Medial Collateral Ligament Injury Research Articles

Effectiveness of Ultrasound-guided Platelet-rich Plasma Injection Vs Pulsed Ultrasound Therapy on Improving Pain and Function in Athletes with Medial Collateral Ligament Injury of Knee: A Randomised Controlled Trial

Effectiveness of Ultrasound-guided Platelet-rich Plasma Injection Vs Pulsed Ultrasound Therapy on Improving Pain and Function in Athletes with Medial Collateral Ligament Injury of Knee: A Randomised Controlled Trial

Recent Advances in Non Surgical Rehabilitation Approaches for Medial Collateral Ligament Injuries: A Narrative Review

Recent Advances in Non Surgical Rehabilitation Approaches for Medial Collateral Ligament Injuries: A Narrative Review

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. 
 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 < 0.05. 
 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. 
 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.

QUANTIFYING ANTERIOR MEDIAL ROTATIONAL STABILITY IN ANTERIOR CRUCIATE LIGAMENT-INJURED PATIENTS WITH ASSOCIATED COLLATERAL INVOLVEMENT

IntroductionAnterior tibial translation (ATT) is assessed in the acutely injured knee to investigate for ligamentous injury and rotational laxity. Specifically, there is a growing recognition of the significance of anterior medial rotary laxity (AMRI) as a crucial element in assessing knee stability. Anterior cruciate ligament (ACL) injuries are often accompanied with medial collateral ligament (MCL) damage. It has been suggested that Deep MCL (dMCL) fibres are a primary restraint in rotational displacement. This research aims to quantify the difference in rotational laxity of patients with ACL and MCL injuries to deem if the Feagin-Thomas test can robustly capture metrics of AMRI. 2.MethodsAMRI was assessed using the Feagin-Thomas test in 7 isolated ACL (iACL) injured participants, 3 combined ACL and superficial fibre MCL (sMCL) injuries, 5 combined ACL and deep fibre MCL injuries, and 21 healthy controls. Displacement values were recorded using an optical motion capture (OMC) system and bespoke processing pipeline which map and model the knee's anterior displacement values relative to the medial compartment. Since absolute values (mm) of rotational laxity vary dependant on the person, values were recorded as a proportion of the rotational laxity obtained from the subject's contralateral leg. Values were compared between each patient group using an ANOVA test and Tukey's honesty significant difference post hoc test. 3.ResultsThe healthy control group had a median proportion of 0.97 (3SF), whilst the iACL was 1.12 (3SF), a 12% increase in rotational laxity in the injured leg. The sMCL group yielded a result of 1.64 (3SF), a 64% increase in rotational laxity in the injured leg; finally, dMCL resulted in a proportion of rotational laxity of 1.90 (3SF), a 90% increase in rotational laxity [table 1]. Whilst all groups showed differences in the increase of rotational laxity, dMCL was significantly different from the healthy control group (P value 0.0041). 4.ConclusionACL injuries with MCL involvement led to an increase in anterior medial rotary laxity and this is more evident in patients where deep MCL fibres are involved. The Feagin-Thomas test appears to be sensitive in detecting differences in AMRI and should be considered when performing comprehensive clinical knee examination.For any figures or tables, please contact authors directly.

Shear wave elastography demonstrates different material properties between the medial collateral ligament and anterolateral ligament

BackgroundAnterolateral ligament and medial collateral ligament injuries could happen concomitantly with anterior cruciate ligament ruptures. The anterolateral ligament is injured more often than the medial collateral ligament during concomitant anterior cruciate ligament ruptures although it offers less restraint to knee movement. Comparing the material properties of the medial collateral ligament and anterolateral ligament helps improve our understanding of their structure-function relationship and injury risk before the onset of injury. MethodsEight cadaveric lower extremity specimens were prepared and mechanically tested to failure in a laboratory setting using a hydraulic platform. Measurements of surface strains of superficial surface of each medial collateral ligament and anterolateral ligament specimen were found using three-dimensional digital image correlation. Ligament stiffness was found using ultrasound shear-wave elastography. t-tests were used to assess for significant differences in strain, stress, Young's modulus, and stiffness in the two ligaments. FindingsThe medial collateral ligament exhibited greater ultimate failure strain along its longitudinal axis (p = 0.03) and Young's modulus (p < 0.0018) than the anterolateral ligament. Conversely, the anterolateral ligament exhibited greater ultimate failure stress than the medial collateral ligament (p < 0.0001). Medial collateral ligament failure occurred mostly in the proximal aspect of the ligament, while most anterolateral ligament failure occurred in the distal or midsubstance aspect (P = 0.04). InterpretationDespite both being ligamentous structures, the medial collateral ligament and anterolateral ligament exhibited separate material properties during ultimate failure testing. The weaker material properties of the anterolateral ligament likely contribute to higher rates of concomitant injury with anterior cruciate ligament ruptures.

Lateral subvastus approach to total knee arthroplasty: A novel surgical technique and retrospective review of 931 consecutive cases

BackgroundThe lateral muscle-sparing approach total knee arthroplasty (TKA) has been detailed and indicated selectively for severe valgus deformities. We present the largest, to date, consecutive series of lateral subvastus TKAs and we hypothesize that preoperative alignments would demonstrate no differences in range of motion (ROM), knee society scores (KSS), kneeling ability, patient satisfaction, or complications. Materials and methodsThis retrospective study examined 931 primary TKAs in 824 patients performed through the lateral subvastus approach with one to two years follow-up. All primary TKAs performed between July 2020 and February 2022 were included. We used descriptive statistics, chi-squares, and analysis of variance (ANOVA) to examine the cohort. Significance was set to p < .05. ResultsPatient's ROM significantly improved by six weeks, (1–117°, P < .05) with continued improvement by one-year, (0–121, P < .05) with no significant differences in alignment in extension, (P = .142) or flexion, (P = .253). There were also no significant differences in alignment in KSS scores at six-weeks, (P = .635), three-months, (P = .829), six-months, (P = .836), one-year, (P = .641) or two-years, (P = .776). There were no significant differences in kneeling ability, (P = .563), and 85% of patients reported being able to kneel. There were no differences in patient satisfaction, (P=.436), and 90% of patients reported being satisfied. There was a low 8% complication rate in this cohort. Neutral and varus knees were less likely than valgus knees to develop deep vein thrombosis (DVT; P < .05) or have a medial collateral ligament (MCL) injury (P < .05). ConclusionsPatients with varus, valgus, and neutral knees had similar outcomes when using a lateral subvastus approach to TKA in ROM and KSS that were stable over two years with similar kneeling ability and satisfaction. There was a low incidence of complications with neutral and varus knees at the lowest risk. A lateral subvastus approach to TKA can be safe and effective for all knee deformities.

Treatment of recalcitrant femur nonunion with pedicled corticoperiosteal medial femoral condyle flap

Periosteal or osteoperiosteal medial femoral condyle (MFC) flaps may be good options for atrophic nonunion. The aim of this study was to evaluate the effectiveness and safety of pedicled MFC flap in the treatment of recalcitrant femur nonunion without bone defect. Thirteen patients (11 male and 2 female), who suffered recalcitrant femur nonunion and were treated with pedicled osteoperiosteal MFC flap between January 2014 and April 2018, were included in this study. Patient files were reviewed retrospectively. Atrophic or recalcitrant 2/3 distal femoral nonunion were the indications for this clinical procedure. Demographics and operative data, flap size, visual analog scale (VAS) score, time to union, and complications were evaluated. A total of 13 patients underwent femur nonunion treatment with MFC flap after an average of 3.4 previous surgical procedures. The median age was 34 (Q1: 32.5, Q3:43) years old. The mean flap size was 4.3 × 6.4 cm, all nonunions healed in a median 5 months (Q1: 4.5, Q3: 6). There were an intraoperative knee medial collateral ligament injury in a patient, hematoma in a patient, and seroma in two patients. The median length of the follow-up was 40 months (Q1: 30, Q3: 47). There wasn’t any additional complication in long-term follow-up. Functional outcomes were satisfactory. The median preoperative VAS score was 7 (Q1: 6, Q3: 9.5), decreasing to 1 (Q1: 0, Q3: 1) at the 6-month follow-up, and further reducing to 0 (Q1: 0, Q3: 1) at the 24-month follow-up. The nonunion period ranged from 6 to 18 months. The pedicled MFC flap is a good option for recalcitrant femur nonunion where larger vascularized flaps are not warranted. It is easy to harvest, does not require microvascular anastomosis, is effective, and offers minimal donor site morbidity.

The effects of knee ligament load using simulated hip abductor and hamstring muscle strengthening during cutting maneuver.

This study aimed to analyze knee ligament of load and joint moment to simulate the strengthening of the hip abductor and hamstring muscles using musculoskeletal modeling, thereby contributing to decrease of knee ligament load. Forty participants (age: 21.85 ± 1.90 years; height: 1.76 ± 0.06 m; body mass: 68.5 ± 7.06 kg) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their feet on the force plate, and perform the cutting maneuver on the left. In the musculoskeletal modeling, the hip abductor and hamstring muscles were targeted to construct a model with a 30% increase in the contraction force of the hip abductor, hamstring, and both 2 muscles. The variables were the ligament force and knee joint moment. One-way repeated measure ANOVA and Bonferroni test were used to compare the abductor/hamstring, abductor, hamstring and control models. There were significant differences in anterior bundle of the anterior cruciate ligament (ACL) (P = .001), inferior bundle of the superficial layer of the medial collateral ligament (MCL) (P = .016), and posterior bundle of the superficial layer of the MCL (P = .022) force. The post hoc showed that the hamstring model had lower anterior bundle of the ACL and inferior bundle of the superficial layer of the MCL than the abductor/hamstring and abductor models (P < .05) and lower posterior bundle of the superficial layer of the MCL than the abductor and control models (P < .05). There was a significant difference in the adduction (P = .028) and internal rotation moments (P = .014). The post hoc showed that both moments were lower in the hamstring model than in the other models (P < .05). The hamstring strengthening may contribute significantly to preventing ACL or MCL injury by reducing knee ligament load.

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.

Weave Technique for Reconstruction of Medial Collateral Ligament and Posterior Oblique Ligament: A Functional Percutaneous Approach Using Gracilis Tendon

Background: Injury to the medial collateral ligament (MCL) is common. MCL injuries, with impairment of its superficial portion, associated with the deep portion, lead to valgus instability and extrusion of the medial meniscus, resulting in instability and increased pressure in the medial compartment, with consequent damage to the cartilage. We can synthesize this set of structures as the medial meniscocapsular complex. Treating medial, superficial, and deep capsular meniscal complex together aims to restore the normal anatomy, stability, and function of the medial meniscus. Indications: • Anterior cruciate ligament with MCL grade III or MCL grade II • MCL grade III or grade II with clinical instability Technique Description: An arthroscopic examination was performed to assess the “floating meniscus” sign and to confirm a tear of the MCL. The gracilis tendon is harvested in a usual fashion, leaving its distal insertion pedicle fixed to the tibial bone. An incision over the medial epicondyle is made, and a 6-mm drill is used to create a 2.5-cm bone tunnel. The passage of the medial subfascial graft is made toward the medial epicondyle. At this point, its fixation is performed with an interference screw. After fixing the anterior arm, we will return with the free portion of the graft in the most posterior portion and also percutaneously. This posterior arm is biologically fixed, closing the sartorius fascia over the 2 arms of the reconstruction with periosteal stitches. Results: Reconstruction tests were performed on cadaver models, obtaining a graft tension without compromising the range of motion (ROM) and a good result in their final analysis. We ended up publishing our results in a clinical study, with good functional results in both the Lysholm and Tegner scores, at a follow-up of 2 years. Discussion/Conclusion: We present an arthroscopic-assisted technique for a medial, percutaneous, aesthetic, and extremely functional approach. A technical limitation of our procedure is the absence of a biomechanical test for the gracilis double reconstruction: a strong point is that we performed some reconstruction tests on cadaver models, obtained good visual results and graft tension without compromising the ROM, and performed a positive clinical study with a minimum follow-up of 2 years. In conclusion, a simple and inexpensive technique that uses known anatomic principles of graft placement, without compromising ROM was performed. 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.

Pattern in Simultaneous Rupture of the Medial Collateral Ligament and Anterior Cruciate Ligament Assessed by Magnetic Resonance Imaging

Background: Determining the exact details of complex traumatic injuries such as knee ligament rupture will be a crucial point in planning the surgical approach, which is determined through accurate imaging techniques such as magnetic resonance imaging (MRI). We aimed to evaluate the pattern of medial collateral ligament (MCL) rupture in patients who presented with simultaneous rupture of the anterior cruciate ligament (ACL) and MCL.&#x0D; Methods: We evaluated knee MRI in 44 patients (25 women and 19 men, mean age: 38.6 ± 5.4 years) who suffered from clinically acute simultaneous ACL and MCL injuries. Meniscus status, MCL rupture patterns, and pivot bone bruise were analyzed.&#x0D; Results: Concerning ACL rupture, 38.6% had a partial ACL rupture, and 61.4% had a complete rupture. The meniscus ruptured in 61.4%. The most common site of the meniscus rupture was related to the medial posterior horn (37.0%). The vertical type rupture was the most common (37.0%), followed by the horizontal rupture (29.6%). MCL rupture was present in all patients with grade 2 rupture revealed in 52.3%. Regarding the location of MCL ligament rupture, the highest ratio was found in the femoral site (65.9%). Semimembranosus rupture was observed in 2.3%. Pivot bone bruise was positive in 34.1%. Medial patellofemoral ligament (MPFL) rupture was also revealed in 68.2%. There was a significant relationship between the grade of rupture in the MCL and the presence of pivot bone bruise (P &lt; 0.001).&#x0D; Conclusion: Femoral detachment of MCL and posterior horn of medial meniscus (PHMM) are the most common sites of MCL injury and meniscus rupture in the context of ACL rupture. Besides, our results show a relevant influence of the extent of bone bruise on the grade of MCL rupture.

Contribution of the Medial Hamstrings to Valgus Stability of the Knee.

Multiligament knee injuries involving the medial side are common. When performing surgical reconstruction, use of the medial hamstrings (HS) as grafts remains controversial in this setting. To determine the role of the medial HS in stabilizing the valgus knee for different types of medial-sided knee injury. Controlled laboratory study. A biomechanical study on 10 cadaveric knees was performed. Valgus load (force moment of 10 N/m) was applied at 0°, 30°, and 60° of flexion, and the resultant rotation was recorded using an optoelectronic motion analysis system. Measurements were repeated for 4 different knee states: intact knee, superficial medial collateral ligament (sMCL) injury, deep medial collateral ligament (dMCL) injury, and posterior oblique ligament (POL) injury. For each state, 4 loading conditions (+ loaded; - unloaded) of the semitendinosus (ST) and gracilis (GRA) tendons were tested: ST+/GRA+, ST+/GRA-, ST-/GRA+, and ST-/GRA-. At 0° of flexion, combined unloading of the ST and GRA (ST-/GRA-) increased valgus laxity on the intact knee compared with the ST+/GRA+ condition (P < .05). For all medial-sided injury states (isolated sMCL; combined sMCL and dMCL; and combined sMCL, dMCL, and POL damage), ST-/GRA- increased valgus laxity at 0° and 30° of flexion versus ST+/GRA+ (P < .05 for all). The absolute value of valgus laxity increased with the severity of medial-sided ligament injury. Isolated ST unloading increased valgus laxity for the intact knee and the MCL-injured knee (combined sMCL and dMCL) at 0° of flexion (P < .05 vs ST+/GRA+). Isolated unloading of the GRA had no effect on valgus knee stability. The medial HS tendons contributed to the stabilization of the knee in valgus, and this was even more important when the medial side was severely affected (POL damage). This stabilizing effect was greater between 0° and 30°, in which the POL is the main valgus stabilizer. When deciding on graft selection for multiligament knee injury reconstruction, the surgeon should be aware of the effect of harvesting the medial HS tendon on valgus laxity.

Relationship between shoulder rotation deficit and elbow instability in healthy baseball players.

Elbow valgus instability is a risk factor for elbow medial collateral ligament injury. This study aimed to investigate the relationship between shoulder range of motion and elbow valgus instability using an ultrasound imaging system. A questionnaire and ultrasound examination were used for the study. Thirty-seven high school baseball players (15-18 years) with no history of shoulder or elbow disorders were included. Shoulder range of motion was measured at 90° of adduction, 10° of horizontal adduction, and 90° of elbow flexion in the supine resting position. To evaluate elbow valgus instability, an ultrasound imaging system was used to measure the shortest distance from the apex of the ulnar capitulum to the humeral glenoid with 2.5 kg of valgus stress applied to the ulnohumeral joint. The presence of elbow valgus instability was determined by the value obtained by subtracting the joint space distance on the non-throwing side from that on the throwing side. Student's t-test was applied for the range of shoulder rotation between the two groups, and Pearson's correlation coefficient was used for the relationship between the range of shoulder rotation and elbow instability. Statistical significance was set at 5%. The range of internal and total shoulder rotation was significantly lower in participants with elbow valgus instability than those without elbow valgus instability (P<0.001). In addition, a significant moderate correlation was found in the range of internal (r=0.608, P<0.001) and total shoulder (r=0.479, P<0.001) rotations. Decreased shoulder range of motion may affect elbow valgus instability.

Intra-operative Safety of an Autonomous Robotic System for Total Knee Replacement: A Review of 500 Cases in India.

Manual total knee arthroplasty (TKA) has been documented several times for their safety and complications data. In contrast, there is a limited evidence-based analysis for safety and complications of autonomous robotic-assisted (RA)-TKA. This study aimed to evaluate the safety features and intra-operative surgical complications associated with the use of Cuvis Joint™ autonomous robotic system for TKA. The study included 500 consecutive patients who underwent TKA using the Cuvis Joint™ autonomous robotic system from November 2020 to November 2021. All surgeries were performed by a senior surgeon. Patients in whom the surgery was abandoned midway due to technical errors, were excluded from the analysis. In case of unilateral abandonment of the robotic arm during a bilateral RA-TKA, data of the side on which the surgery was completed with robotic assistance was recorded. There was no incidence of neurological injury, vascular injury, extensor mechanism disruption, or medial collateral ligament injury. There was one case of superficial abrasion of the patellar tendon; however, it did not require any intervention. There were no cases of midway abandonment due to threatened soft tissue injury. There was no intra-operative pin loosening or stress-related fractures at the pin sites. There was one case of Steinmann pin breakage and another case of drill bit breakage, which were removed without any damage to the bone. The Cuvis Joint™ autonomous robotic system for TKA is safe with no significant intra-operative complications.

A New Algorithm to Treat Chronic Combined ACL/MCL Injuries: Let's Come Back to the “Rotatory Instability Test”

Background: Chronic combined medial collateral ligament (MCL) and anterior cruciate ligament (ACL) injuries are frequent. Medial residual laxity is a risk factor for ACL rerupture. It should be treated at the same time as the ACL reconstruction (ACLR) if necessary, but there are still questions surrounding the indications for abstention or surgery of the medial plan, especially for grade 2 MCL injuries of the Fetto and Marshall classification. Indications: The purpose is to come back to a simple test, the “Rotatory Instability Test” as described by Slocum and Larson in 1968 for systematic clinical examination of the knee to improve the sensitivity and accuracy of the deep MCL (dMCL) and superficial MCL (sMCL) examination and to propose a decision-making algorithm for the treatment of the chronic combined ACL/MCL injuries based on the assessment of anteromedial rotatory instability (AMRI). Technique Description: Examination of the ACL with Lachman test, anterior drawer in neutral rotation, and pivot shift test confirm the ACL injury. Valgus laxity is tested in extension and at 20° of flexion. Then, an anterior drawer test at 90° of flexion with external rotation is done (the anterior drawer in external rotation [ADER] test) allowing to identify isolated dMCL, dMCL + sMCL, or MCL + posterior oblique ligament (POL) injuries. Discussion: As persistent medial laxity is a risk factor for ACL graft failure and there is no reliable method of instrumented laxity assessment, careful clinical examination remains essential. Systematic examination of the medial side with valgus laxity testing at 0° and 20° flexion combined with the ADER test assessment of AMRI can guide treatment of the MCL injury component. Where there is no valgus laxity and the ADER test is negative, isolated ACLR is indicated. If there is significant medial laxity at 0°, this suggests combining sMCL and POL reconstruction with ACLR. Where the knee is stable at 0° but there is valgus laxity at 20° and a positive ADER test, the dMCL can be reconstructed using a gracilis graft or a combined sMCL and dMCL reconstruction can be added to the ACLR depending on the degree of laxity. 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.

Investigating Risk Factors and Magnetic Resonance Imaging (MRI)-Based Grading of Subchondral Incomplete Fracture (SIF) of Medial Femoral Condyle.

Subchondral insufficiency fractures (SIF) of the knee joint are prevalent in osteoporosis patients over the age of 55. Early diagnosis of SIF fracture of the medial femoral condyle is crucial for delaying disease progression, early therapy, and potential disease reversal. Magnetic resonance imaging (MRI) is useful in detecting SIF, which is often undetectable on initial radiographs. This study aimed at developing a grading system for subchondral insufficiency fractures (SIF) based on MRI to predict outcomes and evaluate risk factors. In this study, MRI was used to examine SIF risk variables in the medial condyle of the femur to help clinicians diagnose, treat, and delay the condition. A total of 386 patients with SIF from 2019 to 2021 were retrospectively analyzed and divided into 106 patients in the disease group and 280 patients in the control group according to whether they had SIF. The lesion site, meniscus, ligament, and other parameters were evaluated and compared. At the same time, a grading system was introduced to stratify and statistically analyze the size of the lesion area, the degree of bone marrow edema (BME), meniscus tears, and other parameters in the patients. Most SIF were low-grade (LG) fractures, and the predictors of LG and high-grade (HG) fractures included heel tear (P =0.031), degree of medial malleolus degeneration (P < 0.001), advanced age (P < 0.001), and lesion size (P < 0.001). The prognostic factors that showed significant differences between the two groups included age (P =0.027), gender (P =0.005), side (P =0.005), medial tibial plateau injury (P < 0.0001), femoral medullary bone marrow edema (P < 0.0001), medial tibial plateau bone marrow edema (P < 0.0001), meniscus body partial injury (P =0.016), heel tear (P =0.001), anterior cruciate ligament injury (P =0.002), and medial collateral ligament injury (P < 0.0001). This current study proposed an MRI-based grading system for inferior condylar fractures of the femur, in which HG inferior condylar fractures are associated with severe medial malleolus degeneration, advanced age, lesion size (correlation), and meniscus heel tears.

Current Clinical Approaches to Acute Medial Collateral Ligament Injuries

Current Clinical Approaches to Acute Medial Collateral Ligament Injuries

Poster 326: Concomitant Meniscal and Ligamentous Injuries Associated with Pediatric and Adolescent ACL Tears: Data from the Boston Children’s Hospital ACL Registry

Objectives: There has been a well-documented increase in pediatric and adolescent ACL injuries and surgery in recent years, especially in athletes. ACL tears are infrequently isolated injuries, as there are known associated concomitant injuries. However, the risk factors for and incidence of these different associated injuries are poorly characterized, particularly in this high-risk population. Therefore, the purpose of this study was to use a large database of pediatric and adolescent ACL surgeries to examine the incidence of common concomitant soft tissue injuries and their associated risk factors in this sub- population. Methods: Following institutional review board approval, a natural language processing (NLP) pipeline was developed to identify ACL surgery cases from the electronic health records of patient evaluated at Boston Children’s Hospital Orthopedics and Sports Medicine clinics between 2000-2020 (from &gt;23 million notes). Following training and validation, the model achieved median accuracy of 98%, median sensitivity 97% and median specificity of 98% in identifying ACL surgery cases and extracting variables from clinical visits and operative notes. Stepwise logistic regression was performed to evaluate the associations between sex, age, body mass index (BMI), injury mechanism (contact vs. non-contact injury), and history of prior ipsilateral ACL injury with presence of concomitant injuries to the meniscus (lateral, medial, or both), medial collateral ligament (MCL), posterior cruciate ligament (PCL) and posterolateral corner (PLC), which was defined as any grade 2 or 3 fibular/lateral collateral ligament, popliteofibular ligament, or popliteus tendon injury. Adjusted odds ratios (aOR) and corresponding 95% confidence interval (95%CI) were calculated and considered significant at P&lt;.05. Results: The model identified 5,648 ACL surgeries from 4,992 unique patients of any age (age: 17.0 ± 4.0; 53% females), of which 4,727 surgeries (4,221 unique patients, age: 15.9 ± 2.2; 55% females) were performed in children and adolescents (&lt;20 years old). Of these cases in the study population, 2,895 (61%) demonstrated at least one concomitant soft-tissue injury. These concomitant injuries included 1,715 (36%) medial meniscus injuries, 1,632 (35%) lateral meniscus injuries, 1,274 (27%) MCL injuries, 312 (7%) PCL injuries, and 445 (9%) PLC injuries. For meniscal injury, higher BMI (aOR=1.03 [95%CI: 1.01, 1.04]) and older age (aOR=1.12 [95%CI: 1.09, 1.15]) were associated with increased rate of concomitant medial meniscus injuries (P&lt;.001). Similarly, higher BMI (aOR=1.02 [95%CI: 1.00, 1.03]), older age (aOR=1.09 [95%CI: 1.06, 1.12]), and history of prior ipsilateral ACL injury (aOR=1.39 [95%CI: 1.10, 1.76]) were associated with increased rate of concomitant lateral meniscus injury, while female sex (aOR=0.79 [95%CI: 0.70, 0.90]) was associated with decreased rate of concomitant lateral meniscus injuries (P&lt;.01). Female sex (aOR=1.31 [95%CI: 1.14, 1.51]), older age (aOR=1.17 [95%CI: 1.14, 1.21]), and contact injury (aOR=1.59 [95%CI: 1.36, 1.85]) were associated with increased rate of concomitant MCL injury. History of prior ipsilateral ACL injury (aOR=0.68 [95%CI: 0.52, 0.89]) was associated with decreased rate of concomitant MCL injury (P&lt;.01). Older age (aOR=1.06 [95%CI: 1.01, 1.12]) was associated with increased rate of concomitant PCL injury, while female sex (aOR=0.63 [95%CI: 0.49, 0.79]) was associated with decreased rate of concomitant PCL injury (P&lt;.03). Finally, older age (aOR=1.21 [95%CI: 1.15, 1.27]) and contact injury (aOR=1.37 [95%CI: 1.10, 1.69]) were associated with increased rate of concomitant PLC injury, whereas history of prior ipsilateral ACL injury (aOR=0.46 [95%CI: 0.27, 0.78]) was associated with decreased rate of concomitant PLC injury (P&lt;.01). Conclusions: The current largescale single-site study of well over 4,000 surgical cases suggests that the majority (61%) of pediatric and adolescent ACL injuries are accompanied with one or more injuries to major soft tissue structures within the knee, with injuries to the medial and lateral menisci being the most prevalent. Notably, this rate is higher than what was previously reported in the pediatric literature, adding additional concerns and complexities to the clinical care of pediatric and adolescent patients with ACL tears. Higher BMI, older age, and a contact injury mechanism showed consistent adverse effects, in terms of concomitant soft tissue injury risk. History of prior ipsilateral ACL injury and female sex had some positive and some negative prognostic value, in terms of soft tissue risk, though to a varying degree. Specifically, older age and higher BMI were associated with increased rates of concomitant meniscal injury, which is in line with current literature. Patient with contact injuries were more likely to have injury to the collateral ligaments. The sex-related differences in injury patterns, as well as the potentially protective effect of prior ipsilateral ACL injury on collateral ligaments suggest potentially lower energy injury mechanisms being associated with ACL graft tear, compared with native ACL ligament tear. Given the implications of concomitant soft tissue injuries on overall prognosis and arthritis risk in this young, active sub-population, these data underscore the importance of future studies investigating prevention strategies and awareness and the vigilance ACL surgeons must apply to the detection and thoughtful treatment of these common additional injuries.

Incidence of anterior cruciate ligament injury patterns in Japanese judo players from a nationwide insurance database

ObjectiveThis study aimed to characterize the age- and sex-specific Anterior cruciate ligament (ACL) injury rates and related injury patterns in judo players in Japan using the nationwide insurance database. MethodsThis was a descriptive epidemiological study. We examined a total of 2142 adolescents with anterior cruciate ligament injuries registered in the insurance system of the Japan Sports Council between January 2009 and December 2018. The age- and sex-specific incidences were estimated for the levels of 7th, 8th, and 9th grades of junior high school and 10th, 11th, and 12th grades of high school. The anterior cruciate ligament injury circumstances were classified into three patterns based on the impact to the involved knee: high-impact valgus force, low-impact trunk displacement, or no-impact knee twisting. ResultsThe incidence of anterior cruciate ligament injury from the 7th to 12th grades were 0.5, 0.9, 0.9, 6.9, 8.6, and 6.1 per 1000 athlete-years in male players and 1.3, 3.8, 3.4, 16.8, 19.5, and 13.6 per 1000 athlete-years in female players. The most prevalent injury pattern was a low-impact contact injury (42.6%) with Osoto-gari, followed by a high-impact contact injury (29.8%). The concomitant medial collateral ligament (MCL) injury rate was 18.1%, which was correlated with a high-impact contact injury (p = 0.005) by multiple regression analysis. ConclusionsThe highest incidence of age- and sex-specific anterior cruciate ligament injury was 19.5 per 1000 athlete-years in female high school students in the 11th grade. The most frequent injury pattern was low-impact contact injury with trunk displacement, indicating that trunk stabilization training could help prevent anterior cruciate ligament injury in judo.

High Prevalence of Superficial and Deep Medial Collateral Ligament Injuries on Magnetic Resonance Imaging in Patients With Anterior Cruciate Ligament Tears

To assess the prevalence of and factors associated with medial collateral ligament (MCL) complex injuries on magnetic resonance imaging (MRI) in patients with anterior cruciate ligament (ACL) tears. Data were extracted from the Natural Corollaries and Recovery After ACL Injury (NACOX) multicenter longitudinal cohort study. Between May 2016 and October 2018, patients who presented to 1 of 7 health care clinics across Sweden with an ACL tear sustained no more than 6 weeks earlier and who were aged between 15 and 40 years at the time of injury were invited to participate. All the patients included in this study underwent MRI. The mean time from injury to MRI was 19.6 ± 15.2 days. An orthopaedic surgeon specializing in knee surgery and a musculoskeletal radiologist reviewed all MRI scans. Injuries to the superficial MCL (sMCL), deep MCL (dMCL), and posterior oblique ligament were identified. Stepwise forward multiple binary logistic regression analyses were used to evaluate patient characteristics (age, sex, body mass index, preinjury Tegner activity level, and activity at injury) and injuries on MRI (lateral meniscus [LM] injury, medial meniscus [MM] injury, pivot shift-type bone bruising, medial femoral condyle [MFC] bone bruising, and lateral femoral condyle [LFC] impaction) associated with the presence of MCL complex tears. In total, 254 patients (48.4% male patients) with a mean age of 25.4 ± 7.1 years were included. The overall prevalence of MCL (sMCL and dMCL) injuries and isolated dMCL injuries was 16.5% (42 of 254) and 24.8% (63 of 254), respectively. No isolated sMCL injuries were found. Posterior oblique ligament injuries were found in 12 patients (4.7%) with MCL (sMCL and dMCL) injuries. An LM injury (odds ratio [OR], 3.94; 95% confidence interval [CI], 1.73-8.94; P= .001) and LFC impaction (OR, 2.37; 95% CI, 1.11-5.07; P= .02) increased the odds of having an MCL injury, whereas an MM injury (OR, 0.26; 95% CI, 0.12-0.59; P= .001) reduced the odds. Isolated dMCL injuries were significantly associated with MFC bone bruising (OR, 4.21; 95% CI, 1.92-9.25; P < .001) and LFC impaction (OR, 3.86; 95% CI, 1.99-7.49; P < .001). The overall combined prevalence of MCL (sMCL and dMCL) injuries and isolated dMCL injuries in patients with ACL tears was high (16.5%+ 24.8%= 41.3%). The presence of an LM injury and LFC impaction increased the odds of having an MCL injury, whereas the presence of an MM injury reduced the odds. MFC bone bruising and LFC impaction were associated with the presence of isolated dMCL injuries. Level III, retrospective cohort study.