A Prospective Magnetic Resonance Imaging Study of the Incidence of Posterolateral and Multiple Ligament Injuries in Acute Knee Injuries Presenting With a Hemarthrosis

Sports Medicine and Shoulder Divisions, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis 55454, USA.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 01/2008; 23(12):1341-7. DOI: 10.1016/j.arthro.2007.07.024
Source: PubMed


The purpose of this study was to determine whether the incidence of posterolateral knee injuries, as well as other concurrent knee ligament injuries, could be obtained from a prospective evaluation of magnetic resonance imaging scans in patients with an acute knee injury with a hemarthrosis.
We prospectively documented all patients with acute (within 30 days) knee injuries with a hemarthrosis over a 90-day period who underwent 1.5-T magnetic resonance imaging at a large referral imaging facility with 6 sites, effectively covering a large metropolitan area. The anterior cruciate ligament, superficial medial collateral ligament, and posterior cruciate ligament (PCL) and the following individual structures of the posterolateral corner were evaluated for high-grade injury: fibular collateral ligament, popliteus tendon, and popliteofibular ligament.
Out of 331 consecutive acute knee injuries with a hemarthrosis, 265 ligament injuries occurred in 187 patients (56%). Of these 187 patients with ligament injuries, 126 had isolated ligament injuries and 61 (33%) had combined multiple ligament injuries. Of the 187 patients with knee ligament injuries, 83 (44%) had isolated anterior cruciate ligament tears, 28 (15%) had isolated superficial medial collateral ligament tears, 11 (5%) had isolated PCL tears, and 4 (2.1%) had isolated posterolateral knee tears. Of the patients with posterolateral knee structure injuries, 87% (26/30) had multiple ligament injuries, with the overall incidence of posterolateral knee injuries among all knee ligament injuries being 16% and among all acute knee injuries with a hemarthrosis being 9.1%. Of the 27 patients with PCL tears, 16 (52%) had combined multiple ligament injuries.
This study shows that in this population, the incidence of posterolateral knee injuries in patients with acute knee ligament injuries with a hemarthrosis was 9.1%. It also verified that most PCL and posterolateral corner injuries occur in combination with other ligament injuries.
Level II, development of diagnostic criteria on the basis of consecutive patients with a universally applied gold standard.

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Available from: Robert F LaPrade, Oct 03, 2014
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    • "In recent years, injuries of the posterior cruciate ligament (PCL) have received more attention. The incidence of PCL tears in trauma patients with acute haemarthrosis of the knee is stated to be between 8.1% and 38% [1,2]. Approximately half of patients with PCL tears have combined multiple ligament injuries (52%) [2]. "
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    ABSTRACT: With incorrect or even without treatment, acute injuries of the posterior cruciate ligament (PCL) can lead to chronic instability of the knee joint. After delayed treatment, negative occupational changes and reduced quality of life can occur. These aspects have not yet been investigated. The purpose of this study was to evaluate occupational consequences after isolated reconstruction in cases of chronic PCL insufficiency. 12 patients treated with PCL reconstruction in a single bundle technique, using hamstring tendon grafts, were evaluated. All patients were operated upon at least 3 months after injury. Mean time of follow-up was 51 +/- 18.2 months (14-75). Radiological assessment (Telos stress device) showed a side comparison of total translation of 4.5 +/- 2.6 mm. Occupational consequences have been evaluated by the classification system "REFA". Median time incapacity for work was 8 weeks. Nearly all patients achieved the mental status of the normal population (SF-36), but physical status was still restricted. A pre- to postoperative improvement of the clinical scores could be seen: Lysholm-Score: 46.4 +/- 17.3 to 84.7 +/- 14.1, HSS-Score: 74.3 +/- 10.5 to 88.3 +/- 10.7. Postoperative evaluated scores were: Tegner score: 4.8 +/- 1.2, IKDC score: 80.0 +/- 16.2, VPS: 3.4 +/- 2.7. Patients with low physical load in their workplace described significantly better clinical results in every clinical score (p < .05) and less pain than patients with high physical load prior to the accident (VPS: REFA < 2: 2.4 +/- 2.6, REFA >= 2: 5.5 +/- 1.7; p < 0.05). Operative treated patients with a chronic PCL insufficiency achieve an improvement of the clinical result. Patients with low physical load at their workplace achieve less restrictions.
    BMC Research Notes 03/2014; 7(1):201. DOI:10.1186/1756-0500-7-201
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    • "This situation has not been studied in the literature, since the existing studies include only acute cases or insufficient number of such cases for comparison.( 14 , 15 , 20 ) Since lateral stretches most easily evolve with impaired compartment on patients follow up due to a progressive loosening, lesions with little change in imaging may evolve with poor follow up outcome.( 21 ) This situation differs from the medial compartment, that has better healing potential with conservative procedure.( "
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    ABSTRACT: Objective: Evaluate the correlation between magnetic resonance imaging, clinical examination and intraoperative identification of posterolateral corner injuries of the knee. Methods: We compared the findings of physical examination under anesthesia and intraoperative findings as the gold standard for the posterolateral corner injury with the reports of the MRIs of patients who underwent reconstruction of the posterolateral corner. Thus, we evaluated the use of MRI for the diagnosis of lesions. Results: We found a sensitivity of 100% in lesions of the anterior cruciate ligament (ACL), 86.96% in lesions of the posterior cruciate ligament (PCL), 57.58% in lesions of the lateral collateral ligament (LCL) and 24.24 % in tendon injuries of the popliteal muscle (PMT). Conclusion: Posterolateral corner injury is difficult to visualize and interpret; therefore, MRI imaging should not be used alone for diagnosis.
    Acta Ortopédica Brasileira 03/2014; 22(3):124-6. DOI:10.1590/1413-78522014220300928 · 0.19 Impact Factor
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    • "Prade et al., reported a relatively higher prevalence (44%) of single ACL tear among patients with acute knee injuries accompanied with hemarthrosis over a 90-days period.[14] Similarly, Frobell et al., reported the prevalence of ACL rupture in the general population to be about 30%, which was higher than previously described.[17] "
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    ABSTRACT: To review a single-surgeon series of 616 athletic patients with anterior cruciate ligament reconstructions in order to evaluate the relationship between the timing of the reconstruction and the incidence of meniscal and chondral injuries. SIX GROUP OF PATIENTS WERE CATEGORIZED BASED ON THE TIME INTERVAL FROM THEIR INJURY TO SURGERY IN THE FOLLOWING MANNER: <3 months, 3-6 months, 6-9 months, 9-18 months, 18-36 months, and >36 months. The presence of meniscal tears was documented and chondral pathology was scored based on the Outerbridge classification. Incidence of medial meniscus tear was significantly higher in patients undergoing reconstruction after 3 months from their injury (P = 0.032). The opportunity of patients with chondral pathology was recorded to be significantly higher in the groups operated on after 6 months from their injuries time (P = 0.008). Considering the effect of time on the rate of having meniscus injury and chondral pathology, reducing the time between the injury and surgery could improve the long-term health outcomes in this population.
    International journal of preventive medicine 04/2013; 4(Suppl 1):S98-S103.
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