BACKGROUNDDiscoid lateral meniscus was a common meniscal dysplasia and was predisposed to tear. There were some anatomical knee variants in patients with discoid lateral meniscus. The aim of this study was to analyze the relationship between anatomical knee variants and discoid lateral meniscal tears.

METHODSThere were totally 125 cases of discoid lateral meniscus enrolled in this study from February 2008 to December 2013. Eighty-seven patients who underwent arthroscopic surgery for right torn discoid lateral meniscus were enrolled in the torn group. An additional 38 patients who were incidentally identified as having intact discoid lateral menisci on magnetic resonance imaging (MRI) findings were included in the control group. All patients were evaluated for anatomical knee variants on plain radiographs, including lateral joint space distance, height of the lateral tibial spine, height of the fibular head, obliquity of the lateral tibial plateau, squaring of the lateral femoral condyle, cupping of the lateral tibial plateau, lateral femoral condylar notch, and condylar cutoff sign. The relationship between anatomical variants and meniscal tear was evaluated. These anatomical variants in cases with complete discoid meniscus were also compared with those in cases with incomplete discoid meniscus.

RESULTSThere were no significant differences between the two groups in lateral joint space distance (P = 0.528), height of the lateral tibial spine (P = 0.927), height of the fibular head (P = 0.684), obliquity of the lateral tibial plateau (P = 0.672), and the positive rates of squaring of the lateral femoral condyle (P = 0.665), cupping of the lateral tibial plateau (P = 0.239), and lateral femoral condylar notch (P = 0.624). The condylar cutoff sign was significantly different between the two groups, with the prominence ratio in the torn group being smaller than that in the control group (0.74 ± 0.11 vs. 0.81 ± 0.04, P = 0.049). With the decision value of the prominence ratio (0.78) in predicting discoid lateral meniscal tear, the sensitivity and specificity of the cutoff sign were 66% and 71%, respectively. There were no significant differences in radiographic variants between the complete and incomplete discoid lateral meniscal groups.

CONCLUSIONSThe condylar cutoff sign observed on the tunnel view of the radiograph is helpful in predicting meniscal tear in adult patients with discoid lateral meniscus. As for these patients, further MRI test is recommended.

Adolescent ; Adult ; Aged ; Arthroscopy ; Child ; Female ; Humans ; Knee Injuries ; diagnosis ; Knee Joint ; anatomy & histology ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Retrospective Studies ; Young Adult

BACKGROUND: Several tendon graft and fixation methods have been introduced in medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar dislocation. The purpose of this study was to evaluate the results of MPFL reconstruction using a gracilis autograft fixation without bone tunnel in patients with recurrent patellar instability. METHODS: Nine patients (four males and five females) diagnosed with recurrent patellar instability from July 2009 to January 2013 and had MPFL reconstruction using a gracilis autograft were included. The average age of the patients was 24.6 years (range, 13 to 48 years), and the average follow-up period was 19.3 months (range, 12 to 30 months). For every patient, femoral attachment was fixed using suture anchors securing the patella by suturing the periosteum and surrounding soft tissue. Clinical evaluation included the Kujala, Lysholm, and Tegner scores; in addition, patients were examined for any complication including recurrent dislocation. The congruence angle and patella alta were assessed radiologically before and after surgery. RESULTS: The Kujala score improved from an average of 42.7 ± 8.4 before surgery to 79.6 ± 13.6 (p = 0.008) at final follow-up; the Lysholm score improved from 45.8 ± 5.7 to 82.0 ± 10.5 (p = 0.008); and the Tegner score improved from 2.8 ± 0.8 to 5.6 ± 1.5 (p = 0.007). The Insall-Salvati ratio changed from 1.16 ± 0.1 (range, 0.94 to 1.35) before surgery to 1.14 ± 0.1 (range, 0.96 to 1.29; p = 0.233) at the final follow-up without significance. The congruence angle significantly improved from 26.5°± 10.6° (range, 12° to 43°) before surgery to -4.0°± 4.3° (range, -12° to 5°; p = 0.008) at final follow-up. Subluxation was observed in one patient and hemarthrosis occurred in another patient 2 years after surgery, but these patients were asymptomatic. CONCLUSIONS: We achieved good results with a patellar fixation technique in MPFL reconstruction using a gracilis autograft employing soft tissue suturing in patients with recurrent patellar dislocation.
Adolescent ; Adult ; *Autografts ; Female ; Humans ; Knee Injuries/radiography/*surgery ; Ligaments, Articular/radiography/*surgery ; Male ; Middle Aged ; Muscle, Skeletal/surgery/transplantation ; Patella/radiography/*surgery ; Patellofemoral Joint/radiography/*surgery ; Reconstructive Surgical Procedures/adverse effects/instrumentation/*methods ; Retrospective Studies ; Thigh/surgery ; Young Adult

OBJECTIVETo determine the mechanism of pseudo-tears of the lateral meniscus caused by the transverse geniculate ligament (TL) and the miniscofemoral ligament(MFL) and to investigate a method to differentiate pseudo-tears from true tear of the lateral meniscus.

METHODSForm June 2012 to February 2014, MR examinations of 72 knees (44 left knees and 28 right knees) without tear of the lateral meniscus verified by arthroscopy were performed in the sagittal and coronal plane. There were 41 males and 31 females in the group, with an average age of 33.7 years old (ranged from 25 to 61). The MR appearance of the TL and the MFL was carefully observed.

RESULTSThere existed fatty tissue in the gap between the TL and the anterior horn of the lateral meniscus and its central tendinous attachment. On the sagittal images, the fatty tissue formed a linear high-signal cleft between the TL and the anterior horn of the lateral meniscus. This might be mistaken as an oblique tear within the anterior horn of the lateral meniscus. It was called as pseudo-tears of the anterior horn of the lateral meniscus. In sagittal plane, the MFL was identified as a circle-like or short stick-like area of low signal intensity anterior or posterior to the posterior cruciateligament. Nevertheless, a belt-shaped area of low signal intensity from the posterior horn of the lateral meniscus to lateral facet of the medial femoral condyle was identified in the coronal plane. A linear area of high signal intensity between the MFL and the lateral meniscus was found in sagittal plane, which might be mistaken as an oblique tear within the posterior horn of the lateral meniscus. It was called pseudo-tears of the posterior horn of the lateral meniscus. The occurrence rate of the TL was 34.7% (25/72). The prevaleribe of pseudo-tears of the anterior horn of the lateral meniscus was 18 cases. The shape of the anterior horn of the lateral meniscus was regular, and the course of the pseudo-tears cleft was oblique. The occurrence rate of the MFL was 73.6% (53/72), which included the anterior MFL 23.6% (17/72), the posterior MFL 70.8% (51/72) and the two ligaments coexisted 16.7% (12/72). The prevalence of pseudo-tears of the posterior horn of the lateral meniscus was 25 cases. All observed pseudo-tears had either in posteroinferiorly oblique direction (19/25) or in vertical direction (6/25).

CONCLUSIONBased on the location and direction of pseudo-tears and observation in the continuous sagittal plane and the coronal plane, pseudo-tears is easily differentiated from the true tear of the lateral meniscus

Adult ; Female ; Humans ; Knee Injuries ; diagnostic imaging ; surgery ; Knee Joint ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial ; diagnostic imaging ; surgery ; Middle Aged ; Radiography ; Tibial Meniscus Injuries

Fracture Fixation, Internal ; methods ; standards ; Fractures, Bone ; diagnostic imaging ; surgery ; Humans ; Knee Injuries ; diagnostic imaging ; surgery ; Patella ; injuries ; surgery ; Radiography

Ganglion cysts are more commonly associated with the anterior cruciate ligament than the posterior cruciate ligament (PCL). A literature review showed that all reported cases of ganglion cysts to date involved adults. We report a rare case of ganglion cyst in the PCL of a four-year-old boy, and discuss its aetiology, clinical presentation, imaging features and management. Ganglion cysts of the PCL may be confused with meniscal cysts arising from tears of the posterior horn of the medial meniscus on magnetic resonance (MR) imaging. Hence, the posterior horn of the medial meniscus has to be carefully evaluated to rule out a tear. MR imaging is the method of choice to confirm diagnosis, and arthroscopic resection is a safe treatment modality even in children.
Arthroscopy ; Child, Preschool ; Ganglion Cysts ; diagnosis ; surgery ; Humans ; Knee Joint ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Posterior Cruciate Ligament ; injuries ; pathology ; Radiography

OBJECTIVETo investigate the clinical effects of surgery reduction and internal fixation through posteromedial knee approaches in the treatment of posteromedial condylar split fracture of tibial plateau.

METHODSFrom January 2006 to July 2009,21 patients with posteromedial condylar split fracture of tibial plateau were treated by posteromedial knee approaches. Among the patients, 14 cases were males and 7 cases were females,ranging from 28 to 68 years old with an average of 36.9 years old. For traumatic causes, 14 cases were injured by traffic accident and 7 cases by fall. Compound injury, 15 cases combined with anterior cruciate ligament injury and tibia insertion avulsion fracture; 14 cases combined with posterolateral de-pressed tibial plateau fracture. Rasmussen assessment criteria was used to evaluate the therapeutic effects.

RESULTSAll patients were followed up,from 12 to 30 months with an average of 17.3 months. All patients didn't undergo infection,looseness and rupture of fixation,nonunion of fracture,inversion and eversion of the knee or displacement of fracture. All cases attained anatomical reduction after operation,only 1 patient felt numbness of posterior lower part of the calf. According to Rasmussen assessment criteria, 12 cases got an excellent result, 7 good and 2 fair.

CONCLUSIONIt is beneficial for the postermedial knee approaches to be used in the reduction and fixation of posteromedial condylar split fracture of tibial plateau. It has advantages of clearly exposure, convenient placement of the internal fixation, less trauma and good therapeutic effects.

Adult ; Aged ; Bone Nails ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; Fractures, Closed ; surgery ; Humans ; Knee Injuries ; surgery ; Knee Joint ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Tibial Fractures ; surgery

BACKGROUND: The clinical and radiologic features of radial tears of the medial meniscus posterior horn were compared with those of horizontal tears. METHODS: From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Among these, 91 were radial tears in the medial meniscus posterior horn, and 95 were horizontal tears in the posterior segment of the medial meniscus. The patients' data (age, gender, duration of symptom, body mass index, and injury history), radiographic findings (Kellgren and Lawrence score, posterior tibial slope, and femorotibial angle), and chondral lesions were recorded. RESULTS: The patient factors of age, gender, and body mass index were related to radial tears of the medial meniscus posterior horn. Radial tears were significantly correlated with Kellgren and Lawrence score, varus alignment, posterior tibial slope, and severity of the chondral lesion. CONCLUSIONS: Radial tears of the medial meniscus posterior horn are a unique clinical entity that are associated with older age, females and obesity, and are strongly associated with an increased incidence and severity of cartilage degeneration compared to horizontal tears.
Adult ; Age Factors ; Aged ; Arthroscopy ; Body Mass Index ; Female ; Humans ; Knee Injuries/*pathology/radiography/surgery ; Male ; Menisci, Tibial/*injuries/*pathology/radiography/surgery ; Middle Aged ; Retrospective Studies ; Sex Factors

Adolescent ; Adult ; Female ; Femoral Fractures ; diagnostic imaging ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Knee Injuries ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Tibial Fractures ; diagnostic imaging ; surgery

Severe injury to the knee and the surrounding area is frequently associated with injury to ligaments of the knee joint and structures in the popliteal fossa. This case involved a popliteal artery occlusion, severe bone loss of distal femur, loss of collateral ligaments, and extensor mechanism destruction of the knee. Initially, prompt recognition and correction of associated popliteal artery injury are important for good results after treatment. After successful revascularization, treatment for severe bone loss of distal femur and injury of the knee joint must be followed. We treated this case by delayed reconstruction using modular segmental endoprosthesis after revascularization of the popliteal artery. This allowed early ambulation. At 36 months after surgery, the patient had good circulation of the lower limb and was ambulating independently.
*Arthroplasty, Replacement, Knee ; Femur/*injuries/radiography/*surgery ; Humans ; Internal Fixators ; Knee Injuries/*surgery ; Knee Joint/surgery ; Male ; Middle Aged ; Popliteal Artery/*injuries/radiography/*surgery

BACKGROUNDIt has been demonstrated that bone tunnel widening could appear after knee anterior cruciate ligament (ACL) reconstruction, especially for those patients whose ruptured ACL were reconstructed with semitendinosus and gracilis tendons. Many factors can influence the extent of tunnel widening. Few studies have investigated the relationship between bone tunnel widening and rehabilitation procedures. This research was carried out to find the rehabilitation procedures' influence on the tibial bone tunnel widening after ACL reconstruction.

METHODSSixty-five cases, whose ACL reconstructions were done using quadrupled semitendinosus and gracilis tendons, were divided into two groups. Group A had 33 cases, 19 men, 14 women, averaged (31.2 +/- 12.4) years old, only ACL reconstruction was done using Paessler's technique, and aggressive rehabilitation procedure was used for function recovery post operation. Group B had 32 cases, 20 men, 12 women, averaged (30.3 +/- 10.3) years old. Except for ACL reconstruction, every patient in group B accepted meniscus repair using re-fixation methods or cartilage repair using microfracture technique, conservative rehabilitation procedure was used post operation. Six months post operation, standard posterior-anterior radiographic plates were taken for each case, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification effect of X-ray plates was taken out after measurement.

RESULTSSix months after ACL reconstruction the tibial tunnel widening of the upper, middle and lower parts on both the posterior-anterior and lateral X-ray plates in Group A with aggressive rehabilitation procedure was much more serious than in Group B with conservative rehabilitation. KT-1000 knee stability measurement and clinical manifestation showed no difference between the two groups.

CONCLUSIONSRehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It not only can directly influence the function recovery of ACL reconstructed knee, but also perhaps indirectly influence the function recovery and long-term clinical result of the operated knee by influencing the tunnel widening.

Adult ; Anterior Cruciate Ligament ; diagnostic imaging ; surgery ; Female ; Humans ; Joint Instability ; Knee Injuries ; rehabilitation ; surgery ; Male ; Middle Aged ; Orthopedic Procedures ; Radiography ; Reconstructive Surgical Procedures ; Retrospective Studies ; Tendons ; transplantation ; Tibia ; diagnostic imaging ; pathology