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PubMed1993

The incomplete bicruciate knee injury. A report of two cases.

Two patients suffered similar knee injuries due to valgus stress and hyperextension. Examination under anesthesia and arthroscopic evaluation revealed a previously unreported ligament injury pattern. Both patients had a complete tear of the anterior cruciate ligament and a partial tear of the posterior cruciate ligament; neither was noted to have a dislocation. The descriptive term identifying this injury pattern is "incomplete bicruciate knee injury." The purpose of this report is to identify this knee-injury complex, which appears to be part of the sequence that leads to complete tears of both cruciate ligaments--the classic knee dislocation.

Adolescent↗
PubMed1985

Screening of athletic knee injuries.

The screening of athletic knee injuries requires a great deal of judgment and experience on the part of the physician. There are many gray areas with differences of opinion regarding methods of treatment by experts in the field. There is, however, unanimity of opinion regarding the necessity for immediate careful and thorough evaluation of injuries to the athlete's knee as well as prompt, appropriate treatment in order to prevent severe disability in the future.

Adolescent↗
PubMed1997

Magnetic resonance imaging of knee injuries in children.

The appearances of knee injuries on MR imaging are less well documented in children than adults. Some patterns of injury are shared by both groups of patients, e. g. meniscal damage. The frequency of specific injuries may differ, e. g. anterior cruciate ligament (ACL) tear. Congenital abnormality, coexistent pathology and previous treatment of the knee appear to be associated with meniscal problems. Discoid menisci are seen most frequently in children and have unique features on MR scans. Cruciate ligament tears are difficult to diagnose in the smallest children. The ACL may not be identified due to its small size. Normal bone marrow signal may be confused with marrow infiltration or bone microfracture. Radiographically occult fractures around the knee appear to be strongly associated with ligamentous injury as in adult patients. Osteochondral fractures, osteochondral lesions and articular cartilage damage are revealed on MR scans, but their long-term effects are uncertain. It is possible to diagnose a range of knee injuries on MR scans in children. The biggest diagnostic challenge is in pre-school children.

Adult↗
PubMed2006

Effect of functional bracing on knee injury in skiers with anterior cruciate ligament reconstruction: a prospective cohort study.

BACKGROUND: The role of knee bracing in anterior cruciate ligament reconstructions is controversial. HYPOTHESIS: Functional bracing will have an effect on subsequent knee injury in skiers with anterior cruciate ligament reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From 1991 to 1997, 11606 skiers at a major destination ski resort underwent preseason knee screening. The anterior cruciate ligament-reconstructed group consisted of 820 skiers who had had an anterior cruciate ligament reconstruction 2 years or more earlier. Of these, 257 skiers selected the use of functional knee brace during skiing. The dependent variable was subsequent knee injury, identified via workers' compensation records. Covariates included age, gender, ski occupation, Lachman grade, pivot-shift grade, KT-1000 arthrometer manual maximum displacement, and use of a functional brace. Univariate and multivariate risk factors for subsequent knee injury were determined. RESULTS: In this study, 257 skier-employees with anterior cruciate ligament reconstruction wore braces and 563 skier-employees with anterior cruciate ligament reconstruction did not. Braced skiers had significantly higher preseason rates of grade II or higher Lachman and pivot-shift tests (braced, 29% and 22%, respectively; nonbraced, 11% and 10%, respectively; P < .05). Sixty-one subsequent knee injuries were identified, 51 (8.9 injuries/100 knees/ski season) in the nonbraced group and 10 (4.0 injuries/100 knees/ski season) in the braced group (P = .009). Nonbraced skiers were 2.74 times more likely to suffer subsequent injury than were braced skiers (odds ratio, 2.74 [confidence interval, 1.2-4.9]). Logistic regression modeling identified nonbracing as a significant independent multivariate risk factor for subsequent knee injury in the high-demand skiers with anterior cruciate ligament reconstruction. CONCLUSION: Because of the increased risk of subsequent knee injury in nonbraced skiers, the authors recommend functional bracing for skiers with anterior cruciate ligament reconstruction. Whether the protective effect of functional bracing can be extrapolated to other high-demand patients is yet to be determined.

Adolescent↗
PubMed2006

Cross-cultural adaptation and validation of Singapore English and Chinese versions of the Knee injury and Osteoarthritis Outcome Score (KOOS) in Asians with knee osteoarthritis in Singapore.

OBJECTIVE: To cross-culturally adapt and validate Singapore English and Chinese versions of the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients with knee osteoarthritis (OA) in Singapore. METHODS: Singapore English and Chinese versions were cross-culturally adapted from the source English KOOS following standard guidelines (including cognitive debriefing). Patients were asked to complete identical questionnaires containing the KOOS, Short Form 36 Health Survey, and EQ-5D twice within 6 days. Reliability was assessed using Cronbach's alpha and intraclass correlation coefficients (ICC), dimensionality using item-to-domain correlations and convergent and divergent construct validity using 14 and 13 a priori hypotheses, respectively. RESULTS: Singapore English and Chinese KOOS versions were well accepted by patients in pilot testing and were therefore administered to a consecutive sample of 127 English and 131 Chinese-speaking Singaporeans with knee OA. Cronbach's alpha exceeded 0.7 for all domains except for Chinese pain and symptoms domains. ICC exceeded 0.7 for all domains except for English sport and recreation and Chinese knee-related QoL domains. Hypothesized item-to-domain correlations (Spearman's rho>or=0.4) were observed for 38 items in English and 29 in Chinese versions. Convergent construct validity was supported by the presence of hypothesized moderate/strong correlations (rho=0.37-0.65) for 13 and 11 a priori hypotheses in the English and Chinese KOOS, respectively. Divergent construct validity was supported by the presence of weak correlations (rho=0.02-0.34) for 12 and 11 a priori hypotheses in the English and Chinese KOOS, respectively. CONCLUSION: The Singapore English and Chinese KOOS were well accepted and demonstrated acceptable reliability and validity in Asian patients with knee OA in Singapore.

Aged↗
PubMedDate not supplied

Magnetic resonance imaging as a tool for evaluation of traumatic knee injuries. Anatomical and pathoanatomical correlations.

Traumatic injury to the knee remains a diagnostic and therapeutic challenge. Magnetic resonance imaging (MRI) has been applied to musculoskeletal pathoanatomy and has been shown to be an effective tool for definition and characterization of knee pathology. A systematic approach is taken to establish anatomical and pathoanatomical correlations, as well as the role of MRI in the management of knee injuries. Imaging was performed at the UCLA Medical Center using a permanent magnet system and a combination of solenoidal surface coils and thin-section, high-resolution scanning techniques. Images depict structural anatomical and spatial details of the knee that correlate well with corresponding cadaveric cryosections. To determine pathoanatomical correlations and the efficacy of MRI, 105 patients with preoperative diagnoses of meniscal tears, anterior and posterior cruciate ligament tears, tibial plateau fracture, and patella and quadriceps injuries were imaged. Results indicated that for the medial meniscus MRI demonstrated a 95.7% sensitivity, 81.8% specificity, 90% accuracy, 88.2% positive predictive value (PPV), and 93.1% negative predictive value (NPV). Imaging of the lateral meniscus demonstrated a 75% sensitivity, 95% specificity, 91% accuracy, 80% PPV, and 94% NPV. MRI of the ACL revealed 100% sensitivity, specificity, accuracy, positive and negative predictive values. MRI is a noninvasive tool which uses no ionizing radiation and can accurately define and characterize anatomy and pathoanatomy. This study indicates that MRI in conjunction with clinical evaluation can contribute to treatment decision-making processes and assist in preoperative planning. An algorithm demonstrating the potential clinical use of MRI is presented.

Humans↗
PubMedDate not supplied

The efficacy of a prophylactic knee brace to reduce knee injuries in football. A prospective, randomized study at West Point.

The purpose of this prospective, randomized study was to determine the efficacy of a prophylactic knee brace to reduce the frequency and severity of acute knee injuries in football in an athletic environment in which the athletic shoe, playing surface, athlete-exposure, knee injury history, and brace assignment were either statistically or experimentally controlled. The participants in the study were 1396 cadets at the United States Military Academy, West Point, New York, who experienced a total of 21,570 athlete-exposures in the 1986 and 1987 fall intramural tackle football seasons. The use of prophylactic knee braces significantly reduced the frequency of knee injuries, both in the total number of subjects injured and in the total number of medial collateral ligament injuries incurred. However, the reduction in the frequency of knee injuries (total and medial collateral ligament) was dependent on player position. Defensive players who wore prophylactic knee braces had statistically fewer knee injuries than players who served as controls. This was not true of offensive players who served as controls; they had statistically no difference in the number of knee injuries from players who wore prophylactic knee braces. The severity of medical collateral ligament and anterior cruciate ligament knee injuries was not significantly reduced with the use of prophylactic knee braces.

Adult↗
PubMed2000

Isolated acute knee injuries in the general population.

OBJECTIVE: Knee injuries are common in the general population, yet most studies have concentrated on special populations. The purpose of this study was to describe the types of injuries, injury events, age, and sex distributions in a community population. METHODS: The medical records of all residents of Olmsted County, Minnesota, 17 years of age or older who had a first visit for an isolated acute knee (acute was defined as occurring within 60 days of the physician visit) injury between January 1, 1993, and January 1, 1996, were abstracted. RESULTS: A total of 664 patients (4/1,000 community adults, 46% women and 54% men) presented to a physician for evaluation and treatment of an isolated acute knee injury. Injured men were on average younger than women and more likely to have an injury during a sports activity, whereas women's injuries were more likely to be the result of non-sports-related falls. Knee sprain or strain was the most common final diagnosis (36%). Approximately half (49%) of the patients had a single visit. The likelihood of orthopedic surgeon's care (37% overall) increased with injury severity and age of the patient. Overall, 12% of subjects had surgical treatment recommended. CONCLUSION: Knee injuries are common, often result in a single visit, seldom receive surgical intervention, and the majority are cared for entirely by generalist physicians.

Accidental Falls↗
PubMed1994

Knee injuries and Alpine skiing. Treatment and rehabilitation.

Alpine skiing is an increasingly popular recreational sport worldwide. While the overall injury rate has declined and the pattern of injury changed over the years, the incidence of knee injuries has not changed substantially and accounts for 20 to 30% of all alpine skiing injuries. Medial collateral ligament (MCL) injuries are the most common in skiing, accounting for 15 to 20% of all skiing injuries and 60% of knee injuries in skiers. Tears are commonly isolated, but may occur in association with other ligamentous injuries. Associated meniscal pathology is rare. Isolated MCL injuries are treated nonoperatively with a programme of initial immobilisation, early range-of-motion, and isometric quadriceps strengthening exercises. When full range of motion is achieved, a programme of progressive resistance exercises, isokinetic and closed chain exercises, and functional rehabilitation is instituted. Good results with return to skiing can be expected in most cases. Isolated lateral collateral ligament (LCL) injuries are rare in skiers. There is usually associated cruciate or arcuate ligament complex. Careful physical examination is essential to rule out associated ligament injuries and more complex instability patterns. In the rare case of isolated LCL injury, a similar approach to isolated MCL injury should be instituted. Anterior cruciate ligament (ACL) injuries have become increasingly common in skiers. This may reflect a true increase in the incidence or an improved awareness and ability to diagnose ACL injury. Physical examination and arthrometric analysis are important in assessing the integrity of the ACL. Radiographic and magnetic resonance imaging (MRI) evaluation may be helpful in assessing associated meniscal pathology. Treatment of the ACL-deficient knee is usually surgical. However, prior to reconstruction, a programme aimed at reducing effusion and regaining a full, pain-free range of motion is recommended. Surgical reconstruction is usually with the central third of the patella tendon using a bone-tendon-bone autograft. Postoperative rehabilitation employs a functional staged approach, requiring vigilant supervision by the surgeon. Isolated posterior cruciate ligament (PCL) injury is rare in skiing, constituting less than 1% of all knee injuries in most series. Careful physical examination must be employed to rule out associated arcuate ligament complex injury and more complex patterns of instability. Most isolated PCL injuries are treated nonoperatively with a programme of initial immobilisation in extension, ice, protected weight-bearing, early range-of-motion exercises and progressive isometric strengthening.(ABSTRACT TRUNCATED AT 400 WORDS)

Anterior Cruciate Ligament Injuries↗
PubMed2000

Acute knee injuries.

Skeletally immature athletes do get major knee injuries. Hemarthrosis is associated with peripheral meniscal tears, anterior cruciate ligament ruptures, tibial tubercle avulsion injuries, and patellar/femoral osteochondral fractures and cannot be ignored. The primary diagnostic tool for patients with a knee injury is a clinical examination by a physician well trained in knee evaluation. MR imaging has significant limitations in this age group. The algorithm for anterior cruciate ligament injury treatment must take into account the patient's physiologic maturity, not chronological age.

Acute Disease↗
PubMed1989

Incidence of knee injuries and the need for further care. A one-year prospective follow-up study.

All visits to physicians paid due to knee injuries in the Orivesi Region Federation of Municipalities for Public Health Work in Finland were prospectively recorded over a period of one year. The visits totalled 360, which accounted for 1.0% of all visits. The number of patients was 148, and the total incidence rate of knee injuries was 1.1% corresponding to that during one year period every hundredth inhabitant sought medical treatment from a physician because of a knee injury. Forty-eight per cent of the knee injuries were sustained in sports activities. The injuries affected mostly knee ligaments and/or menisci. Every tenth visit led to a surgical consultation for assessment of the need for surgery, equalling three patients per 1000 inhabitants annually. The study provides basic information concerning the occurrence of knee injuries and the need for further care. The results can be used as an aid in the planning of arthroscopy as well as other examination and treatment resources of knee injuries as well as in the assessment of need for such services.

Adolescent↗
PubMed2006

Epidemiology of athletic knee injuries: A 10-year study.

The knee is an anatomically and biomechanically complex joint. Few studies have been published reporting the type and frequency of knee injuries. However, this information that may help to prevent, diagnose, and treat knee joint injuries. We have documented 17,397 patients with 19,530 sport injuries over a 10-year period of time. 6434 patients (37%) had 7769 injuries (39.8%) related to the knee joint. 68.1% of those patients were men and 31.6% were women. Almost 50% of the patients were between the ages of 20-29 (43.1%) at the time of injury. The injuries documented were ACL lesion (20.3%), medial meniscus lesion (10.8%), lateral meniscus lesion (3.7%), MCL lesion (7.9%), LCL lesion (1.1%), and PCL lesion (0.65%). The activities leading to most injuries were soccer (35%) and skiing (26%). LCL injury was associated with tennis and gymnastics, MCL with judo and skiing, ACL with handball and volleyball, PCL with handball, lateral meniscus with gymnastics and dancing, and medial meniscus with tennis and jogging.

Adolescent↗
PubMedDate not supplied

[The Knee Injury and Osteoarthritis Outcome Score--a multifunctional questionnaire to measure outcome in knee arthroplasty].

AIM: It was the purpose of this investigation to create a German version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) and to test its appropriateness in patients with advanced gonarthritis. METHOD: Reliability (test-retest reliability, internal consistency), validity (convergent construct validity and divergent construct validity), sensitivity to change as well as practicability and acceptance of this questionnaire were tested in 90 patients. RESULTS: The test-retest reliability was acceptably high for all subscales, it ranged between r = 0.65 and 0.78 and the questionnaire showed a high internal consistency in almost all of the subscales. The comparison to the results of the questionnaire "Short Form-12" (SF-12) as well as to the patients self-assessment of health status showed high concordance in nearly all subscales, however it was only moderate for the symptom scale. Furthermore the KOOS was able to show significant differences between patients and healthy controls. When testing the sensitivity to change, the KOOS could demonstrate significant improvements within 3 months and the instrument has shown to be practicable with a high acceptance by the patients. CONCLUSION: With the German version of the Knee Injury and Osteoarthritis Outcome Score a multidimensional instrument is available now to measure health status as well as therapeutic effects in patients with knee problems. Modifying the subscale "symptoms" could further optimize this questionnaire in patients with advanced gonarthritis.

Adolescent↗
PubMedDate not supplied

Does a major knee injury definitely sideline an elite soccer player?

Injuries occurring in three Swedish elite soccer teams were analyzed during 1 year. A total of 49 of 64 players (75%) sustained 85 injuries. The incidence of injury during games was 13 injuries per 1000 hours, while the incidence during training was 3 injuries per 1000 hours. Twenty percent of the injuries required hospital facilities. The majority of the traumatic injuries (93%) were to the lower extremities, with one third of the total injuries occurring in the knee. Overuse injuries accounted for 35% of all injuries and occurred mainly during preseason training and at the end of each season. Conversely, the majority of traumatic injuries occurred during games, equally distributed between the first and second halves with a predominance toward the end of each half. The position of the player within the team did not influence injury rate. The referee considered 28% of the traumatic injuries to be caused by violation of existing rules. Thirty-four percent of the injuries were major, causing more than 1 month of absence from training and/or games. Eleven knee injuries required surgical intervention revealing seven ruptured ACLs, of which three were chronic. At followup, 9 to 18.5 months after injury, 4 of 12 players with major knee injuries had returned to play at the elite level. The others had either been transferred to lower divisions or were still in rehabilitation.

Adult↗
PubMed2004

Sideline management of acute knee injuries.

Sideline management of acute knee injuries requires medical personnel to have knowledge of injury patterns, mechanisms, physical findings, and treatment strategies. Fractures and multiple-ligament injured knees need to be rapidly diagnosed and stabilized to allow for timely transfer to a location where further evaluation and definitive treatment can be provided.

Acute Disease↗
PubMed1984

The role of arthroscopy in the management of knee injuries in the athlete.

The athlete who has an acute knee injury requires early diagnosis and treatment, an accurate estimate of the extent of the injury and the time required for rehabilitation, and an ultimate prognosis for function. Arthroscopic evaluation is extremely useful in these persons because it allows an accurate early diagnosis of injuries to the menisci, cruciate ligaments, articular cartilage, joint capsule, and synovium. Early diagnosis allows selection of the treatment modalities that will permit the most rapid return of the athlete to sports activities in the minimal amount of time. The concept of temporizing rather than early diagnosis is not a viable technique in the athlete. A review of 63 bucket-handle tears of the medial meniscus which were treated arthroscopically revealed a rapid return to function. Athletic endeavors could be performed competitively an average of 4 weeks after arthroscopic treatment. Arthroscopy is a valuable agent in the evaluation and management of acute knee injuries in athletes. An aggressive program of diagnosis should be pursued.

Arthroscopy↗
PubMed1993

Audit of knee injuries seen in a sports medicine clinic.

In order to assess the management of knee injuries in a sports medicine clinic, an audit was performed of all new patients who attended the clinic over a 12-month period. Of the 167 new patients seen, 76 (46%) had sustained knee injuries. Of these, 43 (57%) were treated in the sports medicine clinic and 33 (43%) were referred for arthroscopic assessment. The maximum waiting time from the time of referral was 3 weeks, with 85% of patients seen within 1 week and 92% within 2 weeks. Arthroscopy was performed on 28 (85%) of the 33 patients referred, and the positive correlation between the sports clinic diagnosis and the arthroscopic diagnosis was 64%. Of the 33 patients referred for arthroscopy, 28 (85%) had sustained acute knee injuries while five (15%) had been treated at other hospitals before referral to the sports medicine clinic. A National Health Service sports medicine clinic is an effective means of treating knee injuries, provided that access to arthroscopy is readily available.

England↗
PubMed2003

Effect of functional bracing on subsequent knee injury in ACL-deficient professional skiers.

The effect of functional bracing on subsequent knee injury in anterior cruciate ligament (ACL) deficient professional skiers was evaluated. A cohort of 180 ACL-deficient skiers was identified from a knee screening of 9410 professional skiers from 1991-1997. An ACL-deficient knee was defined by an abnormal examination (Lachman or pivot-shift) and a > or = 5-mm KT-1000 manual maximum difference. The dependent variable was subsequent knee injury, which occurred in 12 knees. A significantly higher proportion of injuries occurred in nonbraced skiers compared with braced skiers (P = .005). The risk ratio for subsequent knee injury comparing nonbraced with braced skiers was 6.4 (13% and 2%, respectively). Univariate analysis revealed no significant effects of the other covariates. Logistic regression identified bracing status (P < .01; odds ratio = 8) and KT-1000 manual maximum difference (P = .02; odds ratio = 1.3) as significant multivariate risk factors for subsequent knee injury, controlling for covariates.

Adult↗