scholarly journals The knee in congenital femoral deficiency and its implication in limb lengthening: a systematic review

2021 ◽  
Vol 6 (7) ◽  
pp. 565-571
Author(s):  
Chilan Bou Ghosson Leite ◽  
Patricia Moreno Grangeiro ◽  
Diego Ubrig Munhoz ◽  
Pedro Nogueira Giglio ◽  
Gilberto Luis Camanho ◽  
...  
Keyword(s):  
Lower Limb ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Dislocation ◽  
Limb Lengthening ◽  
Cruciate Ligaments ◽  
Knee Ligament ◽  
Rotatory Instability ◽  
Posterolateral Rotatory Instability ◽  
Knee Ligament Reconstruction

Congenital femoral deficiency (CFD) is a rare disorder with several limb anomalies including limb shortening and knee cruciate ligament dysplasia. Limb lengthening is usually performed to correct lower limb discrepancy. However, complications, such as knee subluxation/dislocation, can occur during this treatment. Here, we explore CFD knee abnormalities and knee dislocation during limb elongation, discussing when and whether knee ligament reconstruction prior to the lengthening would be necessary to reduce the risk of knee dislocation. There is not enough support in the literature for the routine reconstruction of cruciate ligaments in CFD patients. Of note, in cases of severe anteroposterior or posterolateral rotatory instability, cruciate ligament reconstruction might be considered to decrease the risk of knee subluxation/dislocation during the lengthening treatment. Cite this article: EFORT Open Rev 2021;6:565-571. DOI: 10.1302/2058-5241.6.200075

scholarly journals Timing of Repair or Reconstruction after Knee Dislocation

2019 ◽  
Vol 33 (04) ◽  
pp. 335-338
Author(s):  
Gregory C. Fanelli
Keyword(s):  
Ligament Reconstruction ◽  
Head Injuries ◽  
Knee Dislocation ◽  
Organ System ◽  
Initial Assessment ◽  
Surgical Timing ◽  
Knee Ligament ◽  
Knee Ligament Reconstruction ◽  
Assessment And Treatment ◽  
Injured Knee

AbstractThe multiple ligament injured knee (knee dislocation) is, often times, part of a multisystem injury complex that can include not only injuries to knee ligaments but also to blood vessels, skin, nerves, bones (fractures), head injuries, and other organ system trauma. These additional injuries can affect surgical timing for knee ligament reconstruction and also affect the results of the treatment. This article will present the author's approach and experience in the initial assessment and treatment of the acute multiple ligament injured (dislocated) knee, and also present considerations in the treatment of chronic multiple ligament injured knee.

scholarly journals The Influence of Graft Tensioning Sequence on Tibiofemoral Orientation During Bicruciate and Posterolateral Corner Knee Ligament Reconstruction: A Biomechanical Study

2018 ◽  
Vol 46 (8) ◽  
pp. 1863-1869 ◽  
Author(s):  
Gilbert Moatshe ◽  
Jorge Chahla ◽  
Alex W. Brady ◽  
Grant J. Dornan ◽  
Kyle J. Muckenhirn ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Ligament Reconstruction ◽  
Sagittal Plane ◽  
Cruciate Ligament ◽  
Posterolateral Corner ◽  
Knee Ligament ◽  
Intact State ◽  
Tibial Internal Rotation ◽  
Knee Ligament Reconstruction ◽  
Significant Difference

Background: During multiple knee ligament reconstructions, the graft tensioning order may influence the final tibiofemoral orientation and corresponding knee kinematics. Nonanatomic tibiofemoral orientation may result in residual knee instability, altered joint loading, and an increased propensity for graft failure. Purpose: To biomechanically evaluate the effect of different graft tensioning sequences on knee tibiofemoral orientation after multiple knee ligament reconstructions in a bicruciate ligament (anterior cruciate ligament [ACL] and posterior cruciate ligament [PCL]) with a posterolateral corner (PLC)–injured knee. Study Design: Controlled laboratory study. Methods: Ten nonpaired, fresh-frozen human cadaveric knees were utilized for this study. After reconstruction of both cruciate ligaments and the PLC and proximal graft fixation, each knee was randomly assigned to each of 4 graft tensioning order groups: (1) PCL → ACL → PLC, (2) PCL → PLC → ACL, (3) PLC → ACL → PCL, and (4) ACL → PCL → PLC. Tibiofemoral orientation after graft tensioning was measured and compared with the intact state. Results: Tensioning the ACL first (tensioning order 4) resulted in posterior displacement of the tibia at 0° by 1.7 ± 1.3 mm compared with the intact state ( P = .002). All tensioning orders resulted in significantly increased tibial anterior translation compared with the intact state at higher flexion angles ranging from 2.7 mm to 3.2 mm at 60° and from 3.1 mm to 3.4 mm at 90° for tensioning orders 1 and 2, respectively (all P < .001). There was no significant difference in tibiofemoral orientation in the sagittal plane between the tensioning orders at higher flexion angles. All tensioning orders resulted in increased tibial internal rotation (all P < .001). Tensioning and fixing the PLC first (tensioning order 3) resulted in the most increases in internal rotation of the tibia: 2.4° ± 1.9°, 2.7° ± 1.8°, and 2.0° ± 2.0° at 0°, 30°, and 60°, respectively. Conclusion: None of the tensioning orders restored intact knee tibiofemoral orientation. Tensioning the PLC first should be avoided in bicruciate knee ligament reconstruction with concurrent PLC reconstruction because it significantly increased tibial internal rotation. We recommend that the PCL be tensioned first, followed by the ACL, to avoid posterior translation of the tibia in extension where the knee is primarily loaded during most activities. The PLC should be tensioned last. Clinical Relevance: This study will help guide surgeons in decision making for the graft tensioning order during multiple knee ligament reconstructions.

scholarly journals The Influence of Graft Tensioning Sequence on Tibiofemoral Orientation during Bicruciate and Posterolateral Corner Knee Ligament Reconstruction: A Biomechanical Study

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0006
Author(s):  
Gilbert Moatshe ◽  
Jorge Chahla ◽  
Alex Brady ◽  
Grant Dornan ◽  
Kyle Muckenhirn ◽  
...  
Keyword(s):  
Internal Rotation ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Posterolateral Corner ◽  
Tibial Rotation ◽  
Knee Ligament ◽  
Intact State ◽  
Knee Ligament Reconstruction ◽  
Significant Difference ◽  
Tibial Translation

Objectives: During a multiple knee ligament reconstruction, the graft tensioning order may influence the final tibiofemoral orientation and corresponding knee kinematics. Therefore, the objective of this study was to biomechanically evaluate the effect of different graft tensioning sequences on knee tibiofemoral orientation following multiple knee ligament reconstruction in a bicruciate ligament (anterior cruciate ligament [ACL] and posterior cruciate ligament [PCL]) with posterolateral corner [PLC] injured knee. Methods: Ten non-paired, fresh-frozen human cadaveric knees were utilized for this study. Following reconstruction of both cruciate and posterolateral corner ligaments and proximal graft fixation, each knee was randomly assigned to each of four graft tensioning order groups: (1) PCL → ACL → PLC, (2) PCL → PLC → ACL, (3) PLC → ACL → PCL and (4) ACL → PCL → PLC. The tibiofemoral orientation after graft tensioning was measured and compared to the intact states. Results: Tensioning the ACL first (tensioning order 4) resulted in posterior displacement of the tibia at 0° by 1.7 ± 1.3 mm compared to the intact state (p=0.002) (Figure 1). All tensioning orders resulted in significantly increased anterior tibial translation compared to the intact state at higher flexion angles ranging from 2.7 mm to 3.2 mm at 60° and 3.1 mm to 3.4 mm at 90° for tensioning orders 1 and 2 respectively (all p<0.001). There was no significant difference in tibiofemoral orientation in the sagittal plane between the tensioning orders at higher flexion angles. All tensioning orders resulted in increased internal tibial rotation (all p<0.001). Tensioning and fixing the PLC first (tensioning order 3) resulted in the most increases in internal rotation of the tibia; 2.4° ± 1.9°, 2.7° ± 1.8° and 2.0° ± 2.0° at 0°, 30° and 60° respectively (Table 1). Conclusion: None of the tensioning orders restored intact knee tibiofemoral orientation. Tensioning the posterolateral corner first should be avoided in bicruciate knee ligament reconstruction with a concurrent posterolateral corner reconstruction because it significantly increased tibial internal rotation. We recommend that the PCL be tensioned first, followed by the ACL to avoid posterior translation of the tibia in extension where the knee is primarily loaded with most activities and finally the PLC. [Figure: see text][Table: see text]

scholarly journals Knee Dislocation with Ipsilateral Tibial Fracture Treated with an Intramedullary Locked Nail and Simultaneous Transtibial Tunnel Knee Ligament Reconstruction: A Case Report of Autografts and Limited Resources

2020 ◽  
Vol 06 (03) ◽  
pp. e160-e163
Author(s):  
Túlio Vinícius de Oliveira Campos ◽  
Marcelo Nacif Moraes ◽  
Marco Antônio Percope de Andrade ◽  
Robert C. Schenck ◽  
Simon T. Donell
Keyword(s):  
Ligament Reconstruction ◽  
Tibial Fracture ◽  
Trauma Surgery ◽  
Knee Dislocation ◽  
Shaft Fracture ◽  
Tibial Shaft Fracture ◽  
Tibial Shaft ◽  
Knee Ligament ◽  
Knee Ligament Reconstruction ◽  
Ligamentous Reconstruction

AbstractKnee dislocations associated with ipsilateral tibial shaft fracture represent one of the most challenging injuries in trauma surgery. This injury occurs in only 2% of all tibial fractures in several series. With the use of intramedullary nail (IMN) of the tibia, current practice paraments suggest that transtibial tunnels should be avoided and ligamentous knee surgery be delayed until healing of the shaft fracture occurs. We report a novel case which was successfully managed by delayed IMN and multiligamentous transtibial posterior cruciate ligament (PCL) and posterolateral corner (PLC) autograft reconstructions. A 27-year-old male sustained a Gustilo-Anderson grade IIIa tibial shaft fracture and a Schenck IIIL knee dislocation (KD3L) in the ipsilateral knee. At 2 weeks, the patient was then taken back to the operating theater to undergo definitive bone fixation and ipsilateral simultaneous knee ligamentous reconstruction. The knee was stabilized by open reconstruction of the PCL under fluoroscopic control using an ipsilateral quadriceps autograft fixed with metallic interference screws. The PLC was reconstructed with ipsilateral semitendinosus autograft harvested through a separate 1.5-cm standard anteromedial incision using the technique described by Stannard et al. After graft fixation, the 90 degree posterior and posterolateral drawer and 0 and 30 degrees varus stress tests were negative. After 12 months follow-up, the patient had no complaints regarding pain or instability. The tibial fracture had healed and no knee axis deviation could be noted. The patient had returned to recreational low demand activities and motorcycle riding. Treatment of a combined tibial shaft fracture with an ipsilateral knee dislocation may be satisfactorily accomplished with an IMN for the tibia and transtibial tunnel fixation for knee ligament reconstruction allowing for a single rehabilitation course and a shorter recovery without having to use a third stage for knee ligamentous reconstruction.

scholarly journals CLINICAL OUTCOMES AFTER TWO-STAGE BICRUCIATE KNEE LIGAMENT RECONSTRUCTION

2021 ◽  
Vol 29 (1) ◽  
pp. 7-11
Author(s):  
MAURO MITUSO INADA ◽  
SÉRGIO ROCHA PIEDADE
Keyword(s):  
Mental Health ◽  
Ligament Reconstruction ◽  
Short Form ◽  
Cruciate Ligament ◽  
Activity Level ◽  
Self Assessment ◽  
Two Stage ◽  
Knee Ligament ◽  
Sf 36 ◽  
Knee Ligament Reconstruction

ABSTRACT Objective: To correlate clinical and intraoperative findings with the postoperative evaluation of two-stage bicruciate knee ligament reconstruction. Methods: The study was conducted with 25 patients (20 men and 05 women) with mean age of 32.3 years, mean body mass index (BMI) of 26.2, and mean lesion duration of 18.3 months. The treatment consisted of an Inlay reconstruction of the posterior cruciate ligament (PCL) followed by the anterior cruciate ligament (ACL) reconstruction, at least 3 months after the first surgical procedure. Four patients required additional procedures: patellar tendon (02), medial collateral ligament (MCL) (02). Results: With an average follow-up of 24.8 months, 60% of the patients scored zero or + at the posterior drawer test, while 40% scored ++; 60% of patients were evaluated as good/excellent according to the Lysholm scale. Only one patient reached the pre-injury Tegner activity level. Injury duration had a negative influence on functional limitation, vitality, and mental health (SF-36). Conclusion: Although two-stage bicruciate knee ligament reconstruction improved knee stability and self-assessment, 96% of patients did not recover their pre-injury state. In the 36-item short form survey (SF-36), injury duration was inversely correlated with self-assessment of functional capacity, physical limitation, vitality, and mental health. Level of Evidence II, retrospective study.

scholarly journals Passive Knee Stability After Anterior Cruciate Ligament Reconstruction Using the Endobutton or ToggleLoc With ZipLoop as a Femoral Fixation Device: A Comparison of 1654 Patients From the Danish Knee Ligament Reconstruction Registry

2018 ◽  
Vol 6 (6) ◽  
pp. 232596711877850 ◽  
Author(s):  
Christian Asmus Peter Asmussen ◽  
Mikkel Lindegaard Attrup ◽  
Kristian Thorborg ◽  
Per Hölmich
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Pivot Shift ◽  
Cruciate Ligament ◽  
Pivot Shift Test ◽  
Knee Stability ◽  
Knee Ligament ◽  
Knee Ligament Reconstruction ◽  
Anterior Cruciate ◽  
Tibial Translation

Background: Biomechanical studies show varying results regarding the elongation of adjustable fixation devices. This has led to growing concern over the stability of the ToggleLoc with ZipLoop used in anterior cruciate ligament (ACL) reconstruction (ACLR) in vivo. Purpose/Hypothesis: The purpose of this study was to compare passive knee stability 1 year after ACLR in patients in whom the Endobutton or ToggleLoc with ZipLoop was used for femoral graft fixation. The hypothesis was that the ToggleLoc with ZipLoop would be inferior in knee stability to the Endobutton 1 year after primary ACLR. Study Design: Cohort study; Level of evidence, 2. Methods: Data from 3175 patients (Endobutton: n = 2807; ToggleLoc with ZipLoop: n = 368) were included from the Danish Knee Ligament Reconstruction Registry (DKRR) between June 2010 and September 2013. Data were retrieved from standardized ACL forms filled out by the operating surgeon preoperatively, during surgery, and at a clinical examination 1 year after surgery. Passive knee stability was evaluated using 1 of 2 arthrometers (Rolimeter or KT-1000 arthrometer) and the pivot-shift test. Using the same database, the number of reoperations performed up to 4 years after primary surgery was examined. Results: Full data were available for 1654 patients (Endobutton: n = 1538; ToggleLoc with ZipLoop: n = 116). ACLR with both devices resulted in increased passive knee stability ( P < .001). Patients who received the ToggleLoc with ZipLoop were found to have a better preoperative ( P = .005 ) and postoperative ( P < .001) pivot-shift test result. No statistically significant difference regarding the number of reoperations ( P = .086) or the time to reoperation ( P = .295) was found. Conclusion: Patients who underwent fixation with the ToggleLoc with ZipLoop had improved passive knee stability 1 year after surgery, measured by anterior tibial translation and pivot-shift test results, similar to patients who underwent fixation with the Endobutton. No difference was seen in knee stability or reoperation rates between the 2 devices.

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