A Closer Look is necessary: Traumatic luxation of the patella as a co-injury of an acl-rupture

Aims and Objectives: The rupture of the acl is considered to be one of the most common knee injuries in sports traumatology. Many patients report that they felt the sensation of a luxated patella during their knee distorsion. In many cases patients patients with the suspicion of a traumatic patella luxation showed in the mri a complete rupture of the acl. Materials and Methods: We report about 10 patients consulting our department within the last year after a significant knee trauma. In the mri as well as during the arthroscopic evaluation they showed a complete rupture of the acl as well as the findings of a fresh, traumatic patella luxation. We evaluated and analysed the preoperative and intraoperative pictures (mri and arthrosopy). Results: All patients showed in the posttraumatic mri a complete rupture of the acl as well as an at least partial rupture of the mpfl and a rupture of the medial retinaculum. 4 patients showed a persistent subluxation of the patella, 8 patients showed also a rupture of the medial collateral ligament. During the operation we verified a significant instability of the patella in 8 patients so that a stabilization of the patella was performed (open medial stabilization or mpfl reconstruction) in the same operation the acl was reconstructed (semi-t). Eventhough the patients were treated with only one operation and the regaining of motion was prolonged compared with isolated acl-reconstruction, after 12 months postoperatively all patients had a satisfactory range of motion. Conclusion: The typical trauma mechanism for an acl rupture is a valgus position of the knee in combination with an external rotation of the tibia, which leads to an enlargement of the q-angle which is considered a predisposition for a patella luxation. If an acl rupture occurs, the patella can luxate within the same trauma. In the posttraumatic mri the rupture of the mpfl is often misinterpreted as a rupture of the medial collateral ligament, particularly if the patella is, as in most cases, in full reposition. Within an acl-rupture a luxation of the patella can occur simultaneously, leading to a significant instability which needs to be treated (medial stabilization or mpfl-reconstruction). Our data shows that a single stage treatment with acl-reconstruction and medial stabilization is technical practicable and mid-term investigation shows good clinical results without a higher risk of an arthrofibrosis.

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Medial Knee Injury: Part 1, Static Function of the Individual Components of the Main Medial Knee Structures

The American Journal of Sports Medicine ◽

10.1177/0363546509333852 ◽

2009 ◽

Vol 37 (9) ◽

pp. 1762-1770 ◽

Cited By ~ 151

Author(s):

Chad J. Griffith ◽

Robert F. LaPrade ◽

Steinar Johansen ◽

Bryan Armitage ◽

Coen Wijdicks ◽

...

Keyword(s):

Medial Collateral Ligament ◽

Knee Flexion ◽

External Rotation ◽

Tracking System ◽

Knee Injuries ◽

Collateral Ligament ◽

Medial Knee ◽

Superficial Medial Collateral Ligament ◽

The Individual ◽

Dial Test

Background There is a lack of knowledge on the primary and secondary static stabilizing functions of the posterior oblique ligament (POL), the proximal and distal divisions of the superficial medial collateral ligament (sMCL), and the meniscofemoral and meniscotibial portions of the deep medial collateral ligament (MCL). Hypothesis Identification of the primary and secondary stabilizing functions of the individual components of the main medial knee structures will provide increased knowledge of the medial knee ligamentous stability. Study Design Descriptive laboratory study. Methods Twenty-four cadaveric knees were equally divided into 3 groups with unique sequential sectioning sequences of the POL, sMCL (proximal and distal divisions), and deep MCL (meniscofemoral and meniscotibial portions). A 6 degree of freedom electromagnetic tracking system monitored motion after application of valgus loads (10 N·m) and internal and external rotation torques (5 N·m) at 0°, 20°, 30°, 60°, and 90° of knee flexion. Results The primary valgus stabilizer was the proximal division of the sMCL. The primary external rotation stabilizer was the distal division of the sMCL at 30° of knee flexion. The primary internal rotation stabilizers were the POL and the distal division of the sMCL at all tested knee flexion angles, the meniscofemoral portion of the deep MCL at 20°, 60°, and 90° of knee flexion, and the meniscotibial portion of the deep MCL at 0° and 30° of knee flexion. Conclusion An intricate relationship exists among the main medial knee structures and their individual components for static function to applied loads. Clinical Significance: Interpretation of clinical knee motion testing following medial knee injuries will improve with the information in this study. Significant increases in external rotation at 30° of knee flexion were found with all medial knee structures sectioned, which indicates that a positive dial test may be found not only for posterolateral knee injuries but also for medial knee injuries.

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Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

Case Reports in Orthopedics ◽

10.1155/2020/7348201 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Ryo Murakami ◽

Eisaburo Honda ◽

Atsushi Fukai ◽

Hiroki Yoshitomi ◽

Takaki Sanada ◽

...

Keyword(s):

Posterior Cruciate Ligament ◽

Medial Collateral Ligament ◽

Cruciate Ligament ◽

Knee Injuries ◽

Knee Dislocation ◽

Single Stage ◽

Lateral Condyle ◽

Ligament Repair ◽

Collateral Ligament ◽

Medial Condyle

Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries; however, reports on arthroscopic-combined single-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repairs are scarce. In this report, we describe a case of type III knee dislocation (ACL, PCL, and medial collateral ligament (MCL) injuries) in a 43-year-old man, caused by contact while playing futsal. On the sixth day after injury, arthroscopic ACL and PCL repairs were performed with open MCL repair. The proximal lesions in the three ligaments that were injured were sutured using no. 2 strong surgical sutures. The ACL was pulled out to the lateral condyle of the femur and fixed using a suspensory fixation device. The PCL was pulled out to the medial condyle of the femur, and the MCL was pulled towards the proximal end of the femur; both were fixed using suture anchors. Early mobilization was performed, and both, clinical and imaging outcomes, were good two years after surgery.

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ANATOMICAL DISSECTION AND CT IMAGING OF THE ANTERIOR CRUCIATE AND MEDIAL COLLATERAL LIGAMENT FOOTPRINT ANATOMY IN SKELETALLY IMMATURE CADAVER KNEES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00148 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0014

Author(s):

Kevin Shea ◽

Peter C. Cannamela ◽

Aleksei Dingel ◽

Peter D. Fabricant ◽

John D. Polousky ◽

...

Keyword(s):

Acl Reconstruction ◽

Medial Collateral Ligament ◽

Interquartile Range ◽

Skeletally Immature ◽

Collateral Ligament ◽

Acl Repair ◽

Median Distance ◽

Text Figure ◽

Anterior Cruciate ◽

Femoral Physis

Background: Anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries in skeletally immature patients are increasingly recognized and surgically treated. However, the relationship between the footprint anatomy and the physes are not clearly defined. The purpose of this study was to identify the origin and insertion of the ACL and MCL, and define the footprint anatomy in relation to the physes in skeletally immature knees. Methods: Twenty-nine skeletally immature knees from 16 human cadaver specimens were dissected and divided into two groups: Group A (ages 2-5 years), and Group B (ages 7-11 years). Metallic markers were placed to mark the femoral and tibial attachments of the ACL and MCL. CT scans were obtained for each specimen used to measure the distance from the center of the ligament footprints to the respective distal femoral and proximal tibial physes. Results: Median distance from the ACL femoral epiphyseal origin to the distal femoral physis was 0.30 cm (interquartile range, 0.20 cm to 0.50 cm) and 0.70 cm (interquartile range, 0.45 cm to 0.90 cm) for Groups A and B, respectively. The median distance from the ACL epiphyseal tibial insertion to the proximal tibial physis for Groups A and B were 1.50 cm (interquartile range, 1.40 cm to 1.60 cm) and 1.80 cm (interquartile range, 1.60 cm to 1.85 cm), respectively. Median distance from the MCL femoral origin on the epiphysis to the distal femoral physis was 1.20 cm (interquartile range, 1.00 cm to 1.20 cm) and 0.85 cm (interquartile range, 0.63 cm to 1.00 cm) for Groups A and B, respectively. Median distance from the MCL insertion on the tibial metaphysis to the tibial physis was 3.05 cm (interquartile range, 2.63 cm to 3.30 cm) and 4.80 cm (interquartile range, 3.90 cm to 5.10 cm) for Groups A and B, respectively. Conclusion: Surgical reconstruction is a common treatment for ACL injury, and occasionally MCL reconstruction or repair is also required. Cadaveric dissection and CT scanning of exceptionally rare pediatric tissue clearly defines the location of the ACL and MCL with respect to the femoral and tibial physes, and may guide surgeons for physeal respecting procedures for both ACL reconstruction, and ACL repair procedures. Clinical Relevance: In addition to ACL reconstruction, recent basic science and clinical research suggest that ACL repair may be more commonly performed in the future. MCL repair and reconstruction is also occasionally required in skeletally immature patients. This information may be useful to help surgeons avoid or minimize physeal injury during ACL/MCL reconstructions and/or repair in skeletally immature patients. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]

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Early return to play following complete rupture of the medial collateral ligament of the elbow using preparation rich in growth factors: A case report

Journal of Shoulder and Elbow Surgery ◽

10.1016/j.jse.2009.12.004 ◽

2010 ◽

Vol 19 (5) ◽

pp. e1-e5 ◽

Cited By ~ 9

Author(s):

Omer Mei-Dan ◽

Mike Carmont ◽

Eugene Kots ◽

Vidal Barchilon ◽

Meir Nyska ◽

...

Keyword(s):

Case Report ◽

Growth Factors ◽

Medial Collateral Ligament ◽

Return To Play ◽

Collateral Ligament ◽

Complete Rupture ◽

Early Return

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The Effect of Hamstring Tendon Autograft Harvest on the Restoration of Knee Stability in the Setting of Concurrent Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

The American Journal of Sports Medicine ◽

10.1177/0363546517732743 ◽

2017 ◽

Vol 46 (1) ◽

pp. 163-170 ◽

Cited By ~ 12

Author(s):

Thomas J. Kremen ◽

Landon S. Polakof ◽

Sean S. Rajaee ◽

Trevor J. Nelson ◽

Melodie F. Metzger

Keyword(s):

Anterior Cruciate Ligament ◽

Medial Collateral Ligament ◽

External Rotation ◽

Cruciate Ligament ◽

Knee Stability ◽

Hamstring Autograft ◽

Collateral Ligament ◽

Intact State ◽

Anterior Cruciate ◽

Acl Deficient

Background: A hamstring autograft is commonly used in anterior cruciate ligament (ACL) reconstruction (ACLR); however, there is evidence to suggest that the tendons harvested may contribute to medial knee instability. Hypothesis: We tested the hypothesis that the gracilis (G) and semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury. Study Design: Controlled laboratory study. Methods: Twelve human cadaveric knees were subject to static forces applied to the tibia including an anterior-directed force as well as varus, valgus, and internal and external rotation moments to quantify laxity at 0°, 30°, 60°, and 90° of flexion. The following ligament conditions were tested on each specimen: (1) ACL intact/MCL intact, (2) ACL deficient/MCL intact, (3) ACL deficient/partial MCL injury, and (4) ACLR/partial MCL injury. To quantify the effect of muscle loads, the quadriceps, semimembranosus, biceps femoris, sartorius (SR), ST, and G muscles were subjected to static loads. The loads on the G, ST, and SR could be added or removed during various test conditions. For each ligament condition, the responses to loading and unloading the G/ST and SR were determined. Three-dimensional positional data of the tibia relative to the femur were recorded to determine tibiofemoral rotations and translations. Results: ACLR restored anterior stability regardless of whether static muscle loads were applied. There was no significant increase in valgus motion after ACL transection. However, when a partial MCL tear was added to the ACL injury, there was a 30% increase in valgus rotation ( P < .05). ACLR restored valgus stability toward that of the intact state when the G/ST muscles were loaded. A load on the SR muscle without a load on the G/ST muscles restored 19% of valgus rotation; however, it was still significantly less stable than the intact state. Conclusion: After ACLR in knees with a concurrent partial MCL injury, the absence of loading on the G/ST did not significantly alter anterior stability. Simulated G/ST harvest did lead to increased valgus motion. These results may have important clinical implications and warrant further investigation to better outline the role of the medial hamstrings, particularly among patients with a concomitant ACL and MCL injury. Clinical Relevance: A concurrent ACL and MCL injury is a commonly encountered clinical problem. Knowledge regarding the implications of hamstring autograft harvest techniques on joint kinematics may help guide management decisions.

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A Novel Medial Collateral Ligament Reconstruction Procedure Using Semitendinosus Tendon Autograft in Patients With Multiligamentous Knee Injuries

The American Journal of Sports Medicine ◽

10.1177/0363546513485716 ◽

2013 ◽

Vol 41 (6) ◽

pp. 1274-1281 ◽

Cited By ~ 17

Author(s):

Nobuto Kitamura ◽

Munehiro Ogawa ◽

Eiji Kondo ◽

Soichiro Kitayama ◽

Harukazu Tohyama ◽

...

Keyword(s):

Medial Collateral Ligament ◽

Ligament Reconstruction ◽

Knee Injuries ◽

Semitendinosus Tendon ◽

Collateral Ligament ◽

Reconstruction Procedure ◽

Medial Collateral Ligament Reconstruction ◽

Tendon Autograft

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Reconstruction of the anterior cruciate ligament alone in the treatment of a combined instability with complete rupture of the medial collateral ligament

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/bf00395795 ◽

1991 ◽

Vol 110 (3) ◽

pp. 139-141 ◽

Cited By ~ 47

Author(s):

P. M. Ballmer ◽

F. T. Ballmer ◽

R. P. Jakob

Keyword(s):

Anterior Cruciate Ligament ◽

Medial Collateral Ligament ◽

Cruciate Ligament ◽

Collateral Ligament ◽

Complete Rupture ◽

Anterior Cruciate

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Results of a New Treatment Concept for Concomitant Lesion of Medial Collateral Ligament in Patients with Rupture of Anterior Cruciate Ligament

The Journal of Knee Surgery ◽

10.1055/s-0036-1593873 ◽

2016 ◽

Vol 30 (07) ◽

pp. 652-658 ◽

Cited By ~ 2

Author(s):

Jochen Paul ◽

Maximilian Haenle ◽

Jannes Sailer ◽

Geert Pagenstert ◽

Lutz Wehren ◽

...

Keyword(s):

Anterior Cruciate Ligament ◽

Medial Collateral Ligament ◽

Cruciate Ligament ◽

Acl Rupture ◽

Treatment Concept ◽

Collateral Ligament ◽

Term Outcome ◽

Anterior Cruciate ◽

New Treatment

AbstractAnteromedial knee injury with rupture of anterior cruciate ligament (ACL) and concomitant lesion of medial collateral ligament (MCL) is common in athletes. No standardized treatment concept can be found within the literature. This study presents results of a new treatment concept for concomitant MCL lesions in patients with ACL rupture. In this study, 67 recreational athletes with ACL injury and concomitant MCL lesion were treated according to a distinct treatment concept. Patients were classified in six different types of concomitant MCL lesion depending on grade of MCL lesion and presence of anteromedial rotatory instability (AMRI). Final classification and surgical indication were determined 6 weeks posttraumatic. All patients received ACL reconstruction. MCL was treated by surgical or conservative regime due to type of concomitant MCL lesion. International Knee Documentation Committee (IKDC), AMRI, and Lysholm scores were evaluated both preoperatively and after 6 weeks, 16 weeks, 12 months, and 18 months postoperatively. All patients could be uniquely classified and treated according to the introduced treatment concept. AMRI was verifiable in patients with grade II and III MCL lesions. All patients showed good to excellent clinical results at the follow-up examinations. In all 67 patients (100%), the findings were graded as normal or nearly normal according to the IKDC knee examination form. Lysholm score averaged 93.9 at final follow-up. The introduced treatment concept showed good results on short-term outcome and provides a sufficient treatment strategy for concomitant MCL lesions in athletes with ACL rupture.

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