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 our study was to determine the effectiveness of primary repair of arcuate ligament complex in posterolateral rotary instability of knee. MATERIALS AND METHODS: We reviewed the clinical records and operative notes of 9 patients who were treated by primary repair for the acute posterolateral rotary instability and followed more than 1 year. All the 9 knees had a positive external rotation recurvatum test and a positive posterolateral drawer test, One or more components of the arcuate ligament complex were injured in all cases and associated injuries were posterior cruciate ligament rupture in 6, lateral collateral ligament in 5, anterior cruciate ligament partial rupture in 2, biceps femoris rupture in 2, meniscus tear in 3, iliotibial band rupture in 1, ipsilateral femur fracture in 1 and peroneal nerve palsy in 1. RESULTS: By objective rating index, the results were classified as good (4 patients), fair (4 patients) and poor (1 patient). By functionally, the results were classified as good (6 patients), fair (3 patients). CONCLUSIONS: Consequently, we believe that primary repair of arcuate ligament complex in acute stage can result in objectively and functionally acceptable knee function.
Anterior Cruciate Ligament ; Femur ; Humans ; Knee* ; Lateral Ligament, Ankle ; Ligaments ; Paralysis ; Peroneal Nerve ; Posterior Cruciate Ligament ; Rupture

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

In acute tears of the lateral complex of the knee, it is extremely important to make a complete diagnosis not to overlook the other injured structures in the knee since tears are rarely limited to just the lateral collateral ligament. Among the primary individual structures of the lateral ligament complex that may be involved are the lateral collateral ligament, lateral capsule, popliteus muscle, arcuate ligament complex, iliotibial band, biceps femories, intermuscular septum, and of course, the lateral meniscus as well. Further, it is important to repair lateral tears as soon as possible after injury even though the lateral instability of the knee is less frequent but because it is more easily overlooked and more disabling than the other instability of the knee. Therefore, to evaluate the result of surgically treated patients having the lateral instability, we analyzed the 33 cases with minimum 1 year follow-up period who were treated at the Orthopaedic Department, Kangnam St. Mary's Hospital, from February, 1982 to June, 1985. Among 145 knee ligament injury cases, 39(26.9%) had lateral instability but six were lost to follow-up. Among these remaining 33 cases, 5(15.2%) had isolated lateral collateral ligament injury, 18(54.5%) had associated anterior cruciate ligament injury, 4(11.8%) had associated posterior cruciate ligament injury and 26(78.9%) had injury of other lateral structures including lateral collateral ligament. In all cases having associated anterior cruciate ligament injury there was severe anterolateral rotatory instability under the general anesthesia. The severity of the anterolateral rotatory instability was very much correlated with the severity of the lateral structural injuries. Eighteen out of 19 cases having associated injuries of anterior or posterior cruciate ligament, had 5 mm or more joint opening at the 0 varus stress radiogram. Thirteen(92.8%) out of fourteen isolated ligament complex injuries, and 8(53.3%) out of 15 cases having associated anterior cruciate ligament injury had good-excellent or fair(+) result. None of the patients who had associated anterior and posterior cruciate ligament injuries had good-excellet result. Therefore, the patients who had the lateral ligament complex injury associating with anterior cruciate ligament tend to have residual anterolateral rotatory instability even though the repair or reconstruction was carefully done in comparision with the patients of isolated lateral ligament complex or anterior cruciate ligament injury. Because anterior cruciate ligament injury associated with lateral ligament complex increases the anterolateral rotatory instability significantly.
Anesthesia, General ; Anterior Cruciate Ligament ; Collateral Ligaments ; Diagnosis ; Follow-Up Studies ; Humans ; Joints ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Lost to Follow-Up ; Menisci, Tibial ; Posterior Cruciate Ligament ; Tears

The knee joint is one of the most susceptable joint to ligamentous injury. For good results, it is very important to make an early diagnosis and to give prompt management. The aim of treatment is to restore the ligaments to their previous anatomic position and tension. The authors reviewed 420 cases of ligamentous injuries in 400 patients who were admitted and managed for 6 years from March, 1981 to February, 1987. The results were as follows : 1. The athletic injury was the most commcn cause of injury(55%), and fall-down was next(26%). 2. The most common ruptured individual ligament was the medial collateral ligament. Combined ligament rupture was more common in medial collateral ligament and anterior cruciate ligament. 3. The ruptured sites of the individual ligament were found to be the following ; a) the medial collateral ligament was ruptured most frequently at the femoral attachment(43%), with the superficial layer ruptured in the midsubstance and the deep layer at the femoral attachment; b) the lateral collateral ligament torn at the fibular attachment(51%); c) the anterior cruciate ligament torn at the femoral attachment(39%); d) the posterior cruciate ligament torn at the femoral attachment(64%). 4. Many ligamentous injuries were associated with fracture(44%) and tear of meniscus- (42%). 5. In stress-radiogram, the significance of ligament injuries was present in more than 10 and 10 mm. 6. Excellent and good results were obtained in 94% by non-surgical treatment and in 92% by surgical treatment. 7. Early surgical repair of the ligament within 2 weeks after injury, gave much better result than later repairs.
Anterior Cruciate Ligament ; Athletic Injuries ; Clinical Study ; Collateral Ligaments ; Early Diagnosis ; Humans ; Joints ; Knee Joint ; Knee ; Lateral Ligament, Ankle ; Ligaments ; Posterior Cruciate Ligament ; Rupture ; Tears

PURPOSE: This study is for the evaluation of low tesla(0.064T) MR imaging diagnostic accuracy in the internal derangement of the knee. MATERIALS AND METHODS: We retrospectively analysed the MR images of 36 injured knees of 35 patients. The presence of tear was determined by arthroscopy or surgery in all cases. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, negative predictive value of low tesla MRI for the diagnosis of anterior cruciate ligament injury were 83%, 88%, 86%, 77%, 91%, for the posterior cruciate ligament 75%, 95%, 86%, 92%, 83%, for the medial collateral ligament 83%, 96%, 92%, 91%, 92%, for the lateral collateral ligament 67%, 97%, 94%, 67%, 97%, for the menisci 75%, 93%, 89%, 75%, 93%. CONCLUSION: The low tesla MRI is an accurate method in detection and evaluation of the internal derangement of the knee.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Diagnosis ; Humans ; Knee* ; Lateral Ligament, Ankle ; Magnetic Resonance Imaging* ; Posterior Cruciate Ligament ; Retrospective Studies ; Sensitivity and Specificity

Authors analyzed the findings of nineteen cases of arthroscopic second-look operations after posterior cruciate ligament (PCL) reconstruction with autogenous bone-patellar tendon-bone (BPTB) and Trevira augmentation by two tunnel technique during the period from Nov, 1993 to Jan. l997 in fifty-one cases, along with the results of reconstruction in terms of clinica1 knee scoring, radiographichl and arthroscopic findings. The results were as follows; Age ranged fmm 20 to 53 years, the average being 32.3 years. Thirteen cases (68%) had associated knee injuries; five medial collateral ligament (MCL) injuries, four lateral collateral ligament (LCL) injuries, two associated injuries of MCL and medial meniscus, one both menisci and one associated injury of anterior cruciate ligament and MCL. The average period fmm PCL injury to reconstruction was 7 weeks (range, 1 to 52 wecks) and the mean period from PCL reconstruction to second-look operation was 20.3 months (range, 10 to 46 months). The average Miiller s knee score at the last follow-up was 86 paints. The radiographical results: The distance of posterior translation of the PCL reconstrueted knee compared with the normal sidc knee in posterior stress roentgenography was average 3.8mm (range, 0 to 1 1 mm). The position of the fernoral bone block on the plane of extended Blumansaats line, from the anterior end of the line, was average 32%. The level of proximal end of the tibial bone block according to the tibial tunnel orifice into the joint was mean negative 2.6 degrees position. The findings of arthroscopic second-look examination; In 9 cases (47%), the reconstructed ligamcnts were well covered with synovial tissue and looked like almost normal PCL. There were five cases (26%) of severe fragmentation, three cases (16%) of partial torn fibers of the grafted tendon. And one case showed the thinning of thc grafted tendon compared with the initial diameter at the time of reconstruction and one case showed overgrawth of the synovial membrane which suitounding the grafted tendon. All the Trevira which were augmented at the time of PCL reconstruction were ruptured. Twelve cases (63%) were stable, three cases (16%) were slightly lax and 4 cases (21%) showed laxity of the grafted tendon by the posterior drawer test and probing under arthroscopy, The isometricity which was checked at the time of PCL reconstruction was average 3.4mm. From the ahove results, PCL reconstruction with autogenous BPTB by the two tunnel technique seemed to be a valuable procedure, but there were some cases of unfavorable results. Authors think that a new graft fixation method is needed for resolving the problem mentioned above.
Anterior Cruciate Ligament ; Arthroscopy ; Collateral Ligaments ; Dronabinol ; Follow-Up Studies ; Joints ; Knee ; Knee Injuries ; Lateral Ligament, Ankle ; Menisci, Tibial ; Paint ; Posterior Cruciate Ligament* ; Radiography ; Synovial Membrane ; Tendons ; Transplants