Lateral Collateral Ligament Injury Research Articles

A Study Evaluating the Functional Outcomes of Mason Type III and IV Radial Head Fractures Treated With a Radial Head Prosthesis.

Objective This research aimed to assess the functional result of type III and IV radial head fractures that were treated using a radial head prosthesis. Methods A retrospective investigation was conducted on 70 patients with type III and IV radial head and neck fractures, as classified by Mason. The patients were hospitalized and received treatment at the Orthopaedics Department, where they had radial head prosthesis surgery for three years. Results Among the total of 70 cases, 42 (60%) cases were below the age of 40, while 28 (47%) cases were over 40 years. The average age was 36.4 years. The maximum age recorded was 54 years, while the lowest age recorded was 30 years. The female population outnumbered the male population. The majority of instances (42, 60%) were attributed to falls, while the remaining cases were caused by road traffic accidents (RTAs). Out of the total 70 instances, 52 cases (74.28%) exhibited right-side dominance, whereas 18 cases (25.72%) exhibited left-side dominance. Within our case study group, 56 (80%) cases fell under modified Mason's classification type Ill, totaling 56 instances. The remaining 20% of the cases, amounting to 11 cases, were classified as modified Mason's classification type IV. Among the 70 patients, 55 cases (78.58%) did not have any ligamentous damage, whereas seven (10%) cases had lateral ulnar collateral ligament (LUCL) injury and eight (11%) cases had medial collateral ligament (MCL)injury. The P value for flexion, extension, pronation, and supination was shown to be very significant. Out of the total, 47 (67%) instances had an MEPI score (Mayo Elbow Performance Index) of more than 90, indicating exceptional performance. In addition, 16 cases (22.85%) had an MEPI score ranging from 75 to 89, which is considered a good result. Lastly, seven cases (10%) had an MEPI score ranging from 60 to 74, indicating a fair result. Conclusion The use of a radial head prosthesis is considered a viable option for managing severe and irreparable fractures of the radial head. Effective outcomes hinge on meticulous preoperative planning, skilled intraoperative techniques, and intensive postoperative rehabilitation. These elements collectively contribute to achieving consistent and favorable results in patients undergoing this surgical intervention.

Combined Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction Using a Flexible Reaming System

The combination of anterior cruciate ligament (ACL) and anterolateral ligament (ALL) reconstruction represents a therapeutic modality that exhibits superior clinical efficacy for certain risk groups when compared with isolated ACL reconstruction. This approach is progressively gaining broader applicability owing to its inherent prospective advantages. Despite the absence of a universally acknowledged gold-standard surgical technique, several methods have been delineated for its implementation. Typically, conventional practice involves the creation of distinct individual tunnels in the femur, followed by graft fixation using interference screws. However, the conventional steps in the technique are not without potential drawbacks. These include tunnel convergence, screw migration, screw irritation, and the risk of lateral collateral ligament injury. The manifestation of such unfavorable outcomes can necessitate a subsequent surgical intervention for effective management. Consequently, adopting a single socket-shaped tunnel strategy for concurrent reconstruction of the ACL and ALL, coupled with femoral fixation using an adjustable-loop button facilitated by a flexible reaming system, presents potential advantages. This alternative approach can mitigate the aforementioned risks by minimizing morbidity and preserving bone stock. The technique is feasible and reproducible, offering a pragmatic avenue for optimizing clinical outcomes in combined ACL and ALL reconstruction.

Surgeon Factors Rather than Patient Factors Account for Variation in Recommended Treatment Strategy for Patients with Multi-ligament Knee Injury

Objectives: To seek the factors associated with timing, staging, and type of surgery in the management of multi-ligament knee injuries. Design: Cross-sectional scenario-based experiment. Setting: 15 fictional patient scenarios with randomized elements. Participants: Fracture surgeons of the Science of Variation Group, an international collaborative of musculoskeletal surgeons that studies variation in care, were invited to participate. Surgeons with limited experience treating multi-ligament knee injuries were asked to self-exclude. Outcome measures and comparisons: Surgeon recommendations for operative treatment, timing of surgery, and use of open surgery in addition to arthroscopy were measured. Patient factors (age, time from injury, contralateral fracture, knee dislocation, combinations of ruptured ligaments, pre-existing osteoarthritis) and surgeon factors (gender, practice location, years of experience, supervision of trainees) associated with surgeon recommendations were assessed. Results: Eighty-five surgeons participated, of which most were men (89%) and practiced in the United States (44%) or Europe (38%). Operative treatment was less likely among older patients (OR=0.051) and pre-existing osteoarthritis (OR=0.32), and more likely in knee dislocation (OR=1.9) and disruption of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and lateral collateral ligament (LCL) with or without medial collateral ligament (MCL; OR=5.1 and OR=3.1, respectively). Disruption of ACL, PCL, and MCL was associated with shorter time to surgery (β=-11). Longer time to surgery was associated with contralateral fracture (β=9.2), and surgeons supervising trainees (β=23) and practicing in Europe (β=13). Surgeon factors accounted for more variation in timing than patient and injury factors (5.1% vs 1.4%, respectively). Open surgery was more likely in patients with LCL injury (OR=2.9 to 3.3). Conclusion: The observation that surgeons were more likely to operate in younger patients with more severe injury has face validity, while the finding that surgeon factors accounted for more variation in timing of surgery than patient or injury factors suggests that treatment variation is based on opinion more so than evidence. Level of Evidence: Level III. See Instructions for Authors for a complete description of levels of evidence.

Tibial plateau fractures are associated with ligamentous and meniscal injuries. Preoperative evaluation of magnetic resonance imaging influences surgical treatment.

Tibial plateau fractures (TPFs) are usually associated with ligamentous or meniscal injuries that could remain misdiagnosed. An appropriate and early recognition may change the surgical management of these soft tissue injuries (STIs) that could be addressed concomitantly with TPF treatment. Magnetic resonance imaging (MRI) is an efficient diagnostic test to identify all associated STIs in TPFs. This study aims to analyze the MRI impact in identifying and guiding the STIs treatment in TPFs. This retrospective study included a consecutive series of 57 patients with TPFs treated between January 1st, 2022, and December 31st, 2022. All fracture patterns were classified according to the AO/OTA and Schatzker classification. The prevalence of STIs, including medial meniscus (MM), lateral meniscus (LM), anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL) injuries, was assessed through the MRI evaluation. A statistical significance was found regarding the MRI detection of LM, ACL, PCL and MCL injuries that led to additional surgical procedures at the same time as the TPFs treatment (p < 0.05). In contrast, the amount of additional MM and LCL injuries identified by MRI, which resulted in other surgical procedures, was not statistically significant (p > 0.05). Preoperative MRI has been demonstrated to be an effective procedure for diagnosing STIs in TPFs, significantly influencing and changing the surgical treatment. IV.

Transformer-Based Multilabel Deep Learning Model Is Efficient for Detecting Ankle Lateral and Medial Ligament Injuries on Magnetic Resonance Imaging and Improving Clinicians’ Diagnostic Accuracy for Rotational Chronic Ankle Instability

To develop a deep learning (DL) model that can simultaneously detect lateral and medial collateral ligament injuries of the ankle, aiding in the diagnosis of chronic ankle instability (CAI), and assess its impact on clinicians' diagnostic performance. DL models were developed and external validated on retrospectively collected ankle MRIs between April 2016 and March 2022 respectively at three centers. Included patients were confirmed diagnoses of CAI through arthroscopy, as well as individuals who had undergone MRI and physical examinations that ruled out ligament injuries. DL models were constructed based on a multi-label paradigm. A transformer-based multi-label DL model (AnkleNet) was developed and compared with four convolution neural network (CNN) models. Subsequently, a reader study was conducted to evaluate the impact of model assistance on clinicians when diagnosing challenging cases: identifying rotational CAI (RCAI). Diagnostic performance was assessed using area under the receiver operating characteristic curve (AUC). Our transformer-based model achieved AUC of 0.910 and 0.892 for detecting lateral and medial collateral ligament injury, respectively, both of which was significantly higher than that of CNN-based models (all P < 0.001). In terms of further CAI diagnosis, it exhibited a macro-average AUC of 0.870 and a balanced accuracy of 0.805. The reader study indicated that incorporation with our model significantly enhanced the diagnostic accuracy of clinicians (P = 0.042), particularly junior clinicians, and led to a reduction in diagnostic variability. The code of the model can be accessed at https://github.com/ChiariRay/AnkleNet. Our transformer-based model was able to detect lateral and medial collateral ligament injuries based on MRI and outperformed CNN-based models, demonstrating a promising performance in diagnosing CAI, especially RCAI patients.

The presence of a deep lateral femoral notch sign in ACL-injured patients is associated with a 2.7° steeper posterior tibial slope and a 19% higher frequency of lateral meniscal injuries.

The purpose of this study was to study the relationship between the presence of a deep lateral femoral notch sign (DLFNS) in anterior cruciate ligament (ACL)-injured patients and a higher posterior lateral tibial slope (LPTS), a reduced meniscal bone angle (MBA), a higher LPTS/MBA ratio and a higher incidence of concomitant injuries in primary ACL tears. A retrospective case-control study was performed in patients submitted to primary ACL reconstruction with an available preoperative magnetic resonance imaging (MRI) scan. Patients with ACL tears and a femoral impactation with a depth ≥2 mm were assorted to the DLFNS groupand patients with ACL tear and without a DLFNS to the control group. LPTS and MBA were measured in MRI. The presence of concomitant injuries (meniscal, posterior cruciate ligament, medial collateral ligament, lateral collateral ligament and bone injuries) was assessed in MRI. Quantitative data are presented in the median ± interquartile range (IQR). There were 206 patients included in the study, with 46 patients assorted to the DLFNS group and 160 patients to the control group. In the DLFNS group, the median LPTS was 6.7° (IQR: 4.0-8.2) versus 4.0° in the control group (IQR: 2.2-6.5) (p = 0.003). The LPTS/MBA ratio was significantly higher in the DLFNS group, with a median of 0.32 (IQR: 0.19-0.44), in comparison to the control group, with a median of 0.19 (IQR: 0.11-0.31) (p < 0.001). The multivariable logistic regression analysis showed that the LPTS is an independent risk factor to having a DLFNS (odds ratio [OR] = 1.161; 95% confidence interval [CI]: 1.042-1.293, p = 0.007). There was a higher incidence of concomitant lateral meniscal injuries in the DLFNS group (67% vs. 48%, p = 0.017). In patients with ACL tears, the presence of a DLFNS is associated with a steeper lateral posterior tibial slope, as well as a higher incidence of concomitant lateral meniscal injuries. Level III.

A Novel Fixation Method of the Graft to the Fibular Head in Knee Lateral Collateral Ligament Reconstruction: Technical Note.

The lateral collateral ligament (LCL) is the strongest lateral stabilizer of the knee. It provides support against varus stress and posterolateral rotation of the knee. Lateral collateral ligament injuries mostly occur together with anterior and/or posterior cruciate ligament injuries. While grades 1 and 2 injuries are treated conservatively since they are partial injuries, total ruptures, as in grade 3, require surgical treatment. In conventional LCL reconstruction methods, hamstring grafts are used, and bioscrews are used in bone-tendon fixation. Lateral collateral ligament reconstruction is usually performed as a component of multiple ligament surgery. Therefore, there is a need for a contralateral hamstring tendon or allograft. The present article aims to define a technique that does not require tendon grafts and bioscrews in fibular fixation.

Combined ACL and Anterolateral Ligament Reconstruction Using an Adjustable-Loop Fixation Device: Surgical Technique

Background: There are several techniques for the combined reconstruction of the anterior cruciate ligament (ACL) and the anterolateral ligament (ALL), but none have shown superiority. This study aims to present a surgical technique that theoretically reduces some of the risks reported in these procedures. Indications: The main indications for the ALL reconstruction include chronic ACL injuries, revision ACL reconstruction, acute ACL injuries in patients with high-grade pivot-shift (grades 2 or 3), patients involved in pivoting sports, and generalized ligament hyperlaxity or knee hyperextension. Technique Description: Hamstring tendon autografts are used for the ACL and ALL reconstruction; a common femoral ACL and ALL tunnel is made outside-in, making a short socket. A continuous looped hamstring tendon autograft attached to one button is used. The ACL is fixed with an adjustable-loop button. Through small incisions, the tibial fixation of both grafts is performed with bioabsorbable screws. Results: We present a 19-year-old professional soccer player with an acute ACL tear, with no associated meniscal or chondral lesions. Owing to his young age and high-risk sports practice, a combined ACL and ALL reconstruction was performed. The combined ACL and ALL reconstruction with a single femoral tunnel using the hamstrings tendons graft is a well-established procedure for ACL augmentation, reducing failure rates for certain risk groups, with excellent outcomes reported. The use of an adjustable-loop button on the femur is a viable option for this kind of reconstruction with postoperative stability comparable to the interference screw, classically used for this kind of reconstruction. Discussion/Conclusion: This technique has some advantages, such as the use of a short outside-in femoral socket, thus theoretically improving healing. In addition, this lowers the risk of lateral collateral ligament injury, and since the ileotibial band graft is not used, the risk of injuring the lateral inferior genicular vessels and the peroneal nerve is theoretically reduced. Besides, using an adjustable-loop cortical button in the femur can theoretically reduce potential complications such as screw migration, soft-tissue impingement, femoral-site pain, and implant removal. Finally, the reconstruction is done with small incisions, improving the aesthetic result and postoperative pain. Considering all the aforementioned factors, this technique theoretically offers some benefits. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Retracted: Application of Doctor-Nurse-Patient Co-Decision-Making Nursing Intervention Based on Evidence-Based Problems in the Rehabilitation of Acute Ankle Lateral Collateral Ligament Injury.

[This retracts the article DOI: 10.1155/2022/2363230.].

Capitellum Fracture: Surgical Exposure and Fixation Strategies

Fractures of the capitellum are uncommon, often accompanied by radial head or lateral collateral ligament injuries, and typically treated operatively. Operative fixation is often technically challenging due to limited surgical windows, limited bone stock for fixation, its articular nature, and fracture extension into the trochlea or condyles. The goal of treatment is stable internal fixation to permit an early range of motion. Aside from open reduction internal fixation (ORIF), alternative treatment options include fragment excision and arthroscopic assisted reduction and fixation. Here we detail our preferred approach to treat capitellum fractures, including, preoperative planning, surgical anatomy, surgical setup and technique utilizing a posterior utility incision and olecranon osteotomy, postoperative care, and avoidance of potential complications.

The Incidence of the Associated Meniscal Ligament (ML) With the Anterior Cruciate Ligament (ACL) Tears

Objective: To assess the incidence of the associated meniscal ligament (ML) with the anterior cruciate ligament (ACL) tears in hospital A in Medina-KSA. And to see the effect of sports activities in comparison between males and females. &#x0D; Materials and Methods: In a retrospective study, ninety-nine patients' knee magnetic resonance imaging (MRI) records were selected conveniently from the (A) hospital's picture archiving and communication system (PACS). Patients with suspected anterior cruciate and meniscal ligament' tears were included. Patients with posterior cruciate ligament (PCL) tear, medial collateral ligament (MCL) or lateral collateral ligament (LCL) injury, and previously operated index knees were excluded. All patients were scanned by a 1.5T MRI machine using standard MRI knee scanning protocol. The categorical and continuous variables were presented as percentages, frequencies, and descriptive statistics. The cross-tabulations and chi-square test were applied to obtain the statistical associations between the study variables. A statistical association was considered significant if the P-value was &lt; 0.05. &#x0D; Results: 72 males and 27 females were included, with a mean age of 33 ± 2.43. 42.4% of the knee tears were ML tears, followed by associated (ACL with ML) tears, noted in 31.3%, and 26.3% were ACL tears. The tears were more frequent in the age group (31-40), reported in 35.3% (out of 99). There was no statistical association between the tears and the participants' age, gender, or sports activities; P value = 0.3, 0.5, and 0.9, respectively. &#x0D; Conclusion: The study concluded that the isolated ML tears were more frequent than the associated (ACL with ML) tears—moreover, there was no significant statistical association between the participants' age, gender, or sports activities.

Outcomes and complications after treatment for anteromedial facet fracture of the coronoid process: A systematic review

BackgroundFracture of the anteromedial facet (AMF) of the coronoid process is associated with varus posteromedial rotatory instability (VPMRI). However, there is still controversy regarding the optimal treatment for AMF fracture. The purpose of this study is to report on a systematic review of the outcomes and complications after treatment for AMF fracture. MethodsThis study was conducted using electronic databases, PubMed, EMBASE and Scopus. Studies reporting outcome scores and complications were included. Studies that did not utilize O'Driscoll classification for AMF fractures were excluded. Through conduct of a thorough review of included studies, definite VPMRI were identified and cases involving other injury mechanisms were excluded. ResultsFifteen articles reporting on 246 patients were included. According to O'Driscoll classification, 6.2% of cases were anteromedial subtype I, 73.7% were subtype II, and 20.1% were subtype III. Two-hundred sixteen patients (87.8%) were treated surgically and 30 patients (12.2%) were treated conservatively. Lateral collateral ligament (LCL) injuries were 76.2% (157/206) and medial collateral ligament injuries were 16.9% (33/195). Among 216 cases who underwent surgical treatment, depending on the fragment size, displacement, and instability, coronoid fixation was performed in 189 cases and LCL repair alone was performed in 27 cases. The mean final Mayo Elbow Performance Score was 92.1 and the Broberg & Morrey score was 89.5. The overall complication and reoperation rates were 17.7% (41/232) and 12.9% (26/202). ConclusionsBoth surgical and conservative treatment for AMF fractures resulted in satisfactory final clinical outcomes. However, high complication and reoperation rates were observed.

Isolated distal grade III lateral collateral ligament injury: what is the real clinical impact in professional athletes?

The isolated III grade lateral collateral ligament injuries are rare, and there is limited literature available on their management. We report 3 cases of professional soccer players with isolated distal lateral collateral ligament III grade injury, confirmed by MRI studies. After undergoing MRI examinations, all three players resumed competitive activity without resting and experienced no consequences regarding joint stability. We assessed the significance of the lateral collateral ligament in providing lateral stabilization to the knee joint in professional footballers with clinical tears of the lateral collateral ligament. The other structures of posterolateral area that remain intact contribute to joint stability, and the lateral collateral ligament's extra-articular position appears to expedite the ligament's healing process. Therefore, we propose a possible conservative treatment approach, mostly for professional athletes and adolescent patients, involving a rehabilitation plan without the need for surgery.

Diagnostic Accuracy of Conventional Ankle CT Scan With External Rotation and Dorsiflexion in Patients With Acute Isolated Syndesmotic Instability

Category: Ankle; Sports Introduction/Purpose: Syndesmotic injury in an athletic population is associated with a prolonged ankle disability after an ankle sprain and often requires a longer recovery than a lateral collateral ligament injury. Although several imaging tests are available, diagnosing syndesmotic instability remains challenging. The main objective was to determine the diagnostic accuracy of conventional ankle computed tomography (CT) scans with the joint in external rotation and dorsiflexion and compare it with that of conventional ankle CT scans in a neutral position. Methods: Between September 2018 and April 2021, this prospective study consecutively included adults visiting the foot and ankle outpatient clinic with a positive orthopedic examination for acute syndesmotic injury. Participants underwent 3 CT scan tests. First, ankles were scanned in a neutral position. Second, ankles were scanned with 45° of external rotation, dorsiflexion, and extended knees. Third, ankles were scanned with 45° of external rotation, dorsiflexion, and flexed knees. Three measurements, comprising rotation (measurement a), lateral translation (measurement c), and anteroposterior translation (measurement f) of the fibula concerning the tibia, were used to diagnose syndesmotic instability in the 3 CT scans. Magnetic resonance imaging was used as a reference standard. The area under the curve (AUC) was used to compare the diagnostic accuracy, and Youden’s J index was calculated to determine the ideal cutoff point. Results: Images obtained in 68 participants (mean age, 36.5 years; range, 18-69 years) were analyzed, comprising 36 syndesmotic injuries and 32 lateral collateral ligament injuries. The best diagnostic accuracy occurred with the rotational measurement a, in which the second and third CT scans with stress maneuvers presented greater AUCs (0.97 and 0.99) than the first CT scan in a neutral position (0.62). The ideal cutoff point for the stress maneuvers was 1.0 mm in the rotational measurement and reached a sensitivity and specificity of 83% and 97% for the second CT scan with extended knees and 86% and 100% for the third CT scan with flexed knees, respectively. Conclusion: Conventional ankle CT with stress maneuvers has excellent performance for diagnosing subtle syndesmotic rotational instability, as it shows a greater AUC and enhanced sensitivity at the ideal cutoff point compared with ankle CT in the neutral position.

Effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament tibial insertion fracture in adults

To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults. Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing. All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results ( Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results ( P<0.05). For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient's knee joint function recovers well.

The Management of Elbow Dislocations and Associated Lesions: A Review Article

Dislocations around the elbow joint can be isolated (termed a simple elbow dislocation), or occur with concurrent ligamentous and/or bony injuries. In cases of a simple elbow dislocation, surgery is rarely required. Patients should be evaluated radiographically for a concentric reduction, immobilized for 7-10 days, and begin early range of motion activities. In patients who return for follow-up with no bony injuries but a loss of concentric reduction, surgical treatment is recommended. This may consist of static or dynamic external/internal fixation or direct repair of the damaged ligamentous structures. Fractures associated with elbow dislocations may be difficult to identify and require computed tomography (CT) scans to characterize. A terrible triad injury consists of a radial head fracture, coronoid fracture, and ulnohumeral dislocation. This may be associated with lateral collateral ligament (LCL) and/or medial collateral ligament (MCL) injuries. These injuries require operative treatment with open reduction and internal fixation of the coronoid, fixation or replacement of the radial head, and repair of damaged ligamentous structures, depending on the specific injuries.

Study on the effects of sports induced injuries on Janu sandhi (knee joint) marma - A retrospective observational study

In Ayurvedic samhita, it is explained that marma viddha lakshana are caused due to aghat (trauma). Sports injuries are concerned with traumatic injuries. Comparative study of marma sharira vigyan in shalyatantra of ayurveda with modern aspects of sports medicine can aware a sportsmen about the injuries. Janu sandhi (knee joint) is the mostly used joint in various sports leading to a wide range of injuries. The aim of this study was to evaluate sports injuries especially in Janusandhi Marma and structural damage occurring in it. The viddh lakshannas(traumatic injuries) of Janu Marma are limping (Khanjata) and the objective of this study is to determine the specific injury at the knee joint that might cause limping. Total 30 patients were selected as per the inclusion and exclusion criteria mention in proforma. Observation &amp; Results were noted with the help of Objective criteria mentioned in the proforma which included sports wise distribution, types of injury, mode of trauma, structural deformities clinical examination score and final diagnosis in study group. The result was Maximum patients had Medial Collateral Ligament involvement followed by Anterior Cruciate Ligament &amp; Medial Meniscus injuries. Patellar injuries and Lateral Collateral Ligament injuries were comparatively less. So it was concluded that with the assessment of clinical examination score it is possible to judge the severity of trauma to janu sandhi marma and the structures involved in the traumatic injuries amongst sports athletes. This study can be helpful for deciding the treatment regime of the patient.

Patient demographic and magnetic resonance imaging evaluation of isolated posterolateral corner knee injuries.

Posterolateral stability of the knee is maintained by capsular, ligamentous and tendinous structures, which collectively are known as the posterolateral corner (PLC). Injuries to the PLC of the knee rarely occur without associated anterior (ACL) or posterior cruciate (PCL) ligament tears. The main objectives of our study were to report patient demographics and magnetic resonance imaging (MRI) findings of patients with isolated PLC injuries. This study consists of a retrospective analysis of knee MRI from January 2011 to June 2016, in two hospitals in São Paulo, Brazil, where PLC injuries without associated ACL and PCL injuries were identified in MRI by two radiologists specialized in musculoskeletal injuries. Relative and absolute frequencies were used to describe the injuries of each of the PLC structures in the study cases. A total of 23 cases of PLC injuries without associated cruciate ligament injuries were identified. The mean age of patients was 32.0±8.1 years and 91% patients were male. The main sport associated with isolated PLC injury was Brazilian Jiu-Jitsu (48%), followed by soccer (35%). MRI evaluations of the knees showed lateral collateral ligament (LCL) injuries in 70% of cases, popliteus tendon injuries in 26% of cases and distal biceps tendon injuries in 30% of cases. The popliteofibular ligament (PFL) was damaged in 83% of cases. An associated ALL injury was observed in 43% of cases. Isolated PLC injuries occurred mainly in young men when practicing Brazilian Jiu-Jitsu and soccer. The LCL was the most frequently injured larger structure in association, and the capsuloligamentous structures (PFL) were the most frequently injured structures overall. ALL injuries occurred in approximately half of the cases, most often concomitantly with LCL injuries.

Diagnostic Accuracy of Conventional Ankle CT Scan With External Rotation and Dorsiflexion in Patients With Acute Isolated Syndesmotic Instability

Background: Syndesmotic injury in an athletic population is associated with a prolonged ankle disability after an ankle sprain and often requires a longer recovery than a lateral collateral ligament injury. Although several imaging tests are available, diagnosing syndesmotic instability remains challenging. Purpose: To determine the diagnostic accuracy of conventional ankle computed tomography (CT) scans with the joint in external rotation and dorsiflexion and compare it with that of conventional ankle CT scans in a neutral position. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Between September 2018 and April 2021, this prospective study consecutively included adults visiting the foot and ankle outpatient clinic with a positive orthopaedic examination for acute syndesmotic injury. Participants underwent 3 CT scan tests. First, ankles were scanned in a neutral position. Second, ankles were scanned with 45° of external rotation, dorsiflexion, and extended knees. Third, ankles were scanned with 45° of external rotation, dorsiflexion, and flexed knees. Three measurements, comprising rotation (measurement a ), lateral translation (measurement c ), and anteroposterior translation (measurement f ) of the fibula concerning the tibia, were used to diagnose syndesmotic instability in the 3 CT scans. Magnetic resonance imaging was used as a reference standard. The area under the curve (AUC) was used to compare the diagnostic accuracy, and Youden’s J index was calculated to determine the ideal cutoff point. Results: Images obtained in 68 participants (mean age, 36.5 years; range, 18-69 years) were analyzed, comprising 36 syndesmotic injuries and 32 lateral collateral ligament injuries. The best diagnostic accuracy occurred with the rotational measurement a , in which the second and third CT scans with stress maneuvers presented greater AUCs (0.97 and 0.99) than did the first CT scan in a neutral position (0.62). The ideal cutoff point for the stress maneuvers was 1.0 mm in the rotational measurement a and reached a sensitivity and specificity of 83% and 97% for the second CT scan with extended knees and 86% and 100% for the third CT scan with flexed knees, respectively. The ideal cutoff point for the first CT scan with a neutral position was 0.7 mm in the rotational measurement a , with a sensitivity of 25% and specificity of 97%. Conclusion: Conventional ankle CT with stress maneuvers has excellent performance for diagnosing subtle syndesmotic rotational instability, as it shows a greater AUC and enhanced sensitivity at the ideal cutoff point compared with ankle CT in the neutral position.

The Association Between Bone Bruises and Concomitant Ligaments Injuries in Anterior Cruciate Ligament Injuries: A Systematic Review and Meta-analysis.

Bone bruises and concomitant ligament injuries after anterior cruciate ligament (ACL) injuries have attracted attention, but their correlation and potential clinical significance remain unclear. To assess the relationship between bone bruises and concomitant ligamentous injuries in ACL injuries. Systematic review. A comprehensive search of PubMed, Embase, Web of Science, and Cochrane Library was completed from inception to October 20, 2021. All articles that evaluated the relationship between bone bruises and related ligaments injuries were included. Methodological Index for Non-Randomized Studies (MINORS) was used for quality assessment as well as Review Manager 5.3 was used for data analysis. A total of 19 studies evaluating 3292 patients were included. After meta-analysis, anterolateral ligament (ALL) injuries were associated with bone bruising on the lateral tibial plateau (LTP) (RR = 2.33; 95% CI 1.44-3.77; p = 0.0006), lateral femoral condyle (LFC) (RR = 1.97; 95% CI 1.37-2.85; p = 0.0003) and medial tibial plateau (MTP) (RR = 1.62; 95% CI 1.24-2.11; p = 0.0004); Moreover, medial collateral ligament (MCL) injuries were associated with bone bruising on the femur (RR = 1.49; 95% CI 1.17-1.90; p = 0.001), and no statistical significance was found between bone bruising on the MTP and Kaplan fiber (KF) injuries (RR = 1.58; 95% CI 1.00-2.49; p = 0.05). Nonetheless, the current evidence did not conclude that bone bruises were associated with lateral collateral ligament (LCL) injuries. For individuals with an ACL injury, bone bruises of the LTP, LFC, and MTP can assist in the diagnosis of ALL injuries. Furthermore, femoral bruising has potential diagnostic value for MCL injuries. Knowing these associations allows surgeons to be alert to ACL-related ligament injuries on MRI and during operations in future clinical practice.