Magnetic Resonance Imaging for Irreducible Posterolateral Knee Dislocation

Tsiagadigui, Jean-Gustave; Sabri, Fariborz; Sintzoff, Serge; Schuind, Frédéric

doi:10.1097/00005131-199708000-00018

Cited by 18 publications

(10 citation statements)

References 16 publications

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“…A review of several recent cases, clearly defined as posterolateral dislocations, revealed only 1 case of accompanying neurologic injury. 3,8,12,13 Neurologic deficits are infrequent, but peroneal nerve injury is more common among posterolateral types than other dislocations. 9 Vascular injury from a rotary mechanism occurs less frequently compared to other types of dislocation.…”

Section: Mri Findings In Our Studymentioning

confidence: 99%

“…The associated findings in previous reports include lateral patellar subluxation, 12 inferior descent of the patella, 12 cruciate ligament tears, 3,4,6,10,12,13 impaction fracture of the posterior margin of the lateral tibia plateau, 12 avulsion of the posterior horn of the medial and lateral menisci, 8 and quadriceps tendon rupture. 3 No mention of the posterolateral structures was made in any previous reports.…”

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confidence: 92%

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Irreducible Posterolateral Knee Dislocation Associated with Interposition of the Vastus Medialis

Silverberg

Acus

2004

Am J Sports Med

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Posterolateral rotary knee dislocations are irreducible due to soft tissue incarceration within the joint. [3][4][5][6]8,11,13 Most commonly, the injury traps the free end of the torn medial collateral ligament (MCL) in the intercondylar notch. We present a previously unreported finding of vastus medialis interposition. The MRI, intraoperative findings, and clinical course unique to this case are described as well as the findings most common to posterolateral knee dislocations. CASE REPORTA 17-year-old male injured his right knee falling from the hood of a moving vehicle. The patient received initial care at an outside institution. A dislocation was recognized, but 2 attempts at closed reduction failed. The patient arrived at our institution 24 hours after the injury for definitive treatment.Physical examination revealed the right knee fixed at 30° of flexion with lateral subluxation of the patella and a prominent medial femoral condyle. A large skin pucker ( Figure 1) was noted over the medial joint line. The medial skin furrow was recognized as a sign of irreducibility, and no closed reduction was attempted. The limb was neurovascularly intact and the skin viable. Despite a palpable pulse in the foot, the concern for an occult vessel injury prompted further investigation. An arteriogram was normal.Plain radiographs showed widening of the medial compartment (Figure 2) of the knee joint. The patella was subluxated laterally. No evidence of bony ligamentous avulsion was found.The MRI demonstrated a soft tissue signal consistent with muscle within the notch and medial compartment.The torn posterior cruciate ligament (PCL) rested on the superior portion of this mass (Figure 3). The anterior cruciate ligament (ACL) was torn from its origin and was less clearly defined. The MCL and capsule did not appear on the cross sections and were obscured by the large muscle mass. The menisci, bone, and cartilage surfaces were unremarkable.A gentle examination under anesthesia accentuated the medial skin furrow, confirming the irreducibility of the injury. An open reduction was done 36 hours following the injury. The delay was secondary to failed attempts at closed reduction at an outside institution followed by a transfer to our institution. The medial femoral condyle rested deep to the subcutaneous tissue through a rent in the vastus musculature. The muscle belly was removed from the notch and medial compartment of the joint to expose the incarcerated MCL and capsule. A congruent reduction was achieved following removal of these structures. The PCL was repaired to its avulsed insertion site through a posteroanterior bony tunnel and tied over a post on the anterior cortex of the tibia (Figure 4). The MCL was Figure 1. The arrow indicates the pathognomonic sign of irreducibility, the medial skin furrow.

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Section: Mri Findings In Our Studymentioning

confidence: 99%

mentioning

confidence: 92%

Irreducible Posterolateral Knee Dislocation Associated with Interposition of the Vastus Medialis

Silverberg

Acus

2004

Am J Sports Med

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“…Entrapment of the capsuloligamentary elements in the intercondylar notch, with or without dislocation of the patella, is the specific causal mechanism for irreducible dislocation [7][8][9] . Up until now, incarcerated patellar tendon 10 , vastus medialis [11][12][13][14] , anteromedial capsule and retinaculum 3 , and the major part-the medial capsuloligamentary structures such as the medial capsule, the medial retinacular structures and the medial collateral ligament [1][2][3][4]6,8,11,[15][16][17][18][19][20] , have been emphasized as the principle factors which prevent closed manipulation.…”

Section: Discussionmentioning

confidence: 99%

“…Irreducible knee dislocation usually results from posterolateral dislocation but may exceptionally occur after lateral dislocation 19 . The medial collateral ligament and both cruciate ligaments are often injured in irreducible knee dislocations, but the lateral ligaments are usually spared 2,6,21 .…”

Section: W Chen Et Al Irreducible Lateral Knee Dislocationmentioning

confidence: 99%

“…Siegmeth et al have reported a case which had the same radiological characteristics as ours, yet in their case the fibular collateral ligament and both menisci were intact 16 . MRI scans are preferable because they allow preoperative diagnosis of entrapment of capsuloligamentary structures or muscle bundles 14,19 . In our case, a preoperative MRI scan identified the main reason for the dislocation being irreducible, which facilitated surgery.…”

Section: W Chen Et Al Irreducible Lateral Knee Dislocationmentioning

confidence: 99%

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