Clinical, imaging, arthroscopic, and histologic features of bilateral anteromedial meniscofemoral ligament: A case report.

BACKGROUND: The anteromedial meniscofemoral ligament (AMMFL) is a very rare entity, commonly unrecognized and underreported. Although it was not proved to be a cause of anterior knee pain, concerns have been raised on the relationship between the presence of this structure and medial meniscus injury secondary to its abnormal motion. Regarding histologic examination, some studies have shown meniscus-like fibrocartilage, while others have identified it as ligament-like collagenous fibrous connective tissue. CASE SUMMARY: We report the case of a 34-year-old ballerina with an AMMFL associated with a torn medial meniscus of both knees. Surgery was performed to treat the meniscal injury and two biopsies of each AMMFL were taken in different locations to define the histopathological composition. Histologic examination revealed fibrocartilaginous tissue compatible with meniscus. Follow-up evaluation one year after surgery evidenced full remission of symptoms and the patient had resumed her athletic activities. CONCLUSION: Clinical, magnetic resonance imaging, arthroscopic, and histological features have been carefully described to better characterize the AMMFL.

Overview of the anterolateral complex of the knee.

In the last few years, much more information on the anterolateral complex of the knee has become available. It has now been demonstrated how it works in conjunction with the anterior cruciate ligament (ACL) controlling anterolateral rotatory laxity. Biomechanical studies have shown that the anterolateral complex (ALC) has a role as a secondary stabilizer to the ACL in opposing anterior tibial translation and internal tibial rotation. It is of utmost importance that surgeons comprehend the intricate anatomy of the entire anterolateral aspect of the knee. Although most studies have only focused on the anterolateral ligament (ALL), the ALC of the knee consists of a functional unit formed by the layers of the iliotibial band combined with the anterolateral joint capsule. Considerable interest has also been given to imaging evaluation using magnetic resonance and several studies have targeted the evaluation of the ALC in the setting of ACL injury. Results are inconsistent with a lack of association between magnetic resonance imaging evidence of injury and clinical findings. Isolated ACL reconstruction may not always reestablish knee rotatory stability in patients with associated ALC injury. In such cases, additional procedures, such as anterolateral reconstruction or lateral tenodesis, may be indicated. There are several techniques available for ALL reconstruction. Graft options include the iliotibial band, gracilis or semitendinosus tendon autograft, or allograft.

Osteotomía varizante distal de fémur para genu valgo / Distal femoral varus osteotomy for genu valgum

Objetivo: Analizar una serie de pacientes con osteotomías varizante de fémur distal y evaluar los resultados, tanto clínicos como radiográficos. Material y Métodos: Se analizaron retrospectivamente 11 pacientes con osteotomía varizante de fémur realizada en nuestra institución, entre los años 2005 y 2013. En 7 casos se realizó una osteotomía aditiva externa y en 4 sustractiva interna. Como procedimientos asociados se realizaron: 1 trasplante meniscal, 4 mosaicoplastias, 1 reconstrucción del LCP y en 1 caso microperforaciones. El promedio de seguimiento fue de 39 meses (rango de 12-102 meses). Se midieron el eje, la consolidación ósea y la progresión de la artrosis del compartimento lateral (Score de Kellgren-Lawrence). Se realizaron las siguientes evaluaciones funcionales: IKDC subjetivo, Lysholm y Tegner. Resultados: El Promedio de corrección del eje fue de 12,6°, no se observó modificación del mismo durante el seguimiento. Todas las osteotomías consolidaron y no se observó progresión de la artrosis en el compartimento externo. El IKDC subjetivo promedio fue de 70,5, el Lysholm promedio de 83,1 y el Tegner de 4. Dos pacientes evolucionaron con rigidez articular y 1 presento molestias a nivel de la placa, por lo que se realizaron 2 movilizaciones bajo anestesia y 1 retiro de material de osteosintesis. Ninguno de los pacientes fue sometido a una artroplastia hasta la fecha. Conclusión: Se logró corregir la mala alineación en valgo que presentaban los pacientes, con buenos escores funcionales y baja tasa de complicaciones, ubicando la osteotomía de fémur distal para genu valgo como una alternativa válida en casos bien seleccionados. Nivel de Evidencia: IV. Tipo de Estudio: Serie de Casos.

Objective: To analyze a series of patients who underwent varus osteotomy of distal femur and evaluate both clinical and radiographic results. Method: We retrospectively analyzed 11 patients with distal femoral varus osteotomy performed at our institution between 2005 and 2013. 7 of these were open wedge osteotomies, whereas the remaining 4 were closing wedge ones. Associated procedures were performed as follows: 1 meniscal transplant, 4 mosaicplasties, 1 LCP reconstruction and in 1 case microfractures. The mean follow-up was 39 months (range 12 to 102 months). Pre- and postoperative radiographs were evaluated for tibiofemoral angle, bone healing and progression of lateral compartment osereoarthritis (Kellgren-Lawrence Score). The IKDC, Lysholm and Tegner scores assessed clinical outcomes. Results: The average correction of the femorotibial angle was of 12.6°, there were no changes evidenced along the follow up. Union of the osteotomy site was achieved in all cases. Osteoarthritis of the lateral compartment did not show progression. The mean results of the clinical scores were: IKDC 70.5, Lysholm 83.1, and Tegner 4. Two patients revealed joint stiffness and 1 complained about discomfort at the plate site. For these reasons, two mobilizations under anesthesia and 1 material removal were performed. To the date, none of the patients required an arthroplasty. Conclusion: We were able to correct the valgus malalignment in all patients, with good functional outcomes and low complication rate, placing the distal femoral osteotomy for valgus arthritic knees as a valid alternative in well-selected cases. Level of Evidence: IV. Type of study: Case Series.

Spontaneous healing in complete ACL ruptures: a clinical and MRI study.

BACKGROUND: Most authors believe the ACL does not spontaneously heal after a complete rupture. Although several studies have reported spontaneous healing of torn ACLs, it is difficult to determine its healing potential and whether patients will be able to return to sports activities. QUESTIONS/PURPOSES: We therefore asked whether (1) a complete ACL rupture in patients can spontaneously heal without the use of a specific rehabilitation program or bracing and (2) patients are able to return to their athletic activity after spontaneous ACL healing. PATIENTS AND METHODS: We retrospectively reviewed 14 patients with acute ACL injury established by physical examination and MRI (proximal third in eight patients and the midligament in six). Average age at injury was 31 years (range, 23-41 years). All patients were athletically active before injury. Surgery was indicated in all patients but for various reasons postponed. We obtained International Knee Documentation Committee scores, Lysholm-Gillquist scores, and MRI. The minimum followup was 25 months (mean, 30 months; range, 25-36 months). RESULTS: At last followup, the mean Lysholm-Gillquist score was 97. According to the International Knee Documentation Committee evaluation, 10 knees were normal and four nearly normal. All knees regained end point with a negative pivot shift test; MRI at followup showed an end-to-end continuous ACL with homogeneous signal. All patients returned to their former activity level. However, after the study period, two patients had a rerupture of the ACL (2.5 years after the first lesion). CONCLUSIONS: Our observations indicate an acutely injured ACL may eventually spontaneously heal without using an extension brace, allowing return to athletic activity. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.