The ALL was consistently found in all knees. Segond fractures appear to occur primarily from the avulsion of the ALL.

The MFLs protect the lateral compartment from changes in contact mechanics in the setting of a lateral meniscal posterior root avulsion, whereas a combination of lateral meniscal root avulsion and deficient MFLs leads to significant changes. Concurrent ACL reconstruction and lateral meniscal root repair restore mean contact pressure and area to the intact state and are recommended in this combined injury to prevent or slow the development of lateral compartment arthritis.

OBJECTIVE: The primary purpose of this study was to determine the characteristics and outcomes of the patients admitted at our clinics diagnosed with cauda equina syndrome (CES). Secondarily, this study will serve as a basis for other comparative studies aiming at a better understanding of this condition and its epidemiology. METHODS: We conducted a retrospective study by reviewing the medical records of patients diagnosed with CES and neurogenic bladder between 2005 and 2011. The following variables were analyzed: gender, age, etiology, topographic level of the lesion, time between disease onset and diagnosis, presence of neurogenic bladder, time between diagnosis and surgery, neurological damage and neurogenic bladder persistence. RESULTS: Considering that CES is a rare condition, we were not able to establish statistic correlation between the analyzed variables and the outcomes of the disease. However, this study brought to light the inadequacy of our public health system in treating that kind of patient. CONCLUSION: The study shows that despite the well-defined basis for managing CES, we noted a greater number of patients with sequels caused by this condition, than is seen in the literature. The delayed diagnosis and, consequently, delayed treatment, were the main causes for the results observed. Level of Evidence IV, Case Series.

Rotating the patellar tendon is an efficient method for shortening a relatively long graft; however, more biomechanical studies are necessary to recommend this technique in clinical practice owing to the resulting decrease in graft stiffness that could compromise knee stability.

Objectives:Recent publications have described significant variability in the femoral attachment and overall anatomy of the anterolateral ligament (ALL). Additionally, there is a paucity of data on its structural properties. The purpose of this comprehensive investigation was to provide quantitative data characterizing the anatomic and radiographic locations, and structural properties of the ALL to assist in the development of an evidence-based approach to anterolateral ligament reconstructions.Methods:In this descriptive laboratory study, identification of the ALL was performed by a combined outside-in and inside-out anatomic dissection of 15 nonpaired cadaveric knees. Quantitative anatomic relationships were made using a three-dimensional coordinate measuring device. The ALL attachments and additional structures were marked with radiopaque markers prior to obtaining true anteroposterior (AP) and lateral radiographs. Radiographic distances were subsequently made using a picture archiving and communications system program. Structural properties were characterized during a single pull-to-failure test in line with the ALL fibers using a tensile testing machine. Ultimate failure strength (N), stiffness (N/mm), and mechanism of failure were recorded for each specimen. All anatomic, radiographic, and biomechanical measurements were reported as mean values and 95% confidence intervals (95% Confidence interval (CI), Lower bound, Upper bound).Results:Anatomy. The ALL was identified as a thickening of the lateral capsule coming under tension with an applied internal rotation at 30° of flexion. Its femoral attachment was consistently located posterior and proximal to the lateral epicondyle (LE), 4.7 mm posterior and proximal to the fibular collateral ligament (FCL) attachment. The ALL coursed anterodistally to its anterolateral tibial attachment approximately midway between Gerdy's tubercle and the anterior margin of the fibular head, located 24.7 mm (95% CI, 23.3, 26.2) and 26.1 mm (95% CI, 23.9, 28.3) from each structure respectively. Radiography. On the AP view, the ALL originated on the femur 22.3 mm (95% CI, 20.7, 23.9) proximal to the joint line and inserted on the tibia 13.1 mm (95% CI, 12.3, 13.9) distal to the lateral tibial plateau. On the lateral view, the femoral attachment was 8.4 mm (95% CI, 6.8, 10.0) posterior and proximal from the lateral epicondyle. The tibial attachment was 19.0 mm (95% CI, 17.1, 20.9) posterior and superior from Gerdy's Tubercle. Structural Properties. The average maximum load during pull-to-failure was 175 N (95% CI, 139, 211) and the stiffness was 20 N/mm (95% CI, 16, 25). Failure occurred by four distinct mechanisms: ligamentous tear at the femoral (n=4) or tibial attachment (n=1), midsubstance tear (n=4) and bony avulsion of the tibial attachment (Segond fracture; n=6).Conclusion:In conclusion, the ALL was observed as a capsular thickening of the lateral knee, primarily coursing from an attachment posterior and proximal to the lateral femoral epicondyle to the anterolateral tibia whi...