The pushed quadriceps active test – A modification of the quadriceps active test to diagnose PCL deficiency

Quadriceps active (QA) test has been described and well known for the diagnosis of posterior cruciate ligament (PCL) deficiency. We describe a modification of the QA test to diagnose PCL deficiency. Pushed QA test consists of two components where the examiner pushes the proximal tibia posteriorly with the knee flexed <90° in the first part of the test translating the tibia posteriorly like in the posterior drawer test while the patient reduces the translation actively by contracting the quadriceps in the second part like in the QA test.

Acute primary repair of extraarticular ligaments and staged surgery in multiple ligament knee injuries

Background The purpose of this study is to compare the outcomes of acute primary repair of extraarticular ligaments with staged surgery for acute knee dislocations (KDs) and multiligament knee injuries (MLKIs). Materials and methods Between January 2005 and May 2018, 61 consecutive patients diagnosed with MLKI or KD were referred to or visited our institution. Of these, 31 patients who underwent acute repair of extraarticular ligaments within 3 weeks of injury were included in this study. These patients were retrospectively classified into two groups: those who underwent only primary repair (repair group) and those who underwent staged reconstructive surgery (staged group). Follow-up examination included range of motion (ROM), knee joint stability (Lachman test, posterior drawer test, and varus and valgus stress test), Lysholm knee score, Tegner activity scale, and Knee Injury and Osteoarthritis and Outcome Score (KOOS). Results Twelve of the 31 patients did not need or desire further surgery and were included in the repair group. No significant difference was observed in demographic data between the repair and staged groups. Although staged surgery decreased positive posterior drawer test results, no significant difference was observed between the two groups regarding ROM, other knee joint stability tests, Lysholm scores, Tegner scale, or KOOS. Conclusions In this series, all patients returned to their activities of daily living and preinjury occupation levels. Acute primary repair of extraarticular ligaments provides essential knee stability without varus/valgus instability and may reduce the need for subsequent cruciate ligament reconstruction. Level of evidence Level IV, retrospective observational study.

Arthroscopic Suture Fixation With Autograft Augmentation Reconstruction for Delayed Tibial Avulsion Fractures of the Posterior Cruciate Ligament

Background: The optimal surgical treatment of delayed avulsion fractures of the posterior cruciate ligament (PCL) is still controversial. Purpose: To evaluate the clinical results of arthroscopic suture fixation of tibial avulsion fractures of the PCL with autograft augmentation reconstruction. Study Design: Case series; Level of evidence, 4. Methods: From January 2013 to February 2017, we treated 15 patients with delayed tibial avulsion fractures of the PCL arthroscopically through posteromedial and posterolateral portals. The PCL and avulsion bone fragment were fixed with No. 2 nonabsorbable FiberWire sutures that were pulled out through a single tibial bone tunnel and fixed on a small Endobutton. Concomitantly, anatomic PCL augmentation reconstruction was performed, and the graft was pulled out through the same tunnel and fixed with an interference screw. Knee stability was assessed using the posterior drawer test, and the side-to-side difference was determined using a KT-1000 arthrometer with 134 N of posterior force at 30° of knee flexion. The International Knee Documentation Committee (IKDC) 2000 subjective form and Lysholm scale were used to evaluate clinical outcomes at follow-up. Overall, 12 patients were enrolled for analysis. The mean follow-up period was 34.4 months (range, 26-49 months). Results: At the final follow-up, 2 patients encountered 10° terminal flexion limitations. All patients had negative posterior drawer test results. The KT-1000 arthrometer side-to-side difference was significantly decreased from 8.25 ± 1.96 mm preoperatively to 1.08 ± 0.86 mm at the last follow-up ( P < .001). The mean IKDC and Lysholm scores, respectively, increased from 54.67 ± 7.13 and 53.50 ± 7.90 preoperatively to 91.13 ± 3.78 and 94.25 ± 3.32 at the final follow-up ( P < .001 for both). Conclusion: Arthroscopic suture fixation with autograft augmentation reconstruction for delayed tibial avulsion fractures of the PCL showed good clinical stability and function in this study.

AUGMENTATION POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PERONEAL LONGUS TENDON ON AVULSION PCL : CASE SERIES

Posterior Cruciate Ligament (PCL) avulsion may mimics PCL rupture with positive posterior drawer test. Treatment of choice to PCL avulsion is vary from open surgery to arthroscopic surgery. This study aims is to evaluate the knee functional score using augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Presentation of Case: We report 3 cases, 1 male and 2 females. The result of physical examination, X-ray examination, and MRI of the knee showed a PCL avulsion. Posterior drawer test showed grade 2 result. We performed an augmented PCL reconstruction on PCL avulsion using peroneus longus tendon. Knee scoring (IKDC, Modified Cincinnati, TegnerLysholm) collected pre-operative and 2 years post-operative. The result of knee scoring was significant improved in post-operative compare to before surgery. Discussions: The use of conventional screw on thin, small, and comminuted fragments cannot fix the bone and may causes bone fragmentation. Fixation technique using sutures produces unstable results and does not provide maximum pressure to fix the bone. Augmented PCL reconstruction surgery gives excellent result based on knee scoring system. Conclusion: Augmented PCL reconstruction can be considered to be an alternative treatment of PCL avulsion because the procedure has excellent post-operative knee scoring result.

PCL rupture tibial avulsion in a contact athlete teen with open physis. One case presentation and literature review

Introduction: Given the infrequency and lack of consensus in the treatment of children and adolescents with these injuries, we decided to write this report with the aim of present a case of PCL tibial avulsion in a contact athlete teen with open physis and a review of the literature published. Materials and Methods: RF.male, 13 years, rugby, suffers French tackle and fall on knees flexed. 3 months post-trauma consultation with left knee pain, joint fluid and sport limitation. Whidout instability but "not feeling well". The posterior drawer test + + / ++++, gravitational test +. Rx posterior drawer: 8mm difference between the two nenes. MRI: tibial avulsion PCL. We interpreted as symptomatic PCL injury in athletes, surgery (arthroscopy + posterior approach) is decided reintegration of chondral fragment in 1 time P.OP: no load 4 Weeks . plaster wedge extension 6 weeks, then 3 months and passive immobilizer progressive mobility. Results: 0-90 mobility achieving in 8th week. The 3rd month drawer rx 4mm. MRI posterior translation of the 4th month reintegration of LCP with anchor . 6ª month later minimally elongated drawer with stop net. 11th month continuous strengthening recrearional and sports activities. Discussion and Conclusion: Most avulsion of PCL in patients with open physis probably be for greater strength and endurance ligament compared with the phisis and bone at this age. We suspected in patients with vague knee pain, with or without instability, history of trauma and normal Rx a correct examination and MRI to be essential for diagnosis. We beleave that athletes with open physis, because of the risk of joint degeneration, surgery is justified to restore kinematics, prevent osteoarthritis and resume activity prior to the injury.

Healing of the Acutely Injured Anterior Cruciate Ligament: Functional Treatment with the ACL-Jack, a Dynamic Posterior Drawer Brace

Background. The injured anterior cruciate ligament (ACL) has a limited healing capacity leading to persisting instability. Hypothesis/Purpose. To study if the application of a brace, producing a dynamic posterior drawer force, after acute ACL injury reduces initial instability. Study Design. Cohort study. Methods. Patients treated with the ACL-Jack brace were compared to controls treated with primary ACL reconstruction und controls treated nonsurgically with functional rehabilitation. Measurements included anterior laxity (Rolimeter), clinical scores (Lysholm, Tegner, and IKDC), and MRI evaluation. Patients were followed up to 24 months. Results. Patients treated with the ACL-Jack brace showed a significant improvement of anterior knee laxity comparable to patients treated with ACL reconstruction, whereas laxity persisted after nonsurgical functional rehabilitation. The failure risk (secondary reconstruction necessary) of the ACL-Jack group was however 21% (18 of 86) within 24 months. Clinical scores were similar in all treatment groups. Conclusion. Treatment of acute ACL tears with the ACL-Jack brace leads to improved anterior knee laxity compared to nonsurgical treatment with functional rehabilitation.

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN POSTERIOR CRUCIATE LIGAMENT DEFICIENT KNEES - WHAT CAN BE SAVED?

The floppy Anterior Cruciate Ligament (ACL) sign is a well-established arthroscopic and MRI indicator of Posterior Cruciate Ligament (PCL) insufficiency. We explored the diagnostic and therapeutic options in such cases by retrospectively analyzing the management of a series of five consecutive cases of iatrogenic floppy ACL reconstructions which resulted in fixed posterior drawer. All patients were young athletes. Because their ACL rehabilitation program was failing they sought for a new medical expertise. In all cases arthroscopic PCL reconstruction was performed and the acquired injuries after the initial ACL reconstruction were treated. All patients regained full range of motion and stable knees. Confusion between a PCL and an ACL injury still seems to be high. If not addressed accordingly, the fixed posterior drawer may lead to irreversible damage of the knee joint.