Distal posterolateral corner injury in the setting of multiligament knee injury increases risk of common peroneal palsy

Knee injuries are common in sports and depending on the mechanism of fall, injury of different ligaments can occur. Knee injury mostly involves the anterior cruciate ligament (ACL), and is the most common injury reported on MRI. It can be associated with posterolateral corner (PLC) injury and other osseous injuries, these injuries are rarely reported as they are very complex in structure. A detail knowledge about this complex helps to evaluate the associated ligaments as well. In association with anterior cruciate ligament injuries presence of a Segond fracture indicates occurrence of a concomitant or isolated injury to the posterolateral corner injury. The evaluation of these associated injuries along with anterior cruciate ligament aids in their repair and hence improving the postoperative outcome. Three main components of posterolateral corner are divided into three layers – superficial, middle, and deep. Clinically few tests have been advised to evaluate injury of different structures of knee joint. For example - McMurray's test and Ege's test are used to evaluate meniscus, Lachman test, Anterior drawer test and Pivot Shift Test are performed to evaluate anterior cruciate ligament tear while posterior drawer test is done to evaluate posterior cruciate ligament tear. Availability of special closely coupled extremity coils, high field systems, open system & extremity units have made MRI supplemental to clinical examination and plain radiographs for virtually all suspected disorders of knee. Here, we are presenting a case of MRI of knee injury involving posterolateral corner injury with anterior cruciate ligament tear and Segond fracture. Along with anterior cruciate ligament, medial meniscus, other ligaments and osseous injury are associated as well. The other structures responsible for stabilizing the knee joints are posterolateral corner and meniscus, which when involved may need to be treated simultaneously with anterior cruciate ligament tear, for full re stabilization of knee joint. If any associated fracture is present, it has to be treated simultaneously as well.

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Always fighting and keeping hope: my experience of a complete quadriceps rupture and multiligament knee injury

British Journal of Sports Medicine ◽

10.1136/bjsports-2021-104137 ◽

2021 ◽

pp. bjsports-2021-104137

Author(s):

Johan Rodriguez

Keyword(s):

Knee Injury ◽

Multiligament Knee Injury

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Posterior Cruciate Ligament Reconstruction and Posterolateral Corner Injury

Knee Surgery and Related Research ◽

10.5792/ksrr.17.087 ◽

2017 ◽

Vol 29 (4) ◽

pp. 243-245 ◽

Cited By ~ 1

Author(s):

Young Mo Kim

Keyword(s):

Posterior Cruciate Ligament ◽

Ligament Reconstruction ◽

Cruciate Ligament ◽

Posterolateral Corner ◽

Posterior Cruciate Ligament Reconstruction ◽

Cruciate Ligament Reconstruction ◽

Posterolateral Corner Injury

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Nerve Injury Complicating Multiligament Knee Injury: Current Concepts and Treatment Algorithm

Journal of the American Academy of Orthopaedic Surgeons ◽

10.5435/jaaos-21-06-343 ◽

2013 ◽

Vol 21 (6) ◽

pp. 343-354 ◽

Cited By ~ 9

Author(s):

W. R. Mook ◽

C. A. Ligh ◽

C. T. Moorman ◽

F. J. Leversedge

Keyword(s):

Nerve Injury ◽

Knee Injury ◽

Treatment Algorithm ◽

Multiligament Knee Injury

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Diagnosis and treatment of multiligament knee injury: state of the art

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2016-000072 ◽

2017 ◽

Vol 2 (3) ◽

pp. 152-161 ◽

Cited By ~ 25

Author(s):

Gilbert Moatshe ◽

Jorge Chahla ◽

Robert F LaPrade ◽

Lars Engebretsen

Keyword(s):

Knee Injury ◽

State Of The Art ◽

Diagnosis And Treatment ◽

Multiligament Knee Injury

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Result of single stage early surgical treatment of high-grade multiligamentous knee injuries (Schenck Type III, IV and V)

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00519 ◽

2020 ◽

Vol 8 (9_suppl7) ◽

pp. 2325967120S0051

Author(s):

Arvind Prasad Gupta

Keyword(s):

Surgical Treatment ◽

Knee Injury ◽

Cruciate Ligament ◽

Weight Bearing ◽

Single Stage ◽

High Grade ◽

Collateral Ligament ◽

Multiligament Knee Injury ◽

Early Surgical Treatment

Introduction: The Multiligament Knee Injury is a complex knee problem and mostly associated with subluxation or dislocation of knee joint. Failure to diagnose and treat them appropriately can leads to devastating outcome particularly high-grade injury (Schenck Type 3,4 and 5). We favor single stage early surgical treatment of high grade Multiligament knee injury which leads to good functional outcome and return to work. Hypotheses: Single stage early surgical treatment of high grade Multiligament knee injury will leads to good functional outcome with higher IKDC and Lysholm score and helps the patients to in return early to work with higher satisfaction rate. Methods: From June 2013 to January 2020, 42 patients with age from 18 years to 56 years with acute (< 6 weeks) Multiligament knee injury included in surgical treatment. Patients with neurovascular injury were not included in study. From 42 patients, 28 patients was type 3,8 patients was type 4 and 6 patients was type 5 in this study. In all 42 patients, single stage treatment first Intraarticular ligament (anterior cruciate ligament ACL, posterior cruciate ligament PCL or both) reconstruction done by arthroscopic method then Extraarticular ligament (medial collateral ligament MCL, lateral collateral ligament LCL, Posterolateral corner PLC) treated with repair/augmentation/reconstruction depending upon status of ligaments by open method. We used only autograft (hamstring and peroneal longus tendon) of same limb or contralateral limb. Patient evaluation done with IKDC and Lyshlom score both in preoperative and postoperative period. Patient limb was kept in full extention in brace and started with aggressive physiotherapy with passive ROM at 2 weeks in post operative period . Follow up done at 2 weeks then every 6 weeks interval till 6 months then every 3 months interval. Partial weight bearing started at 6 weeks and full weight bearing usually between 10 weeks to 12 weeks. Results: Road traffic accident was the most common cause of Multiligament knee injury. Average follow up was 4 years (range 2 to 6.5 years) .40 % has excellent ,40% has good and 20% has average result. There was a significant improvement in both outcome scores as compared with the preoperative scores. Postoperatively average IKDC was 78 and Lyshlom was 86. Terminal restriction of knee movement was in 19% patients particularly those associated with medial side injury was the major complication in our study. Manipulation under anaesthesia was done in 4 cases and implant removal in 1 case and arthroscopic synovectomy and long term antibiotic in 1 case who develop early infection. Gade 1 posterior laxity and grade 1 varus stress was observed in 10 patints.Recovery after surgery takes 9 to 12 months of rehabilitation prior to returning to full activities. Conclusion: Proper evaluation and full diagnosis is key in Multiligament injury of knee. Failure to treat all injured structure can lead to change in knee kinematics and poorer outcome and increased risk for graft failure.Operative treatment with proper rehabilitation yields good functional and clinical outcome with early return to work and sports activity.

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