PURPOSE: The aim of this study is to analyse the clinical characteristics and results of treatment of knee dislocation. MATERIALS AND METHODS: The 18 cases of the traumatic dislocation of knee were treated at Yeung-nam university hospital from 1991 Jan. to 1997 Apr. and those were followed more than one year after injury. Result: Anterior and posterior cruciate ligament were ruptured in all cases and the two thirds of the ruptured site of cruciate ligament was femoral attachment, Medial collateral ligament injury(13 cases) were more than lateral collateral injury(8 cases) and more than half cases of collateral ligament injury were rup- tured at tibial and fibular attachment. The functional result by Lysholm knee scoring revealed fair(81 score) in average and excellent in 3 cases, good in 5 cases, fair in 10 cases. Complications were limitation of motion in 6 cases, pain in 2 cases and nerve paraiysis in 1 case. CONCLUSION: Applying classification system according to direction of displacement is sometimes difficult because the dislocation of knee could be transferred after reduction. It was thought that another subclassifica- tion system in terms of ligaments involved should be used. Functional results by Lysholm knee scoring revealed fair(81 score) in average. Early range of motion should be started after surgical repair and minimal immobilization to avoid limitation of knee motion.
Classification ; Collateral Ligaments ; Dislocations* ; Immobilization ; Knee Dislocation ; Knee* ; Ligaments ; Posterior Cruciate Ligament ; Range of Motion, Articular

Combined rupture of the medial collateral ligament, medial meniscus, and anterior cruciate ligament is common. Since O Donoghue described this combined injury in 1950, it has been referred to as O Donoghue's triad. But the rupture of the patellar tendon is a relatively uncommon form of injury, particularly in a young, well-conditioned athlete. Baker (1980) presented a case of O' Donoghue' s triad with a rupture of the patellar tendon. We present an unusual case of patellar tendon rupture associated with rupture of anterior cruciate ligament, medial collateral ligament, lateral collateral ligament and lateral meniscus. This case differs from Baker's case and has not yet been reported in the literature. The senior author performed arthroscopic partial menisectomy, patellar tendon repair by Matava's method and arthroscopic anterior cruciate ligament reconstruction, using the autogenous bone-patellar tendon-bone graft from the controlateral knee. The clinical results were good, and as far as the authors have reviewed, no report has been published about this rare injury. So we report this case with a review of the literature.
Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament* ; Athletes ; Bone-Patellar Tendon-Bone Grafts ; Collateral Ligaments ; Humans ; Knee ; Lateral Ligament, Ankle ; Menisci, Tibial* ; Patellar Ligament* ; Rupture*

PURPOSE: The purpose of this study is to elucidate the clinical features of the acute lateral ligamentous complex injuries and evaluate the postoperative results. MATERIALS AND METHODS: Between 1991 and 1997, 27 patients (28 cases) were treated surgically for acute lateral ligament complex injuries. All cases showed 2+ or more varus instability and were treated within 6 weeks after trauma. 20 cases combined other ligamentous injuries and 8 cases had isolated injuries. Among the lateral ligament complex the lateral collateral ligament was ruptured in all cases. Meniscal injuries were associated in 12 cases and 5 cases showed common peroneal nerve injury but no cases showed vascular injuries. RESULTS: On Telos stress X-ray, the varus stability was improved from 2,12+(mean 8.6mm) to 0.50+(mean 2.8mm) in isolated injuries and from 2.95+(mean 9.5mm) to 1.10+(4.5mm) in combined injuries. Cases with isolated injury showed no C and D grade on IKDC subjective evaluation, ligament evaluation and range of motion evaluation. Cases of combined injuries showed 5C and 3D on subjective evaluation, 3C and 2D on ligament evaluation, 3C and 1D on range of motion evaluation. Most common postoperative complication was joint stiffness, of which 2 cases were treated with arthroscopic adhesiolysis. CONCLUSION: Prognosis in isolated cases was good and the results were influenced with combined injuries. To reduce postoperative complications a secure fixation and early rehabilitation was recommended. Our study supports the notion that operation performed at an early stage in fresh injuries with a varus instability of 2+ or more gives improved stability as a final result.
Collateral Ligaments* ; Humans ; Joints ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Peroneal Nerve ; Postoperative Complications ; Prognosis ; Range of Motion, Articular ; Rehabilitation ; Vascular System Injuries

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: 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: The purpose of this study was to determine the effectiveness of a new two stage surgical treatment for acute traumatic knee dislocation. MATERIALS AND METHODS: The study involved 15 knees in 14 patients treated between October 1997 and November 2001. The mean follow-up period was 24 months. In the first surgical stage, medial and/or lateral ligament complexes were repaired or reconstructed within two weeks of the injury. In the second surgical stage, once full range of motion was obtained 3-6 months later, anterior or posterior cruciate ligaments (ACL or PCL) were reconstructed if significant laxity was present. The final outcomes were assessed using stress X-rays, range of motion and Lysholm score. RESULTS: There were ten cases of MCL tear and eight cases of LCL tear. All MCL and LCL injuries were either repaired or reconstructed. All cases had both ACL and PCL tears. Following the first stage of MCL/LCL surgery, the second stage surgery of ACL or PCL reconstructions was deemed to be necessary in three and seven cases, respectively. Five cases did not require ACL or PCL reconstruction. In stress X-rays at the last follow up examination, MCL, LCL, ACL and PCL instability was graded as 0 or 1 in 15, 14, 15 and 11 cases, respectively. PCL instability was graded as 2 in four cases. The mean postoperative Lysholm score was 87.6 points. CONCLUSION: The two stage surgical approach described here resulted in good outcomes for patients suffering from acute knee dislocation patients in terms of range of motion and stability.
Collateral Ligaments ; Follow-Up Studies ; Humans ; Knee Dislocation* ; Knee* ; Posterior Cruciate Ligament ; Range of Motion, Articular

PURPOSE: The aim of this study was to compare the results between early and delayed reconstruction of the anterior cruciate ligament (ACL) in patients with combined medial collateral ligament (MCL) injuries. MATERIALS AND METHODS: From February 2001 to January 2007, fifty-five patients who had undergone ACL reconstruction for combined ACL and MCL injuries and who were followed for more than 18 months were included in this study. The Tegner Activity Score, the Lysholm Knee Scoring Scale, the interval to recover 90degrees of motion, the Lachman test, the anterior and valgus laxity noted on stress radiograph, and the International Knee Documentation Committee (IKDC, 1993) documentation were recorded and compared between the early reconstruction group, which underwent ACL reconstruction within 3 weeks, and the delayed reconstruction group, which underwent ACL reconstruction after 3 weeks. RESULTS: At the final follow up, the Tegner score was 7.4 in the early reconstruction group and 7.6 in the delayed reconstruction group. The Lysholom score was 90.5 and 91.3, respectively (p>0.05). All the cases were rated near normal or normal on the IKDC subjective assessment. The early reconstruction group needed a longer time to recover motion and especially in the female patients. However, there was no statistical difference between the groups for the final range of motion, in addition to the Lachman test and the anterior or valgus laxity. CONCLUSION: In this study, satisfactory clinical and radiological results were obtained in both the early and delayed reconstruction groups. The early reconstruction of the ACL seems to be one of the surgical options for reconstruction of acute ACL injury combined with torn MCL.
Anterior Cruciate Ligament ; Collateral Ligaments ; Female ; Follow-Up Studies ; Humans ; Knee ; Range of Motion, Articular

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

PURPOSE: Patients with Segond fracture have a high probability of anterior cruciate ligament and meniscal injury. The purpose of this study is to evaluate the site and shape of fragment of Segond fracture on plain radiograph and to analyze associated intraarticular injuries of knee joint on Magnetic Resonance(MR) imaging. MATERIALS AND METHODS: From July. 1994 to June 2002, 10 Segond fractures were reviewed retrospectively on plain radiograph and MR imaging. We confirmed by arthroscopic findings that ligamentous injuries and meniscal injuries were associated in all of the 10 cases. RESULTS: The radiographic findings of Segond fractures were as follows: the elliplical shape was 8 case, the average size 7.2 mm x 2.5 mm (length x width), the location average 4.3mm below tibial articular surface and the displacement average 2.0 mm from original site. Of the 10 patients, 9 (90%) had anterior cruciate ligament (ACL), 2 posterior cruciate ligament, 2 lateral collateral ligament and 4 medial collateral ligament injury. Meniscal injury was also diagnosed in 6. CONCLUSION: In plain radiograph of patients with acute traumatic knee injury, the caution is needed to examine Segond fracture. MR imaging is an useful study because anterior cruciating ligament disruption is often associated with Segond fracure.
Anterior Cruciate Ligament ; Collateral Ligaments ; Humans ; Knee Injuries ; Knee Joint* ; Knee* ; Lateral Ligament, Ankle ; Ligaments ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament ; Retrospective Studies

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