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Journal articles on the topic 'Acute knee injury'

Author: Grafiati

Published: 4 June 2021

Last updated: 1 February 2022

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1

Eranki, Vivek, Collie Begg, and Brian Wallace. "Outcomes of Operatively Treated Acute Knee Dislocations." Open Orthopaedics Journal 4, no. 1 (January 19, 2010): 22–30. http://dx.doi.org/10.2174/1874325001004010022.

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Knee dislocation is a complex and rare injury often presenting in the context of high velocity trauma. The aim of this study is to establish the subjective outcomes of surgically treated knee dislocations. A total of 20 knees dislocations treated by open repair were reviewed. Their progress and outcomes were assessed by using a modified Lysholm score questionnaire. Data was obtained on patient demographics, details of injury, investigation, treatment, rehabilitation, 24 months objective outcome and subjective outcomes. Six patients had a vascular deficit and six had neurological deficits. The median range of motion was 0°-100°. Patients with an initially lower pre-injury level of function were able to return an activity level comparable to their pre-injury status. 22% of competitive athletes retuned to competitive sports. 38% of patients undertaking heavy activity returned to comparable pre-injury level of activity and 67% of patients undertaking moderate level of activity before injury returned to a comparable level after repair. 68% regularly had problems running, 70% problem squatting, 40% swelling and 42% problem with stairs. Most patients however did not have locking of the knee or problems with knees giving way. Patients pain scores decreased over time to an acceptable level. Despite the severity of the injury, majority of patients achieved a satisfactory outcome, although none of the patients reached the same level of function as before the injury. 80% of the patients were satisfied with their outcome. All dissatisfied patients suffered postoperative complications.

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2

Kozanek, Michal, Samuel K. Van de Velde, Thomas J. Gill, and Guoan Li. "The Contralateral Knee Joint in Cruciate Ligament Deficiency." American Journal of Sports Medicine 36, no. 11 (July 14, 2008): 2151–57. http://dx.doi.org/10.1177/0363546508319051.

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Background Patients with unilateral ligament deficiency are believed to have altered kinematics of the contralateral knee, increasing the risk of contralateral joint injury. Therefore, the contralateral knees might not be a reliable normal kinematic control. Purpose To compare the in vivo kinematics of the uninjured contralateral knees of patients with anterior or posterior cruciate ligament deficiency with knee kinematics of age-matched patients without joint injury. Study Design Controlled laboratory study. Methods Ten subjects with bilateral healthy knees, 10 patients with acute unilateral anterior cruciate ligament injury, and 10 with acute unilateral posterior cruciate ligament injury participated in this study. Kinematics were measured from 0° to 90° of flexion using imaging and 3-dimensional modeling. Results No significant differences were found across the groups in all rotations and translations during weightbearing flexion (P > .9). Conclusion Patients with unilateral cruciate ligament deficiency did not alter kinematics of the contralateral uninjured knee during weightbearing flexion. In addition, these findings suggest that the included patients with anterior cruciate ligament or posterior cruciate ligament deficiency did not have preexisting abnormal kinematics of the knee. Clinical Relevance As the contralateral joint kinematics of the injured patients were not affected by the ipsilateral ligament injury in the short term, physicians and researchers might use the contralateral knee as a reliable normal kinematic control.

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3

Harvey, Jack, and Garron G. Weiker. "Acute Knee Injury in Wrestling." Physician and Sportsmedicine 17, no. 11 (November 1989): 70–78. http://dx.doi.org/10.1080/00913847.1989.11709913.

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4

Teh, J., G. Kambouroglou, and J. Newton. "Investigation of acute knee injury." BMJ 344, may25 1 (May 25, 2012): e3167-e3167. http://dx.doi.org/10.1136/bmj.e3167.

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5

Wu, Brian, Max Berger, Jonathan Sum, George Rick Hatch, and E. Todd Schroeder. "Acute vs Chronic Knee Injury- Basketball." Medicine & Science in Sports & Exercise 46 (May 2014): 287. http://dx.doi.org/10.1249/01.mss.0000494055.43002.b4.

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6

Roberson, Troy A., Thomas W. Throckmorton, Robert H. Miller, Richard A. Smith, and Frederick M. Azar. "Neurovascular injury in acute knee dislocation." Current Orthopaedic Practice 27, no. 5 (2016): 508–14. http://dx.doi.org/10.1097/bco.0000000000000404.

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7

Fomin, Sanne, Håkan Gauffin, and Joanna Kvist. "Short-term recovery of physical activity and knee function after an acute knee injury." BMJ Open Sport & Exercise Medicine 6, no. 1 (December 2020): e000950. http://dx.doi.org/10.1136/bmjsem-2020-000950.

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ObjectivesTo describe self-reported knee function, participation in physical activity and the number of knee surgeries at 3 and 6 months following acute knee injury.MethodsProspective cohort study. Participants, aged 15–40 years with an acute knee injury sustained no more than 6 weeks prior to inclusion, were recruited. There were 279 participants with ACL injury and 101 participants with other acute knee injuries included. Follow-up questionnaires were sent at 3 and 6 months after injury. Demographic information, activity participation, International Knee Documentation Committee subjective knee form (IKDC-SKF) and the Single Assessment Numeric Evaluation (SANE) score were collected. Additional knee injuries were obtained from self-report and medical charts.ResultsThe IKDC-SKF, SANE and physical activity participation were reduced at 3-month and 6-month follow-up. The number of participants who achieved health-promoting physical activity levels was reduced by 50% at 6-month follow-up compared with before injury. Seventeen per cent of participants with ACL injury and 41% of participants with other acute knee injuries had returned to their preinjury physical activity at 6 months. Participants with ACL injury reported worse knee function, lower physical activity participation and had more surgeries (128 surgeries, including 109 ACL-reconstructions) compared with participants with other acute knee injuries (six surgeries).ConclusionAcute knee injuries, including ACL injuries, affected self-reported knee function and physical activity participation for at least 6 months after index injury. More research is needed to understand how best to help people with acute knee injuries return to physical activity and achieve satisfactory knee function.

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8

Ferretti, Andrea, Edoardo Monaco, Andrea Redler, Giuseppe Argento, Angelo De Carli, Adnan Saithna, Paulo Victor Partezani Helito, and Camilo Partezani Helito. "High Prevalence of Anterolateral Ligament Abnormalities on MRI in Knees With Acute Anterior Cruciate Ligament Injuries: A Case-Control Series From the SANTI Study Group." Orthopaedic Journal of Sports Medicine 7, no. 6 (June 1, 2019): 232596711985291. http://dx.doi.org/10.1177/2325967119852916.

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Background: Broad variation in the reported rate of magnetic resonance imaging (MRI)–detected abnormalities of the anterolateral structures of the anterior cruciate ligament (ACL)–injured knee suggests a lack of reliability that has limited the use of MRI in clinical decision making. Purpose/Hypothesis: The aim of this study was to use MRI to determine the prevalence and spectrum of abnormalities of the anterolateral structures in acute ACL-injured knees, using the contralateral uninjured knee as a reference. We hypothesized that MRI evaluation of the acutely injured knee (using the uninjured knee as a reference) would allow reliable identification of abnormalities of the anterolateral structures. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Patients with acute ACL injury underwent MRI scan of both knees. Images were evaluated by 3 observers. Inter- and intraobserver reliabilities were determined for MRI parameters of anterolateral ligament (ALL) injury by use of the kappa (κ) test. Univariate and multivariate analyses were conducted to test associations between ALL abnormality and associated injuries. Results: A total of 34 patients were evaluated. Of these, 30 patients (88.2%) had at least 1 ALL abnormality in the ACL-injured knee (increased signal: n = 27[79.4%]; increased thickness: n = 15[44.1%]; tapering: n = 7[20.6%]; irregularities in the path of the ALL fibers: n = 21[61.7%]). Asymmetries of the genicular vessels were observed in 21 patients (61.7%). ALL abnormality was significantly associated with lateral joint capsular tears ( P < .001). No correlation was found between ALL lesions and iliotibial band lesions ( P = .49). Inter- and intraobserver reliabilities were very good concerning ALL signal changes and femoral and tibial bone bruises (κ coefficient, 0.81-1). Conclusion: MRI evaluation of the ALL was associated with good and very good inter- and intraobserver reliabilities, and it demonstrated abnormalities of the ALL in the majority of acutely ACL-injured knees. The index of suspicion for ALL injury should be elevated by the presence of lesions of the lateral capsule. This suggests that the ALL is part of a wider area of the lateral capsule that is often injured simultaneously in an acute ACL tear.

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9

Ptasznik, Ronald. "ULTRASOUND IN ACUTE AND CHRONIC KNEE INJURY." Radiologic Clinics of North America 37, no. 4 (July 1999): 797–830. http://dx.doi.org/10.1016/s0033-8389(05)70130-5.

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10

Cross, Mervyn J., Leo A. Pinczewski, and Desmond J. Bokor. "Acute Knee Injury in a Rock Musician." Physician and Sportsmedicine 17, no. 7 (July 1989): 79–82. http://dx.doi.org/10.1080/00913847.1989.11709827.

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11

Dascola, Jacqueline S., and Kelly Ward. "Injury-related causes of acute knee pain." Journal of the American Academy of Physician Assistants 18, no. 7 (July 2005): 34–40. http://dx.doi.org/10.1097/01720610-200507000-00007.

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12

Kopp, Jennell, and Robert Hosey. "Acute Knee Injury in a Soccer Player." Medicine & Science in Sports & Exercise 43, Suppl 1 (May 2011): 226. http://dx.doi.org/10.1249/01.mss.0000400612.62738.13.

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13

Devitt, Brian M., Ian Al’khafaji, Nicola Blucher, Lachlan M. Batty, Jerome Murgier, Kate E. Webster, and Julian A. Feller. "Association Between Radiological Evidence of Kaplan Fiber Injury, Intraoperative Findings, and Pivot-Shift Grade in the Setting of Acute Anterior Cruciate Ligament Injury." American Journal of Sports Medicine 49, no. 5 (March 15, 2021): 1262–69. http://dx.doi.org/10.1177/0363546521994467.

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Background: Biomechanical studies have suggested that the Kaplan fibers (KFs) of the iliotibial band play a role in controlling anterolateral rotation of the knee. There is a paucity of clinical information on whether injury to the KF in the setting of anterior cruciate ligament (ACL) rupture contributes to increased rotatory laxity of the knee. Purpose/Hypothesis: The purpose was to evaluate the association among radiological evidence of KF injury, intraoperative arthroscopic findings, and grade of pivot shift at the time of ACL reconstruction (ACLR). It was hypothesized that KF injury would be associated with increased injury to the lateral compartment of the knee and a higher grade of pivot shift. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective magnetic resonance imaging (MRI) analysis was conducted on 267 patients with ACL-injured knees who underwent primary ACLR. Patients who had MRI and surgery within 60 days of injury were included (mean age, 23.6 years); there were 158 (59.2%) male patients. MRI was performed using standard knee protocols, and diagnostic criteria were applied to identify KF injury. Associations were made among MRI findings, intraoperative findings, and grade of pivot shift with the patient examined under anesthesia at the time of ACLR. A comparison was made between patients with and without radiological evidence of KF injury. Results: The prevalence of KF injury was 17.6% (47/267 patients). Arthroscopic evidence of lateral meniscal injury was associated with KF injury (KF intact, 31%; KF injured, 55%; P = .010). The majority of patients in the intact and injured KF groups had a grade 2 pivot shift (75% and 70%, respectively). A minority had grade 3 pivot shift: 5% in the intact group versus 6.4% in the injured group. There was no association between radiological evidence of KF injury and pivot-shift grade ( P = .600). Conclusion: In acute ACL injury, KF injuries were not very common (17.6%), and the rate of grade 3 pivot shift was low (5.2%). When present, KF injuries were not associated with a higher-grade pivot shift. However, there was an association between KF injury and lateral meniscal tears identified at the time of ACLR. The role of KFS in controlling anterolateral rotatory laxity in the acute ACL injury in the clinical setting may be less evident when compared with the biomechanical setting.

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Messer, Malynda S., Brendan Southam, and Brian M. Grawe. "Bilateral Multiligamentous Knee Injuries: A Case Report and Technique Review." Case Reports in Orthopedics 2018 (June 19, 2018): 1–8. http://dx.doi.org/10.1155/2018/3460153.

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Bilateral knee dislocations are rare musculoskeletal injuries. We report a case of a patient who sustained traumatic bilateral knee dislocations resulting in multiligamentous injuries to both knees. The patient subsequently underwent acute ligamentous reconstructions of both knees performed at 2 weeks and 3 weeks after the initial injury. One year after these procedures, the patient has achieved excellent functional outcomes and has returned to recreational sports.

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15

Huang, Patrick, Don Li, Logan Petit, Jack Porrino, Michael Medvecky, and Joseph Kahan. "The Multiligament Knee Injury Classification Stratifies Patients into Risk Categories." Orthopaedic Journal of Sports Medicine 8, no. 7_suppl6 (July 1, 2020): 2325967120S0049. http://dx.doi.org/10.1177/2325967120s00493.

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Objectives: Our goal was to characterize the precise ligamentous injury locations and patterns of acute multi-ligament knee injuries (MLKI) and determine associated rates of dislocations, fractures, peroneal nerve palsies, and vascular injuries. Methods: All patients at a single level one trauma center who received operative treatment for MLKI between 2001 and 2019 were retrospectively identified. Demographic, injury mechanism, injury patterns, presence of dislocation, and associated injuries including vascular injury, peroneal nerve palsy, and fracture were assessed for each patient. MLKI both with and without a document knee dislocation were classified into five classes based on pattern of ligamentous tear (Figure 1). Class 1 included unicruciate tear with any combination of collateral tear. Class 2 are a bicruciate tear without collateral involvement. Class 3 are bicruciate tears with either a medial or lateral sided tear. Class 4 are bicruciate tears with both medial and lateral sided tears. Class 5 are periarticular fracture with any of the preceding ligamentous injury patterns. Rates of dislocation, vascular injury and peroneal nerve injury were analyzed among each class. Single variable statistics such as t-tests as well as multivariable techniques such as Chi square and multiple regression analysis was performed to identify patterns of injury and to predict risk of associated injuries. Results: 100 knees were identified as multiligament knee injuries. 34 of the knees (34%) were dislocated at presentation, and the remaining 66 (66%) did not have a documented knee dislocation. Patients with a documented knee dislocation had higher rates of vascular injury (24% vs. 3%, p = 0.0148), but not higher rates of peroneal nerve injury (32% vs. 20%, p = 0.0863). Patients with PLC injuries had statistically higher rates of peroneal nerve injury compared to acute multiligament knee injuries without a lateral sided injury (30% vs. 3%, p = 0.005). Rates of vascular injury between MLK Class are shown in Table 1. MLK Class was found to be predictive of vascular injury, but not of peroneal nerve injury. Conclusion: We present a new classification of multiligament knee injuries with the goal of providing a more precise diagnosis to aid in the surgical planning and decision making as well as to enhance clinical outcomes research of these complicated injury patterns. By classifying these injuries into five separate classes and further subclassified based on presence of dislocation and lateral sided injury, we are better able to predict likelihood of neurovascular injury. We hope that understanding the risks associated with each class will allow physicians to better appreciate the likelihood of potential complications of these injuries.

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16

Marson, Blake M. "Acute meniscal injury following successful unicompartmental knee arthroplasty." Journal of Arthroplasty 11, no. 8 (December 1996): 989–91. http://dx.doi.org/10.1016/s0883-5403(96)80147-1.

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17

Iordache, Edna A., Michael T. Hirschmann, Felix Amsler, Schu-Ren Yang, Silvan Hess, and Anna Hirschmann. "Injuries of Kaplan fibers in ACL deficient and reconstructed knees – redefining the structure and risk assessment on MRI using injury patterns." Orthopaedic Journal of Sports Medicine 9, no. 6_suppl2 (June 1, 2021): 2325967121S0018. http://dx.doi.org/10.1177/2325967121s00182.

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Objectives: To determine an injury pattern of knee structures along torn Kaplan fibers in ACL deficient knees and to observe the healing process of Kaplan fibers in ACL reconstructed knees. Methods: A total of 101 knee MRIs obtained between January 2004 and April 2020 with full-thickness ACL tears were retrospectively assessed for visibility and impairment of three Kaplan bundles (proximal, distal and epicondylar band) and for associated injuries by two fellowship-trained independent musculoskeletal radiologists. A subgroup of 33 follow-up knee MRIs after ACL reconstruction was assessed to observe the natural evolution of Kaplan fibers injury. Descriptive statistics and Spearman correlation coefficients (P<.05) were used to determine injury patterns. Results: Kaplan fibers were injured in 43 of 101 (43%) acute ACL deficient knees. Proximal Kaplan fibers were visible in less than 48 of 101 (50%) knees as opposed to the distal Kaplan fibers and epicondylar Kaplan band which were both visible in 98 of 101 (97%) knees. Injury to the Kaplan complex was significantly associated with anterolateral (rho, 0.36; P<.001) and lateral collateral ligament impairment (rho, 0.21;P<.05) and medial femoral bone marrow edema (rho, 0.21;P<.05). After ACL reconstruction, only two of 33 (6%) patients showed torn Kaplan and 13 of 33 (39%) distal Kaplan fibers were scarred. Conclusion: Torn Kaplan fibers are associated with anterolateral and lateral collateral ligament injuries in ACL deficiency, indicating a more severe anterolateral and rotatory instability. Injury patterns in ACL deficient knees can eliminate the uncertainty of proximal Kaplan fibers identification. Kaplan fiber tears tend to heal following ACL reconstruction.

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McKee, Lesley, Mazin S. Ibrahim, Trevor Lawrence, Ioannis P. Pengas, and Wasim S. Khan. "Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?" Open Orthopaedics Journal 8, no. 1 (June 27, 2014): 162–67. http://dx.doi.org/10.2174/1874325001408010162.

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Traumatic knee dislocation is a serious and potentially limb threatening injury that can be easily missed if meticulous history and examination have not been employed. Neurovascular injuries are common in this condition, and due diligence should be given to their thorough evaluation at time of secondary survey so as to avoid complications such as ischaemia, compartment syndrome and eventual amputation. There is growing evidence in the literature that morbid obesity is associated with low energy knee dislocation, therefore this should be considered when assessing this cohort of patients presenting with an acute knee injury. Early operative intervention especially with multi ligaments involvement is the preferable strategy in the management of this acute injury. Controversy exists whether to reconstruct or repair damaged structures, and whether to adopt a one stage or two stage reconstruction of the cruciate ligaments. Early rehabilitation is important and essential to achieve satisfactory outcomes. This article is an evidence-based overview of this rare but devastating injury.

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L, Henry Goodnough, E. Hall Kimberley, E. Krygier Jeffrey, and P. Comstock Curt. "Acute Septic Arthritis Following Supra-Patellar Nailing of an Open Diaphyseal Tibia Fracture in an Immune Compromised Patient." Journal of Clinical Cases & Reports 1, no. 3 (October 30, 2018): 130–34. http://dx.doi.org/10.46619/joccr.2018.1-1027.

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The supra-patellar approach represents one approach to intramedullary nailing (IMN) of diaphyseal tibia fractures. Violation of the knee joint utilizing an intra-articular start point represents a risk for septic arthritis of the knee in the post-operative period. Previous retrospective studies of open tibia and femur fractures demonstrated that post-operative knee sepsis is rare, occurs in the chronic phase after injury, and due to extent of soft tissue injury rather than immune compromise. Here, we review current literature on post-operative knee sepsis, and present a case of acute septic arthritis of the knee following supra-patellar nailing of an open tibia fracture in a patient on chronic immune suppression. In this unique case, co-morbid patient factors likely led to this manifestation of a rare complication.

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Fanelli, Gregory C. "Timing of Repair or Reconstruction after Knee Dislocation." Journal of Knee Surgery 33, no. 04 (November 4, 2019): 335–38. http://dx.doi.org/10.1055/s-0039-1700573.

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AbstractThe multiple ligament injured knee (knee dislocation) is, often times, part of a multisystem injury complex that can include not only injuries to knee ligaments but also to blood vessels, skin, nerves, bones (fractures), head injuries, and other organ system trauma. These additional injuries can affect surgical timing for knee ligament reconstruction and also affect the results of the treatment. This article will present the author's approach and experience in the initial assessment and treatment of the acute multiple ligament injured (dislocated) knee, and also present considerations in the treatment of chronic multiple ligament injured knee.

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Cattano, Nicole M., Jeffrey B. Driban, Mary F. Barbe, Ryan T. Tierney, Mamta Amin, and Michael R. Sitler. "Biochemical Response to a Moderate Running Bout in Participants With or Without a History of Acute Knee Injury." Journal of Athletic Training 52, no. 6 (June 1, 2017): 567–74. http://dx.doi.org/10.4085/1062-6050-51.5.09.

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Context: Individuals with an acute knee-injury history are 4 times more likely to develop knee osteoarthritis than those without a prior knee injury, and it is unknown why. Individuals with an injury history may exhibit aberrant changes in tissue turnover after physical activity (eg, running), which could lead to osteoarthritis, but this has yet to be determined among young, physically active individuals. Objective: To determine collagen degradation and synthesis and inflammatory biomarker concentration levels before exercise and changes in response to an acute running bout in injured participants compared with healthy control participants. Design: Cohort study. Setting: Research laboratory. Patients or Other Participants: A total of 22 physically active individuals between 18 and 25 years of age were recruited for the study: 11 injured participants (knee injury within 4 years of the study) who were medically cleared for physical activity and 11 matched healthy control participants. Main Outcome Measure(s): The independent variable was group (injured or control). Dependent variables were serum biomarker concentrations for cartilage oligomeric matrix protein, matrix metalloproteinase-13, proinflammatory marker interleukin-1β, c-terminal cross-linking telopeptide of type II collagen, and type II collagen synthesis marker. Each participant provided prerun and postrun blood samples for biomarker-concentration analysis. Results: No group differences existed in serum biomarker concentrations before exercise or in serum biomarker changes from pre-exercise to postexercise. Conclusions: After an acute bout of moderate-intensity running, young, active individuals in a high-risk postinjury population had similar biochemical responses as matched healthy controls. However, the external generalizability of these findings to other exercises and populations has yet to be determined.

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Kvist, Joanna, Stephanie Filbay, Christer Andersson, Clare L. Ardern, and Håkan Gauffin. "Radiographic and Symptomatic Knee Osteoarthritis 32 to 37 Years After Acute Anterior Cruciate Ligament Rupture." American Journal of Sports Medicine 48, no. 10 (July 31, 2020): 2387–94. http://dx.doi.org/10.1177/0363546520939897.

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Background: The long-term prevalence of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is unknown, especially in patients without a history of ACL surgery. Purpose: To (1) describe the prevalence of radiographic OA, symptomatic OA, and knee replacement surgery 32 to 37 years after acute ACL injury and to (2) compare the prevalence of radiographic OA, symptomatic OA, and knee symptoms between patients allocated to early ACL surgery or no ACL surgery and patients who crossed over to ACL surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Participants aged 15 to 40 years at the time of ACL injury were allocated to surgical (augmented or nonaugmented ACL repair) or nonsurgical ACL treatment within 14 days of injury. At 32 to 37 years after the initial injury, 153 participants were followed up with plain weightbearing radiographs and completed 4 subscales from the Knee injury and Osteoarthritis Outcome Score (KOOS). Radiographic OA was defined as Kellgren and Lawrence grade 2 or higher. Symptomatic OA was defined as radiographic OA plus knee symptoms measured with the KOOS. Results: Participants allocated to ACL surgery (n = 64) underwent surgery at a mean ± SD of 5 ± 4 days (range, 0-11 days) after injury. Of the 89 participants allocated to no ACL surgery, 53 remained nonsurgically treated, 27 had ACL surgery within 2 years, and 9 had ACL surgery between 3 and 21 years after injury. In the total sample, 95 participants (62%) had radiographic tibiofemoral OA, including 11 (7%) who had knee replacement. The prevalence of radiographic tibiofemoral OA was lower in the group allocated to ACL surgery compared with the group who never had ACL surgery (50% vs 75%; P = .005). The prevalence of symptomatic OA (50% in the total sample) and patellofemoral radiographic OA (35% in the total sample) was similar between groups. Conclusion: Patients allocated to early ACL surgery, performed a mean 5 days after injury, had a lower prevalence of tibiofemoral radiographic OA at 32 to 37 years after injury compared with patients who never had ACL surgery. The prevalences of symptomatic OA, radiographic patellofemoral OA, and knee symptoms were similar irrespective of ACL treatment. Overall, the prevalence of OA after ACL injury was high. Registration: NCT03182647 (ClinicalTrials.gov identifier)

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Pheo, Mun Sik, Myung Hwan Son, and Byung Yun Hwang. "Clinical Diagnosis of Acute ACL Injury of Knee Joint." Journal of the Korean Orthopaedic Association 35, no. 6 (2000): 921. http://dx.doi.org/10.4055/jkoa.2000.35.6.921.

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Chmielewski, Terese L., Katherine S. Rudolph, and Lynn Snyder-Mackler. "Development of dynamic knee stability after acute ACL injury." Journal of Electromyography and Kinesiology 12, no. 4 (August 2002): 267–74. http://dx.doi.org/10.1016/s1050-6411(02)00013-5.

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Fanelli, Gregory. "Surgical Reconstruction for Acute Posterolateral Injury of the Knee." Journal of Knee Surgery 18, no. 02 (2005): 157–62. http://dx.doi.org/10.1055/s-0030-1248175.

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Witjes, Suzanne, Tammo H. Pels Rijcken, and Cor P. van der Hart. "A 30-year-old woman with acute knee injury." British Journal of Sports Medicine 48, no. 18 (December 6, 2012): 1394–96. http://dx.doi.org/10.1136/bjsports-2012-090952a.

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Lutter, Christoph, Thomas Tischer, Carrie Cooper, Luisa Frank, Thilo Hotfiel, Robert Lenz, and Volker Schöffl. "Mechanisms of Acute Knee Injuries in Bouldering and Rock Climbing Athletes." American Journal of Sports Medicine 48, no. 3 (January 31, 2020): 730–38. http://dx.doi.org/10.1177/0363546519899931.

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Background: There is limited insight into the mechanisms of knee injuries in rock climbing and bouldering in noncompetitive and competitive athletes. Purpose: To examine the traumatic mechanisms of injury, demographics, distribution, and severity of knee injuries in affected athletes. Study Design: Case series; Level of evidence, 4. Methods: During a 4-year period, we performed a retrospective multicenter analysis of acute knee injuries in competitive and noncompetitive climbing athletes. Traumatic mechanisms were inquired and severity levels, therapies, and outcomes recorded with visual analog scale, Tegner, Lysholm, and climbing-specific outcome scores. Results: Within the observation period, 71 patients (35% competitive athletes, 65% noncompetitive athletes) with 77 independent acute knee injuries were recorded. Four trauma mechanisms were identified: high step (20.8%), drop knee (16.9%), heel hook (40.3%), and (ground) fall (22.1%). The leading structural damage was a medial meniscal tear (28.6%), found significantly more often in the noncompetitive group. A specific climbing injury is iliotibial band strain during the heel hook position. Most injuries resulted from indoor bouldering (46.8%). Surgical procedures were predominantly necessary in noncompetitive climbers. One year after the injury, the Tegner score was 5.9 ± 0.8 (mean ± SD; range, 3-7); the Lysholm score was 97 ± 4.8 (range, 74-100); and the climbing-specific outcome score was 4.8 ± 0.6 (range, 2-5). Conclusion: Increased attention should be placed on the climber’s knee, especially given the worldwide rise of indoor bouldering. Sport-specific awareness and training programs for noncompetitive and competitive climbing athletes to reduce knee injuries should be developed, and sports medical supervision is mandatory.

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Kahan, Joseph B., Don Li, Christopher A. Schneble, Patrick Huang, James Bullock, Jack Porrino, and Michael J. Medvecky. "The Pathoanatomy of Posterolateral Corner Ligamentous Disruption in Multiligament Knee Injuries Is Predictive of Peroneal Nerve Injury." American Journal of Sports Medicine 48, no. 14 (October 19, 2020): 3541–48. http://dx.doi.org/10.1177/0363546520962503.

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Background: A description of the precise locations of ligamentous and myotendinous injury patterns of acute posterolateral corner (PLC) injuries and their associated osseous and neurovascular injuries is lacking in the literature. Purpose: To characterize the ligamentous and myotendinous injury patterns and zones of injury that occur in acute PLC injuries and determine associated rates of peroneal nerve palsies and vascular injuries, as well as fracture and dislocation. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively identified all patients treated for an acute multiligament knee injury (MLKI) at our level 1 trauma center from 2001 to 2018. From this cohort, all patients with PLC injuries were identified. Demographics, involved ligaments and tendons, neurovascular injury, and presence of fracture and dislocation were compared with the larger multiligament knee cohort. Incidence and location of injury of PLC structures—from proximal to midsubstance and distal injury—were recorded. Results: A total of 100 knees in 100 patients were identified as having MLKIs. A total of 74 patients (74%) had lateral-sided ligament injuries. Of these, 23 (31%) had a peroneal nerve palsy associated with their injury; 10 (14%), a vascular injury; and 23 (31%), a fracture. Patients with PLC injuries had higher rates of peroneal nerve injury as compared with those having acute MLKIs without a PLC injury (31% vs 4%; P = .005). Patients with a complete peroneal nerve palsy (n = 17) were less likely to regain function than those with a partial peroneal nerve palsy (n = 6; 12% vs 100%; P < .0001). Complete injury to the lateral collateral ligament (LCL) occurred in 71 of 74 (96%) PLC injuries, with 3 distinct patterns of injury demonstrated. Fibular avulsion of the LCL was the most common zone of injury (65%), followed by femoral avulsion (20%) and midsubstance tear (15%). Location of injury to the LCL was associated with the rate of peroneal nerve injury, with midsubstance tears and fibular avulsions associated with higher rates of peroneal nerve injury. Conclusion: MLKIs with involvement of the PLC are more likely to suffer peroneal nerve injury. The LCL is nearly always involved, and its location of injury is predictive of peroneal nerve injury. Patients with a complete peroneal nerve palsy at presentation are much less likely to regain function.

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Lutter, Christoph, Thomas Tischer, Carrie Cooper, Luisa Frank, Thilo Hotfiel, Robert Lenz, and Volker Schöffl. "Trauma Mechanisms of Acute Knee injuries in Bouldering and Sport Climbing." Orthopaedic Journal of Sports Medicine 8, no. 5_suppl4 (May 1, 2020): 2325967120S0031. http://dx.doi.org/10.1177/2325967120s00317.

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Background There is limited insight into trauma mechanisms of knee injuries in bouldering and sport climbing for both non-competitive and competitive athletes. Purpose Based on a recent rapid increase of knee injuries caused by bouldering and sport climbing, we aimed to examine traumatic mechanisms of injury, demographics, distribution and severity of knee injuries in affected athletes. Study Design Case series; Level of evidence, 4. Methods Within a four-year period, we performed a retrospective multi-center analysis of acute knee injuries in both competitive and non-competitive climbers. Traumatic mechanisms were inquired and severity levels, therapies and outcomes recorded using Visual Analog Scale (VAS), Tegner, Lysholm and a climbing-specific outcome score. Results A total number of 71 patients (35% competitive athletes and 65% non-competitive athletes) with 77 independent acute knee injuries were identified. Four different trauma mechanisms were thereby recorded: High step (20.8%), Drop knee (16.9%), Heel hook (40.3%) and (ground) Fall (22.1%). The leading structural damage was medial meniscal tear (29.3%), found significantly more often in non-competitive athletes. A specific climbing injury is iliotibial band strain during the heel hook position, causing 46.8 % of all injuries; most injuries resulted from indoor bouldering. Surgical procedures were predominantly necessary within the non-competitive group. One year after the injury, the average Tegner score was 5.6 ± 0.6 (3-6), Lysholm score was 97 ± 4.8 (74-100) and climbing specific outcome score was 4.8 ± 0.6 (2-5). Conclusion: Increased attention on the climber’s knee is required, especially due to the worldwide rise of indoor bouldering. Sport specific awareness- and training programs for both noncompetitive and competitive climbers to reduce acute knee injuries should be developed and sports medical supervision is mandatory.

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Stagnaro, Joaquin, Carlos Yacuzzi, Jorge Barla, Juan Pablo Zicaro, and Matias Costa-Paz. "Lower limb fractures associated with multiligament knee injury." Orthopaedic Journal of Sports Medicine 5, no. 1_suppl (January 1, 2017): 2325967117S0002. http://dx.doi.org/10.1177/2325967117s00029.

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Objectives: Knee ligament injuries related to lower limb fractures are common and frequently unnoticed. Management of acute polytrauma is usually focused in the bone lesion and a complete physical examination might be really difficult. The purpose of this study was to analyze a series of patients who suffered multiligament knee injuries associated to a lower limb fracture. Hypothesis: The use of magnetic resonance imaging (MRI) during the initial management can lead to an early diagnosis of ligament injuries. Methods: A retrospective search was conducted from our hospital´s electronic database. We evaluated the initial diagnosis and acute surgical treatment, and management and functional outcomes after the ligament lesion was diagnosed. Results: Seven patients who presented a knee multiligament injury associated with a lower limb fracture were evaluated. The average age was 29 years. Primary diagnoses were: four tibial plateau fractures; one open fracture-dislocation of the knee; one open leg fracture and ipsilateral hip dislocation; and one bifocal femur fracture. Only three patients had an MRI during the initial management of trauma. Six out of seven patients had to be operated on for the multiligament knee injury. The period between the resolution of the fracture and the ligamentous repair was from 3 to 24 months. Conclusion: Poor functional outcomes are reported in patients with multiligament knee injuries associated with high-energy lower limb fractures. We consider an MRI during the initial management can lead to better outcomes. A trauma surgeon working alongside an arthroscopic surgeon might optimize the results for these lesions.

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Stickley, Christopher D., Melanie M. Presuto, Kara N. Radzak, Christina M. Bourbeau, and Ronald K. Hetzler. "Dynamic Varus and the Development of Iliotibial Band Syndrome." Journal of Athletic Training 53, no. 2 (February 1, 2018): 128–34. http://dx.doi.org/10.4085/1062-6050-122-16.

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Context: Although the risk of osteoarthritis development after acute knee injury has been widely studied, the long-term consequences of knee overuse injury are not well understood. Objective: To identify the relationship between gait-related risk factors associated with osteoarthritis and the development of iliotibial band syndrome (ITBS) in members of a single University Army Reserve Officers' Training Corps unit. Design: Prospective cohort study. Setting: Biomechanics laboratory. Patients or Other Participants: Sixty-eight cadets undergoing standardized physical fitness training. Intervention(s): Three-dimensional lower extremity kinematics (240 Hz) and kinetics (960 Hz) were collected for 3 bilateral trials during shod running at 4.0 m/s ± 10%. Injury tracking was conducted for 7 months of training. Main Outcome Measure(s): Biomechanical variables, including varus thrust and knee-adduction moment, were compared between the injured and control groups. Results: Twenty-six cadets with no history of overuse injury served as the control group, whereas 6 cadets (7 limbs) who developed ITBS that required them to modify their training program or seek medical care (or both) served as the injured group. Maximum varus velocity was higher (P = .006) and occurred sooner during stance (P = .04) in the injured group than in the control group, indicating greater varus thrust. Maximum knee-varus angle and maximum knee-adduction moment were higher (P = .02 and P = .002, respectively) and vertical stiffness was lower (P = .03) in the injured group. Conclusions: Measures of dynamic varus stability appeared to be altered in individuals who developed ITBS. Biomechanical knee variables previously identified as increasing the risk for knee osteoarthritis were also associated with the development of ITBS in healthy adults.

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Richey, Bradley, and Cassidy M. Foley Davelaar. "Physeal injury in a skeletally immature male athlete." BMJ Case Reports 14, no. 7 (July 2021): e243044. http://dx.doi.org/10.1136/bcr-2021-243044.

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A 12-year-old skeletally immature male athlete presented for evaluation with acute bilateral knee pain. Initial radiographs revealed subtle lucency of the medial proximal tibial physis and MRI was recommended. On MRI, broad-based intravasation of the physis into the proximal femoral and tibial physes was observed. This represented physeal widening, a phenomenon that has been observed in skeletally immature athletes presenting for acute knee pain. While such changes to the physis may be quite prominent on MRI, conventional radiographic findings may be much more subtle. As many causes of chronic knee pain in this population are managed with active rehabilitation, a high index of suspicion for this diagnosis in the presence of physeal abnormalities may warrant evaluation with MRI. The literature suggests this pathology will resolve with rest, but, if weight-bearing activities are continued, there is a risk for significant growth abnormalities.

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Imbergamo, Casey, Andrzej Brzezinski, Tiffany Smith, Patrick S. Buckley, and Kenneth G. Swan. "Bilateral Knee Dislocations Treated with Acute, Single-Stage Multiligament Reconstructions." Case Reports in Orthopedics 2021 (May 3, 2021): 1–11. http://dx.doi.org/10.1155/2021/9985788.

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Bilateral knee dislocations are exceedingly rare in orthopaedics. Managing these injuries presents a difficult task given their high complication rate and guarded prognosis. We report the case of a 21-year-old male who presented to our institution with bilateral knee dislocations sustained in a motor vehicle collision. The patient subsequently underwent multiligament knee reconstruction surgeries for each knee at one and three weeks following the initial injury. At one-year follow-up, the patient has achieved a successful outcome and has returned to regular activities which include hiking and exercising at the gym.

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Räisänen, Anu M., Kati Pasanen, Tron Krosshaug, Tommi Vasankari, Pekka Kannus, Ari Heinonen, Urho M. Kujala, Janne Avela, Jarmo Perttunen, and Jari Parkkari. "Association between frontal plane knee control and lower extremity injuries: a prospective study on young team sport athletes." BMJ Open Sport & Exercise Medicine 4, no. 1 (January 2018): e000311. http://dx.doi.org/10.1136/bmjsem-2017-000311.

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Background/aimPoor frontal plane knee control can manifest as increased dynamic knee valgus during athletic tasks. The purpose of this study was to investigate the association between frontal plane knee control and the risk of acute lower extremity injuries. In addition, we wanted to study if the single-leg squat (SLS) test can be used as a screening tool to identify athletes with an increased injury risk.MethodsA total of 306 basketball and floorball players participated in the baseline SLS test and a 12-month injury registration follow-up. Acute lower extremity time-loss injuries were registered. Frontal plane knee projection angles (FPKPA) during the SLS were calculated using a two-dimensional video analysis.ResultsAthletes displaying a high FPKPA were 2.7 times more likely to sustain a lower extremity injury (adjusted OR 2.67, 95% CI 1.23 to 5.83) and 2.4 times more likely to sustain an ankle injury (OR 2.37, 95% CI 1.13 to 4.98). There was no statistically significant association between FPKPA and knee injury (OR 1.49, 95% CI 0.56 to 3.98). The receiver operating characteristic curve analyses indicated poor combined sensitivity and specificity when FPKPA was used as a screening test for lower extremity injuries (area under the curve of 0.59) and ankle injuries (area under the curve of 0.58).ConclusionsAthletes displaying a large FPKPA in the SLS test had an elevated risk of acute lower extremity and ankle injuries. However, the SLS test is not sensitive and specific enough to be used as a screening tool for future injury risk.

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Zamami, Shin, Norimasa Sunagawa, Jun Asato, Kiyohisa Uchida, Fuminori Kanaya, Chojo Futenma, and Kunio Ibaraki. "MRI Imaging of the Acute Knee Injury Associated with Fracture Around the Knee Joint." Orthopedics & Traumatology 42, no. 3 (1993): 1002–7. http://dx.doi.org/10.5035/nishiseisai.42.1002.

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Wilder, F. V., B. J. Hall, J. P. Barrett, and N. B. Lemrow. "History of acute knee injury and osteoarthritis of the knee: a prospective epidemiological assessment." Osteoarthritis and Cartilage 10, no. 8 (August 2002): 611–16. http://dx.doi.org/10.1053/joca.2002.0795.

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Kostogiannis, Ioannis, Eva Ageberg, Paul Neuman, Leif Dahlberg, Thomas Friden, and Harald Roos. "Activity Level and Subjective Knee Function 15 Years after Anterior Cruciate Ligament Injury." American Journal of Sports Medicine 35, no. 7 (July 2007): 1135–43. http://dx.doi.org/10.1177/0363546507299238.

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Background The activity level and subjective knee function after an anterior cruciate ligament (ACL) injury treated without reconstruction have not been well elucidated. Hypothesis Patients with ACL injury can achieve good knee function and satisfactory long-term activity level when treated by early activity modification combined with rehabilitation. Study Design Cohort study (prognosis); Level of evidence, 2. Materials and Methods One hundred patients with an acute total ACL injury were observed for 15 years. All patients initially underwent arthroscopic surgery and a rehabilitation program. They were advised to modify their activity level, especially by avoiding contact sports. Patients with recurrent giving-way episodes and/or secondary meniscal injuries that required fixation (n = 6) were subsequently excluded and underwent reconstruction (n = 22). Sixty-seven patients with unilateral nonreconstructed ACL injury remained at the 15-year follow-up. The Lysholm knee score, Tegner activity level, and a visual analog score for global knee function were recorded at regular intervals. At the final follow-up, patients were further evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) subjective knee evaluation form. Results Forty patients resumed their preinjury activity level or higher within 3 years. The median activity level 15 years after injury had decreased from 7 to 4 according to Tegner activity scale (P < .001). The mean Lysholm knee score was 96 and 95, 1 and 3 years after injury, respectively, but declined to 86 after 15 years (P < .001). Forty-nine patients had good/excellent results, and 14 had fair (n = 6) or poor function (n = 8) at 15 years. Patients injured in contact sports scored lower in the quality of life sub-scale of KOOS than those injured in noncontact sports (P < .05). Thirteen of the 67 patients (19%) were reoperated with an arthroscopic procedure because of knee symptoms. Conclusion Early activity modification and neuromuscular rehabilitation resulted in a good knee function and an acceptable activity level in the majority of the nonreconstructed patients. The decline in activity level of patients engaged in contact sports at the time of injury affected their subjective quality of life more than patients involved in noncontact sports.

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Zhou, Ming, and Wen Zou. "Application of suture bridge technique in the treatment of acute patellar ligament injury." Orthopaedic Journal of Sports Medicine 8, no. 9_suppl7 (September 1, 2020): 2325967120S0052. http://dx.doi.org/10.1177/2325967120s00522.

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Introduction: The patellar ligament, as a knee extensor, plays an important role in knee movement. Patellar ligament tear completely divided into acute and chronic, acute general mishandling lead to fracture again, chronic patellar ligament rupture, need surgery to restore again and device, the integrity of the patellar ligament rupture time more than 2 weeks or more, it’s easy to have a different degree of scar healing, a normal tendinous portion elasticity and tension were significantly decreased, eventually leading to knee disorders. If scar tissue is removed by surgery and sutured again, the required strength of the patellar ligament cannot be provided, resulting in long postoperative recovery time, knee joint dysfunction, muscle atrophy, joint degeneration and other problems. Hypotheses: To explore the method and clinical effect of suture bridge technique in the treatment of acute patellar ligament injury. Methods: From January 2016 to October 2018, 13 patients with Acute injury of patellar ligament insertion were treated with suture bridge technique.Among them, there were 11 males and 2 females, aged from 17 to 35 years, with an average age of 26.3 years.The average time from injury to operation was from 3 to 5 days, with an average day of 3.5 days.Thirteen patients all suffered from closed injury at the inferior end of patella. Among them, 8 had no fracture at the inferior end of patella, 5 had bone fragments and none had avulsion at the tibial end.Thirteen patients all suffered from closed injury at the inferior end of patella. Among them, 8 had no fracture at the inferior end of patella, 5 had bone fragments and none had avulsion at the tibial end.Suture bridge technique was used in 13 cases.Postoperative knee function was assessed by Lysholm score Results: All patients were followed up for 7 to 15 months, with an average of 11.2 months.All incisions healed well, and there were no complications such as infection and re-rupture of patellar ligament.At 6-12 weeks after operation, the range of motion of 13 patients reached the level of uninjured side.According to Lysholm scoring criteria, knee joint function was excellent in 9 cases and good in 4 cases Conclusion: Suture bridge technique in the treatment of acute patellar ligament injury has the characteristics of firm fixation, fewer complications, quick recovery and avoidance of second operation.

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Sago, Carrie E., and Craig S. Labuda. "Diagnostic Imaging in a Patient With an Acute Knee Injury." Journal of Orthopaedic & Sports Physical Therapy 43, no. 1 (January 2013): 30. http://dx.doi.org/10.2519/jospt.2013.0402.

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Roe, J. "Management of acute knee injury – the role of the surgeon." Journal of Science and Medicine in Sport 15 (December 2012): S339—S340. http://dx.doi.org/10.1016/j.jsams.2012.11.826.

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Shetty, Teena, Joseph T. Nguyen, Mayu Sasaki, Anita Wu, Eric Bogner, Alissa Burge, Taylor Cogsil, et al. "Risk factors for acute nerve injury after total knee arthroplasty." Muscle & Nerve 57, no. 6 (March 12, 2018): 946–50. http://dx.doi.org/10.1002/mus.26045.

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Taylor, Clare F., and Daniel H. Williams. "An acute knee injury: tracking a two-year recovery online." International Journal of Electronic Healthcare 8, no. 1 (2015): 1. http://dx.doi.org/10.1504/ijeh.2015.071636.

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Hägglund, Martin, and Markus Waldén. "Risk factors for acute knee injury in female youth football." Knee Surgery, Sports Traumatology, Arthroscopy 24, no. 3 (December 24, 2015): 737–46. http://dx.doi.org/10.1007/s00167-015-3922-z.

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Yadav, Anju, Pouya Alijanipour, Colin T. Ackerman, Siddharth Karanth, William J. Hozack, and Edward J. Filippone. "Acute Kidney Injury Following Failed Total Hip and Knee Arthroplasty." Journal of Arthroplasty 33, no. 10 (October 2018): 3297–303. http://dx.doi.org/10.1016/j.arth.2018.06.019.

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Ferguson, KB, A. Winter, L. Russo, A. Khan, M. Hair, MS MacGregor, and G. Holt. "Acute kidney injury following primary hip and knee arthroplasty surgery." Annals of The Royal College of Surgeons of England 99, no. 4 (April 2017): 307–12. http://dx.doi.org/10.1308/rcsann.2016.0324.

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Acute kidney injury (AKI) is a recognised postoperative complication following primary hip/knee arthroplasty surgery. The aim of this study was to determine causative and potentially modifiable risk factors associated with postoperative AKI. Standard data were collected for 413 consecutive arthroplasty patients, both retrospectively and prospectively. Univariate and multivariate analyses were performed to identify any potential causative factors. Eight percent of patients developed postoperative AKI. Univariate analysis found increasing age, history of previous chronic kidney disease and requirement for postoperative intravenous fluids to be risk factors for AKI. The multivariate regression analysis model identified age and volume of postoperative fluid prescription as predictive of postoperative AKI. Antibiotic regime and prescription of non-steroidal anti-inflammatory drugs had no significant effect on the risk of AKI. No patients required dialysis but length of stay increased by 50% in the AKI group. Postoperative AKI may result in significant postoperative morbidity and increased length of stay, and may necessitate invasive therapies such as dialysis. Episodes of AKI could also predispose to future similar episodes and are associated with a long-term decrease in baseline renal function. This study has demonstrated that the identified risk factors are generally non-modifiable. Further work is suggested to determine whether targeted interventions in high risk patients would reduce the incidence of AKI.

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Fujimura, Kenjiro, Koji Sakuraba, Satoshi Kamura, Kiyoshi Miyazaki, Nobuo Kobara, Kazumasa Terada, and Hisaaki Miyahara. "Reconstruction of Acute Patellar Tendon Rupture after Patellectomy." Case Reports in Orthopedics 2018 (2018): 1–5. http://dx.doi.org/10.1155/2018/7549476.

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Acute rupture of the knee extensor mechanism after patellectomy is extremely rare. We present the case of a patient with acute patellar tendon rupture who had undergone patellectomy 53 years before. Twelve days after the injury, the ruptured patellar tendon was repaired with end-to-end suture. Postoperatively, we splinted the knee for 6 weeks but permitted the patient to walk without limiting weight bearing at 1 week postoperatively. At one-year follow-up, the patient is able to move his knee almost full range of motion and the Lysholm knee score is 81. The patient is satisfied with the outcome. This is the first report to treat acute rupture of the patellar tendon in a patient who had undergone patellectomy. Although careful rehabilitation is required, end-to-end suture might be an adequate surgical procedure for acute rupture of the knee extensor mechanism after patellectomy.

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Ferretti, Andrea, Edoardo Monaco, Edoardo Gaj, Valerio Andreozzi, Alessandro Annibaldi, Alessandro Carrozzo, Thais Dutra Vieira, Bertrand Sonnery-Cottet, and Adnan Saithna. "Risk Factors for Grade 3 Pivot Shift in Knees With Acute Anterior Cruciate Ligament Injuries: A Comprehensive Evaluation of the Importance of Osseous and Soft Tissue Parameters From the SANTI Study Group." American Journal of Sports Medicine 48, no. 10 (July 6, 2020): 2408–17. http://dx.doi.org/10.1177/0363546520935866.

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Background: Preoperative grade 3 pivot shift has been reported to be associated with higher rates of anterior cruciate ligament (ACL) failure, persistent instability, and inferior patient-reported outcomes. The etiology of a high-grade pivot shift is multifactorial, and numerous factors have been suggested to be responsible. More attention has recently been focused on injury to the anterolateral structures (ALS) as a risk factor for a grade 3 pivot shift. Purpose: To determine risk factors for grade 3 pivot shift, including soft tissue and osseous parameters. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A prospective evaluation was undertaken of 200 consecutive patients undergoing acute ACL reconstruction (within 10 days of injury). An open exploration of the lateral side of the injured knee was performed at the time of the index procedure. Details regarding patient and injury characteristics were recorded, as were details of soft tissue injuries, including meniscal tears, ALS lesions, medial collateral ligament tears, and chondral injuries. Osseous parameters (tibial slope and condylar ratios) were determined per established magnetic resonance imaging protocols. A multivariate logistic regression with penalized maximum likelihood was used to identify risk factors associated with International Knee Documentation Committee (IKDC) grade 3 pivot shift. Results: The mean ± SD age of the population was 28.3 ± 9.8 years; 67.5% of patients were male. Among patients, 35 (17.5%) had a high-grade pivot shift (IKDC grade 3), and 165 (82.5%) had a low-grade pivot shift (IKDC grades 1 and 2). Univariate and multivariate logistic regression analysis demonstrated that injury to the ALS was the only significant risk factor for grade 3 pivot shift (odds ratio, 13.49; 95% CI, 1.80-1725.53). Conclusion: This comprehensive evaluation of soft tissue and osseous factors has identified that injury to the ALS is the most important risk factor for grade 3 pivot shift in acute ACL-injured knees.

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Davis, Derik L., and Prasann Vachhani. "Traumatic Extra-capsular and Intra-capsular Floating Fat: Fat-fluid Levels of the Knee Revisited." Journal of Clinical Imaging Science 5 (November 30, 2015): 60. http://dx.doi.org/10.4103/2156-7514.170729.

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Floating fat is a sign of acute bone injury at the knee following trauma. The goal of this article is to review the etiology, patterns, and mimickers of extra-capsular and intra-capsular floating fat, with the major emphasis on knee trauma in the acute setting. We will discuss the spectrum of multimodal imaging findings for rare presentations of extra-capsular floating fat, and contrast these with common and atypical forms of intra-capsular lipohemarthrosis, as an aid to the assessment of acute bone trauma at the knee.

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Watt, F. E., E. Paterson, A. Freidin, J. Saklatvala, A. Williams, and T. L. Vincent. "Acute and sustained molecular changes in synovial fluid following acute knee injury mirror the murine joint injury response." Osteoarthritis and Cartilage 22 (April 2014): S7—S8. http://dx.doi.org/10.1016/j.joca.2014.02.035.

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Moström, Eva Bengtsson, Christina Mikkelsen, Lars Weidenhielm, and Per-Mats Janarv. "Long-Term Follow-Up of Nonoperatively and Operatively Treated Acute Primary Patellar Dislocation in Skeletally Immature Patients." Scientific World Journal 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/473281.

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Purpose. The present study reports a long-term follow-up of acute primary patellar dislocation in patients with open physes. The purpose of the study was to evaluate knee function and recurrence rates after surgical and nonsurgical treatment of patellar dislocation.Methods. A total of 51 patients, including 29 girls and 22 boys, who were 9–14 years of age at the time of injury, were retrospectively evaluated. The minimum follow-up time was 5 years. Thigh muscle torque, range of motion, the squat test, the knee injury and osteoarthritis outcome score (KOOS), the Kujala score, and the recurrence rate were registered. Radiological predisposing factors at the time of injury were determined.Results. Quality of life and sports/recreation were the most affected subscales, according to KOOS, and a reduced Kujala score was also observed in all treatment groups. The surgically treated patients had a significantly lower recurrence rate. Those patients also exhibited reduced muscle performance, with a hamstring to quadriceps ratio (H/Q) of 1.03. The recurrence rate was not correlated with knee function.Conclusions. Patellar dislocation in children influences subjective knee function in the long term. Surgery appears to reduce the recurrence rate, but subjective knee function was not restored.

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