of movement could be obtained by the use of surgery. The valgus deformity was significantly reduced by invasive treatment that reinforced the fragile inner components. Experience with nine patients with multiple lower-limb joint deformities indicates that the knee dislocation should be treated before any of the other deformities.

Abnormalities, Multiple↗
PubMed2005

An unusual rotational injury: Pantibial ligamentous injury.

Pantibial ligamentous injury including knee dislocation and tibiotalar joint subluxation is an uncommon severe rotational injury. A 21-year-old male injured his right knee falling from a motorcycle. Physical examination revealed effusion on the right knee and ankle, and posterior translation of the tibia as well. The MRI of the right knee and ankle demonstrated the following findings: a complete disruption of cruciate ligaments, the medial collateral ligament, posteromedial corner injury together with a peripheric tear in the medial meniscus, the ruptured deltoid ligament, ankle syndesmosis space widening (>5 mm) and lateral subluxation of talus. Deltoid ligament of the right ankle was repaired and ankle syndesmosis was fixed with a cortical screw. The PCL and ACL were reconstructed arthroscopically with autogeneous bone-patellar tendon-bone graft. The midsubstance tear of MCL, posteromedial corner and medial meniscus tear were primarily repaired with nonabsorbable sutures. 3 years after the surgery, the patient was called for the final examination. MRI and X-ray findings of the knee and ankle joint demonstrated the continuity of ACL, PCL, MCL, and deltoid ligament. The patient, who is a farmer, can go back to his job and perform his daily activities. We presented a previously unreported case that involves both simultaneous occurrence of knee dislocation and tibiotalar joint subluxation. We used the term "Pantibial ligamentous injury" for this case.

Accidental Falls↗
PubMed2003

Ligament repair and reconstruction in traumatic dislocation of the knee.

We treated 21 patients with 22 dislocations of the knee by repair or reconstruction of all injured ligaments. Eight knees were treated in the acute phase (less than two weeks after injury); the remainder were treated more than six months after injury (6 to 72). Reconstructions were carried out with a combination of autograft and allograft tendons and by direct ligament repair where possible. At a mean follow-up of 32 months (11 to 77) the mean Lysholm score was 87 (81 to 91) in the acute group and 75 (53 to 100) in the delayed group. The mean Tegner activity rating was 5 in the acute group and 4.4 in the delayed group. The International Knee Documentation Committee assessment revealed no differences between the two groups. Instrumented testing of knee stability indicated better results for anterior cruciate ligament reconstructions which had been undertaken in the acute phase, but no difference in the outcome of posterior cruciate ligament reconstructions. There was no difference in the loss of knee movement between the two groups. Although the differences were small, the outcome in terms of overall knee function, activity levels and anterior tibial translation were better in those knees which had been reconstructed within two weeks of injury.

Acute Disease↗