PURPOSE: The purpose of this study is to review the indications of ankle lateral complex reconstruction using tendon graft. MATERIALS AND METHODS: We searched PubMed using the index, "ankle, instability, lateral ligament, reconstruction" from 1990 to present (September 30, 2015). We excluded 1) modified Brostrom operation (MBO), 2) conventional tenodesis surgery, 3) review article, 4) technical note, and 5) articles written in another foreign language. We reviewed 24 papers through the publication events, operational method, the indications of surgery, and the specific features of the patient group. RESULTS: There were the indications of 1) previous ligament surgery failure, 2) situation when ligament repair is impossible due to the ligament defect, 3) severe instability (preoperative talar tilt >15degrees, anterior draw >10 mm or the difference of contralateral side talar tilt >5degrees, anterior draw >3 mm), and 4) overweight (body mass index >30 kg/m2). Other considerations included 1) generalized joint laxity and 2) workers, highly-demanded or athlete highly-affected by instability. CONCLUSION: The ankle lateral complex reconstruction using tendon graft could be indicated in patients with the possibility of MBO failure with several considerations.
Ankle* ; Athletes ; Collateral Ligaments ; Humans ; Joint Instability ; Lateral Ligament, Ankle* ; Ligaments ; Overweight ; Publications ; Tendons* ; Tenodesis ; Transplants*

The author reviewed 67 cases having medial instability of the knee joint from 1971 to 1980 who were treated by surgery at the Department of Orthopaedic Surgery at Ewha Womans University Hospital. The author reviewed 67 cases which showed medial instability from 1971 to 1980 who had been treated by surgery in the Department of Orthopaedic Surgery at Ewha Womans University Hospital and summarized as follows. 1. The majority of the medial instability was due to rupture of medial collateral ligament with capsular ligament (43.3%), and the rest were due to rupture of tibial collateral ligament only (35.8%). 2. The medial instability also produced by rupture of the other structures of the medial side of the knee joint without tibial collateral ligament rupture. 3. The stress radiogram was important guide line for the diagnosis of the injury of the medial structures of the knee joint. 4. The degree of medial joint space opening was increased with the number of structures injured.
Collateral Ligaments ; Diagnosis ; Female ; Humans ; Joints ; Knee Joint ; Knee ; Ligaments ; Medial Collateral Ligament, Knee ; Rupture

The significance of the physical examination is controversial since Slocum and Larson first described the concept of rotatory instability of the knee. The findings of the physical examination of the 101 knees of 95 patients from 1982 to 1985 were compared with the operative findings. The results were as follows. 1. Valgus stress test a) The valgus stress test c the knee in extension was positive in 1) combined tear of medial collateral ligament, posterior oblique ligament, either anterior or posterior cruciate ligament, 2) avulsion fracture of medial collateral ligament and 3) extensive tear of medial capsular ligament. But the test was negative when the posterior oblique ligament was intact although the medial collateral ligament and the anterior cruciate ligament were torn. b) The valgus stress test c the knee in 30° flexion was positive in all cases of torn medial collateral ligament, But it was severer in cases of positive test in full extension. 2. The varus stress test in extension was positive when the anterior or posterior cruciate ligament was torn in addition to lateral collateral ligament and posterolateral capsule. 3. The Slocum test was negative, or positive only in neutral rotation in isolated tear of the anterior cruciate ligament. 4. The Ritchey-Lachman test was positive in all cases of torn anterior cruciate ligament. 5. The posterior drawer test could be positive in cases of intact posterior cruciate ligament. 6. The pivot shift test was negative in cases of torn medial collateral ligament and posterior oblique ligament although there was associated tear of the anterior cruciate ligament. 7. The flexion rotation drawer test was positive in all cases of torn anterior cruciate ligament although there was associated tear of the medial collateral ligament. The positive test didn't always mean anterolateral rotatory instability, 8. The reversed pivot shift test was positive in cases of posterolateral rotatory instability but it was negative in cases of associated tear of posteromedial capsule. 9. The drawback of external rotation drawer test was that it depended on subjective evaluation. 10. The rotation test was very good for the rotatory instability but it could not be used in bilateral injury and the anterolateral rotatory instability of isolated tear of anterior cruciate ligament.
Anterior Cruciate Ligament ; Collateral Ligaments ; Exercise Test ; Humans ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Physical Examination ; Posterior Cruciate Ligament ; Tears

PURPOSE: Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. MATERIALS AND METHODS: We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. RESULTS: ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%). In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p<0.05), but differences in the prevalence and location of meniscal tears were not (p>0.05). CONCLUSION: Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no signifficant difference in meniscal tears with or without kissing contusion.
Animals ; Arthroscopy ; Collateral Ligaments ; Contusions* ; Diagnosis ; Horns ; Knee ; Lateral Ligament, Ankle ; Ligaments* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Prevalence ; Retrospective Studies

OBJECTIVE: To explore the clinical effect of arthroscopic combined with small needle knife in the treatment of degenerative medial meniscus (MM) injury of knee joint by releasing the superficial layer of medial collateral ligament (SMCL). METHODS: From February 2016 to November 2018, 56 patients (56 knees) with limited pain, strangulation and flexion in medial knee joint space were selected. X-ray Kellgren-Lawrence grading was I-II. MRI showed medial meniscus injury(III degree) of knee joint. There were 30 males(30 knees) and 26 females(26 knees). Arthroscopic MM plasty and small needle knife were used to release SMCL. The Lysholm knee score was used to evaluate the effect of operation. RESULTS: All 56 patients were followed up, and the duration ranged from 3 to 24 months, with an average of 10 months. According to the Lysholm knee score standard, the final follow-up was compared with that of before operation. The results showed that the preoperative knee score was 37.24±1.32, the latest follow-up knee score was 85.72±5.28, the knee score was higher than that before the operation(<0.05). CONCLUSIONS Arthroscopy combined with small needle knife release of superficial medial collateral ligament in the treatment of degenerative medial knee meniscus injury can effectively improve the mechanical balance of the knee joint, improve Lysholm knee score in patients with knee meniscus injury, and promote the recovery of knee joint function, which has clinical value.
Arthroscopy ; Collateral Ligaments ; Female ; Humans ; Knee Joint ; Male ; Medial Collateral Ligament, Knee ; Menisci, Tibial ; Treatment Outcome

PURPOSE: To confirm the complex structures of the deep layer of posterolateral corner and the safe range of the posterior capsule incision. MATERIALS AND METHODS: Seven cadaveric knees were obtained ranging in age from 39 to 55 years and male to female ratio was 5 to 2. RESULTS: The lateral collateral ligament was inserted on 18.3 mm inferiolateral part of the fibular head. The popliteofibular ligament was identified in all cases and 6 of the 7 ligaments were separated into anterior and posterior fascicle. Popliteomeniscal fascicles were divided superoinferiorly and could be identified in all cases. The direct attachment of the popliteal tendon to the tibia was not identified.Safe range of the posterior capsular incision to protect the oblique popliteal ligment and popliteal muscle was 18.7 mm in average. CONCLUSION: Covering with thick fibrous tissue, the third layer of the posterolateral ligament should be dissected with sharp blade.Lateral collateral ligament was inserted on anteroinferior portion of the fibular head and popliteofibular ligament was inserted on posterosuperior medial portion of the fibula. The direct attachment of the popliteal tendon to the tibia could not be identified. Careful protection of popliteal muscle would be needed in posterior capsular approach.
Bundle of His ; Cadaver ; Collateral Ligaments ; Female ; Fibula ; Head ; Humans ; Knee* ; Lateral Ligament, Ankle ; Ligaments ; Male ; Tendons ; Tibia

A clinical analysis on the 33 cases of the collateral ligament injuries of the knee joint was made. Those cases were classified in three groups depend upon the width of the joint space by means of stress-radiogram as one plue (less than 5 mm), two plus(5~10 mm), and three plus(more than 10 mm). Twenty one cases were three plus group and were treated operatively and remaining had conservative treatment. This injury is more prevalent in male with the peak in male with the peak incidence of 21~30 years old age group. The most common site of injury of medial collateral ligament is the mid-portion of the ligament where cross the joint line by the 42.3% on operated cases. The lateral collateral ligament has no specific location of injury but more even on its whole length of femoral or fibullar attachment and mid-portion of the ligament. Results were evaluated in three groups of excellent, good and poor. Six out of 12 cases of conservative treatment and nine out of 21 cases of operative group were excellent in result without joint instability, pain and muscle weakness on walking and flexion was available more than 120 degress. Four cases of conservative treatment group and ten of operative group were good in result with occasional pain on walking, mild degree of instability and range of joint motion between 100 to 120 degrees. Four cases had poor result with pain on walking, marked joint instability and less than 100 degrees of joint motion. Overall result of more than good were 90.5% in operative group and 83.3% in conservative treatment group.
Clinical Study ; Collateral Ligaments ; Humans ; Incidence ; Joint Instability ; Joints ; Knee Joint ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Male ; Muscle Weakness ; Walking

PURPOSE: To evaluate the patterns of injuries and frequency of associated findings on MR imaging in patients with both anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) tears; to compare the associated findings, as seen on MR imaging, in cases with both ACL and PCL tears with those with ACL or PCL tears. MATERIALS AND METHODS: Ten patients with combined ACL and PCL tears, 16 with ACL tears and 18 with PCL tears, all confirmed by arthroscopy or open surgery, were involved in this study. To identify the associated knee injuries, MR images were retrospectively evaluated. RESULTS: In ten patients with combined ACL and PCL tears, open surgery led to the identification of six complete ACL tears (60%), four partial ACL tears (40%), eight complete PCL tears (80%) and two partial PCL tears (20%). Injuries associated with these combined tears, and revealed by MR imaging, comprised six medial collateral ligament injuries (60%), six lateral collateral ligament injuries (60%), five medial meniscal injuries (50%), three lateral meniscal injuries (30%), nine bony injuries (90%), two posterior capsular injuries (20%), and three popliteus muscle injuries (30%). The frequency of popliteus muscle injury was significantly different (p<0.05, Fisher's exact test) between the group with both ACL and PCL tears and that with ACL or PCL tears. CONCLUSION: Associated findings in patients with combined ACL and PCL tears are more frequentthan in those with ACL or PCL tears. In cases involving combined ACL and PCL tears, associated findings-as seen on MR images-should thus be carefully examined.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Humans ; Knee Injuries ; Lateral Ligament, Ankle ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament* ; Retrospective Studies

PURPOSE: To demonstrate the frequency of soft tissue injuries associated with tibial plateau fracture and analyze the pattern of fracture more accurately by magnetic resonance imaging (MRI). MATERIALS AND METHODS: The plain films and MRI of 27 patients with acute tibial plateau fracture were analyzed. Every fracture was classified by findings on plain film and MRI respectively according to the Schatzker system and they were compared with each other. The degree of displacement and depression of the fracture fragments were measured on plain film and MRI. RESULTS: MRI was more accurate in determining the classification of the fracture and in measuring the displacement and depression of fragments. Fracture types of 2 cases classified by the findings of plain film were changed to different types by MRI findings. Evidence of internal derangement of the knee was found in 26(96.3%) patients. Anterior cruciate ligament injuries were seen in 12(44.4%) patients and posterior cruciate ligament injuries in 10(37.0%) patients. Medial collateral ligament injuries were seen in 11(40.7%) patients and lateral collateral ligament injuries in 8(29.6%) patients. Medial and lateral meniscus tears were seen in 8(29.6%) patients respectively. CONCLUSIONS: Most of the patients with acute tibial plateau fracture were commonly associated with ligamentous and meniscal injuries. MRI can aid in accurate evaluation of tibial plateau fracture patterns and decision of treatment plan.
Anterior Cruciate Ligament ; Classification ; Collateral Ligaments ; Depression ; Humans ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Magnetic Resonance Imaging* ; Menisci, Tibial ; Posterior Cruciate Ligament ; Soft Tissue Injuries

The function of the knee joint is determined by the anatomical integrity of ligamentous structures, however the ligaments and soft tissues which support by the knee joint are too weak to tolerate forceful stresses. The knee joint is one of the most susceptible joints to ligamentous injury. Recently, the incidence of ligamentous injuries of the knee increased because of rise in traffic accidents and participation in sports. For good results, it is very important to make an early diagnosis and to give prompt management. The authors reviewed 67 cases of ligamentous injuries in patients who were admitted and managed at the Department of Orthopaedic Surgery of Presbyterian Medical Center from March of 1976 to December of 1982. The results of the clinical study are as follows: 1. The prevalent age group is the 3rd through 5th decades, and more frequent in males (8. 6 times). 2. The traffic accident is the most common cause of injury (80. 6%) and many ligamentous injuries were associated with fracture (53. 2%). 3. The most common ruptured individual ligament was the medial collateral ligament. The isolated ligamentous rupture of anterior and posterior cruciate ligament was 3 cases each, but most of the cruciate ligaments were combined with other ligament injury. 4. The rupture sites of the individual ligaments were found to be the following: (a) The medial collateral ligament was ruptured most frequently in the mid-substance (45. 2%), with the deep layer ruptured at the femoral attachment and the superficial layer in the mid-substance; (b) The lateral collateral ligament torn at the fibular attachment (62. 5%); (c) The anterior cruciate ligament torn at the femoral and tibial (47. 6%, respectively); (d) The posterior cruciate ligament torn at the femoral attachment (40. 0%). 5. It is significant if the difference between the normal knee and the injured knee on the stress film is more than 10 or 10mm. 6. Excellent and good results were obtained in 95.2% by non-surgical management and in 93.0% by surgical management. 7. Early surgical repairs, made within 2 weeks after injury, gave much better results than late repairs.
Accidents, Traffic ; Anterior Cruciate Ligament ; Clinical Study ; Collateral Ligaments ; Early Diagnosis ; Humans ; Incidence ; Joints ; Knee Joint ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Male ; Posterior Cruciate Ligament ; Protestantism ; Rupture ; Sports