Posterolateral complex knee injuries: magnetic resonance imaging with surgical correlation

Theodorou, Daphne J.; Theodorou, Stavroula J.; Fithian, Donald C.; L, Paxton; Garelick, D. H.; Resnick, Donald

doi:10.1080/02841850510021067

Cited by 35 publications

(22 citation statements)

References 40 publications

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“…While some studies have suggested that the PFL is inconsistently seen on MR examinations [22,23], other more recent work has reported that the PFL may be detected in up to 91 % of MRI scans [24]. The ligament usually appears as a small low-signal-intensity structure on coronal and sagittal images and can be followed over several images in the axial imaging plane.…”

Section: Introductionmentioning

confidence: 97%

The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

et al. 2015

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Section: Introductionmentioning

confidence: 97%

The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

et al. 2015

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“…Patients with these injuries often complain about their knee "giving way backward" and report difficulty in stair accent and descent [4]. While isolated injuries to the PLS are less common (28%) [5], about 29-89% of the patients injure their PLS in conjunction with the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) or both [4,[6][7][8][9]. Failure to diagnose the injury to the PLS has been found to increase the forces experienced by the ACL and ACL grafts and lead to their subsequent failure [10,11].…”

Section: Introductionmentioning

confidence: 99%

The effect of isolated popliteus tendon complex injury on graft force in anterior cruciate ligament reconstructed knees

Gadikota

Seon

et al. 2010

International Orthopaedics (SICOT)

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Failure to diagnose injury to the posterolateral structures has been found to increase the forces experienced by the anterior cruciate ligament (ACL) and ACL grafts which may cause their subsequent failure. An isolated injury to the popliteus complex (PC) consisting of the popliteus tendon and popliteofibular ligament is not uncommon. Therefore, the purpose of this study was to discover if an isolated injury to the PC can significantly affect the forces experienced by the ACL graft under external loading conditions. We hypothesised that, under external tibial torque, the ACL graft will experience a significant increase in force, in knees with PC injury compared to the intact PC condition. Under varus tibial torque (10 N m), we observed minimal changes in the varus tibial rotation due to isolated sectioning of the PC in an ACL reconstructed knee (P> 0.05). Consequently, no significant increase in the ACL graft force was observed under varus tibial torque. In contrast, sectioning the PC resulted in a significant increase in the external tibial rotation compared to the intact PC knee condition under the external rotational tibial torque (5 N m) at all flexion angles (P<0.05). These changes in kinematics under external tibial torque were manifested as elevated ACL graft forces at all selected flexion angles (P<0.05). Prompt diagnosis of isolated PC injury and its treatment are warranted to prevent potential failure of ACL reconstruction.

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“…In a study of 17 acute knee dislocations, Twaddle et al [33] found MRI positively predicted surgical FCL, PLC, and arcuate complex injury in 92%, 100%, and 64% of cases, respectively. In a more recent study of 14 suspected PLC injuries, Theodorou et al [32] reported MRI accuracy for FCL and popliteus injury to be 100% and 86%, respectively. In that study, using conventional MRI sequences, a surgical popliteofibular ligament injury went unnoticed on MRI in three cases.…”

Section: Discussionmentioning

confidence: 99%

“…The anatomic complexity, variability, and oblique orientation of its individual structures make it difficult to reliably identify all major PLC injuries on conventional MRI sequences [1,2,23,32]. The diagnostic specificity of MRI for knee ligament injury decreases when more than one ligament is injured [26], as is usually the case with PLC injury [24], and chronic injuries may not be well demonstrated [22].…”

Section: Introductionmentioning

confidence: 99%

“…The diagnostic specificity of MRI for knee ligament injury decreases when more than one ligament is injured [26], as is usually the case with PLC injury [24], and chronic injuries may not be well demonstrated [22]. As a static study, MRI also has inherent limitations for diagnosing clinically relevant instability, and partial tears or edema revealed on MRI may not correlate with laxity [32]. High-power magnets [1,12], thinslice scans [12], and coronal oblique technique [1,12,34] have improved MRI of the PLC, but access to this technology and experienced musculoskeletal radiologists may not be universally available, particularly in community hospitals or clinics [23].…”

Section: Introductionmentioning

confidence: 99%

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Can Stress Radiography of the Knee Help Characterize Posterolateral Corner Injury?

Gwathmey

Tompkins

Gaskin

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Conventional MRI is limited for characterizing the posterolateral corner of the knee due to the region's anatomic variability and complexity; further, MRI is a static study and cannot demonstrate pathologic laxity. Stress radiography may provide additional information about instability. Questions/purposes We therefore (1) correlated varus stress radiography with MRI findings, (2) compared opening in patients who underwent surgical posterolateral corner stabilization versus those who did not, and (3) determined whether stress radiography findings could supplement MRI for making treatment decisions. Patients and Methods We retrospectively studied 26 patients (27 knee injuries) and correlated lateral compartment opening on varus stress radiography with severity of posterolateral corner injury on MRI. We compared radiographic findings in 18 patients with complete injuries who underwent posterolateral corner stabilization with five who did not. Results A complete posterolateral corner injury on MRI was associated with an average of 18.6 mm (10.0-36.5 mm) of varus opening versus 12.8 mm (7.5-17.0 mm) in partial injuries. Opening in operative cases that underwent stabilization was 16.5 mm (11.0-36.5 mm) versus 11.0 mm (7.5-13.5 mm) for those that did not. Ten of 15 partial injuries underwent stabilization, for which the varus opening was 13.6 mm (11.0-17.0 mm). Average varus opening in partial injuries that did not undergo stabilization was 11.0 mm (7.5-13.5 mm). Conclusions Varus stress radiography correlated to MRI findings for posterolateral corner injury. The injuries we treated with reconstruction were associated with increased varus opening. In patients with partial posterolateral corner injury on MRI, we used degree of opening on varus stress radiography to aid the decision for stabilization.

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Posterolateral complex knee injuries: magnetic resonance imaging with surgical correlation

Abstract: MRI is well suited for demonstrating the presence and extent of injuries of the major structures of the posterolateral complex of the knee, allowing characterization of the severity of injury.

Cited by 35 publications

References 40 publications

The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

The effect of isolated popliteus tendon complex injury on graft force in anterior cruciate ligament reconstructed knees

Can Stress Radiography of the Knee Help Characterize Posterolateral Corner Injury?

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