Valgus Injury Research Articles

Retrospective cohort study on radial head arthroplasty comparing long-term outcomes between valgus type injury and fracture dislocation

BackgroundRadial head arthroplasty (RHA) has been commonly adopted for irreparable radial head fractures while little information is addressed on valgus type injury. The purpose of this study is to report long-term outcomes and radiographic analysis in RHA for valgus type injury with comparison to fracture dislocation injury.MethodsA retrospective cohort study was conducted in patients receiving unilateral RHA with loose-fit, modular metal prosthesis for irreparable radial head fractures between 2004 and 2012. Totally, 33 patients with a mean follow up of 9 years (range, 7 to 15 years) were enrolled and divided into two groups including 14 valgus injuries and 19 fracture-dislocations. Demographics of the patients, injury details, clinical and radiographic outcomes, and correlation analysis were investigated and compared between two groups.ResultsIn patient demographics, significant difference was noted in sex distribution (p = 0.001), lateral collateral ligament involvement (p = 0.000) and time from injury to RHA (p = 0.031) between two groups. No patient underwent subsequent removal or revision of prosthesis. Good to excellent results according to Mayo Elbow Performance Score (MEPS) was achieved in 13 and 14 patients in group A and B respectively. Final motion range and Disabilities of the Arm, Shoulder, and Hand score was significantly better in valgus injury group. Radiographic analysis demonstrated fewer patients in valgus injury group presented periprosthetic osteolysis with weak to moderate negative correlation between radiolucency score and MEPS.ConclusionsWith an average of 9 years follow-up, RHA using loose-fit, modular metal prosthesis achieves encouraging outcomes for both valgus injury and fracture dislocation. In valgus type injury, better motion range, lower disability score and lower incidence of periprosthetic osteolysis is noted while correlation analysis of radiolucency score suggests extended, long-term investigation.

Distal Femoral Varus Osteotomy for the Valgus Knee after Distal Femoral Growth Plate Fractures in Children: A Case Report

An 18-year-old male suffered a valgus injury to the right knee due to a fall during a bigfoot race he took part in when he was 15 years old. He visited a different hospital at the age of 15. No obvious ligament injury or fracture was noted on MRI and physical examination. However, he gradually became aware of the valgus deformity of the right knee. Finally, he could not take part in a sports activity because of right knee pain. X-ray images at the age of 18 at an initial visit to our department showed severe valgus deformity with mechanical lateral distal femoral angle (mLDFA) of 71 degrees in contrast to left mLDFA which was 87 degrees. We performed a biplane-cut distal femoral varus osteotomy (DFO). Postoperative X-ray images showed an improvement of 86 degrees in mLDFA. Bony fusion was achieved six months after surgery, and he could play several sports activity.

Meniscal root tears occur frequently in multi-ligament knee injury and can be predicted by associated MRI injury patterns.

The frequency of meniscal root tears in association with multi-ligament knee injury has not been established but adds to the complexity of surgical reconstruction and may have long-term consequences. Therefore, identifying root tears, on preoperative imaging, is important. The aim of this study was to identify the frequency of meniscal root tears, on preoperative magnetic resonance imaging, following multi-ligament injury and distinguish associated injury patterns that may aid detection. Cases were identified from a prospectively collected institutional database. The magnetic resonance imaging of 188 multi-ligament injuries [median age 31years (range 16-64)] was retrospectively reviewed by three musculoskeletal radiologists with the presence of meniscal injuries recorded alongside the ligament injury pattern and intra-articular fractures. Assessment of injury pattern was solely made on this imaging. 38 meniscal root injuries were identified in 37 knees (overall frequency = 20.2%; medial = 10.6%; lateral = 9.6%). The frequency of meniscal root tears was not increased in higher grade injuries (21.5% vs. 17.0%, n.s.). Valgus injury patterns were associated with lateral root tears (p < 0.05) and varus patterns were associated with medial root tears (p < 0.05). Further, fractures in the same compartment were associated with both medial and lateral root tears (p < 0.05). Meniscal root tears occur more frequently in multi-ligament knee injury than previously reported with isolated anterior cruciate rupture. Root tears can be predicted by ligament injury patterns and fractures sustained (suggestive of a compressive force). In multi-ligament cases, the preoperative magnetic resonance imaging can be used to detect these tears and associated patterns of injury. IV.

Fracture morphology and injury mechanisms of tibial plateau fracture: analysis of 200 cases

Objective To classify tibial plateau fractures based on the analysis of the morphology and injury mechanisms of 200 cases of tibial plateau feature. Methods We collected the X-ray and CT images of 200 consecutive cases of tibial plateau fracture in 199 patients who had been treated at our department from January 2010 to April 2011. They were 134 males and 65 females, from 15 to 77 years of age (average, 45.7 years). According to the Schatzker classification, 9 cases were type Ⅰ (4.5% ), 105 type Ⅱ (52.5% ), 19 type Ⅳ (9.5% ), 37 type Ⅴ (18.5% ), 30 type Ⅵ (15.0% ), and none type Ⅲ. The fracture morphology and injury mechanism of each case were analyzed to propose a new classification system. Results Fractures of tibial plateau can be classified into the following five types: (a) Lateral condylar fracture and valgus injury (100 cases, 50% ). The injury mechanism is the axial force on the valgus and extended knee joint. (b) Fracture-dislocation injury (24 cases, 12.0% ). This type includes typical Schatzker type Ⅳ, and some cases of Schatzker type Ⅵ associated with lateral subluxation. Its mechanism is a compound force of valgus, varus, rotational and axial stresses. The rotational force is the key factor leading to subluxation of the knee joint. (c) Double-condylar fracture (40 cases, 20.0% ). This type is caused by an axial force on the extended knee, including Schatzker type Ⅴ and some cases of Schatzker type Ⅵ not associated with knee subluxation. (d) Posterior condylar fracture and flexion injury (32 cases, 16.0% ). This type only involves the posterior condylar plateau, and is caused by an axial force on the flexed knee. Based on the morphology, posterior condylar fractures can be further divided into three subtypes: simple split of posteromedial condyle, simple collapse of posterolateral condyle, and a combination of the two. (e) Frontal plateau compression fracture and hyperextension injury (4 cases, 2.0% ). This type is caused by an axial force on the hyper-extended knee. It is characterized by significant compression of the anterior plateau and intact posterior plateau. Conclusion Based on the morphological features and injury mechanisms, tibial plateau fractures can be classified into 5 types: lateral condylar fracture, fracture-dislocation injury, double-condylar fracture, posterior condylar fracture, and frontal plateau compression fracture. Key words: Knee joint; Fractures, bone; Radiography; Injury mechanism; Fracture classification

Anterolateral Versus Medial Plating of Distal Extra-articular Tibia Fractures: A Biomechanical Model.

Both medial and anterolateral plate applications have been described for the treatment of distal tibia fractures, each with distinct advantages and disadvantages. The objective of this study was to compare the biomechanical properties of medial and anterolateral plating constructs used to stabilize simulated varus and valgus fracture patterns of the distal tibia. In 16 synthetic tibia models, a 45° oblique cut was made to model an Orthopedic Trauma Association type 43-A1.2 distal tibia fracture in either a varus or valgus injury pattern. Each fracture was then reduced and plated with a precontoured medial or anterolateral distal tibia plate. The specimens were biomechanically tested in axial and torsional loading, cyclic axial loading, and load to failure. For the varus fracture pattern, medial plating showed less fracture site displacement and rotation and was stiffer in both axial and torsional loading (P<.05). For the valgus fracture pattern, there was no statistically significant difference between medial and anterolateral plating. There were no significant differences between the 2 constructs for either fracture pattern with respect to ultimate load, displacement, or energy absorption in load to failure testing. When used to stabilize varus fracture patterns, medial plates showed superior biomechanical performance compared with anterolateral plates. In this application, the medial plates functioned in anti-glide mode. For valgus fracture patterns, no biomechanical differences between anterolateral and medial plating were observed. In clinical practice, surgeons should take this biomechanical evidence into account when devising a treatment strategy for fixation of distal tibia fractures.

Simultaneous Rupture of the Patellar Tendon and the Anterior Cruciate Ligament: Report of Three Cases

This study describes three cases of simultaneous ruptures of the patellar tendon (PT) and the anterior cruciate ligament (ACL). The treatment and the pathogenesis of this rare lesion are discussed. All three cases demonstrated lesions of all structures at the medial compartment. Unlike other reported cases, where an eccentric contraction of the quadriceps was present, the patients of the present study had sustained a forceful valgus injury with external rotation. We detected no displacements of the patella in any patients. All cases underwent a staged surgical procedure. Repair of the PT and of medial peripheral structures was performed immediately after injury; then, once the patients regained a full range of motion (ROM), they underwent an arthroscopic reconstruction of the ACL with ipsilateral hamstrings. At the follow-up stage, all cases showed a stable knee without restricted ROM.

Acute Knee Injury in a Soccer Player

HISTORY: A fifteen year old female high school soccer player presented to a sports medicine clinic with a 2 day history of right knee pain. During a soccer game, she was tripped up over another player's feet going for the ball suffering a valgus injury to her right knee. Patient reported feeling a pop with immediate pain. She limped off of the field but had been using crutches and knee immobilizer at time of presentation. She complained of swelling and worsening pain with weight-bearing or knee flexion. She denied radiation of her pain, numbness or tingling. Medical HISTORY: Negative for previous knee injury or surgery. Positive for ankle sprain PHYSICAL EXAM: Right knee: Small joint effusion with tenderness to palpation over course of MCL primarily proximal and midportion as well as over lateral femoral condyle. Negative patellar apprehension test. Range of motion limited in flexion to 90 degrees. Patient able to achieve full extension. There was no laxity with valgus and varus stress at 0 degrees. At 30 degrees had guarding and laxity (1+) with valgus stress. stable to varus stress. Guarded with lachman exam without firm endpoint. Negative posterior drawer. Pain with McMurray's test without catch or clunk, localized deep in knee. Full range of motion at ankle, 2+ distal pulses, sensation intact to light touch in LE. DIFFERENTIAL DIAGNOSIS: 1. ACL injury 2. Patellar Dislocation 3. Bone Bruise 4. Occult Fracture 5. Meniscus Injury 6. MCL sprain TESTS AND RESULTS: Plain films: 3 views right knee: no acute fracture MRI right knee: non- displaced Salter-Harris IV fracture of the distal femur. Grade 2 sprain of the superficial medial collateral ligament and patellofemoral ligament at the femoral attachment. Bone marrow contusion pattern suggesting a pivot shift injury with intact ACL. Working Diagnosis: MCL sprain with non-displaced Salter IV femur fracture Treatment: 1. 6 weeks nonweightbearing in TROM with progressive return to weightbearing activities. 2.Locked in extension for 4 weeks, unlocked TROM for 2 weeks 3. Physical therapy: Initially comprised of straight leg raises, quadriceps sets and range of motion modalities. At 4 weeks, therapy was advanced to progressive weightbearing activities. At 6 weeks, patient was transitioned to sport specific modalities and agility training. Outcome: Gradual return to soccer play in 10 weeks

Relationship between mechanism of injury and associated lesions in anterior cruciate ligament tears

Purpose To analyze joint and bone alterations occurring in patients diagnosed with anterior cruciate ligament (ACL) tears and their relationship with the mechanism of injury. Materials and Methods Over one year, 127 patients were selected that had been diagnosed with an ACL rupture. The mechanism of injury was analyzed, i.e. whether the lesions had been caused by valgus tress or by forced varus. Forty-five patients fulfilled the inclusion criteria. We assessed intra-articular lesions by means of MRi and direct arthroscopic visualization and found 33 patients with forced valgus lesions and 12 patients with forced varus injuries. A comparison was made between the intra-articular lesions found in both groups. Results Indirect or non-contact injuries were the most frequent, without any differences being identified as regards the appearance of meniscus or ligament lesions seen in the MRi scans or the meniscus and tibiofemoral and patellar cartilage lesions seen arthroscopically. Nonetheless, we identified 24 patients with subchondral bone lesions in the valgus injury group and only 2 in the varus group, with the difference between both groups reaching statistical significance (p=0,002). Conclusion There exists a relationship between the forced valgus mechanism of injury and the presence of subchondral bone lesions. This relationship could not be demonstrated for varus injuries.

Co-existent medial collateral ligament injury seen following transient patellar dislocation: observations at magnetic resonance imaging

This study reports on a series of patients who were diagnosed as having had a transient lateral patellar dislocation by magnetic resonance imaging (MRI). The images were reviewed with specific...

Medial Collateral Ligament Avulsion from Both Tibial and Femoral Attachments: A Case Report

The medial collateral ligament (MCL) is the most commonly injured ligament of the knee joint. Proximal MCL tears occur more frequently than do distal ones. We report a 28-year-old man with a valgus injury of his left knee joint after a fall from a motorcycle. Magnetic resonance imaging of the affected knee joint revealed complete avulsion of the superficial MCL from both its femoral and tibial insertions. The meniscofemoral portion of the deep part of the MCL was also torn and the medial meniscus was subluxated. Such a pattern, an MCL tear with subluxation of the medial meniscus, is rare.

Arthroscopically-aided lateral meniscal repair and reduction of lateral tibial plateau fracture: long-term follow-up with MR imaging

Three patients sustained a Schatzker type II depressed lateral tibial plateau fracture and a tear of the lateral meniscus following a valgus injury to the knee. An arthroscopically-aided reduction of the articular surface was performed. This was followed by an autogenous iliac crest buttress graft with cancellous screw fixation. The meniscal tear was abrased with a rasp or a shaver. An arthroscopic repair of the lateral meniscus during the same session was performed. Clinical follow-up, including MR imaging of the knee at 68 months (range 60–74 months), showed an excellent clinical result and a completely healed meniscus in all patients. Arthroscopic meniscal repair in combination with arthroscopically-aided reduction of a depressed lateral tibial plateau fracture is technically possible. Restoration of the anatomy of both tibial plateau and lateral meniscus will optimize the outcome.