A Prospective Magnetic Resonance Imaging Study of the Incidence of Posterolateral and Multiple Ligament Injuries in Acute Knee Injuries Presenting With a Hemarthrosis

doi:10.1016/j.arthro.2007.07.024

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 23, Issue 12, December 2007, Pages 1341-1347

https://doi.org/10.1016/j.arthro.2007.07.024 Get rights and content

Purpose: The purpose of this study was to determine whether the incidence of posterolateral knee injuries, as well as other concurrent knee ligament injuries, could be obtained from a prospective evaluation of magnetic resonance imaging scans in patients with an acute knee injury with a hemarthrosis. Methods: We prospectively documented all patients with acute (within 30 days) knee injuries with a hemarthrosis over a 90-day period who underwent 1.5-T magnetic resonance imaging at a large referral imaging facility with 6 sites, effectively covering a large metropolitan area. The anterior cruciate ligament, superficial medial collateral ligament, and posterior cruciate ligament (PCL) and the following individual structures of the posterolateral corner were evaluated for high-grade injury: fibular collateral ligament, popliteus tendon, and popliteofibular ligament. Results: Out of 331 consecutive acute knee injuries with a hemarthrosis, 265 ligament injuries occurred in 187 patients (56%). Of these 187 patients with ligament injuries, 126 had isolated ligament injuries and 61 (33%) had combined multiple ligament injuries. Of the 187 patients with knee ligament injuries, 83 (44%) had isolated anterior cruciate ligament tears, 28 (15%) had isolated superficial medial collateral ligament tears, 11 (5%) had isolated PCL tears, and 4 (2.1%) had isolated posterolateral knee tears. Of the patients with posterolateral knee structure injuries, 87% (26/30) had multiple ligament injuries, with the overall incidence of posterolateral knee injuries among all knee ligament injuries being 16% and among all acute knee injuries with a hemarthrosis being 9.1%. Of the 27 patients with PCL tears, 16 (52%) had combined multiple ligament injuries. Conclusions: This study shows that in this population, the incidence of posterolateral knee injuries in patients with acute knee ligament injuries with a hemarthrosis was 9.1%. It also verified that most PCL and posterolateral corner injuries occur in combination with other ligament injuries. Level of Evidence: Level II, development of diagnostic criteria on the basis of consecutive patients with a universally applied gold standard.

Section snippets

Methods

Approval for this project was obtained through the Human Use Institutional Review Board at the University of Minnesota, Minneapolis, MN. All patients with acute (within 30 days) primary knee injuries who underwent MRI scans over a 90-day period were prospectively identified. All patients who had knee MRI scans obtained during this time filled out the reason for their examination and the date of injury, verified that they had some swelling of their knee within 24 hours of their injury, and

Results

Out of a total of 331 patients (mean age, 28.6 years) with acute knee injuries with a hemarthrosis, 187 (56%) had a ligament injury (Table 1 and Fig 1). Patients were categorized into 1 of 4 age groups (≤17 years, 18 to 26 years, 27 to 39 years, and ≥40 years). There were no significant differences between the age groups and the mean values for any of the previously mentioned injuries.

Discussion

MRI scans have been found to be increasingly accurate in the diagnosis of acute knee ligament tears. In addition, an MRI technique was recently reported to be accurate in the identification of posterolateral knee injuries.¹² Because it has been reported that the historical incidence of posterolateral knee injuries has been underestimated and under-reported, with a reported incidence of between 4% and 7%,1, 5, 16, 17, 26 it was believed that a large prospective MRI study would provide, as

Conclusions

This study showed that in this population, the incidence of posterolateral knee injuries in patients with acute knee ligament injuries with a hemarthrosis was 9.1%. It also verified that most PCL and PLC injuries occur in combination with other ligament injuries.

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Cited by (182)

Double Vector: A Combined Biomechanical and Anatomical Posterolateral Corner Reconstruction Technique
2024, Arthroscopy Techniques
Posterolateral corner (PLC) injuries are complex knee injuries that are becoming increasingly frequent. Often undiagnosed and underestimated, a systematic diagnostic workup is necessary to assess the severity of PLC injury in order to then be able to select the proper surgery approach. Anatomical and nonanatomical PLC-reconstruction techniques have been described. In this Technical Note, we describe our technique of biomechanical reconstruction of PLC in case of severe posterolateral rotational instability.
Could medial femoral notching be a marker in posterolateral corner injuries?
2023, Injury
Posterolateral corner (PLC) injuries constitute 16 % of all knee ligament injuries and are often seen with other ligamentous injuries. PLC injuries can be overlooked. If left untreated, other ligamentous reconstructions are at risk, residual laxity may occur, and early osteoarthritis may result.
Patients diagnosed with PLC injury and who underwent surgical treatment between November 2018 and November 2022 were retrospectively analyzed. Two groups were formed 44 PLC patients with a concomitant ligament injury and 50 patients with an isolated ACL injury (control group). Preoperative MRI findings and arthroscopic surgery findings of the patients were evaluated. Medial femoral condyle notching sign (MFNS) and lateral femoral condyle notching sign (LFNS) data were obtained from preoperative MRI sections. If the lesion depth was less than 1.5 mm, it was not considered a notching sign.
In group 1, there were 44 patients with PLC injuries accompanied by other ligamentous injuries. In group 2, there were 50 patients with isolated ACL injuries not accompanied by other ligamentous injuries. Medial femoral notching sign (MFNS) was higher in Group 1 (p < 0.00001). The lateral femoral notching sign (LFNS) was higher in Group 2 (p:0.023).
PLC injuries are difficult to diagnose. MFNS is a finding that may facilitate diagnosis in PLC injuries.
Patients With Anterior Cruciate Ligament Rupture and Ipsilateral Segond Fractures Have High Rates of Concurrent Knee Pathology
2023, Arthroscopy, Sports Medicine, and Rehabilitation
The purpose of this study was to determine the rates of concomitant knee pathology in patients with ACL injuries and Segond fractures.
A retrospective study is undertaken with patients identified via query of CPT codes for ACL reconstruction from 2014 to 2020. All patients with preoperative radiographs were reviewed for the presence of Segond fractures. Operative reports were analyzed for the presence of concurrent pathology, including meniscus, cartilage, and other ligamentous injuries at the time of arthroscopic ACL reconstruction.
A total of 1,058 patients were included in the study. Segond fractures were identified in 50 (4.7%) patients. Ipsilateral concomitant knee pathology was identified in 84% of Segond patients. Thirty-eight (76%) patients had meniscal pathology with a total 49 meniscal injuries, of which 43 were treated operatively. Multiligamentous injuries were present in 16 patients (32%), with 8 patients undergoing further ligament repair/reconstruction at the time of surgery. Chondral injuries were identified in 13 patients (26%).
A high prevalence of concomitant meniscal, chondral, and ligamentous injuries was found in patients with Segond fractures. These additional injuries may require further operative management and may place patients at increased risk for future instability or degenerative changes. Patients with Segond fractures should be counseled preoperatively on the nature of their injuries and risk of associated pathologies.
Level IV, prognostic case series.
MR Imaging of Acute Knee Injuries: Systematic Evaluation and Reporting
2023, Radiologic Clinics of North America
Bone Bruise Patterns Associated With Pediatric and Adult Anterior Cruciate Ligament Tears Are Different
2023, Arthroscopy, Sports Medicine, and Rehabilitation
To describe differences in radiographic and magnetic resonance imaging (MRI) findings between adult and pediatric patients with known primary anterior cruciate ligament (ACL) injuries.
We performed a retrospective analysis of surgical patients with a history of ACL tears treated at our institution over a 7-year period. Patients were divided into 2 cohorts based on age (≤15 years and ≥21 years). Patients’ radiographs and MRI studies were used to compare features including fracture incidence, bone bruise pattern, associated ligamentous injuries, and meniscal injuries between the 2 groups. Proportions of associated findings were analyzed using the 2-proportion z test.
Within our cohorts of 52 sex-matched pediatric and adult patients, we found that pediatric patients were more likely to have radiographic evidence of fracture (P = .001) and MRI evidence of lateral femoral condylar bone bruising (P = .012). Adult patients had higher rates of medial femoral condylar bruising (P = .016) and medial proximal tibial bruising (P = .005), as well as popliteal fibular ligament injuries (P = .037), identified on MRI.
In this study, we identified differences in bone bruise patterns between pediatric and adult patients with primary ACL tears. Pediatric patients were more likely to have radiographic evidence of fracture and MRI evidence of lateral femoral condylar bone bruising. Adult patients were more likely to show medial femoral condylar and medial proximal tibial bone bruising, as well as popliteal fibular ligament injuries.
Level IV, prognostic case series.
Non-anatomical reconstruction of chronic posterolateral corner knee injuries show failure rates from 0% to 36% versus 4.3% to 24.2% for anatomic reconstruction techniques: An updated systematic review reflecting the 2019 expert consensus statement
2023, Journal of ISAKOS
To review and update the literature regarding outcomes following surgical management of chronic, grade III posterolateral corner (PLC) injuries, with an emphasis on estimating failure rates based upon objective parameters in light of the 2019 expert consensus, while secondarily comparing the failure rates of anatomic versus non-anatomic reconstruction techniques.
A literature search was performed using the PubMed, Embase, MEDLINE, and Cochrane Library databases. Inclusion criteria consisted of level I-IV human clinical studies reporting subjective and objective outcomes in patients following surgical management for chronic (>6 weeks from injury) grade III PLC injuries, with a minimum two-year follow-up. The criterion for objective surgical failure was based on post-operative varus stress radiographs and defined as a side-to-side difference of 3 mm or more of lateral gapping.
A total of six studies, consisting of 10 separate cohorts encompassing a total of 230 patients, were identified. PLC reconstruction was performed in all cohorts, with 80 % (n = 8/10) of these cohorts utilising an anatomic reconstruction technique. A failure rate ranging from 4.3 % to 36 % was found. Subgroup analysis revealed a failure rate of 4.3 %–24.2 % for anatomic reconstruction techniques, whereas a 0 %–36 % failure rate was found for non-anatomic reconstruction. Arthrofibrosis was the most common complication (range, 0 %–12.1 %) following surgery. 0 %–8 % of patients required revision PLC surgery.
PLC reconstruction yields a wide variability in failure rates according to the side-to-side difference of 3 mm or more of lateral gapping on post-operative varus stress radiographs, with low revision rates following anatomic and non-anatomic reconstruction techniques.
IV; Systematic Review of Level III and IV studies.

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Original ArticleA Prospective Magnetic Resonance Imaging Study of the Incidence of Posterolateral and Multiple Ligament Injuries in Acute Knee Injuries Presenting With a Hemarthrosis

Section snippets

Methods

Results

Discussion

Conclusions

Magn Reson Imaging Clin N Am

Arthroscopy

Diagnosis of acute knee injuries with hemarthrosis

Am J Sports Med

Classification of knee ligament instabilitiesPart II. The lateral compartment

J Bone Joint Surg Am

Chronic posterolateral rotatory instability of the knee

J Bone Joint Surg Am

Injuries to the posterolateral aspect of the kneeAssociation of anatomic injury patterns with clinical instability

Am J Sports Med

Arthroscopy in acute traumatic hemarthrosis of the kneeIncidence of anterior cruciate tears and other injuries

J Bone Joint Surg Am

Biomechanical analysis of a posterior cruciate ligament reconstructionDeficiency of the posterolateral structures as a cause of graft failure

Am J Sports Med

Lateral ligament injuries of the knee

Knee Surg Sports Traumatol Arthrosc

The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft forceA biomechanical analysis

Am J Sports Med

The effect of injury to the posterolateral structures of the knee on force in a posterior cruciate ligament graft: A biomechanical study

Am J Sports Med

Acute posterolateral rotatory instability of the knee

J Bone Joint Surg Am

Nonoperative treatment of grade II and III sprains of the lateral ligament compartment of the knee

Am J Sports Med

The magnetic resonance imaging appearance of individual structures of the posterolateral kneeA prospective study of normal knees and knees with surgically verified grade III injuries

Am J Sports Med

Original Article
A Prospective Magnetic Resonance Imaging Study of the Incidence of Posterolateral and Multiple Ligament Injuries in Acute Knee Injuries Presenting With a Hemarthrosis