Lateral Collateral Ligament Rupture Research Articles

Outcome of percutaneous reconstruction of chronic lateral collateral ligament rupture

PurposeMany techniques have been described for the reconstruction of chronic lateral collateral ligament (LCL) rupture with different autograft options. The advantages of percutaneous LCL reconstruction include small incisions, minimal soft tissue disruption, less postoperative pain, and speedy rehabilitation and recovery. The aim of this study was to report the functional outcome of percutaneous LCL reconstruction and overall patient satisfaction in Africans. MethodsThis prospective and interventional study involving 51 patients with chronic LCL rupture who had percutaneous LCL reconstruction using peroneus longus autograft was conducted between January 2021 and December 2022 in National Orthopaedic Hospital, Dala-Kano, Nigeria. The inclusion criteria were patients between the ages of 18 and 45 years with chronic isolated LCL and not more than 1 injury of knee ligament. Exclusion criteria were active infection, and multi-ligament knee injury requiring 2-staged surgery. The knee functions were assessed preoperatively, 3 months, 6 months, and 12 months postoperatively using the Lysholm scoring system. Patient satisfaction with the outcome of the treatment was assessed using a 5-point Likert scale. Relevant information was recorded into Microsoft Excel sheet and data was analyzed using SPSS version 23.0 for windows. The paired samples t-test was used to compare the clinical outcomes as continuous variables. Statistical significance was considered at p < 0.05. ResultsThe mean age of the patients was (30.10 ± 5.90) years. The median time from injury to surgery was 7 months (ranging from 3 to 28 months). The mean follow-up period was (14.07 ± 3.13) months. The mean preoperative and 1-year postoperative Lysholm scores were 44.33 ± 12.97 and 97.96 ± 1.23, respectively. ConclusionPercutaneous LCL reconstruction using peroneus longus autograft significantly improves patient knee function and results in excellent patient satisfaction.

Isolated avulsion fracture of the fibular head

Introduction. Rupture of lateral collateral ligament of the knee is most often joined with other ligament ruptures. Isolated rupture of this ligament is rare and there are few papers about treatment options and results. Here we reported a case of isolated lateral collateral ligament rupture and the treatment outcome. Case report. A patient, 22 years old male, injured his left knee while playing American football. While landing on the outstretched left leg, he felt a sudden pain in his knee. The patient could not continue the competition. Initial orthopedic examination revealed lateral opening and further diagnostic procedure (magnetic resonance imaging) revealed isolated grade III rupture of lateral collateral ligament with avulsion fracture of the fibular head, and distension of anterior and posterior cruciate ligaments. Patient was surgically treated with metal sutures passed through conjoined tendon and proximal fibula. Postoperatively patient worn above knee cast for 6 weeks and after that he was included in rehabilitation. Three and six years after this injury, the patient has still been professional football player with no symptoms and no clinical instability of the knee despite radiological and computed tomography verified pseudoarthrosis of the fractured fibular head fragment. Conclusion. Early diagnostic and absence of additional injuries of the knee leads to a faster and full functional recovery of patients with isolated avulsion fracture of the fibular head, while surgical treatment provides knee stability with no residual ligament instability during sports activities.

Complete rupture of lateral collateral ligaments of ankle joint: a case report

Complete rupture of lateral collateral ligaments of ankle joint: a case report

Development of a Dual-Energy Computed Tomography-Based Segmentation Method for Collateral Ligaments: A Porcine Knee Model

The clinical value of dual-energy computed tomography (DECT) has gradually been recognized in many applications. In particular, DECT offers a new imaging method to improve the visualization of ligaments and tendons. However, limitations such as two-dimensional display and manual window adjustment hamper the evaluation of knee ligament injuries. In this study, we proposed a method to segment collateral ligaments from DECT images automatically. Based on various segmentation techniques, collateral ligaments can be visualized using the three-dimensional (3D) volume-rendering technique. To validate our methodology, we used a porcine knee model and focused on the detection of the medial collateral ligament (MCL) and lateral collateral ligament (LCL). Twenty porcine hind legs were scanned using DECT after specimens underwent surgery to cut either the MCL or the LCL. Using the proposed method, either a complete or a partial LCL rupture could be detected clearly, and a complete MCL rupture could be shown clearly. However, some cases might present some difficulty in identifying a partial MCL rupture since the MCL is a thin ligament. The proposed method can be used to automatically segment the main ligaments of the knee. In addition, the 3D volume rendering image makes DECT a valuable tool for the diagnosis of knee ligament injuries.

Comparison of Clinical Efficacy of Lateral and Lateral and Medial Double-plating Fixation of Distal Femoral Fractures

The present study was performed to compare the clinical efficacy of lateral plate and lateral and medial double-plating fixation of distal femoral fractures and explore the indication of lateral and medial double-plating fixation of the distal femoral fractures. From March 2006 to April 2014, 48 and 12 cases of distal femoral fractures were treated with lateral plate (single plate) and lateral and medial plates (double plates), respectively. During the surgery, after setting the lateral plate for the distal femoral fractures, if the varus stress test of the knee was positive and the lateral collateral ligament rupture was excluded, lateral and medial double-plating fixation was used for the stability of the fragments. All the patients were followed up at an average period of 15.9 months. The average operation time, the intraoperative hemorrhage and the fracture union time of the two groups were compared. One year after operation, knee function was evaluated by the Kolmert’s standard. There was no significant difference in the average operation time, intraoperative hemorrhage, fracture healing time and excellent and good rates of postoperative knee function between two groups. Positive Varus stress test during operation can be an indication for lateral and medial double-plating fixation of distal femoral fractures.

Ankle fractures combined with lateral ligament rupture

Objective To investigate the diagnosis, treatment and prognosis of ankle fractures combined with rupture of lateral collateral ligaments. Methods A continuous series of 5 cases of ankle fracture combined with lateral collateral ligament injury were reviewed who had been treated by the authors from January 2014 through December 2014. They were one man and 4 women, 33 to 47 years of age (average, 39 years) . All the patients were suspected of lateral clear space of the ankle in preoperative X-ray examination, and MRI indicated rupture of lateral collateral ligament in 3 of them. Lateral collateral ligament injury was confirmed in all of them by direct intro-operative findings. After anatomical reduction and osteosynthesis of lateral and medial malleoli, the ankle joints were checked under the varus stress and drawer test. After the ruptured lateral collateral ligaments were explored directly, they were repaired with suture anchor in 4 cases and with drilling holes in the lateral malleolus in one. The ankles were immobilized for 3 weeks postoperatively. The outcomes were evaluated by Philips and Schwartz clinical scoring system and American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale. Results All the 5 patients were followed up for an average of 9.6 months (range, from 8 to 12 months) . All the fractures healed without pain. No instability was complained of. The mean degree of plantar flexion was 50.0°, with 2° (from 0° to 10°) less than the normal side; the mean degree of dorsiflexion was 17°, with 6° (from 0° to 20°) less than the normal side. The mean Philips & Schwartz score was 93.4 points (from 80 to 100 points) . The mean AOFAS score was 95.2 points (from 88 to 100 points). Conclusions The ankle fractures in which the lateral malleolus is involved can be combined with lateral collateral ligament injury. X-ray stress view and MRI are useful in early diagnosis. It is highly recommended to repair the injured lateral collateral ligament simultaneously with reduction and osteosynthesis of lateral and medial malleoli. Key words: Ankle joint; Fractures, bone; Lateral ligament, ankle; Surgical procedures

Open Rupture of Lateral Collateral Ligament of the Ankle Joint with Hypoplasia of Medial Malleolus : A Case Report

Open Rupture of Lateral Collateral Ligament of the Ankle Joint with Hypoplasia of Medial Malleolus : A Case Report

Outcome of iatrogenic collateral ligaments injuries during total knee arthroplasty

Soft tissue balance is an essential step in total knee arthroplasty by providing a good knee stability and an even distribution of load over the prosthesis components. During surgery, because of the need of having a good balance in most cases is necessary to do some soft tissue release in the medial compartment. Lateral release is far more rare and is generally needed for patients with valgus knees after high tibial osteotomy. Our purpose is to evaluate the complications that arise during soft tissue release and how to manage this unfortunate events for getting the best functional results for the patients. In this study, we analyzed 434 knee arthroplasties that were operated in our clinic in the past 8 years by the same knee team (2005-2012). Average age was 64.8 years. Eight of this patients had medial collateral ligament injuries during surgery, and two had lateral collateral ligament rupture. Average age of patients who suffered from medial collateral ligaments injuries was 62.8 years and for lateral collateral ligaments was 72.5 years. Body mass index was 34 for both groups. We used for evaluation the knee society pain and functional scores, and X-rays obtained after the surgery with a calibrated Siemens machine. Seven patients with MCL repair were satisfied with after surgery (Knee Society score was 87.7, and functional score was 80). One complained of knee instability associated with pain and needed revision. In LCL group, all patients had excellent results (Knee Society score was 91.5, and functional score was 85). We found that repair to collateral ligaments injuries must be obtained during surgery, especially complete ruptures of the MCL. There are several approaches to collateral ligaments ruptures during total knee arthroplasty that will be discussed during the article.

Ligamentous repair of acute lateral collateral ligament rupture of the elbow

We evaluated the clinical outcome and findings of ligamentous repair for acute posterolateral rotatory instability (PLRI) of the elbow. Nineteen patients underwent lateral collateral ligament repair for acute PLRI. Ten male and nine female patients were observed for a mean of 9 months; their mean age was 46 years (14-70 years). The mean time from injury to operation was 8.1 days (1-18 days). The lateral pivot shift and varus stress test results were positive for all cases. We repaired the lateral ulnar collateral ligament with Ethibond in 6 cases and Bio-FASTak in 15 cases. We evaluated the range of motion, pain, and stability by the satisfaction of the patient, the Mayo Elbow Performance Score, and the Nestor grading. The lateral pivot shift test result was negative in all patients at the final follow-up. The mean elbow extension was 13°; flexion, 120°; supination, 74°; and pronation, 78°. Mild valgus laxity was noted in two patients who had mild pain on activity. The mean Mayo Elbow Performance Score was 86.9 points (65-100 points), with 13 excellent cases, 5 good cases, and 1 fair case. According to the Nestor grading, the results were rated excellent in 14 patients and good in 5. All patients were satisfied with their outcome in the subjective assessment. The complications were 1 case of knot irritation and 5 cases of ectopic ossification. We obtained satisfactory outcomes with lateral collateral ligament repair for acute PLRI of the elbow.

Complications Following Quadriceps-sparing Total Knee Arthroplasty

This study examined whether quadriceps-sparing total knee arthroplasty (TKA) through a minimal medial incision could be performed without an increased risk of complications. Data were collected prospectively on 209 patients who underwent quadriceps-sparing TKA though a median parapatellar approach. Surgical complications included 2 patellar tendon avulsions, 2 lateral collateral ligament ruptures, and 1 medal collateral ligament rupture. Arthrofibrosis occurred in 21 patients (10%) requiring manipulation under anesthesia, and minor wound complications occurred in 22 patients (11%). Unintended cement retention was noted on 16 radiographs (8%). At 6 months of follow-up, Knee Society scores and functional outcomes were unchanged from previous experience with standard TKA. Compared to previous experience with traditional medial parapatellar approaches, the rate of intraoperative complications such as ligament rupture and retention of cement were higher than expected. Complication rates in the second 100 patients who underwent quadriceps-sparing TKA showed no significant difference compared to previous patients who underwent standard TKA. Complications were more common in patients with preoperative peripheral vascular disease, body mass index >33, and valgus deformity >10 degrees ; these patients may not be good candidates for this modified procedure. This quadriceps-sparing technique required a progressive learning curve and has not yet proven to be superior to standard approaches. However, complication rates after extensive experience were not significantly increased.

3386: Sonographic evaluation of injury to the lateral collateral ligaments of the ankle

Objectives: Our aim is to demonstrate the usefulness of ultrasound in diagnosis or ankle lateral collateral ligament rupture of sprain.Methods: Six different cases of ankle injuries are presented along with cross related MR images. A high frequency (9 MHz) transducer was used as well as a 1.5 T MR scanner.Results: In all patients ultrasound managed to show the damage to the ligament as well as any concomitant tendon injury and the presence of intra-articular fluid.Conclusions: Ultrasound is a useful tool in evaluating ankle lateral collateral ligament acute injury, thus improving patient management. Objectives: Our aim is to demonstrate the usefulness of ultrasound in diagnosis or ankle lateral collateral ligament rupture of sprain. Methods: Six different cases of ankle injuries are presented along with cross related MR images. A high frequency (9 MHz) transducer was used as well as a 1.5 T MR scanner. Results: In all patients ultrasound managed to show the damage to the ligament as well as any concomitant tendon injury and the presence of intra-articular fluid. Conclusions: Ultrasound is a useful tool in evaluating ankle lateral collateral ligament acute injury, thus improving patient management.

Elbow joint laxity after experimental radial head excision and lateral collateral ligament rupture: Efficacy of prosthetic replacement and ligament repair

The objectives of this experimental study were to investigate the effect of radial head excision and lateral collateral ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL repair, and (5) radial head replacement combined with LCL repair. Isolated radial head excision increased varus (mean, 4.8 degrees) and external rotatory laxity (mean, 7.1 degrees), as did isolated LCL division (mean, 14.1 degrees for varus; mean, 14.7 degrees for external rotation). After removal of both constraints, varus and external rotatory laxities were increased by 19.0 degrees and 20.1 degrees, respectively, compared with the intact specimens. Isolated radial head replacement reduced mean varus laxity to 14.6 degrees and mean external rotatory laxity to 14.8 degrees. Isolated LCL repair normalized varus laxity but resulted in a 2.9 degrees increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints induces severe laxity, and in this case, prosthetic replacement may substitute for the constraining capacity of the native radial head. The combination of LCL repair and radial head replacement restores laxity completely, but an isolated LCL repair performs almost as well, probably by compensating for the ligamentous tension lost from radial head excision.

Anterior cruciate ligament reconstruction in patients with or without accompanying injuries: A re-examination of subjects 5 to 9 years after reconstruction

Purpose: The purpose of this study was to compare the clinical and radioloaic results of an anterior cruciate ligament (ACL) reconstruction in patients with an isolated ACL tear and patients with an ACL tear and accompanying injuries. Type of Study: A retrospective investigation. Methods: Seventy-two patients who did not have previous knee surgery or surgery of the contralateral knee were re-examined 5 to 9 years after the primary ACL reconstruction. The clinical assessment was made using the International Knee Documentation Committee (IKDC) evaluation system, and the Lysholm and the Marshall knee scores. Also, radiographic evaluation and isokinetic strength testing were performed. There were 34 patients (25 men and 9 women) with an isolated ACL tear (group A), and 38 patients (23 men and 15 women) with an ACL tear and accompanying injuries (group B). The mean age was 29 years (SD 9; range, 15 to 49 years) in group A, and 34 years (SD 12; range, 15 to 61 years) in group B. Bone-patellar tendon-bone autograft with mini-arthrotomy technique and screw fixation was used in all patients. Postoperative rehabilitation was also similar in both groups. In group B, 10 medial and 12 lateral (partial or subtotal) arthroscopic meniscectomies were performed at the same time as the ACL reconstruction. Also, 18 of the 19 medial collateral ligament ruptures, the 2 lateral collateral ligament ruptures, and the 1 posterior cruciate ligament rupture were treated surgically at this operation. Results: Subjectively (overall assessment, pain, swelling, and giving way of the knee) and objectively (range of motion, stability, crepitation, isokinetic strength testing, and radiological changes of the knee), the groups did not have any significant differences in the 5- to 9-year results. Also, the final evaluation results using the IKDC and the Lysholm and the Marshall knee scores were similar in both groups. However, there were significantly more subsequent knee surgeries in the injured knee in group B than in group A. Conclusions: Our results show no large differences between patients with an isolated ACL tear and those with an ACL tear with accompanying injuries 5 to 9 years after an ACL reconstruction with a bone-patellar tendon-bone autograft. Tibiofemoral osteoarthritis was quite rare, and this may be partly attributable to the fact that the ACL reconstructions were successful, so that all the knees were stable at the re-examination. However, the future will show the final outcome for the patients.

骨傷を伴わない足関節脱臼の一例

A 30-year-old man was injured in a traffic accident on August 30, 1997, and he was brought to out hospital. His right ankle joint was dislocated postero-medial, and an open wound was recognized outside the ankle. But no bone fracture was seen in his ankle joint roentogenographically. We operated on his ankle joint on that day. At the operation, we recognized complete lateral collateral ligament rupture and partial medial collateral ligament rupture. But there was no damage to the extensor tendon, flexor tendon, and the neuro-vascular system. Ankle joint dislocation was reduced, and medial collateral ligament was sutured, but lateral collateral ligament was let alone. Below-knee cast fixation was done for six weeks postoperarively, after which he began rehabilitation. 11 months later, his ankle joint motion was slightly limited but there were no changes in osteoarthritis and varus instability on X-rays.Cases of ankle joint dislocation without fracture are very rare because of its anatomical character. We believe that some power of traction is related to this trauma and primary suture for lateral collateral ligament rupture is necessary.

T-Fix anchor sutures for arthroscopic meniscal repair.

The results of arthroscopically repaired meniscal tears with the T-Fix system in a short-term follow-up of 6 months was assessed in a non-comparative, prospective study. The T-Fix device consists of a short, rigid Delrin T attached to a braided, non-absorbable, polyester suture which is preloaded inside and deployed through a delivery (spinal) needle. The T grabs inside the tissue and provides an anchor for the suture. Twenty menisci in 20 patients (mean age 29 years) were repaired. Sports-related injuries were documented in 18 patients. In 15 patients, meniscus tears were repaired 6 months or more after injury. Half of the patients had isolated meniscus injuries. Associated injuries included anterior cruciate ligament (ACL), medial or lateral collateral ligament ruptures. These were not treated at the time of meniscal surgery except for an ACL reconstruction. All tears were longitudinal and positioned mainly in the posterior horn of the medial meniscus. A total of 70 T-Fixes were used with an average of 3 per patient (range 2-7). Only 4 T-Fixes (6%) were unsuccessfully placed, and this occurred early on in the series in 4 patients. In 90% of the patients, the postoperative activity levels returned to preoperative levels, and the clinical symptoms had either resolved or were experienced at a higher level of activity. The T-Fix device was relatively easy to use and could be reliably placed in the meniscus. Postoperatively, there were no complications directly associated with the device. However, further studies are needed to confirmed these results in a long-term follow-up in a larger patient population.

The Ulnar Collateral Ligament is Always Torn in the Posterolateral Elbow Dislocation: A Suggestion on the new Mechanism of Dislocation Using MRI Findings

PURPOSE: From the status of ulnar collateral ligament of elbow with magnetic resonance image which suffered with posterolateral dislocation. We would propose the novel mechanism of posterolateral elbow dislocation.MATERIALS AND METHODS: Between November 2005 and October 2009, we prospectively collected 12 cases of simple posterolateral elbow dislocation. The location of bone contusion and the status of collateral ligament were evaluated with MRI. Collateral ligament was divided in 2 subgroups (distraction type, stripping type). We also defined the disengagement as escaping of conoid process from trochlear notch totally.RESULTS: From 12 cases, we could found 11 cases of bone contusion in radial head or capitellum. Trochlea and conoid process were always intact without bone contusion. All ulnar collateral ligament ruptures were distraction type instead of all lateral collateral ligament ruptures were stripping type. Translations of all cases were shown those of the ulnar collateral ligament were longer than those of lateral collateral ligament (p&lt;0.05).CONCLUSION: We carefully conclude that UCL and surrounding soft tissue has responsibility for the initiation of simple posterolateral elbow dislocation.