Anteromedial rotatory laxity

Engebretsen, Lars; Lind, Martin

doi:10.1007/s00167-015-3675-8

Cited by 41 publications

(52 citation statements)

References 38 publications

(96 reference statements)

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“…AMRI is assessed clinically with the dial test and the anteromedial drawer test, which produce anterior tibial plateau subluxation and external rotation in the setting of POL and posteromedial capsule injury. 6 Care should be taken to differentiate a positive dial test in the setting of AMRI versus with PLRI, both of which generate increased tibial external rotation. Assessment of the position of the tibia relative to the femur, whether it moves anteromedially versus posterolaterally, delineates AMRI from PLRI, respectively.…”

Section: Ligamentous Evaluationmentioning

confidence: 99%

“…Assessment of the position of the tibia relative to the femur, whether it moves anteromedially versus posterolaterally, delineates AMRI from PLRI, respectively. 6 Another example of rotational instability is anterolateral rotatory instability (ALRI). ALRI is caused by disruption of the anterolateral soft tissue complex, which includes the anterolateral ligament (ALL), the iliotibial band, and associated attachments.…”

Section: Ligamentous Evaluationmentioning

confidence: 99%

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Impact of Clinical Presentation on Imaging Evaluation to Direct Effective Treatment Strategies

et al. 2017

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A multitude of musculoskeletal disorders of the knee are commonly encountered in clinical practice. Ensuring an accurate diagnosis can be challenging. It is critical to establish a thoughtful and systematic approach to assessing the patient using history and physical exam followed by appropriate imaging studies. The physical exam may be complicated due to various test maneuvers designed to help make the diagnosis. It is also important to understand the limitations of each physical exam maneuver. When appropriate, imaging is obtained to help make the diagnosis and guide treatment. There are various imaging examinations to choose from when evaluating the knee, including X-rays, computed tomography, magnetic resonance imaging, and ultrasound. An algorithmic approach to choosing the best imaging study is often helpful to avoid unnecessary costs and burden to the patients. The combination of a thorough clinical assessment and appropriate imaging examinations will result in accurate diagnosis, which directs proper treatment.

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Section: Ligamentous Evaluationmentioning

confidence: 99%

Section: Ligamentous Evaluationmentioning

confidence: 99%

Impact of Clinical Presentation on Imaging Evaluation to Direct Effective Treatment Strategies

et al. 2017

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“…This is a valgus movement associated with external rotation of the tibia relative to the femur. It occurs when the medial tibial plateau subluxates anteriorly relative to the adjacent femoral condyle 2 . One of the main mechanisms of anterior cruciate ligament (ACL) rupture is the association of valgus with discrete exion and external rotation of the tibia relative to the femur 3,4 , which increases the frequency of the association of ACL injury and medial compartment injury, described in approximately 24% of the total cases of ACL injury 5 .…”

Section: Introductionmentioning

confidence: 99%

“…The posteromedial corner of the knee, represented by the posterior horn of the medial meniscus, posterior oblique ligament (POL), an arm of the semimembranosus, meniscotibial ligaments and the popliteal oblique ligament, is an important restrictor of AMRI over the entire range of motion of the knee 2,6 . However, the main restrictor of external tibial rotation in relation to the femur in the medial compartment is the super cial medial collateral ligament (sMCL) 7 .…”

Section: Introductionmentioning

confidence: 99%

The Anterior Oblique Ligament description in the knee anteromedial compartment

Jorge¹,

Oliveira²,

Resende³

et al. 2020

Preprint

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Purpose: To describe a ligamentous structure in the anteromedial region of the knee identified in a series of anatomical dissections of cadaveric specimens.Methods: Sixteen cadaveric knees were dissected to study the medial compartment. Exclusion criteria were signs of trauma, previous surgery, signs of osteoarthritis and poor preservation state. The main structures of this region were identified during medial dissection. After releasing the superficial medial collateral ligament (sMCL) of the tibia, the Anterior Oblique Ligament (AOL), was isolated. The morphology of the structure and its relationship with known anatomical parameters were determined. For the statistical analysis, the means and standard deviations were calculated for continuous variables. A 95% confidence intervals was defined as significant. Student's t-tests were used for continuous variables.Results: After dissection a distinct ligamentous structure (AOL) was found in the medial region of the knee. This structure was found in 100% of the cases, was located extracapsularly and originated in the anterior aspect of the medial epicondyle, running obliquely toward the tibia. When crossing the joint, the ligament presented a fan-shaped opening, exhibiting a larger area at the tibial insertion. The AOL had a mean thickness of 6.83±1.34 mm at its femoral origin and 13.06±1.91 at its tibial insertion. It had a significantly (p = 0.0009) longer mean length with the knee at 90° of flexion (33.82±9.50 mm) than with the knee in total extension (26.56±9.48 mm), indicating that the ligament is tensioned in flexion.Conclusion: A structure was identified in the anteromedial compartment of the knee with a ligamentous appearance originating in the medial femoral epicondyle and with tibial insertion anterior to the sMCL. Clinical relevance: This study demonstrates the anatomy of a new medial structure of the knee. As a result, there will be a better understanding of the stability of the knee.

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“…Only extreme damage creates biomechanical changes obvious to the clinician during a manual clinical knee examination [ 5 ]. In fact, isolated increased external tibial axial rotation may not identify the patient with a PLC injury without additional manoeuvres during the examination [ 13 , 14 ]. A description of rotatory instability by measuring the relative translation of the lateral compartment of the knee with respect to the medial compartment appears to provide better accuracy in the diagnosis of a PLC injury [ 7 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

The use of a robotic tibial rotation device and an electromagnetic tracking system to accurately reproduce the clinical dial test

Stinton¹,

Siebold

Freedberg

et al. 2016

Knee Surg Sports Traumatol Arthrosc

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PurposeThe purpose of this study was to: (1) determine whether a robotic tibial rotation device and an electromagnetic tracking system could accurately reproduce the clinical dial test at 30° of knee flexion; (2) compare rotation data captured at the footplates of the robotic device to tibial rotation data measured using an electromagnetic sensor on the proximal tibia. MethodsThirty-two unilateral ACL-reconstructed patients were examined using a robotic tibial rotation device that mimicked the dial test. The data reported in this study is only from the healthy legs of these patients. Torque was applied through footplates and was measured using servomotors. Lower leg motion was measured at the foot using the motors. Tibial motion was also measured through an electromagnetic tracking system and a sensor on the proximal tibia. Load-deformation curves representing rotational motion of the foot and tibia were compared using Pearson’s correlation coefficients. Off-axis motions including medial–lateral translation and anterior–posterior translation were also measured using the electromagnetic system. ResultsThe robotic device and electromagnetic system were able to provide axial rotation data and translational data for the tibia during the dial test. Motion measured at the foot was not correlated to motion of the tibial tubercle in internal rotation or in external rotation. The position of the tibial tubercle was 26.9° ± 11.6° more internally rotated than the foot at torque 0 Nm. Medial–lateral translation and anterior–posterior translation were combined to show the path of the tubercle in the coronal plane during tibial rotation.ConclusionsThe information captured during a manual dial test includes both rotation of the tibia and proximal tibia translation. All of this information can be captured using a robotic tibial axial rotation device with an electromagnetic tracking system. The pathway of the tibial tubercle during tibial axial rotation can provide additional information about knee instability without relying on side-to-side comparison between knees. The translation of the proximal tibia is important information that must be considered in addition to axial rotation of the tibia when performing a dial test whether done manually or with a robotic device. Instrumented foot position cannot provide the same information. Level of evidenceIV.

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Anteromedial rotatory laxity

Abstract: This file was dowloaded from the institutional repository Brage NIH -brage.bibsys.no/nih Engebretsen, L., Lind, M. (2016

Cited by 41 publications

References 38 publications

Impact of Clinical Presentation on Imaging Evaluation to Direct Effective Treatment Strategies

Impact of Clinical Presentation on Imaging Evaluation to Direct Effective Treatment Strategies

The Anterior Oblique Ligament description in the knee anteromedial compartment

The use of a robotic tibial rotation device and an electromagnetic tracking system to accurately reproduce the clinical dial test

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