Knee Dislocations in the Morbidly Obese Patient
Ultra-low-velocity knee dislocations are historically rare but increasingly common events. They occur most frequently in obese, morbidly obese, and super obese patients during everyday activities, but they can be as severe or more severe than high-velocity knee dislocations. Ultra-low-velocity knee dislocations frequently are associated with neurovascular injury and other complications. Diagnosis, early reduction, and identification and treatment of vascular injuries are critical to reducing the risk of limb ischemia and possibly amputation. Given the size of the limb, maintenance of reduction in these patients almost alwa...
Source: Sports Medicine and Arthroscopy Review - August 1, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Combined ACL-PCL-Medial and Lateral Side Injuries (Global Laxity)
The multiple ligament injured knee is a complex problem in orthopedic surgery. These injuries may or may not present as acute knee dislocations, and careful assessment of the extremity vascular and neurological status is essential because of the possibility of arterial and/or venous compromise, and nerve injury. These complex injuries require a systematic approach to evaluation and treatment. Physical examination and imaging studies enable the surgeon to make a correct diagnosis and formulate a treatment plan. Knee stability is improved postoperatively when evaluated with knee ligament rating scales, arthrometer testing, a...
Source: Sports Medicine and Arthroscopy Review - August 1, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Surgical Treatment of Combined ACL, PCL, and Lateral Side Injuries
A knee dislocation that involves at least 2 of the 4 major ligament groups—such as the anterior cruciate ligament, the posterior cruciate ligament, or the posterolateral corner—is a catastrophic event for an athlete or trauma patient. Careful evaluation of these patients is needed to avoid disastrous outcomes. Surgeons must be cognizant of a number of key treatment concerns—such as tunnel crowding, controversies over graft fixation methods, and sparsity of level I clinical data—to make proper ligament repair decisions. This manuscript will review treatment principles that govern high-quality care of this complex in...
Source: Sports Medicine and Arthroscopy Review - August 1, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Surgical Treatment of Combined ACL PCL Medial Side Injuries
The multiple ligament knee injury involving the medial collateral ligament, anterior cruciate ligament, and posterior cruciate ligament is typically the result of a high-energy trauma or knee dislocation event. Optimal treatment strategies are debated, specifically in regard to timing of surgery, reconstruction/repair techniques, and postoperative protocols. This review details the stepwise treatment of these complex patients from diagnosis to postoperative rehabilitation and summarizes the current literature. (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - August 1, 2020 Category: Sports Medicine Tags: Digital Exclusive Source Type: research

Initial Evaluation and Classification of Knee Dislocations
The traumatic knee dislocation (KD) is a complex condition resulting in injury to>1 ligament or ligament complexes about the knee, termed multiligament knee injuries. Typically, KDs result in injury to both cruciate ligaments with variable injury to collateral ligament complexes. Very rarely, KD may occur with single cruciate injuries combined with collateral involvement but it is important to understand that not all multiligament knee injuries are KDs. Patients can present in a wide spectrum of severity; from frank dislocation of the tibiofemoral joint to a spontaneously reduced KD, either with or without neurovascular in...
Source: Sports Medicine and Arthroscopy Review - August 1, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Knee Ligament Anatomy and Biomechanics
An understanding of knee ligament anatomy and biomechanics is foundational for physicians treating knee injuries, especially the more rare and morbid multiligamentous knee injuries. This chapter examines the roles that the cruciate and collateral anatomy and morphology play in their kinematics. Additionally, the biomechanics of the ACL, PCL, MCL, and LCL are discussed as they have surgical and reconstructive implications. (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - August 1, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Knee Dislocation
No abstract available (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - August 1, 2020 Category: Sports Medicine Tags: Editorial Source Type: research

Chapter 5: Techniques For ACL Revision Reconstruction
Anterior cruciate ligament (ACL) reconstruction is a commonly performed procedure, with an increasing frequency leading to an increased number of revision procedures. Etiologies for graft rupture are varied and can include technical issues, repeat trauma, and graft choice. The preoperative evaluation before a revision ACL reconstruction should include a detailed history and physical exam, as well as radiographs, magnetic resonance imaging to evaluate graft integrity and for concomitant injuries, as well as computed tomography to measure for bone tunnel osteolysis. Surgical techniques for revision ACL reconstruction include...
Source: Sports Medicine and Arthroscopy Review - April 30, 2020 Category: Sports Medicine Tags: Digital Exclusive Source Type: research

Lateral Extra-articular Tenodesis in Anterior Cruciate Ligament Reconstruction
A subset of patients have residual rotational laxity following anterior cruciate ligament reconstruction (ACLR) despite the evolution of ACLR techniques. In recent years, there has been increased interest in addressing residual laxity because it is associated with poor outcomes after ACLR. There is an expanding body of knowledge on the anatomy and biomechanics of the anterolateral soft tissue restraints in regard to their rotational control of the knee and this has reignited an interest in extra-articular reconstruction techniques for augmenting ACLR. Reconstruction techniques currently used can be broadly categorized as e...
Source: Sports Medicine and Arthroscopy Review - April 30, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Readiness to Return to Sport After ACL Reconstruction: A Combination of Physical and Psychological Factors
Although the incidence of anterior cruciate ligament injuries continues to rise, return to sport (RTS) rates remain low and risk of the second injury remains high. No gold-standard criteria exist for medical clearance to RTS after anterior cruciate ligament reconstruction. The lack of consensus may be driven by the multifactorial nature of the clinical decision that includes a combination of physical and psychological factors. Tools such as the Quality of Movement Assessment, which identifies physical deficits and faulty movement patterns to provide targeted recommendations for safe RTS, and the Anterior Cruciate Ligament ...
Source: Sports Medicine and Arthroscopy Review - April 30, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Techniques for Femoral Socket Creation in ACL Reconstruction
Anterior cruciate ligament (ACL) injury is common and affects a wide variety of individuals. An ACL reconstruction is the treatment of choice for patients with subjective and objective symptoms of instability and is of particular importance to cutting or pivoting athletes. With many variables involved in ACL reconstruction, femoral tunnel placement has been found to affect clinical outcomes with nonanatomic placement being identified as the most common technical error. Traditionally the femoral tunnel was created through the tibial tunnel or transtibial with the use of a guide and a rigid reaming system. Because of proxima...
Source: Sports Medicine and Arthroscopy Review - April 30, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Biological Augmentation of ACL Repair and Reconstruction: Current Status and Future Perspective
Historically, anterior cruciate ligament (ACL) suture repair mostly resulted in failure because of intra-articular hypovascularity and poor intrinsic healing capacity of ACL. ACL reconstruction was therefore deemed the gold standard with a high success rate because of more evolved surgical technique. There are, however, clinical and subclinical disadvantages of reconstruction; low rate in full recovery to sports, donor harvest morbidity, tunnel enlargement, and incomplete microscopic healing of the graft. Recent experimental and clinical studies on biological augmentation of mesenchymal stem cells, platelet-rich plasma, or...
Source: Sports Medicine and Arthroscopy Review - April 30, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Graft Selection in Anterior Cruciate Ligament Reconstruction
Surgical reconstruction of the anterior cruciate ligament (ACL) is often indicated to restore functional stability and prevent early degeneration of the knee joint, as there is little biological healing capacity of the native ACL. Although a reconstructed ACL does not fully restore the original structure or biomechanics properties of the native ACL, the graft used for reconstruction must not only have structural and mechanical properties that closely resemble those of the native ligament, it must also have minimal antigenicity and enough biological potential to incorporate into host bone. There are several considerations i...
Source: Sports Medicine and Arthroscopy Review - April 30, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Objectifying the Pivot Shift Test
The pivot shift test is utilized for assessment of rotatory instability in the anterior cruciate ligament (ACL) deficient knee. There are multiple reports of the pivot shift maneuver, and there is a lack of consensus among clinicians as to a standardized maneuver. Measurement devices are a feasible option to evaluate rotatory knee instability, objectively or quantitatively. Traditionally, measurement systems have been invasive systems. More recently, electromagnetic system, inertial sensor, or imaging analysis systems, specifically with the utilization of a tablet computer, have emerged as noninvasive, and more importantly...
Source: Sports Medicine and Arthroscopy Review - April 30, 2020 Category: Sports Medicine Tags: Review Articles Source Type: research

Latest Trends in ACL Reconstruction
No abstract available (Source: Sports Medicine and Arthroscopy Review)
Source: Sports Medicine and Arthroscopy Review - April 30, 2020 Category: Sports Medicine Tags: Editorial Source Type: research