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The posterolateral corner of the knee is composed of a multilayered complex of ligamentous, musculotendinous, and capsular structures, which interact in a synergistic stabilizing manner with the central structures, particularly the posterior cruciate ligament. Injuries of the posterolateral corner are generally accompanied by rupture of the posterior cruciate ligament. Depending on the injured structures, injuries of the posterolateral corner result in posterolateral rotational instability alone (Fanelli A) or with lateral instability (Fanelli B/C). For rotational instability alone, isolated popliteus bypass is an effective procedure; with concomitant lateral instability in flexion, additional stabilization of the lateral collateral ligament is required. Most of the various available techniques are described as open reconstruction procedures. In recent years, arthroscopic techniques for posterolateral reconstruction have also been successfully developed., (© 2024. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Objective: Anatomic reconstruction of the retropatellar articular surface and repair of the extensor mechanism of the knee joint. The osteosynthesis should allow immediate mobilization as part of an early functional postoperative rehabilitation protocol., Indications: Displaced fractures of the patella, especially multifragment and comminuted fractures with a retropatellar incongruity or dislocation of >2 mm., Contraindications: Critical local soft tissue because of the risk of postoperative infection., Surgical Technique: Median skin incision. For simple (transverse) fractures, preservation of the soft tissue and reduction control via the index finger. For complex fractures, lateral arthrotomy and eversion of the patella. Reconstruction of the articular surface from the joint side with optimal visibility. Temporary fixation with Kirschner wires, osteosynthesis with the fixed angle plate. If necessary, additional screws or wires., Postoperative Management: Immediate mobilization with full weightbearing in full extension with a knee brace. Extension/flexion 0/0/60° for 4 weeks, then 0/0/90° until the 7th week. Active extension after 6 weeks. Climbing stairs after 12 weeks., Results: Good functional results in combination with a low rate of complications and revisions.

Malreduction of tibial head fractures often leads to malalignment of the lower extremity, pain, limited range of motion and instability. The extent of the complaints and the degree of deformity requires an exact analysis and a standardized approach. True ligamentous instability should be distinguished from pseudoinstability of the joint. Also extra- and intra-articular deformities have to be differentiated. In intra-articular deformities the extent of articular surface displacement, defects and clefts must be accurately evaluated. A specific surgical approach is necessary, which allows adequate visualization, correct osteotomy and refixation of the fractured area of the tibial head. In the long-term course good clinical results are described for intra-articular osteotomies. If the joint is damaged to such an extent that it cannot be reconstructed or in cases of advanced posttraumatic osteoarthritis, total knee arthroplasty may be necessary; however, whenever possible and reasonable, anatomical reconstruction and preservation of the joint should be attempted.

Objective: Reconstruction of knee stability by primary ligament sutures and additional augmentation after knee dislocation., Indications: Acute knee dislocation Schenck type III and IV. Operative treatment should be performed within 7 days after injury., Contraindications: Chronic instability after knee dislocation, refixable bony avulsions, critical soft tissue, infection, lack of compliance., Surgical Technique: Supine position with electric leg holder. Short arthroscopic assessment of concomitant injuries. Schenck type III medial injuries and Schenck IV injuries: anteromedial parapatellar arthrotomy. Injuries type Schenck III lateral: anteromedian arthrotomy. Armoring of ligament stumps for transosseus sutures. Placement of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) drill tunnels. Extracortical diversion of the suture armorings and insertion of augmentation systems. Fixation of the PCL augmentation in 70-90° flexion. Fixation of the ACL augmentation in 20-30° flexion. Knotting of the transosseus ligament sutures. If necessary (postero-)lateral and/or medial stabilization., Postoperative Management: Limited weight bearing with 20 kg for 6 weeks. Stabilizing brace (e.g., Hypex-Lite®, Albrecht) generally for 12 weeks. Mobilization under tension of the quadriceps muscle for 6 weeks., Results: In total, 20 patients have been treated using the principle of "ligament bracing". So far 8 patients (aged 18-60 years, median 33 years) have been assessed with a follow-up of 10-15 months (median 12 months) postoperatively. In all, 6 patients showed stable knees with good results. Recurrent instability of the ACL was observed in 2 patients; the collateral ligaments and PCL were stable. For the evaluation the following scores were used: IKDC score, Tegner score, and Lysholm score. To objectify the data, stress radiography and physical examination were performed. Using the operative technique mentioned above, no complications occurred. During follow-up 2 patients reported a deficiency of flexion.

The medial collateral ligament complex (MCL) is the most commonly damaged ligamentous stabilizer of the human knee. The diagnostic algorithm comprises patient history, clinical examination and magnetic resonance imaging (MRI). It is important to distinguish between incomplete and complete ruptures of the MCL. For adequate treatment the classification and exact knowledge about concomitant injuries are important. A nonoperative treatment of incomplete ruptures (grades I and II) is widely accepted and usually results in a good clinical outcome but the treatment of complete ruptures (grade III) is a subject of controversy. Complete intraligamentous ruptures with a correct approximation of the stumps and intact dorsomedial joint capsule can also be treated nonoperatively with good and excellent results. In contrast, ruptures close to the abutment and bony avulsions tend to heal better through operative treatment. Dehiscence or dislocation of the ligament stumps in MRI is an indication for operative treatment. In the context of a multiligamentous injury or complex instability, the majority of authors suggest an operative stabilization. As the treatment of chronic instability can be challenging, the initial and adequate treatment of acute ruptures is of great importance.

Minimally invasive and arthroscopic procedures have become an integral part of orthopedics and arthroscopy of the knee in particular has extensively evolved during recent years. Therefore, the purpose of this article is to show the indications and possibilities and also the limitations of arthroscopy-assisted fracture fixation of the knee joint. Based on the literature and our own experiences we consider the following indications for arthroscopy-assisted fracture fixation in the knee to be appropriate: 1) simple fractures of the tibial plateau, depression fractures of the tibial plateau and simple fractures of the patella, 2) arthroscopic control of reconstruction of the articular surface in complex fractures, 3) bony avulsions of the posterior or anterior cruciate ligament, 4) osteochondral flakes, 5) therapy of concomitant intra-articular lesions in fractures of the knee joint and 6) arthroscopy in posttraumatic situations. The various indications are discussed in relation to the current literature and on the basis of case reports. Arthroscopy is not only an assisting and helpful instrument in the therapy of fractures of the knee joint but in some cases it is also indispensable to guarantee optimal fracture management.

Objective: Reduction and fixation of bony avulsions of the posterior cruciate ligament (PCL) through a minimally invasive dorsal approach to restore stability of the knee joint. Prevention of soft tissue damage through a minimally invasive procedure and achieving early functional rehabilitation by stable osteosynthesis., Indications: Bony tibial avulsions of the PCL and simple posteromedial tibial fractures., Contraindications: Infections in or around the knee, critical soft tissue conditions and lack of patient compliance. OPERATION TECHNIQUE: Supine position, skin incision mediodorsal over the head of the medial gastrocnemius muscle. After dissection of soft tissue and superficial fascia the medial gasteocnemius muscle is retracted to the lateral side, nerves and vessels of the popliteal fossa are thereby protected. Incision of the posterior capsule from the tibial attachment, exposure of the fracture and the PCL, reduction of the fracture, fixation with two drill wires and definitive fixation with two cannulated screws. In case of multifragment fracture a suture anchor is used for fixation., Postoperative Management: Partial weight bearing of 10-20 kg for 4-6 weeks and limitation of knee flexion up to 90° for 4 weeks., Results: Between November 2010 and November 2011 three patients were treated with the new minimally invasive posteromedial approach to fix bony avulsions of the PCL. In two cases an osteosynthesis with two screws was performed and in the other patient a comminuted avulsion fracture was fixed with a suture anchor. In the latter patient the posterolateral corner was additionally augmented according to Larson with an autologous semitendinosus tendon. No intraoperative or postoperative complications could be observed. In all three patients an excellent fracture reduction without steps or gaps could be achieved. In two cases an early functional treatment protocol and in one case (suture anchor fixation plus augmentation of the posterolateral corner) a special postoperative PCL rehabilitation protocol was used. Good clinical results with stable knee joints could be achieved in all cases. The minimally invasive dorsal approach for the treatment of bony avulsions of the PCL was demonstrated to be safe and simple with a low complication rate.

Introduction: Total meniscus resection usually leads to osteoarthritis of the knee joint. Preservation and refixation of the injured menisci are therefore of great clinical importance., Materials and Methods: The present study examines 40 meniscal injuries in 37 patients that were arthroscopically treated with Clearfix meniscal screws (Mitek, Norderstedt, Germany) in the period from August 1999 to December 2002. The mean patient age was 27.7 (range 16-62) years. Nine patients were female. A total of 24 patients (27 meniscal tears) also had an anterior cruciate ligament (ACL) lesion, and 5 patients had cartilage injuries. Twenty-two patients were treated within the first 2 weeks following the trauma, 10 patients within 8 weeks, and 5 patients after 8 weeks. The lesions were a bucket-handle tear of the medial meniscus in 11 cases and a bucket-handle tear of the lateral meniscus in 2 cases. The posterior horn of the medial meniscus was torn in 13 cases, and the pars intermedia in 3 cases. The posterior horn of the lateral meniscus was torn in 8 cases, and the pars intermedia in 3 cases. The mean tear length was 2.9 (+/- 1.5) cm and was fixed with an average of 1.8 (+/- 0.7) screws. In 7 cases, the anterior horn was treated with an additional meniscal suture. A total of 35 patients were examined after an average of 18 (range 7-45) months., Results: In the event of a moderate outcome, MRI was performed as part of the follow-up investigation. The average Lysholm score was 93 (+/- 7.4), the Tegner activity index was 6.3 (+/- 2.0) before the accident and 5.8 (+/- 2.0) at the follow-up, the Marshall knee score was 47 (+/- 3.8). The VAS pain assessment was 1.6 (+/- 1.3) and the VAS function assessment was 7.9 (+/- 1.6). Of the 7 patients with a moderate result, 2 patients without additional ligament lesions suffered re-ruptures after and 13 months, respectively. The other 5 patients with a moderate result each had multiple accompanying injuries or pre-existing damage to the affected knee joint., Conclusion: The Clearfix screws achieved a clinical success rate of 82% in isolated meniscal tears in stable knee joints and a clinical success rate of 100% with additional ACL reconstruction. In view of the good clinical results and the simple procedure for use, the implant should be recommended for meniscal refixation.

Thirty-five patients were prospectively examined on average 5.9 and 11.1 months after reconstruction of the anterior cruciate ligament. Eighteen patients were treated postoperatively with a regular physiotherapy (PT) program 2-3 times per week for 30 min, 17 patients with a special, extended, and supervised rehabilitation program 3-5 times per week for 2.5 h. Criteria for exclusion from this study were previous operation or fractures of the affected knee. The bases for the evaluation of the clinical results were the clinical examination, the Lysholm and Tegner scores, KT 1000, angular reproducibility according to Barrett (proprioception), and the figure-of-eight hop test. It appeared that patients treated with extended ambulatory physiotherapy (EAP) gained a significantly higher degree of functionality in the Lysholm score after 5.9 months (p < 0.02) and the Tegner score after 11.1 months (p < 0.05) than patients treated with regular physiotherapy. Patients treated with EAP also displayed better results in the proprioceptive capability test with an angular deviation of 5.8 degrees after 5.9 months compared to 11 degrees in patients receiving regular PT. After 11.1 months, there were no differences in proprioceptive capability between the two groups. Although the EAP patients were faster in the figure-of-eight hop test (0.39 s difference compared to 0.58 s in the PT patients), the results were not statistically significant. In KT 1000 ventral tibial instability was on average 21% lower in the PT patients than in the EAP patients. After 11.1 months, both groups exhibited the same median value of 3 mm. Furthermore, EAP patients were able to return to work after 36.7 days on average, a 35% shorter period than in the case of PT patients (55 days), also of statistical significance (p < 0.02). To conclude, the primarily higher costs of this intensive rehabilitation program are justified by the better functional outcome linked with an earlier return to work.

Background: Investigation of the association between leg axis alignment and biochemical MRI in young professional soccer players in order to identify a potential influence of the leg axis on cartilage regions at risk. Methods: Sixteen professional soccer players (21 ± 3 years) underwent static and dynamic leg axis analysis via radiation free DIERS formetric 4 D as well as 3-T MRI examination of both knees. Quantitative T2* mapping of the knee cartilage was performed and T2* values were evaluated as 144 regions of interest. Subgroup analysis was performed in players with severe varus alignment (> 6°). Results: Analysis of the leg axis geometry revealed a mean static alignment of 6.6° ± 2.5 varus and a mean dynamic alignment of 5.1° ± 2.6 varus. Quantitative T2* mapping showed significantly increased T2* values in the superficial cartilage layer compared to the deeper region (p < 0.001) as well as a significant increase in relaxation times in the femoral cartilage from anterior to intermediate to posterior (p < 0.001). Combination of both methods revealed a significant correlation for the degree of varus alignment and the femoral, posterior, deep region of the medial knee compartment (r = 0.4; p = 0.03). If severe varus alignment was present this region showed a significant increase in relaxation time compared to players with a less pronounced leg axis deviation (p = 0.003). Conclusion: This study demonstrates that varus alignment in young soccer players is associated with elevated T2* relaxation times in the deep cartilage layer of the medial, posterior, femoral compartment and might therefore be a contributing factor in the early pathogenesis of manifest cartilage lesions. Therefore, these findings should be considered in the development of preventive training programs. [ABSTRACT FROM AUTHOR]

Purpose: Acute knee dislocation is a rare but devastating multi-ligamentous knee injury with only limited evidence-based surgical technique recommendations. The aim of this study was a comparison of two different anterior cruciate ligament (ACL) restoration techniques as part of an early total surgical care concept: (1) repair of ACL with additional internal bracing (ACLIB) compared to; (2) ACL reconstruction with autograft (ACLR). Methods: Retrospective, clinical-study of patients with an acute type III or IV knee dislocation (according to Schenck classification), in which the ACL was treated with ACLIB or ACLR within 12 days. The PCL was sutured and internally braced in all cases. Medial and lateral complex injuries were repaired and additionally laterally augmented by an Arciero reconstruction. After a minimum 12 months follow-up different patient-reported outcome measurements (IKDC, Lysholm, VAS, Tegner Score) and instrumental stability assessment by Rolimeter -test and stress radiographs (Telos™) were analyzed. Groups were compared by t test with p < 0.05 considered significant. Results: In total, 20 patients (5 IIIM, 5 IIIL and 10 IV) were included in this study with an average follow-up of 13.7 ± 2.6 months. There were significant differences in instrumental stability testing (side-to-side difference (SSD) of anterior tibial translation: ACLIB 2.7 ± 1.5 mm vs. ACLR 1.3 ± 1.3; p = 0.0339) and stress radiography (SSD ACL: ACLIB 3.4 ± 2.2 mm vs. ACLR 0.4 ± 2.7; p = 0.0249) between groups. ACLIB group showed greater ROM in terms of flexion (SSD Flexion: ACLIB 7.8 ± 9.9° vs. ACLR 16 ± 7.0°; p = 0.0466; Total Flexion overall 125.5 ± 11.8°). No clinically relevant differences in patient-reported outcome scores (Lysholm Score: ACLIB 82 ± 16.4 vs. ACLR 85 ± 10.4; IKDC subjective score: ACLIB 70.4 ± 17 vs. ACLR 76.6 ± 8.3) were determined. Conclusion: ACLR provides superior translational stability than ACLIB in terms of instrumental testing and stress radiography. Both techniques were equivalent with respect to PROMS and led to good and excellent clinical results. Level of evidence: Retrospective cohort study, III. [ABSTRACT FROM AUTHOR]

Copyright of Operative Orthopädie und Traumatologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As more children and adolescents are involved in sporting activities, the number of injuries to immature knees rises. We will focus on three entities: ruptures of the anterior cruciate ligament, patellar dislocation, and meniscal injuries. There is a trend in recent literature toward early reconstruction of the anterior cruciate ligament in children and adolescents. In this article, we will try to highlight the anatomic specialities and the diagnostic steps toward the correct diagnosis, review technical considerations and risks of the different surgical techniques, and present outcomes and offer a treatment recommendation. The treatment of patellar dislocation has changed considerably since we gained a better understanding of the unique anatomy of the patellofemoral joint. We will show diagnostic steps and risk factors for recurrent patellar dislocation, discuss conservative and different operative therapy options, and present a modified technique to achieve a dynamic reconstruction of the medial patellofemoral ligament without damage to the growth plates. Meniscal tears and discoid menisci are rare in comparison to the other injuries. We will herein explain what specialities in the anatomy should be considered in children and adolescents concerning the menisci, and present the diagnostic steps and treatment options available. [ABSTRACT FROM AUTHOR]

Copyright of Trauma und Berufskrankheit is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)