Patients with multiligament knee injuries require a thorough examination (Lachman, posterior-drawer, varus, valgus, and rotational testing). Diagnoses are confirmed with magnetic resonance imaging as well as stress radiographs (posterior, varus, and valgus) when indicated. Multiple systematic reviews have reported that early (<3 weeks after injury) single-stage surgery and early knee motion improves patient-reported outcomes. Anatomic-based reconstructions of the torn primary static stabilizers and repair of the capsular structures and any tendinous avulsions are performed in a single-stage. Open anteromedial or posterolateral incisions are preferentially performed first to identify the torn structures and to prepare the posterolateral corner (PLC) and medial knee reconstruction tunnels. Next, arthroscopy allows preparation of the anterior cruciate ligament (ACL) and double-bundle (DB) posterior cruciate ligament (PCL) tunnels. Careful attention to tunnel trajectory minimizes the risk for convergence. Meniscal tears are preferentially repaired (root and ramp tears are commonly seen in this patient group). Graft passage is performed after all tunnels are reamed. The graft tensioning and fixation sequence is as follows: anterolateral bundle of the PCL to restore the central pivot, posteromedial bundle of the PCL, ACL, PLC (including fibular [lateral] collateral ligament), and posteromedial corner (including medial collateral ligament). Graft integrity and full knee range of motion should be verified before closure. Physical therapy commences on postoperative day 1 with immediate knee motion (flexion from 0°-90°; prone for DB-PCL reconstruction) and quadriceps activation. Patients are nonweightbearing for 6 weeks. Patients with ACL-based reconstructions wear an immobilizer for 6 weeks then transition to a hinged ACL brace. Patients with PCL-based reconstructions transition into a dynamic PCL brace once swelling subsides and wear it routinely for 6 months. Functional testing and stress radiography are performed to validate return to sports.
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http://dx.doi.org/10.1016/j.arthro.2021.03.033 | DOI Listing |
Rev Bras Ortop (Sao Paulo)
December 2024
Centro de Atenção Especializada do Tratamento da Dismetria e Deformidades do Aparelho Locomotor, Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brasil.
The present study aims to demonstrate the radiological angular parameters of a sample of patients treated at our institution and to compare the radiological abnormalities with other classifications or parameters from the literature. We evaluated a sample of patients submitted to panoramic radiographic examinations of the lower limbs. The inclusion criteria were: (1) Patients without knee osteoarthritis as assessed by an orthopedist.
View Article and Find Full Text PDFKnee
December 2024
Department of Orthopaedic Surgery, Showa University Fujigaoka Hospital, Yokohama, Kanagawa, Japan.
Aims: The aim of the present study was to evaluate the morphology of the distal medial femoral surface during coronal osteotomy in medial closed wedge distal femoral varus osteotomy (MCWDFO) using plain CT.
Methods: Twenty knees (mean age, 55.3 years) were included.
J Exp Orthop
October 2024
Department of Orthopaedic Surgery, Faculty of Medicine The University of Tokyo Bunkyo-ku Tokyo Japan.
Purpose: The efficacy of medial pivot total knee arthroplasty (MP TKA) in treating valgus knees that may cause medial instability is unknown. The purpose of this study was to investigate the in vivo kinematics of MP TKA for the valgus knees and compare them to those for the varus knees.
Methods: The kinematics of 19 valgus knees and 19 varus knees operated in the MP TKA were investigated under fluoroscopy during squatting using a two- to three-dimensional registration technique.
Gait Posture
December 2024
Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Rehabilitation Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
Background: Foot deformities are common in cerebral palsy (CP) and are likely caused by a disturbed interplay of forces in the foot. Evaluation of foot joint moments would therefore be highly relevant. However, kinetic foot models have not previously been applied to children with CP.
View Article and Find Full Text PDFArch Orthop Trauma Surg
December 2024
Sporthopaedicum Regensburg, Regensburg, Germany.
Purpose: Varus posteromedial rotatory instability (VPMRI) involves anteromedial coronoid fracture (AMCF), lateral ulnar collateral ligament (LUCL), and medial collateral ligament (MCL) injury. There is no general consensus regarding the surgical treatment, but most surgeons recommend internal fixation of the coronoid along with primary ligament repair. This methodology involves postoperative immobilization to allow ligament healing, occasionally associated with stiffness.
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