DOCSLIB.ORG

Evaluation and Treatment of Chronic Medial Collateral Ligament Injuries of the Knee Frederick M

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Evaluation and Treatment of Chronic Medial Collateral Ligament Injuries of the Knee Frederick M REVIEW ARTICLE Evaluation and Treatment of Chronic Medial Collateral Ligament Injuries of the Knee Frederick M. Azar, MD sartorius and sartorial fascia. This layer extends poster- Abstract: Injuries to the medial collateral ligament (MCL) can iorly to cover the 2 heads of the gastrocnemius and the occur as isolated injuries or in conjunction with injuries to other neurovascular structures of the popliteal fossa. Ante- structures about the knee. Most grade I and II MCL injuries riorly, it blends with layer 2, which consists of the without meniscal avulsion, alone or in combination with superficial MCL, the posterior oblique ligament (POL), anterior or posterior cruciate ligament injuries, can be treated and the semimembranosus. The tendons of the gracilis nonoperatively. Grade III or complete tears also can be treated and semitendinosus are located in the plane between nonoperatively, but only after careful exclusion of any layers 1 and 2. Layer 3 consists of the deep MCL and associated injuries that may require surgical treatment. Treat- posteromedial capsule, and it merges with layer 2 at the ment recommendations also have been based on the location of posteromedial aspect of the knee. the MCL tear and the associated injuries. Surgical treatment Sims and Jacobson3 described the medial-sided may include reconstruction of the anterior and posterior structures of the knee as divided roughly into thirds cruciate ligaments with primary repair of the MCL. Chronic (Fig. 1). The anterior third includes the loose, thin medial knee injuries often are associated with concomitant capsular ligaments covered superficially by the extensor ligament injuries, which also must be treated. Treatment options retinaculum of the quadriceps mechanism. The middle include nonoperative (bracing, activity modification, and third includes the deep medial capsular ligament and the rehabilitation) and operative reconstruction. superifical medial collateral ligament. The posterior third, 4 Key Words: knee, ligament, medial, injury, treatment the posteromedial corner or semimembranosus corner, includes the POL, the semimembranosus expansions, the (Sports Med Arthrosc Rev 2006;14:84–90) oblique popliteal ligament, and the posteromedial horn of the medial meniscus. nee ligament injuries account for a large percentage of MEDIAL-SIDE BIOMECHANICS Ksports injuries, and the medial collateral ligament Multiple studies have demonstrated that the MCL is (MCL) is one of the most frequently injured ligaments of the primary medial stabilizer of the knee in resisting the knee, exceeded perhaps only by the anterior cruciate valgus loading and the secondary stabilizer against ligament (ACL). Most injuries to the medial supporting excessive external tibial rotation.4–6 The femoral attach- structures of the knee occur as a result of a blow to the ment of the MCL is arranged so that this structure lateral side of the thigh or upper leg, such as occurs in a maintains relatively constant tension throughout knee football tackle from the side. Valgus forces also can be range of motion.7 In contrast to the parallel fibers of the applied to the knee when the tibia is externally rotated MCL, the POL functions to resist valgus stress mainly and the femur is fixed; this mechanism is common in snow when the knee is in full extension. When the knee is skiing. The medial ligaments can be injured by ‘‘cutting’’ flexed, the POL becomes slack and its anterior most maneuvers when an athlete plants his or her foot and aspect actually lies beneath the posterior portion of the 1 forcefully shifts direction off the weight-bearing foot. MCL. The 2 structures are separated by a bursa that These valgus forces usually tear the medial capsular allows anteroposterior excursion during flexion and ligament first, then the MCL, and then the anterior extension of the knee. Consideration of this relationship 1 cruciate ligament. is important in primary repair of the MCL, because suturing of the anterior POL to the posterior MCL with ANATOMY the knee in more than 30 degrees of flexion can result in a 2 postoperative flexion contracture. In 1979, Warren and Marshall dissected 154 fresh 3 4 knees and described a 3-layer anatomic concept (Table 1). Sims and Jacobson, along with Mu¨ller, stressed On the medial side of the knee, layer 1 consists of the the importance of the posteromedial corner of the knee (posterior horn of the medial meniscus, the POL, the semimembranosus expansions, the meniscotibial From the Campbell Clinic, Memphis, TN. Reprints: Frederick M. Azar, Campbell Clinic, 1211 Union Avenue, ligaments, and the oblique popliteal ligament) as a Suite 510, Memphis, TN 38104 (e-mail: [email protected]). static and dynamic restraint to anteromedial rotatory Copyright r 2006 by Lippincott Williams & Wilkins instability. 84 Sports Med Arthrosc Rev Volume 14, Number 2, June 2006 Sports Med Arthrosc Rev Volume 14, Number 2, June 2006 Ligament Injuries of the Knee TABLE 1. Anatomy of the Medial Side of the Knee TABLE 2. Grading of Ligament Injury Severity Layer 1 Sartorius, sartorial fascia Amount of Opening Layer 2 Superficial MCL Grade (mm) Associated Tear Posterior oblique ligament I 0–5 Minimal Semimembranosus II 5–10 Moderate Layer 3 Deep MCL III >10 Complete Posteromedial capsule Layers 1 and 2 Blend anteriorly Layers 2 and 3 Blend posteriorly Semitendinosus and gracilis Lie between layers 1 and 2 than MCL injury. Complaints of knee instability are tendons more frequent with ACL injuries than with MCL injuries. The severity of injuries to the medial side of the knee is graded according by the amount of joint opening when Gardiner et al8 demonstrated that various regions of the valgus stress is applied to the knee at 0 and 30 degrees of MCL experience differing amounts of strain with regard flexion.1 Opening of 0 to 5 mm indicates a grade I to knee flexion angle and valgus torque. Strain in the (minimal) tear, 6 to 10 mm a grade II (moderate) tear, and posterior and central portions of the MCL generally more than 10 mm a grade III (complete) tear (Table 2). decreases with increasing flexion angle, whereas strain in The amount of laxity in each position of flexion is the anterior fibers remains relatively constant throughout indicative of the number of medial structures injured. knee range of motion. The greatest amount of strain in Valgus laxity at 30 degrees of flexion but not at 0 degree the MCL occurs at the femoral origin of the posterior indicates an isolated MCL injury, whereas valgus laxity at fibers at full knee extension. These findings support the both 30 and 0 degrees indicates injury to the MCL and clinical finding that the femoral insertion is the most POL, and likely to the cruciate ligaments. If the knee is common location for MCL injuries. stable to valgus stress in full extension, the POL is likely intact. Because ACL tears occur with up to 78% of grade III MCL tears,3 provocative testing for these injuries also EVALUATION should be done (Lachman, anterior drawer, and posterior Patients with medial-side knee injuries have varying drawer). degrees of swelling, pain, and loss of motion. Damage to A standard radiographic knee series (45-degree the MCL normally causes well-localized pain in the flexion weight-bearing, lateral, and sunrise views) can medial knee with local soft-tissue swelling. Tenderness to identify avulsions or osteochondral fragments that might palpation and localized swelling over the MCL accurately affect treatment decisions. In adolescents, valgus stress indicates location of the injury in about two-thirds of views can be useful to evaluate for physeal injury, but in 1 patients. Midsubstance tears may be associated with skeletally mature individuals they are of little benefit. joint-line tenderness, making it difficulty to differeniate Magnetic resonance imaging (MRI) can identify the MCL injury from meniscal injury, especially because they presence of meniscal tears, the location of the MCL tear, may coexist. Vaguely localized pain or a large knee and any other concomitant injuries (Fig. 2).9 effusion is more indicative of ACL or meniscal injury TREATMENT The MCL is an extracapsular structure and has demonstrated an ability to heal with little to no residual valgus laxity when the torn ligamentous ends are closely apposed.10–21 Therefore, grade I and II MCL injuries without meniscal avulsion, alone or in combina- tion with ACL/posterior cruciate ligament (PCL) injuries, can be treated nonoperatively. Pain and edema control, minimally restrictive protective bracing, and immediate range of motion exercises are instituted, and, in the case of multiple ligament injuries, the ACL and PCL are reconstructed after the MCL injury has had adequate time to heal (4 to 8 wk) (Table 3).22,23 The treatment of grade III MCL tears with associated ACL/PCL injuries remains controversial. FIGURE 1. Anterior, middle, and posterior capsuloligamen- Grade III or complete tears also can be treated tous divisions described by Sims and Jacobsen. (From Sims W, nonoperatively, but only after careful exclusion of any Jacobson K. The posteromedial corner of the knee. Medial- associated injuries that may require surgical treat- 15,24–26 sided injury patterns revisited. Am J Sports Med. 2004; ment, such as cruciate ligament injury, meniscal 32:337–345.) tear requiring repair, or entrapment of the MCL.4 When r 2006 Lippincott Williams & Wilkins 85 Azar Sports Med Arthrosc Rev Volume 14, Number 2, June 2006 predilection to heal with excessive valgus instability.29 Occasionally, distal avulsions result in a Stener type lesion with the torn MCL flipped over the insertion of the pes anserinus and unable to heal.30 Physical examination and MRI (Fig. 2) are beneficial in determining the location of the MCL injury.1,9 A final consideration is the chronically ACL/PCL/MCL-injured knee in which all structures must be reconstructed. Groff and Harner24 described an algorithm for the treatment of medial-side knee injuries based on the associated injuries (Fig.
Load more

Recommended publications
  • Medial Collateral Ligament Injury of the Knee: a Review on Current Concept and Management
    )255( COPYRIGHT 2021 © BY THE ARCHIVES OF BONE AND JOINT SURGERY CURRENT CONCEPTS REVIEW Medial Collateral Ligament Injury of the Knee: A Review on Current Concept and Management Farzad Vosoughi, MD1; Reza Rezaei Dogahe, MD1; Abbas Nuri, MD1; Mohammad Ayati Firoozabadi, MD1; S.M. Javad Mortazavi, MD1,2 Research performed at the Joint Reconstruction Research Center (JRRC) of Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran Received: 10 May 2020 Accepted: 04 March 2021 Abstract The medial collateral ligament (MCL) is a major stabilizer of the knee joint, providing support against rotatory and valgus forces; moreover, it is the most common ligament injured during knee trauma. The MCL injury results in valgus instability of the knee and makes the patient susceptible to degenerative knee osteoarthritis. Although it has been nearly a dogma to manage MCL injury nonoperatively, recent literature has suggested operative MCL management as a suitable option for specific patient populations. The present review aimed to assess the current literature on the management of MCL injuries of the knee. In this regard, we go over the anatomy, physical examination, and MCL imaging. Level of evidence: IV Keywords: MCL, MCL reconstruction, MCL repair, POL, PMC Introduction he medial collateral ligament (MCL) is the most may be indicated in certain instances (5). In this review, common knee ligament to be injured during we discuss this concept with the aim of delineating the Tknee trauma (1). The annual incidence of MCL management principles of the MCL injury. injury has been reported as 0.24-7.3 per 1,000 people with a male to female ratio of 2:1 (1, 2).
    [Show full text]
  • Analysis of an Anatomic Medial Collateral Ligament and Posterior
    This file was dowloaded from the institutional repository Brage NIH - brage.bibsys.no/nih Engebretsen, L., Lind, M. (2016). Anteromedial rotatory laxity. Knee Surgery, Sports Traumatology, Arthroscopy, 23, 2797-2804. Dette er siste tekst-versjon av artikkelen, og den kan inneholde små forskjeller fra forlagets pdf-versjon. Forlagets pdf-versjon finner du på www.springerlink.com: http://dx.doi.org/10.1007/s00167-015-3675-8 This is the final text version of the article, and it may contain minor differences from the journal's pdf version. The original publication is available at www.springerlink.com: http://dx.doi.org/10.1007/s00167-015-3675-8 Abstract This review paper describes anteromedial rotatory laxity of the knee joint. Combined instability of the superficial MCL and the structures of the posteromedial corner is the pathological background anteromedial rotatory laxity. Anteromedial rotatory instability is clinically characterized by anteromedial tibial plateau subluxation anterior to the corresponding femoral condyle. The anatomical and biomechanical background for anteromedial laxity is presented and related to the clinical evaluation and treatment decision strategies are mentioned. A review of the clinical studies that address surgical treatment of anteromedial rotatory instability including surgical techniques and clinical outcomes is presented. Introduction It is well accepted that the superficial medial collateral ligament is a primary static stabilizer preventing anteromedial rotatory instability (AMRI), valgus translation, external rotation and internal rotation about the knee. [11,35] It has also been reported that the posterior oblique ligament (POL) is an important primary restraint to internal rotation and a secondary restraint to valgus translation and external rotation.
    [Show full text]
  • Cricket Sports Injuries HASSAN M Y, HELEN
    Cricket Sports Injuries HASSAN M Y, HELEN Introduction: Sports medicine is a broad and complex branch of the health care profession. It is a demanding field in medicine providing the health care professional with challenges both on and off the field. The principles of treatment include the maintenance of euphysiological benefits of exercise while attending to the injury with specificity. It is important to treat to the biological as well as the psychological component of the injured athlete. Successful management include early and correct diagnosis, rehabilitation and compliance of the athlete and sports administrators. Despite the advent of technology, a small percentage of athletes are unable to return to sports medicine and it is for this reason that primary prevention is imperative to reduce the incidence of injuries where possible. INJURY PREVENTION Injury prevention can be caused by intrinsic or extrinsic causes. Intrinsic causes include anatomical dysfunction while extrinsic causes are environment factors. Addressing both factors is imperative in reducing injury rates in sports medicine. Categorization of prevention into primary, secondary and tertiary structures is possible. Primary prevention: Primary prevention deals with direct or indirect prevention on an individual basis. An example would be correction of muscle imbalances of the shoulder structure of a bowler in an attempt to prevent shoulder dysfunction. Secondary prevention: Secondary prevention deals with preventing injury on a group basis. An example would be educating cricketers to the benefits of warm up, stretching and cooling down in an attempt to reduce musculotendinous injuries. Tertiary prevention: Tertiary prevention is efforts undertaken by the sports governing bodies in the field of cricket with initiation and implementation of strategies to reduce injuries at a club, provincial and national level.
    [Show full text]
  • ACL Grade II, MCL Grade III and Hemarthrosis of Knee Treated Conservatively - 1 Year Physiotherapy Follow Up
    International Journal of Science and Research (IJSR) ISSN: 2319-7064 ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426 ACL Grade II, MCL Grade III and Hemarthrosis of Knee Treated Conservatively - 1 Year Physiotherapy Follow Up Dr. S. S. Subramanian M.P.T (Orthopaedics), M.S (Education), M. Phil (Education), Ph.D (Physiotherapy) The Principal, Sree Balaji College Of physiotherapy, Chennai – 100, India Affiliated To (Bharath) University, BIHER, Chennai – 73, India Abstract: Road traffic accidents are common especially in developing countries proper rehabilitation post soft tissue injuries facilitates early recovery and prevents long term complications. Aims & Objectives of this original research was to evaluate the efficacy of specific tailored exercises post hemarthrosis ACL, MCL of left knee. Materials & Methodology: 43 years old male after an RT accident sustained injury to left knee. He was treated conservatively by specific exercises based on the evaluation during the period from 16.08.2018 to 30.09.2019 in Chennai with twice a week frequency Results: subjects womac score was evaluated and analyzed statistically, (P<.01) prior to starting the study and an year with regular physiotherapy Conclusion: Problem based exercises were found to be more effective in restoration of subjects functional needs, and conservative treatment of knee injuries were more effective with one year follow up. Keywords: QOL - Quality of Life, ACL – anterior Cruciate Ligament, MCL – Medial Collateral Ligament , NWB – Non Weight Bearing, Hemarthrosis,
    [Show full text]
  • Surgical of Treatment of the Medial Collateral Ligament of the Knee Joint. ISJ Theoretical & Applied Science, 12 (92), 282-287
    ISRA (India) = 4.971 SIS (USA) = 0.912 ICV (Poland) = 6.630 ISI (Dubai, UAE) = 0.829 РИНЦ (Russia) = 0.126 PIF (India) = 1.940 Impact Factor: GIF (Australia) = 0.564 ESJI (KZ) = 8.997 IBI (India) = 4.260 JIF = 1.500 SJIF (Morocco) = 5.667 OAJI (USA) = 0.350 QR – Issue QR – Article SOI: 1.1/TAS DOI: 10.15863/TAS International Scientific Journal Theoretical & Applied Science p-ISSN: 2308-4944 (print) e-ISSN: 2409-0085 (online) Year: 2020 Issue: 12 Volume: 92 Published: 23.12.2020 http://T-Science.org M.E. Irismetov Republican Scientific and Practical Medical Center of Traumatology and Orthopedics (RSSPMCTO) Researcher F.R. Rustamov Republican Scientific and Practical Medical Center of Traumatology and Orthopedics (RSSPMCTO) Researcher N.B. Safarov Republican Scientific and Practical Medical Center of Traumatology and Orthopedics (RSSPMCTO) Researcher SURGICAL OF TREATMENT OF THE MEDIAL COLLATERAL LIGAMENT OF THE KNEE JOINT Abstract: The reconstruction of the medial collateral ligament of the knee joint has lost its relevance to our time. There are still difficulties in reconstructing the rupture of the medial collateral ligament. In order to improve the results of treatment of this pathology, we set a goal to improve the method of surgical treatment and thereby reduce the rehabilitation time. During the period of 2015 - 2020 about 78 patients with rupture of the medial collateral ligament were operated using our method. Key words: medial collateral ligament, knee joint, gracilis muscle (m. gracilis), knee joint instability, frontal instability. Language: English Citation: Irismetov, M. E., Rustamov, F. R., & Safarov, N. B. (2020). Surgical of treatment of the medial collateral ligament of the knee joint.
    [Show full text]
  • Isolated Medial Collateral Ligament Tears: an Update on Management
    3.1700EOR0010.1302/2058-5241.3.170035 review-article2018 EOR | volume 3 | July 2018 DOI: 10.1302/2058-5241.3.170035 Sports & arthroscopy www.efortopenreviews.org Isolated medial collateral ligament tears: an update on management Carlos A. Encinas-Ullán E. Carlos Rodríguez-Merchán Tears of the medial collateral ligament (MCL) are the most isolated medial collateral ligament (MCL) tears. Conserv- common knee ligament injury. ative treatment of these lesions usually provides good Incomplete tears (grade I, II) and isolated tears (grade III) results, even for individuals with high physical demands. of the MCL without valgus instability can be treated with- However, surgical treatment is necessary in cases of out surgery, with early functional rehabilitation. severe medial or multi-ligament injury to prevent chronic instability and posttraumatic arthritis. Failure of non-surgical treatment can result in debilitating, persistent medial instability, secondary dysfunction of the anterior cruciate ligament, weakness, and osteoarthritis. Epidemiology Reconstruction or repair of the MCL is a relatively uncom- MCL is the most common knee injury in high school, col- mon procedure, as non-surgical treatment is often suc- legiate, and professional football.1 The annual incidence cessful at returning patients to their prior level of function. of MCL injuries among high school football players is Acute repair is indicated in isolated grade III tears with severe 24.2 per 100,000 athletes.2 Nearly 78% of patients who valgus alignment, MCL entrapment over pes anserinus, or sustained a grade III MCL injury had an injury to another intra-articular or bony avulsion. The indication for primary associated structure.3 Of those additional injuries, 95% repair is based on the resulting quality of the native ligament involved the anterior cruciate ligament (ACL).4 and the time since the injury.
    [Show full text]
  • Medial Knee Injury
    AJSM PreView, published on July 16, 2009 as doi:10.1177/0363546509333852 Winner of the Herodicus Award Medial Knee Injury Part 1, Static Function of the Individual Components of the Main Medial Knee Structures Chad J. Griffith,* MD, Robert F. LaPrade,*† MD, PhD, Steinar Johansen,‡ MD, Bryan Armitage,* MSc, Coen Wijdicks,* MSc, and Lars Engebretsen,‡ MD, PhD From the *Division of Sports Medicine, Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, and the ‡Orthopaedic Center, Ullevaal University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway 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 Nm) and internal and external rotation torques (5 Nm) 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.
    [Show full text]
  • Management of the Multi-Ligamentous Injured Knee: an Evidence-Based Review
    Review Article Page 1 of 7 Management of the multi-ligamentous injured knee: an evidence-based review Linsen T. Samuel1, Jacob Rabin1, Alex Jinnah2, Samuel Rosas2, Linda Chao2, Rashad Sullivan2, Chukwuweike U. Gwam2 1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA; 2Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA Contributions: (I) Conception and design: LT Samuel, J Rabin, CU Gwam; (II) Administrative support: LT Samuel, J Rabin, CU Gwam; (III) Provision of study materials or patients: LT Samuel, J Rabin, CU Gwam; (IV) Collection and assembly of data: LT Samuel, J Rabin, CU Gwam; (V) Data analysis and interpretation: LT Samuel, J Rabin, CU Gwam; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Chukwuweike U. Gwam, MD. Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA. Email: [email protected]. Abstract: Multi-ligamentous knee injury (MLKI) can be a devastating injury, resulting in long-term knee instability and loss of function. For patients with MLKI, areas of controversy persist on how to best optimize outcomes. These areas of contention are often centered operative timing and technique with the aims of restoring patient function, knee range of motion, and stability. Currently, a paucity of studies exists that can be used to direct orthopedists on how to manage MLKI patients. This review critically analyzes literature in attempts to equip readers with best options for managing patients with MLKI. Keywords: Multi-ligamentous knee injury (MLKI); knee dislocation; management Received: 15 December 2018; Accepted: 22 February 2019; Published: 21 March 2019.
    [Show full text]
  • Surgical Approach to the Posteromedial Corner: Indications, Technique, Outcomes
    Curr Rev Musculoskelet Med (2013) 6:124–131 DOI 10.1007/s12178-013-9161-3 KNEE (SL SHERMAN, SECTION EDITOR) Surgical approach to the posteromedial corner: indications, technique, outcomes Kathryn L. Bauer & James P. Stannard Published online: 1 March 2013 # Springer Science+Business Media New York 2013 Abstract Injuries to the medial side of the knee can occur injuries involving the medial collateral ligament and the in isolation or in conjunction with multiple other ligaments structures of the PMC has important clinical implications. about the knee. In addition, medial knee injuries can involve Failure to recognize this difference has been implicated as a isolated injury to the medial collateral ligament or include potential reason for failure of reconstructed cruciate liga- the posteromedial structures of the knee. Treatment strate- ments in combined injuries [1–3]. This article provides gies differ greatly depending on injury pattern. In order to information based on review of recent literature that select an appropriate treatment strategy, one must accurately describes the anatomy, biomechanical function, and current diagnose the injury pattern based on clinical examination treatment principles regarding the PMC. In addition, we will and the use of appropriate imaging studies. The fundamental provide our current preferred method for reconstruction of basis for diagnosis of a medial sided knee injury stems from the PMC based on outcomes in patients treated with multi- understanding the static and dynamic stabilizing structures ligamentous knee injuries. that compose the medial side of the knee. It is our aim to define the anatomic roles of medial sided structures, their importance in protecting the biomechanical stability of the Anatomic considerations knee, as well as provide indications and our preferred pro- cedures for surgical management of these complex injuries.
    [Show full text]
  • Medial Knee Injuries Prof
    Medial Knee Injuries Prof. MD David Figueroa & MD Rodrigo Guiloff Facultad de Medicina Clinica Alemana- Universidad del Desarrollo Santiago, Chile Why is this topic important? Injuries to the medial side of the knee are the most frequent knee ligament injury reported in sports1,2. Historically, these have been treated in a conservatively with a high rate of beneficial results; however, a better understanding of the anatomy and biomechanics of the different structures of the medial side of the knee have led to different opinions about the correct way of managing them. There is a variety of inconsistent concepts that may create confusion in the current literature leading to controversies and the lack of consensus in the management of these injuries. The purpose of this presentation is to give an evidence and clinic base clarification of the controversies regarding the injuries to medial side of the knee and propose an algorithm for their management. 1st Controversy: Structures of the Posteromedial Corner (PMC)? The study by Robinson et al. divided the medial side of the knee into thirds3. Everything posterior to the medial collateral ligament (MCL) was described as the “posterior third” which recent studies have described as the PMC which includes: the posterior oblique ligament (POL), the semimembranosus tendon and its expansions, the oblique popliteal ligament (OPL), the posteromedial joint capsule, and the posterior horn of the medial meniscus4,5. A contemporary study by Cinque et al., also describe the PMC by 5 structures; however, they include the MCL with its superficial and deep portions as individual structures, without considering the semimembranosus and the posteromedial joint capsule6.
    [Show full text]
  • The Management of Injuries to the Medial Side of the Knee
    [ CLINICAL COMMENTARY ] ROBERT F. LAPRADE, MD, PhD1 • COEN A. WIJDICKS, PhD2 The Management of Injuries to the Medial Side of the Knee he injury incidence of the superficial medial collateral ligament of valgus loading and external rotation (MCL) and other medial knee stabilizers (the deep MCL and that occurs in such sports as skiing, ice the posterior oblique ligament) has been reported to be 0.24 per hockey, and soccer, which require knee flexion.17,20,25 The vast majority of grade 19 1000 people in the United States in any given year and to be III (complete tear) medial knee injuries T 19 twice as high in males (0.36) compared to females (0.18). The majority do heal; however, some do not, which can of medial knee ligament tears are isolated injuries, a!ecting only the lead to chronic instability and functional limitations. medial stabilizers of the knee. These ties. The mechanism of injury typically Much of the information about the injuries occur predominantly in young involves valgus knee loading, tibial exter- anatomy, diagnosis, and treatment of individuals participating in sport activi- nal rotation, or a combined force vector medial knee injuries is historical. More recently, it has been recognized that there is more to the medial knee structures SYNOPSIS: Injuries to the medial side of the performed at 30° and 90° of flexion, is important ! than just the medial collateral ligament. knee are the most common knee ligament injuries. because it evaluates for rotational abnormalities. The majority of injuries occur in young athletes Valgus stress radiographs are useful to objectively There are several important individual during sporting events, with the usual mechanism determine the amount of medial compartment structures that provide medial knee sta- involving a valgus contact, tibial external rotation, gapping and to discern whether there is medial bility, which, when injured, can result in or a combined valgus and external rotation force or lateral compartment gapping when a medial functional limitations.
    [Show full text]
  • Robert F. Laprade MD, Phd Publications and Presentations As of September 2018
    Robert F. LaPrade MD, PhD Publications and Presentations as of September 2018 BIBLIOGRAPHY PEER REVIEWED PUBLICATIONS 1. LaPrade RF, Noffsinger MA. Idiopathic osteonecrosis of the patella: an unusual cause of pain in the knee. A case report. J Bone Joint Surg Am. 1990 Oct;72(9):1414-8. No abstract available. 2. LaPrade RF, Rowe DE. The operative treatment of scoliosis in Duchenne muscular dystrophy. Orthop Rev. 1992 Jan;21(1):39-45. 3. LaPrade RF, Burnett QM 2nd.Localized chondrocalcinosis of the lateral tibial condyle presenting as a loose body in a young athlete. Arthroscopy. 1992;8(2):258-61. 4. LaPrade RF, Fowler BL, Ryan TG. Skin necrosis with minidose warfarin used for prophylaxis against thromboembolic disease after hip surgery. Orthopedics. 1993 Jun;16(6):703-4. No abstract available. 5. LaPrade RF, Burnett QM 2nd.Femoral intercondylar notch stenosis and correlation to anterior cruciate ligament injuries. A prospective study. Am J Sports Med. 1994 Mar-Apr;22(2):198-202; discussion 203. 6. LaPrade RF, Burnett QM 2nd, Veenstra MA, Hodgman CG. The prevalence of abnormal magnetic resonance imaging findings in asymptomatic knees. With correlation of magnetic resonance imaging to arthroscopic findings in symptomatic knees. Am J Sports Med. 1994 Nov-Dec;22(6):739-45. 7. Hutchinson MR, LaPrade RF, Burnett QM 2nd, Moss R, Terpstra J. Injury surveillance at the USTA Boys' Tennis Championships: a 6-yr study. Med Sci Sports Exerc. 1995 Jun;27(6):826-30. 8. Blais RE, LaPrade RF, Chaljub G, Adesokan A. The arthroscopic appearance of lipoma arborescens of the knee.Arthroscopy.
    [Show full text]