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
    • "PLC injuries alone are very rare and account for less than 2% of the cases. They may fail to be diagnosed in their initial presentation in up to 70% of the cases [3] [4] [5] [6] [7]. These injuries usually occur through high-energy trauma, such as automotive vehicle accidents, sports trauma and falls. "
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    ABSTRACT: Background Many reconstruction techniques have already been developed for treating posterolateral corner (PLC) injuries, with still no consensus regarding what would be the best option. Some of them use non-bone tunnel fixation, attaching the graft to the femur using a cortical screw with toothed washer. The main objective of the present study is to evaluate complications related to fixation performed by screw and toothed washer technique. Methods A prospective study with surgical reconstruction of the PLC structures of the knee between January 2008 and December 2009 was performed. PLC reconstruction included reconstruction of the lateral collateral ligament, popliteofibular ligament and popliteal muscle tendon. Fixation of the grafts in the femur was achieved by means of a 4.5 mm screw with a toothed washer. The assessments were done using the following methods: objective IKDC, subjective IKDC, Lysholm and Tegner. Radiographic evaluations were performed immediately after the operation, at three, six and twelve months after surgery, and yearly thereafter. Complications were documented. Results The mean subjective IKDC score after the operation was 69.2, Lysholm scale was 80.7. Two patients presented failure of reconstructions of the PLC. In the radiographic evaluations, signs of loosening of the screw with toothed washer in the femur were observed in eight cases (66.6%). Six patients(50%) complained of lateral pain after the operation. Conclusion The technique of femoral fixation shown to be efficient to restoration of stability. However there was a high rate of complications secondary to implant, such as loosening of the screws and iliotibial tract friction.
    No preview · Article · Jun 2014 · The Knee
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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.
    Full-text · Article · Mar 2014 · BMC Research Notes
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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.
    Full-text · Article · Mar 2014 · Acta Ortopédica Brasileira
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