Magnetic Resonance Imaging-Based Prevalence of Anterolateral Ligament Abnormalities and Associated Injuries in Knees with Acute Anterior Cruciate Ligament Injury.

The purpose of this study was to determine and compare the prevalence of anterolateral ligament abnormality and associated injuries among patients with complete and partial anterior cruciate ligament tears. In addition, the prevalence of associated injuries with anterolateral ligament abnormality was further analyzed. Of the 158 patients diagnosed with acute anterior cruciate ligament tear, 82 patients were diagnosed with acute complete anterior cruciate ligament confirmed by magnetic resonance imaging (MRI) and arthroscopic procedures (Group C), and 74 patients were diagnosed with acute partial anterior cruciate ligament tears confirmed by MRI (Group P). The status of the anterolateral ligament, collateral ligaments, menisci, and osseous lesions was assessed. There was a significantly higher prevalence of anterolateral ligament abnormalities in Group C than Group P (36.6 vs. 4.1%, p < 0.001). Medial collateral ligament, lateral collateral ligament, Segond fracture, osseous lesion at the fibular head, lateral tibial plateau, lateral femoral condyle, and medial tibial plateau were significantly associated with anterolateral ligament abnormality. Furthermore, severity of osseous lesion at the lateral tibial plateau, lateral femoral condyle, and medial tibial plateau was significantly associated (with linear correlation) with anterolateral ligament abnormality. The prevalence of anterolateral ligament abnormality was significantly higher in patients with complete anterior cruciate ligament tear (36.6%) than those with partial anterior cruciate ligament tear (4.1%), but with noticeable prevalence of anterolateral ligament abnormality in the partial anterior cruciate ligament tear group. Associated lesions significant to anterolateral ligament abnormality were tears in both collateral ligaments, lateral-sided osseous lesions, and osseous lesion of the medial tibial plateau.

Reconstruction of Extended Bone Defects Using Massive Allografts Combined with Surgical Angiogenesis: A Case Report.

CASE: A 20-year-old patient presented with an extended composite knee defect with destruction of the medial femoral condyle, including the medial collateral ligament. Treatment included using an anterolateral thigh flap for soft-tissue reconstruction, tensor fasciae latae muscle for ligament repair, and a massive allogenic bone graft of the medial femoral condyle that was revascularized with an osteocutaneous composite free flap from the contralateral femur. At 17 months postoperatively, the outcome was evaluated with scores on several established scales and radiographic assessment. CONCLUSION: The combination of vascularized soft-tissue reconstruction and osseous reconstruction using allogenic bone along with surgical angiogenesis proved to be effective. Complex extremity reconstruction should be discussed with interdisciplinary specialists.

Internal derangement of the knee in fibular hemimelia: radiographic and MRI findings.

BACKGROUND: Fibular hemimelia is a rare bone dysplasia with partial or complete absence of the fibula. There are many associated lower limb deformities. METHODS: We describe the commonly associated bone and soft tissue abnormalities in the knee joint in a case series of six knees in five patients with fibular hemimelia who underwent both radiographic and MR imaging. RESULTS: In all knees, there was an elongated conjoint tendon of the lateral collateral ligament and biceps femoris. In five out of six knees, there was trochlear dysplasia. In four out of six, there was complete absence of the anterior cruciate ligament. In four out of six, there was an abnormal lateral meniscus (three were hypoplastic and one absent). CONCLUSION: These associations in fibular hemimelia, although unpredictable, have relevance in the guidance of further orthopaedic management in this complex condition.

Anterior lateral meniscofemoral ligament with congenital absence of the ACL.

PURPOSE: to describe agenesis of the anterior cruciate ligament (ACL) with an anterior lateral meniscofemoral ligament. METHODS AND RESULTS: case report of a 13-year-old girl with an absent ACL and with an anterior lateral meniscofemoral ligament instead, as well as absence of the anterior insertion of the lateral meniscus in the tibia and a discoid ring-like lateral meniscus, with hypoplasia of the lateral femoral condyle. At arthroscopy, the anterior lateral meniscofemoral ligament was found to arise from the anterior horn of the lateral meniscus and insert into the posterolateral aspect of the intercondylar notch, mimicking the course of the native ACL on magnetic resonance imaging (MRI). CONCLUSION: ACL agenesis may be associated with an anomalous anterior lateral meniscofemoral ligament that may mimic a normal ACL on MRI.

Flexor digitorum superficialis opponensplasty with ulnar collateral ligament reconstruction for thumb deficiency.

Thumb hypoplasia represents a spectrum of deficiencies from a slightly smaller thumb to a completely absent thumb. The clinical features of a type II hypoplastic thumb include a narrow thumb-index web space, absent thenar muscles, and instability of the thumb metacarpophalangeal joint. This article will focus thumb reconstruction using the ring finger flexor digitorum superficialis to provide opposition and restore metacarpophalangeal joint stability. The technique, postoperative protocol, outcome, and complications will be emphasized.

Ultrasound assessment of the spring ligament complex.

This study was conducted to document the normal ultrasound anatomy of the spring ligament in asymptomatic subjects and to prospectively determine the frequency of ultrasound abnormality of the spring ligament in patients with suspected posterior tibial tendinopathy. The superomedial calcaneonavicular ligament (CNL) of 10 healthy volunteers was examined by ultrasound. Nineteen patients with a clinical diagnosis of suspected posterior tibial tendinopathy and/or chronic pain along the course of the tendon were examined by ultrasound. The superomedial CNL thickness was measured. Normal anatomy of the superomedial CNL could be demonstrated in all the volunteers. The mean of the combined proximal measurements was 4 mm and of the distal measurements 3.6 mm. Sixteen patients with posterior tibial tendinopathy had increased thickness of the spring ligament, which was more evident on its distal portion over the talar head. One patient had superomedial CNL insufficiency with normal posterior tibial tendon. The mean proximal measurement in the study group was 5.1 mm and the distal measurement 6.1 mm. The differences between the measurements in the study group and controls were highly significant (proximal site P < 0.01, distal site P < 0.001). Spring-ligament laxity or tear is characterised by thickening. There is a strong association between posterior tibial tendinopathy and abnormality of the spring ligament.

The lateral atlantooccipital ligament.

INTRODUCTION: Stability of the atlantooccipital joint is of vital importance. The ligaments of this region, for the most part, have been thoroughly investigated, except for the lateral atlantooccipital ligament (LAO), which is not described in most modern texts. MATERIALS AND METHODS: The authors examined 20 adult cadaveric specimens to observe the morphology of the LAO. RESULTS: All specimens were found to have an LAO, bilaterally, immediately posterior to the rectus capitis lateralis muscle with a fiber direction more or less opposite to this muscle. The LAO was found in intimate contact with the vertebral artery posteriorly and with the contents of the jugular foramen anteriorly. In all specimens, the origin of this ligament was from the anterolateral aspect of the transverse process of the atlas and the insertion onto the jugular process of the occipital bone. The fibers of the LAO had a mean angle of 26 degrees from the midline. The mean length and width of this ligament was 2.2 and 0.5 cm, respectively. The mean thickness of the LAO was 2 mm. The average tensile strength of this band was 37.5 degrees N. The LAO remained lax with flexion and extension of the craniocervical junction. With contralateral lateral flexion of the craniocervical junction, the LAO became fully taut at a mean of 8 degrees . Partial, but never complete, tautness was observed with rotation of the occipital on the atlas bilaterally. Following sectioning of the LAO, approximately an additional 3 degrees -5 degrees of contralateral lateral flexion was observed. CONCLUSIONS: The LAO is a constant anatomical structure of the craniocervical junction that might be of concern to the clinician. This ligament inhibits lateral flexion of the atlantooccipital joint and its disruption appears to add to instability at this articulation.