This technique is more anatomic because it reconstructs the LCL and PFL as well as the popliteal tendon, with two grafts. At the one-year follow-up, the average Lysholm and IKDC scores were 86.4 ± 3.5 and 83.8 ± 4, respectively. The collagen density in the ACL was significantly lower than that in the other ligaments. Arthroscopy The Journal of Arthroscopic and Related Surgery. Both bundles of the posterior cruciate ligament had increased lengths with flexion. The tests were performed with the knee in neutral tibial rotation and in 20 degrees of internal tibial rotation. All patients were followed up 12-36 months (mean, 19 months). Treatment of multiligament knee injuries, especially in adolescent patients, is challenging for orthopedic surgeons. Although many tests are used to document posterolateral knee instability, the authors prefer varus stress testing and the prone external rotation test. We propose a surgical procedure that is a modification of the LaPrade technique using the same tunnel placement, hamstring autografts, and biceps augmentation when necessary. Prospective case series. This pictorial essay demonstrates various reconstructions of the cruciate and the collateral ligaments, as well as several, The combination injury of anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament is a rare injury and occurs in less than 1% of all knee ligament injuries. Objective: To evaluate the short-term effectiveness of a modified Laprade technique in the treatment of lateral multi-ligament injuries of knee by anatomical reconstruction of posterolateral complex (PLC) and anterior lateral ligament (ALL). There was no anterior external rotation instability. LaPrade et al. the posterolateral corner. Modified Lemaire Tenodesis with an Iliotibial Band Graft and ... Smith & Nephew. Results and discussion: Mean posterior tibial displacement as measured through stress radiography at 90 degrees of knee flexion was reduced from -15.06 +/- 4.68 mm preoperatively to -7.12 +/- 3.37 mm postoperatively (P < .001). Privacy, Help Background: Multi-ligament knee injury is common after knee dislocation. Our data demonstrate that the superficial medial collateral ligament is the structure responsible for a decrease in posterior tibial translation in the posterior cruciate ligament-deficient knee. Mean anterior tibial displacement was 0.94 +/- 2.75 mm preoperatively compared with -1.59 +/- 3.50 mm postoperatively (P < .01). Grafts were secured by interference screws in the fibula and femur tunnels. ⢠Reduction of HVA and IMA. Medial Collateral Ligament Reconstruction in Patients With Medial Knee Instability: A Systematic Review. laxity and clinical outcomes. Post-operative (0.09mm ± 0.63mm) SSD was found to be significantly reduced compared to pre-operative (2.07mm ± 0.44mm) SSD (mean diff. This study assessed novel graft constructs and surgical implantation and fixation techniques for, Posterolateral injury is often associated with additional ligamentous injury to the knee. According to IKDC scoring, 8 cases were rated as grade A, 4 as grade B, and 1 as grade C; significant difference was found when compared with preoperative value ( Z=3.182, P=0.000). Instead of allografts, hamstring autografts are used while tunnel diameters and fixation devices are adapted to them. Meniscal Root Repair: Two Tunnel Technique Animation with FIRSTPASS⢠MINI 05:22. Although current reconstruction techniques are not able to restore normal tibiofemoral kinematics, most patients recover a functionally stable knee and have considerably improved knee function compared with their preoperative status, based on subjective parameters and objective criteria. Single-stage arthroscopic primary suturing of the anterior and posterior cruciate ligaments and open medial collateral ligament suturing were performed 7 days after the injury. demonstrates his surgical technique for posterolateral corner reconstruction using the ACUFEX Extra-Articular Reconstruction Guide System. One limb from each pair was reconstructed using the LaPrade technique and the other with the Arciero technique using the Achilles tendon as graft material. The present study was, Reconstruction of knee ligaments is now a common orthopedic procedure. Please enable it to take advantage of the complete set of features! In conclusion, presented technique results in excellent static stability of the knee as measured by valgus stress radiography at a minimum of 6 months postoperative. Patient and methods: By Smith & Nephew FEATURING Scott Faucett. Postoperatively, the mean side-to-side difference (and standard deviation) in anterior tibial translation, measured with a KT2000 arthrometer, was greater for Group I (2.2 ± 1.0 mm) than for Group II (1.6 ± 0.8 mm) (p = 0.031). Deborah Richardson, RN, MS, CNS, clinical nurse specialist for the Infusion Therapy Team at MD Anderson Cancer Center in Houston, offers PICC classes that include the technique. Of those injuries that end seasons or careers, the knee is the most common culprit. We retrospectively studied sixty-nine patients who underwent ACL reconstruction from February 2001 to December 2005. We reviewed 17 patients (13 men and 4 women) with chronic multiligamentous injuries after a, Most knowledge regarding cruciate ligament function is based on in vitro experiments. The Modified Lapidus Procedure for the Treatment of Moderate to Severe Hallux Valgus. According to International Knee Documentation Committee (IKDC) scoring, all were rated as grade D. According to Fanelli classification criteria, all were classified as type C. Anterior cruciate ligament, posterior cruciate ligament, PLC, and ALL were reconstructed simultaneously with autogenous tendon. At last follow-up, the results of anterior and posterior drawer tests and Lachmann test were negative; 2 cases had varus instability, and 1 cases had external rotation instability. Collateral ligament reconstruction requires the use of the patient's own tissue or cadaver tissue to reconstruct the injured ligaments on the medial or lateral side of the knee. Anatomic medial knee reconstruction restores stability and function at minimum 2 years follow-up. In the treatment of lateral multi-ligament injuries knee, anatomical reconstruction of PLC and ALL with a modified Laprade technique can obtain good short-term effectiveness. Historically the decision process to reconstruct or repair the ligaments or tendons is dependent on the location of the injury (medial or lateral structures) and whether the injury is acute or chronic. If initial posterior cruciate ligament laxity is greater than 2+, then semiacute posterior cruciate ligament reconstruction may be needed. A custom made testing fixture was created to isolate and test for a 10 Nm Varus Angulation (VA) moment and a 5 Nm External Rotation (ER) torque at 0 , 20 , 30 , 60 , and 90 of flexion about the knee joint. ⢠Release of contracted lateral structuresâadductor hallucis tendon, transverse metatarsal ligament, and lateral capsule (Fig. Between June 2013 and July 2015, 13 cases of lateral multi-ligament injuries of knee were treated. With the technique described in this Technical Note, the lateral (varus) instability and the external rotational instability can be addressed. Epub 2014 Jun 20. He has received the 2013 OREF Clinical Research Award for his research in improving outcomes for these injuries, and is the author of a textbook on the subject. minimum follow-up of 2 years (range, 24 to 66.3 months). The percentage differences between the anterior and posterior bundles, in relation to the posterior bundles, were about 25% for the anterior cruciate ligament (ACL) and the collateral ligaments and about 10% for the posterior cruciate ligament (PCL). This study recorded similar outcomes in both the groups. that measured in cadavers. The anterior cruciate ligament plays a more important role in low-flexion angles, whereas the posterior cruciate ligament plays a more important role in high flexion. 2014 Oct;27(5):359-68. doi: 10.1055/s-0034-1381961. At final IKDC evaluation, 4 patients (29.4%) were graded level B (nearly normal), 10 patients (58.8%) level C (abnormal), and 2 patients (11.8%) level D (grossly abnormal). The biomechanical role of functional bundles of the anterior cruciate ligament and posterior cruciate ligament under in vivo loading is different from, It is generally recognized that the mechanical properties of soft connective tissues are affected by their structural components. The classically described Lapidus procedure consists of a fusion of the first tarsometatarsal joint and the bases of the first and second metatarsals and a distal soft tissue procedure. Assessment of a patient with multiligamentous knee instability requires a high index of suspicion for a knee dislocation. © 2008-2021 ResearchGate GmbH. Level IV, case series, no historical or control group. Sockets and tunnels with potential for overlap were identified and assessed to measure the minimum distances between them using gross, computed tomographic, and finite element analysis-based measurements. All rights reserved. Bassini developed his hernia repair in 1887, which was minutely described by his student Catterina in 1930. The RAND/UCLA appropriateness method user's manual (No. Varelas AN, Erickson BJ, Cvetanovich GL, Bach BR Jr. Orthop J Sports Med. Objectives: This study aimed to investigate the efficacy of early reconstruction of collateral ligaments and delayed reconstruction of cruciate ligaments in multi-ligament knee injury. Eight patients underwent both pre- and post-operative valgus stress radiographs. Objectives: The purpose of our study was to present an anatomic dorsomedial low-profile locked compression plate with a dorsal ⦠Robert F. LaPrade is a knee surgeon, practicing at Twin Cities Orthopedics in Edina, Minnesota. The posterior-lateral bundle of the anterior cruciate ligament decreased in length with flexion. Clinical outcomes were determined from data obtained before surgery and at the time of the twenty-four-month follow-up examination. Conclusion Epub 2013 Mar 6. Cadaveric knees (n = 3) were instrumented to perform arthroscopic-assisted and open surgical creation of sockets and tunnels for all components of MLKI reconstruction using our novel techniques. We retrospectively reviewed post-operative valgus stress radiographs in 23 multiligament injured patients who underwent concurrent sMCL and cruciate ligament reconstruction by a single surgeon. Furthermore, in varus and valgus stress tests, the outcomes of reconstruction were better on the lateral side of the knee than on the medial side. anatomic augmented repair and reconstruction techniques would reproduce equivalent knee kinematics when compared with the intact state and would create significant improve-ments in translational and rotational laxity compared with the sMCL sectioned state. Tapasvi S, Shekhar A, Patil S, Getgood A. Knee Surg Sports Traumatol Arthrosc. 8600 Rockville Pike ⢠Removal of medial eminence. These variations within and between the ligaments correlate well with the variations in mechanical properties described in the literature; however, other structural differences have to be taken into account to fully explain the variations in mechanical properties from the structural components. Complete radial meniscus tears have been reported to result in deleterious effects in the knee joint if left unrepaired. In Vivo Elongation of the Anterior Cruciate Ligament and Posterior Cruciate Ligament During Knee Fle... Nonuniform distribution of collagen density in human knee ligaments. These avulsions may lead to the development of osteoarthritis. ResearchGate has not been able to resolve any references for this publication. Therefore, the application of sutures may be a useful option for repairing multiligament knee injuries, particularly in adolescent patients. an be modified to fuse only the first tarsometatarsal joint. Posterior root avulsions of the medial and lateral menisci result in decreased areas of tibiofemoral contact and increased tibiofemoral contact pressures. Range of motion was normal in all patients at the end of the study. Does Superficial Medial Collateral Ligament Release in Open-Wedge High Tibial Osteotomy for Varus Osteoarthritic Knees Increase Valgus Laxity? There are different approaches for treating multi-ligament knee injuries; however, choosing the best approach is a challenging issue. MacIntoch technique11. Inter-observer reliability value for medial compartment gap measurement was 0.91 with a 95% confidence interval of 0.34- 0.97. Purpose of this study was to assess postoperative laxity of MCL reconstructions utilizing a modified LaPrade superficial MCL reconstruction. All incisions healed at stage I and no complication occurred. A radial tear was created at the middle third of the meniscal body. Knowledge of the biomechanics of the posterolateral corner provide insight into the clinical evaluation and treatment of posterolateral knee instability. However, we could not identify significant differences between the two groups in terms of functional outcomes. Online ahead of print. A modified transtibial pull-out repair for posterior root avulsions of the lateral meniscus with concomitant anterior cruciate ligament reconstruction: a report of two cases . literature, the distributions of collagen density were correlated with these biomechanical findings. There were 9 males and 4 females with an average age of 38 years (range, 23-49 years). The anterior bundles of all ligaments contained significantly more collagen mass per unit of volume than the posterior bundles did. Patients are frequently referred for magnetic resonance imaging (MRI) after later reinjury, and the ability to recognize normal reconstructed knee ligaments is therefore becoming increasingly important. On the basis of the evaluation of ligamentous laxity with use of the KT2000 arthrometer, we observed that combined ACL and posterolateral corner reconstruction allows less anterior translation than isolated ACL reconstruction. He is a specialist in treating posterolateral knee injuries . Biomechanical studies reveal that the popliteal tendon, the popliteofibular ligament, the arcuate ligament, and the LCL are the principal structures responsible for maintaining stability of, This study was undertaken to determine the contribution of various structures in the posterior cruciate ligament-deficient knee in resisting posterior tibial translation. Results Smith & Nephew. The Delphi technique has four main characteristics 2: â Anonymity â Iteration with controlled feedback of group opinion â Statistical aggregation of group response â Expert input 1 Fitch, K., Bernstein, S. J., Aguilar, M. D., Burnand , B., & LaCalle, J. R. (2001). In order to explain the variations in mechanical properties within and between different knee ligaments as described in the, Background: It relies on artificial graft lengthening provided by the loop of the suspensory fixation device fixed at the anterior tibial cortex. Mean postoperative IKDC score for LaPrade group was 84.9±5.67 with scores ranging from 73-92 with median value of 85.5. In this case report, a complete radial tear of the medial meniscus midbody was repaired using a novel crisscross suture transtibial technique. Unable to load your collection due to an error, Unable to load your delegates due to an error. Methods: All patients studied underwent endoscopic PCL reconstruction with a double-bundle allograft. By Smith & Nephew FEATURING Rob LaPrade. The Lysholm score of the knee was 38.4±7.7. With the knee in neutral rotation, posterior translation continued to increase as each structure was sectioned. Methods 2013 May;41(5):1044-50. doi: 10.1177/0363546513479016. Post- operatively, 23 patients underwent valgus stress radiographs that were assessed at a mean of 8.7 months (range: 4-13 months), and mean SSD was 0.64mm ± 0.42mm.
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