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Knee Surgery, Sports Traumatology, Arthroscopy

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01-10-2017 | Knee

Recurrent posterior knee laxity: diagnosis, technical aspects and treatment algorithm

Authors: Romain Rousseau, Konstantinos G. Makridis, Gilles Pasquier, Bruno Miletic, Patrick Djian

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2017

Abstract

Purpose

Aim of this study was to determine the characteristics, clinical and radiological diagnostic methods of PCL isolated and combined knee injuries.

Methods

One hundred and twelve patients with a recurrent posterior knee laxity were surgically treated. Clinical examination, MRI, Telos™ stress dynamic X-rays, KT-1000 measurements and the IKDC questionnaire were used to diagnose and evaluate these injuries.

Results

Median follow-up was 4.5 years (2–11 years). Thirty-two patients (28.6 %) had an isolated posterior laxity, 53 (47.3 %) a posterior posterolateral laxity, 21 (18.7 %) a posterior posteromedial laxity and six (5.4 %) patients had a complex posterior and mediolateral laxity. Road traffic accidents and sports injuries were the main causes of trauma. The mean preoperative value of posterior tibial translation was 13.5 mm (SD 1.4) and the mean postoperative value was 4.4 mm (SD 1.7) as measured with the Telos device. In the cases with a concomitant ACL rupture, the mean preoperative value of anterior tibial translation was 6.5 mm (SD 1.3) and the mean postoperative value was 1.7 mm (SD 0.8). The mean pre- and postoperative IKDC scores were 74.5 (SD 4.2) and 87.9 (SD 3.1), respectively. Meniscal and/or cartilage injuries were found in 80 patients (71.4 %).

Conclusions

Recurrent posterior knee laxity can be restored with the one-stage PCL reconstruction using a quadriceps graft and reconstruction of the posteromedial-posterolateral lesions using the LaPrade techniques. The benefits of this study include enabling surgeons to accurately manage these injuries from a clinical perspective, and treating them with a specific surgical algorithm.

Level of evidence

III.

Abdel-Hamid MZ, Chang CH, Chan YS, Lo YP, Huang JW, Hsu KY, Wang CJ (2006) Arthroscopic evaluation of soft tissue injuries in tibial plateau fractures: retrospective analysis of 98 cases. Arthroscopy 22:669–675CrossRefPubMed

Arendt E, Dick R (1995) Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med 23:694–701CrossRefPubMed

Bin SI, Nam TS (2007) Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy 23:1066–1072CrossRefPubMed

Cantin O, Magnussen RA, Corbi F, Servien E, Neyret P, Lustig S (2015) The role of high tibial osteotomy in the treatment of knee laxity: a comprehensive review. Knee Surg Sports Traumatol Arthrosc 23:3026–3037CrossRefPubMed

Cook S, Ridley TJ, McCarthy MA, Gao Y, Wolf BR, Amendola A, Bollier MJ (2015) Surgical treatment of multiligament knee injuries. Knee Surg Sports Traumatol Arthrosc 23:2983–2991CrossRefPubMed

Fanelli GC, Boyd JL, Heckler MW (2009) How I manage posterior cruciate ligament injuries. Oper Tech Sports Med 17:175–193CrossRef

Fanelli GC, Edson CJ (2012) Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity): surgical technique and 2- to 18-year results. J Knee Surg 25:307–316CrossRefPubMed

Fanelli GC, Edson CJ (1995) Posterior cruciate ligament injuries in trauma patients: part II. Arthroscopy 11:526–529CrossRefPubMed

Fanelli GC, Orcutt DR, Edson CJ (2005) The multiple-ligament injured knee: evaluation, treatment, and results. Arthroscopy 21:471–486CrossRefPubMed

10.

Fowler PJ, Messieh SS (1987) Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med 15:553–557CrossRefPubMed

11.

Geissler W, Whipple T (1993) Intra-articular abnormalities in association with posterior cruciate ligament. Am J Sport Med 21:846–849CrossRef

12.

Gillespie WJ (1975) The incidence and pattern of knee injury associated with dislocation of the hip. J Bone Joint Surg Br 57:376–378PubMed

13.

Goudie EB, Will EM, Keating JF (2010) Functional outcome following PCL and complex knee ligament reconstruction. Knee 17:230–234CrossRefPubMed

14.

Green NE, Allen BL (1977) Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 59:236–239CrossRefPubMed

15.

Hamada M, Shino K, Mitsuoka T, Toritsuka Y, Natsu-Ume T, Horribe S (2000) Chondral injury associated with acute isolated posterior cruciate ligament injury. Arthroscopy 16:59–63CrossRefPubMed

16.

Harner CD, Hoher J (1998) Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med 26:471–482CrossRefPubMed

17.

Höher J, Akoto R, Helm P, Shafizadeh S, Bouillon B, Balke M (2015) Rolimeter measurements are suitable as substitutes to stress radiographs in the evaluation of posterior knee laxity. Knee Surg Sports Traumatol Arthrosc 23:1107–1112CrossRefPubMed

18.

Hudgens JL, Gillette BP, Krych AJ, Stuart MJ, May JH, Levy BA (2013) Allograft versus autograft in posterior cruciate ligament reconstruction: an evidence-based systematic review. J Knee Surg 26:109–115CrossRefPubMed

19.

Jarrett GJ, Orwin JF, Dick RW (1998) Injuries in collegiate wrestling. Am J Sports Med 26:647–680CrossRef

20.

Jiang W, Yao J, He Y, Sun W, Huang Y, Kong D (2015) The timing of surgical treatment of knee dislocations: a systematic review. Knee Surg Sports Traumatol Arthrosc 23:108–113CrossRef

21.

Johnson ME, Foster L, DeLee JC (2008) Neurologic and vascular injuries associated with knee ligament injuries. Am J Sports Med 36:2448–2462CrossRefPubMed

22.

Kannus P, Bergfeld J, Järvinen M, Johnson RJ, Pope M, Renström P, Yasuda K (1991) Injuries to the posterior cruciate ligament of the knee. Sports Med 12:110–131CrossRefPubMed

23.

LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD (2007) A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy 23:1341–1347CrossRefPubMed

24.

Levy AS, Wetzler MJ, Lewars M (1997) Knee injuries in women collegiate rugby players. Am J Sports Med 25:360–362CrossRefPubMed

25.

Lin YC, Chen SK, Liu TH, Cheng YM, Chou PP (2013) Arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction using patellar tendon graft compared with hamstring tendon graft. Arch Orthop Trauma Surg 133:523–530CrossRefPubMed

26.

Loos WC, Fox JM, Blazina ME, Del Pizzo W, Friedman MJ (1981) Acute posterior cruciate ligament injuries. Am J Sports Med 9:86–92CrossRefPubMed

27.

Margheritini F, Mariani PP (2003) Diagnostic evaluation of posterior cruciate ligament injuries. Knee Surg Sports Traumatol Arthrosc 11:282–288CrossRefPubMed

28.

McAllister DR, Miller MD, Sekiya JK, Wojtys EM (2009) Posterior cruciate ligament biomechanics and options for surgical treatment. Instr Course Lect 58:377–388PubMed

29.

Misayaka KC, Daniel DM (1991) The incidence of knee ligament injuries in the general population. Am J Knee Surg 4:3–8

30.

Myklebust G, Maehlum S, Engebretsen L, Strand T, Solheim E (1997) Registration of cruciate ligament injuries in Norwegian top level team handball. A prospective study covering two seasons. Scand J Med Sci Sports 7:289–292CrossRefPubMed

31.

Nha KW, Bae JH, Kwon JH, Kim JG, Jo DY, Lim HC (2015) Arthroscopic posteromedial drive-through test in posterior cruciate ligament insufficiency: a new diagnostic test. Knee Surg Sports Traumatol Arthrosc 23:1113–1118CrossRefPubMed

32.

Richter D, Wascher DC, Schenck RC Jr (2014) A novel posteromedial approach for tibial inlay PCL reconstruction in KDIIIM injuries: avoiding prone patient positioning. Clin Orthop Relat Res 472:2680–2690CrossRefPubMedPubMedCentral

33.

Schulz MS, Russe K, Weiler A, Eichhorn HJ, Strobel MJ (2003) Epidemiology of posterior cruciate ligament injuries. Arch Orthop Trauma Surg 123:186–191CrossRefPubMed

34.

Strobel MJ, Weiler A, Schulz MS, Russe K, Eichhorn HJ (2003) Arthroscopic evaluation of articular cartilage lesions in posterior cruciate ligament deficient knees. Arthroscopy 19:262–268CrossRefPubMed

35.

Swenson DM, Collins CL, Best TM, Flanigan DC, Fields SK, Comstock RD (2013) Epidemiology of knee injuries among US High School Athletes, 2005/2006–2010/2011. Med Sci Sports Exerc 45:462–469CrossRefPubMedPubMedCentral

36.

Templeman DC, Marder RA (1989) Injuries of the knee associated with fractures of the tibial shaft. Detection by examination under anesthesia: a prospective study. J Bone Joint Surg Am 71:1392–1395CrossRefPubMed

37.

Thiagarajan P, Ang KC, De Das S, Bose K (1997) Ipsilateral knee ligament injuries and open tibial diaphyseal fractures: incidence and nature of knee ligament injuries sustained. Injury 28:87–90CrossRefPubMed

38.

Walker DM, Kennedy JC (1980) Occult knee ligament injuries associated with femoral shaft fractures. Am J Sports Med 8:172–174CrossRefPubMed

39.

Wascher DC (2000) High-velocity knee dislocation with vascular injury: treatment principles. Clin Sports Med 19:457–477CrossRefPubMed

40.

Wilson SM, Mehta N, Do HT, Ghomrawi H, Lyman S, Marx RG (2014) Epidemiology of multiligament knee reconstruction. Clin Orthop Relat Res 472:2603–2608CrossRefPubMedPubMedCentral

Title: Recurrent posterior knee laxity: diagnosis, technical aspects and treatment algorithm
Authors: Romain Rousseau
Konstantinos G. Makridis
Gilles Pasquier
Bruno Miletic
Patrick Djian
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-016-4085-2

At a glance: The STEP trials

Springer Medicine

Recurrent posterior knee laxity: diagnosis, technical aspects and treatment algorithm

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Level of evidence

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