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

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

CLINICAL OUTCOMES AFTER TWO-STAGE BICRUCIATE 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.

Does The Peroneus Longus Tendon Autograft Affect The Ankle Function? A Case Series

Introduction: The peroneus longus (PL) tendon is one of the autograft choices for knee ligament injury because of its safety, length, and strength. However, studies that evaluated donor site morbidity after PL tendon graft are still limited. This case series aims to evaluate the functional outcomes of donor site morbidity after full-thickness PL tendon harvesting for knee ligament reconstruction.Presentation of Case:This study evaluated four patients who had a revision of knee ligament reconstruction surgery using PL tendon autograft from August until September 2018. The functional outcome of the donor site was evaluated before surgery, two weeks, and three months after surgery by using functional scores assessment of foot and ankle.Discussion:There are some donor sites of autograft, but several studies show that the PL tendon autograft has proven to be more favorable methods for knee ligament reconstruction based on the accessibility, safety, and strength of the harvested tendon. The studies also found that using PL tendon as an autograft, has a good result in donor site morbidity evaluation compared to others. This study provides a satisfying result on the functional outcome of the donor site morbidity evaluation.Conclusion:This study showed satisfactory functional outcomes of the foot and ankle after harvesting full-thickness PL tendon. All functional score assessment provides an excellent result in three months after surgery, although lateral ankle bulging has occurred in all patients. However, gait analysis and isokinetic test with a more significant number of patients and longer follow up periods are necessary for further study.

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

Knee 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.

Timing of Repair or Reconstruction after Knee Dislocation

The 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.