Knee Instability: The Orthopedic Approach

Jeffrey R. Cummings; Robert A. Pedowitz

doi:10.1055/s-2005-867100

Seminars in Musculoskeletal Radiology, Table of Contents

Semin Musculoskelet Radiol 2005; 09(1): 5-16
DOI: 10.1055/s-2005-867100

Knee Instability: The Orthopedic Approach

Jeffrey R. Cummings¹ ^, ² ^, ³ , Robert A. Pedowitz¹ ^, ²

¹San Diego Arthroscopy and Sports Medicine Fellowship, University of California San Diego, San Diego, California
²Department of Orthopaedic Surgery, University of California San Diego, San Diego, California
³Tahoe Fracture and Orthopedic Clinic, Tahoe, California

Abstract

ABSTRACT

Clinical management of knee ligament injuries ranges from simple observation to complex multiligament reconstruction. Radiographic evaluation, including magnetic resonance imaging, is an important part of the diagnostic regimen that may significantly alter the treatment plan. This article reviews the clinical presentation and evaluation of isolated and combined knee ligament injuries and presents the indications, utility, and clinical impact of radiographic imaging on surgical management.

KEYWORDS

Knee - instability - ligament - injury - magnetic resonance imaging

Full Text

References

REFERENCES

1 Markolf K L, Mensch J S, Amstutz H C. Stiffness and laxity of the knee-the contribution of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am. 1976; 58 583-594
2 Larson R L, Taillon M. Anterior cruciate ligament insufficiency: principle and treatment. J Am Acad Orthop Surg. 1994; 2 26-35
3 Pedowitz R A, O’Connor J J, Akeson W H. Daniel’s Knee Injuries. 2nd ed. Philadelphia, PA; Lippincott, Williams & Wilkins 2003
4 Fu F H, Bennett C H, Ma C B, Menetrey J, Lattermann C. Current trends in anterior cruciate ligament reconstruction. Am J Sports Med. 2000; 28 124-130
5 Boden B P, Dean G S, Feagin Jr J A, Garrett Jr W E. Mechanisms of anterior cruciate ligament injury. Orthopedics. 2000; 23 573-578
6 Noyes F R, Matthews D S, Mooar P A, Grood E S. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. J Bone Joint Surg Am. 1983; 65 163-174
7 Daniel D M, Stone M L, Dobson B E, Fithian D C, Rossman D J, Kaufman K R. Fate of the ACL injured patients: A prospective outcome study. Am J Sports Med. 1994; 22 632-644
8 Grood E S, Noyes F R, Butler D L et al.. Ligamentous and capsular restraint preventing straight medial and lateral laxity in intact human cadaver knees. J Bone Joint Surg Am. 1981; 63 1257-1269
9 Hunter S C, Marsascalco R, Hughston J C. Disruption of the vastus medialis obliquus with medial knee ligament injuries. Am J Sports Med. 1983; 11 427-431
10 Hughston J C, Andrews J R, Cross M J, Moschi A. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am. 1976; 58 159-172
11 Derscheid G L, Garrick J G. Medial collateral ligament injuries in football. Nonoperative management of grade I and grade II sprains. Am J Sports Med. 1981; 9 365-368
12 Holden D L, Eggert A W, Butler J E. The nonoperative treatment of grade I and grade II medial collateral ligament injuries to the knee. Am J Sports Med. 1983; 11 340-344
13 Reider B, Sathy M R, Talkington J, Blyznak N, Kollias S. Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow up study. Am J Sports Med. 1994; 22 470-477
14 Markolf K L, Wascher D C, Finerman G A. Direct in vitro measurement of force in the cruciate ligaments, II. The effect of section of the posterolateral structures. J Bone Joint Surg Am. 1993; 75 387-394
15 Gollehon D L, Torzilli P A, Warren R F. The role of the posterolateral and cruciate ligaments in the stability in the human knee. A biomechanical study. J Bone Joint Surg Am. 1987; 69 233-242
16 DeLee J C, Riley M B, Rockwood Jr C A. Acute posterolateral rotatory instability of the knee. Am J Sports Med. 1983; 11 199-207
17 DeLee J C, Riley M B, Rockwood Jr C A. Acute straight lateral instability of the knee. Am J Sports Med. 1983; 11 404-411
18 Harner C D, Xerogeanes J W, Livesay G A et al.. The human posterior cruciate ligament complex: an interdisciplinary study: ligament morphology and biomechanical evaluation. Am J Sports Med. 1995; 23 736-745
19 Fanelli G C, Edson C J. Posterior cruciate ligament injuries in trauma patients: part 2. Arthroscopy. 1995; 11 526-529
20 Clancy Jr W G, Shelbourne K D, Zoellner G B, Keene J S, Reider B, Rosenberg T D. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament: report of a new procedure. J Bone Joint Surg Am. 1983; 65 310-322
21 Fowler P J, Messieh S S. Isolated posterior cruciate injuries in athletes. Am J Sports Med. 1987; 15 553-557
22 Fanelli G C, Giannotti B F, Edson C J. The posterior cruciate ligament arthroscopic evaluation and treatment. Arthroscopy. 1994; 10 673-688
23 Johnson D H, Fanelli G C, Miller M D. PCL 2002: Indications, double bundle versus inlay technique and revision surgery. Arthroscopy. 2002; 18 40-52
24 Seika J K, Giffin J R, Harner C D. Posterior cruciate ligament injuries: isolated and combined patterns. In: Schenck RC Multiple Ligamentous Injuries of the Knee in the Athlete, Monograph Series Rosemont, Illinois; American Academy of Orthopedic Surgeons 2002: 73-90
25 Harner C D, Hoher J. Evaluation and treatment of posterior cruciate ligament injuries. Am J Sports Med. 1998; 26 471-481
26 Veltri D M, Deng X H, Torzilli P A, Warren R F, Maynard M J. The role of the cruciate and the posterolateral ligaments in stability of the knee. Am J Sports Med. 1995; 23 436-443
27 La Prade R F, Terry G C. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med. 1997; 25 433-438
28 Veltri D M, Warren R F. Isolated and combined posterior cruciate ligament injuries. J Am Acad Orthop Surg. 1993; 1 67-75
29 Green A, Allen B L. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977; 59 236-239
30 Welling R E, Kakkasseril J, Cranley J J. Complete dislocation of the knee with popliteal vascular injury. J Trauma. 1981; 21 450-453
31 Kennedy J C. Complete dislocation of the knee joint. J Bone Joint Surg Am. 1963; 45 889-904
32 Meyers M H, Moore T M, Harvey Jr J P. Traumatic dislocation of the knee joint. J Bone Joint Surg Am. 1975; 57 430-433
33 Montgomery T J, Savoie F H, White J L, Robert T S, Hughes J L. Orthopedic management of knee dislocations: Comparison of surgical reconstruction and immobilization. Am J Knee Surg. 1995; 8 97-103
34 Alberty R E, Goodried G, Boyden A M. Popliteal artery injury with fractural dislocation of the knee. Am J Surg. 1981; 142 36-40
35 Lynch K, Johansen K. Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma?. Ann Surg. 1991; 214 737-741
36 Dennis J W, Jagger C, Butcher J L, Menawat S S, Neel M, Frykberg E R. Reassessing the role of arteriograms in the management of posterior knee dislocations. J Trauma. 1993; 35 692-697
37 Kendall R W, Taylor D C, Salvian A J, O’Brien P J. The role of arteriography in assessing vascular injury in associated dislocations of the knee. J Trauma. 1993; 35 875-878
38 Halbrecht J L, Jackson D W. Acute Dislocations of the Patella. The Patellofemoral Joint. New York; McGraw-Hill 1993: 123-134
39 Boden B P, Pearsall A W, Garrett Jr W E, Feagin J A. Patellofemoral instability. Evaluation and management. J Am Acad Orthop Surg. 1997; 5 47-57
40 Fulkerson J P, Shea K P. Disorders of patellofemoral alignment. J Bone Joint Surg Am. 1990; 72 1424-1429
41 Fulkerson J P. Patellofemoral pain disorders. Evaluation and management. J Am Acad Orthop Surg. 1994; 2 124-132
42 Sallay P T, Poggi J, Speer K P et al.. Acute dislocation of the patella: a correlative pathoanatomic study. Am J Sports Med. 1996; 24 52-60

Jeffrey CummingsM.D.

Tahoe Fracture and Orthopedic Clinic

1139 Third St., South Lake Tahoe, CA 96150