Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2023

Open Access 08-05-2023 | Tibial Plateau Fracture | KNEE

The “Bankart knee”: high-grade impression fractures of the posterolateral tibial plateau lead to increased translational and anterolateral rotational instability of the ACL-deficient knee

Authors: Danko Dan Milinkovic, Christoph Kittl, Elmar Herbst, Christian Fink, Friedrich Greis, Michael J. Raschke, Robert Śmigielski, Mirco Herbort

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 10/2023

Login to get access

Abstract

Purpose

The aim of this biomechanical cadaver study was to evaluate the effects of high-grade posterolateral tibia plateau fractures on the kinematics of anterior cruciate ligament (ACL)-deficient joints; it was hypothesized that, owing to the loss of the integrity of the osseous support of the posterior horn of the lateral meniscus (PHLM), these fractures would influence the biomechanical function of the lateral meniscus (LM) and consequently lead to an increase in anterior translational and anterolateral rotational (ALR) instability.

Methods

Eight fresh-frozen cadaveric knees were tested using a six-degree-of-freedom robotic setup (KR 125, KUKA Robotics, Germany) with an attached optical tracking system (Optotrack Certus Motion Capture, Northern Digital, Canada). After the passive path from 0 to 90° was established, a simulated Lachman test and pivot-shift test as well as external rotation (ER) and internal rotation (IR) were applied at 0°, 30°, 60° and 90° of flexion under constant 200 N axial loading. All of the parameters were initially tested in the intact and ACL-deficient states, followed by two different types of posterolateral impression fractures. The dislocation height was 10 mm, and the width was 15 mm in both groups. The intraarticular depth of the fracture corresponded to half of the width of the posterior horn of the lateral meniscus in the first group (Bankart 1) and 100% of the meniscus width in the second group (Bankart 2).

Results

There was a significant decrease in knee stability after both types of posterolateral tibial plateau fractures in the ACL-deficient specimens, with increased anterior translation in the simulated Lachman test at 0° and 30° of knee flexion (p = 0.012). The same effect was seen with regard to the simulated pivot-shift test and IR of the tibia (p = 0.0002). In the ER and posterior drawer tests, ACL deficiency and concomitant fractures did not influence knee kinematics (n.s.).

Conclusion

This study demonstrates that high-grade impression fractures of the posterolateral aspect of the tibial plateau increase the instability of ACL-deficient knees and result in an increase in translational and anterolateral rotational instability.
Appendix
Available only for authorised users
Literature
1.
Ahn JH, Koh IJ, McGarry MH, Patel NA, Lin CC, Lee TQ et al (2020) Knee laxity in anterolateral complex injuries versus lateral meniscus posterior horn injuries in anterior cruciate ligament deficient knees: a cadaveric study. Knee 27(2):363–374CrossRefPubMed
2.
3.
Bernholt DL, Dornan GJ, DePhillipo NN, Aman ZS, Kennedy MI, LaPrade RF (2020) High-Grade posterolateral tibial plateau impaction fractures in the setting of a primary anterior cruciate ligament tear are correlated with an increased preoperative Pivot shift and inferior postoperative outcomes after anterior cruciate ligament reconstruction. Am J Sports Med 48(9):2185–2194CrossRefPubMed
4.
Bernholt DL, DePhillipo NN, Crawford MD, Aman ZS, Grantham WJ, LaPrade RF (2020) Incidence of displaced posterolateral tibial plateau and lateral femoral condyle impaction fractures in the setting of primary anterior cruciate ligament tear. Am J Sports Med 48(3):545–553CrossRefPubMed
5.
Bernholt DL, DePhillipo NN, Grantham WJ, Crawford MD, Aman ZS, Kennedy MI et al (2020) Morphologic variants of posterolateral tibial plateau impaction fractures in the setting of primary anterior cruciate ligament tear. Am J Sports Med 48(2):318–325CrossRefPubMed
6.
Bernholt DL, Buchman JM, Baessler AM, Eason RR, Witte DA, Spence DD et al (2022) The incidence of posterolateral tibial plateau and central lateral femoral condylar impaction fractures in a pediatric and young adult population. J Pediatr Orthop 43(1):18–23CrossRefPubMed
7.
Bordoni V, di Laura FG, Previtali D, Tamborini S, Candrian C, Cristallo Lacalamita M et al (2019) Bone bruise and anterior cruciate ligament tears: presence, distribution pattern, and associated lesions in the pediatric population. Am J Sports Med 47(13):3181–3186CrossRefPubMed
8.
Cui W, Nakagawa Y, Katagiri H, Otabe K, Ohara T, Shioda M et al (2021) Knee laxity, lateral meniscus tear and distal femur morphology influence pivot shift test grade in ACL injury patients. Knee Surg Sports Traumatol Arthrosc 29(2):633–640CrossRefPubMed
9.
Ciszkowska-Łysoń B, Dominik B, Zdanowicz U, Śmigielski R (2018) Proposing an MRI-Based classification system allowing proper assessment of the damage to the posteriori edge of the tibia. Poster: European Congress of Radiology, Vienna, Austria. https://​doi.​org/​10.​1594/​ecr2018/​C-3210
10.
Deckey DG, Tummala S, Verhey JT, Hassebrock JD, Dulle D, Miller MD et al (2021) Prevalence, biomechanics, and pathologies of the meniscofemoral ligaments: a systematic review. Arthrosc Sports Med Rehabil. 3(6):2093–2101CrossRef
11.
Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41(4):1149–1160CrossRefPubMed
12.
Filardo G, Andriolo L, di Laura FG, Napoli F, Zaffagnini S, Candrian C (2019) Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression. Knee Surg Sports Traumatol Arthrosc 27(1):44–59CrossRefPubMed
13.
14.
Forkel P, von Deimling C, Lacheta L, Imhoff FB, Foehr P, Willinger L et al (2018) Repair of the lateral posterior meniscal root improves stability in an ACL-deficient knee. Knee Surg Sports Traumatol Arthrosc 26(8):2302–2309CrossRefPubMed
15.
Guenther D, Rahnemai-Azar AA, Bell KM, Irarrázaval S, Fu FH, Musahl V et al (2017) The anterolateral capsule of the knee behaves like a sheet of fibrous tissue. Am J Sports Med 45(4):849–855CrossRefPubMed
16.
Guenther D, Irarrázaval S, Bell KM, Rahnemai-Azar AA, Fu FH, Debski RE et al (2017) The role of extra-articular tenodesis in combined ACL and anterolateral capsular injury. J Bone Jt Surg Am 99(19):1654–1660CrossRef
17.
Hoshino Y, Miyaji N, Nishida K, Nishizawa Y, Araki D, Kanzaki N et al (2019) The concomitant lateral meniscus injury increased the pivot shift in the anterior cruciate ligament-injured knee. Knee Surg Sports Traumatol Arthrosc 27(2):646–651CrossRefPubMed
18.
Hoshino Y, Hiroshima Y, Miyaji N, Nagai K, Araki D, Kanzaki N et al (2020) Unrepaired lateral meniscus tears lead to remaining pivot-shift in ACL-reconstructed knees. Knee Surg Sports Traumatol Arthrosc 28(11):3504–3510CrossRefPubMed
19.
20.
Kaplan PA, Walker CW, Kilcoyne RF, Brown DE, Tusek D, Dussault RG (1992) Occult fracture patterns of the knee associated with anterior cruciate ligament tears: assessment with MR imaging. Radiology 183(3):835–838CrossRefPubMed
21.
22.
Kim Y, Kubota M, Sato T, Inui T, Ohno R, Ishijima M (2022) A bone bruise at the lateral and medial Tibial plateau with an anterior cruciate ligament injury is associated with a meniscus tear. Knee Surg Sports Traumatol Arthrosc 30(7):2298–2306CrossRefPubMed
23.
Kittl C, El-Daou H, Athwal KK, Gupte CM, Weiler A, Williams A et al (2016) The role of the anterolateral structures and the ACL in controlling laxity of the Intact and ACL-deficient knee. Am J Sports Med 44(2):345–354CrossRefPubMed
24.
25.
Konrads C, Petersen N, Histing T, Döbele S (2021) Arthroscopic minimal invasive treatment of posterolateral Tibial plateau impression fractures. Acta Chir Orthop Traumatol Cech 88(5):382–385CrossRefPubMed
26.
Korthaus A, Krause M, Pagenstert G, Warncke M, Brembach F, Frosch KH et al (2021) Tibial slope in the posterolateral quadrant with and without ACL injury. Arch Orthop Trauma Surg 142(12):3917–3925CrossRefPubMedPubMedCentral
27.
Mameri ES, Dasari SP, Fortier LM, Verdejo FG, Gursoy S, Yanke AB et al (2022) Review of meniscus anatomy and biomechanics. Curr Rev Musculoskelet Med 15(5):323–335CrossRefPubMedPubMedCentral
28.
29.
Merican AM, Ghosh KM, Deehan DJ, Amis AA (2009) The transpatellar approach for the knee in the laboratory. J Orthop Res 27(3):330–334CrossRefPubMed
30.
Mink JH, Deutsch AL (1989) Occult cartilage and bone injuries of the knee: detection, classification, and assessment with MR imaging. Radiology 170(3):823–829CrossRefPubMed
31.
Moran J, Lee MS, Kunze KN, Green JS, Katz LD, Wang A et al (2023) Examining the distribution of bone bruise patterns in contact and noncontact acute anterior cruciate ligament injuries. Am J Sports Med 51(5):1155–1161CrossRefPubMed
32.
Moroder P, Danzinger V, Maziak N, Plachel F, Pauly S, Scheibel M et al (2020) Characteristics of functional shoulder instability. J Shoulder Elbow Surg 29(1):68–78CrossRefPubMed
33.
Musahl V, Engler ID, Nazzal EM, Dalton JF, Lucidi GA, Hughes JD et al (2022) Current trends in the anterior cruciate ligament part II: evaluation, surgical technique, prevention, and rehabilitation. Knee Surg Sports Traumatol Arthrosc 30(1):34–51CrossRefPubMed
34.
Musahl V, Citak M, O’Loughlin PF, Choi D, Bedi A, Pearle AD (2010) The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 38(8):1591–1597CrossRefPubMed
35.
Park I, Oh MJ, Shin SJ (2020) Effects of glenoid and humeral bone defects on recurrent anterior instability of the shoulder. Clin Orthop Surg 12(2):145–150CrossRefPubMedPubMedCentral
36.
Schliemann B, Lenschow S, Domnick C, Herbort M, Häberli J, Schulze M et al (2017) Knee joint kinematics after dynamic intraligamentary stabilization: cadaveric study on a novel anterior cruciate ligament repair technique. Knee Surg Sports Traumatol Arthrosc 25(4):1184–1190CrossRefPubMed
37.
Wang Z, Zheng B, Jin Y, Yang G, Chen G, Liang J et al (2020) Arthroscopy-assisted surgery: The management of posterolateral tibial plateau depression fracture accompanying ligament injury: a case series and review of the literature. J Orthop Surg 28(1):2309499019891208. https://​doi.​org/​10.​1177/​2309499019891208​CrossRef
38.
Wierer G, Milinkovic DD, Robinson JR, Raschke MJ, Weiler A, Fink C et al (2021) The superficial medial collateral ligament is the major restraint to anteromedial instability of the knee. Knee Surg Sports Traumatol Arthrosc 29(2):405–416CrossRefPubMed
39.
40.
Yi Z, Jiang J, Liu Z, Wang H, Yi Q, Zhan H et al (2022) The association between bone bruises and concomitant ligaments lnjuries in anterior cruciate ligament injuries: a systematic review and meta-analysis. Indian J Orthop 57(1):20–32CrossRefPubMed
Metadata
Title
The “Bankart knee”: high-grade impression fractures of the posterolateral tibial plateau lead to increased translational and anterolateral rotational instability of the ACL-deficient knee
Authors
Danko Dan Milinkovic
Christoph Kittl
Elmar Herbst
Christian Fink
Friedrich Greis
Michael J. Raschke
Robert Śmigielski
Mirco Herbort
Publication date
08-05-2023
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 10/2023
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-023-07432-w

Other articles of this Issue 10/2023

Knee Surgery, Sports Traumatology, Arthroscopy 10/2023 Go to the issue

ANKLE

Hyaluronic scaffold transplantation with bone marrow concentrate for the treatment of osteochondral lesions of the talus: durable results up to a minimum of 10 years

ANKLE

Evaluation of chronic ankle instability and subtalar instability using the angle between the anterior talofibular ligament and calcaneofibular ligament

KNEE

Tear patterns and locations are different between lateral and medial compartments in patients with early anatomical failure after meniscal allograft transplantation

KNEE

Outside-in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review

KNEE

Delaying ACL reconstruction is associated with increased rates of medial meniscal tear

KNEE

Machine learning can accurately predict risk factors for all-cause reoperation after ACLR: creating a clinical tool to improve patient counseling and outcomes