Chronic Multiple Knee Ligament Injuries: Epidemiological Analysis of More Than One Hundred Cases

INTRODUCTION: Diagnosis and treatment of multiple ligament injuries of the knee remain a real challenge for most surgeons. OBJECTIVE: To find out the epidemiological profile of patients surgically treated at a Reference Service with more than one chronic ligament injury in the knee joint. MATERIALS AND METHODS: Of a total of 978 operated patients, 109 presented at least two associated ligament injuries in the same knee. Demographic and clinical variables were evaluated. RESULTS: The anterior cruciate ligament group presented a larger number of cases of ligament injuries related with sports practice and falls, while the posterior cruciate ligament and anterior cruciate ligament + posterior cruciate ligament groups presented more cases related to traffic accidents and trauma with object (weight on the knee) (p<0.001). The varus group presented significantly higher values of time since injury (p<0.01). In the group with new anterior cruciate ligament injury (neoligament) associated with other ligament injuries the disruption times were higher, showing statistical significance (p<0.001). CONCLUSIONS: Anterior cruciate ligament injury associated with other ligament injuries other than posterior cruciate ligament injury are related to sports practice and falls. Posterior cruciate ligament injury associated to other ligament injuries, including or not anterior cruciate ligament injury, are related to traffic accidents and direct trauma caused by an object on the knee. Significant delay between primary ligament injuries and their reconstructions generates varus deformity of the affected knee. In spite of the large delay in seeking medical treatment, few patients with neoligament anterior cruciate ligament injury and other combined disruptions will develop varus deformity

Reconstruction of chronic lesions in the posterolateral corner of the knee with autologous biceps femoralis and fascia lata grafts

OBJECTIVE: The aim of this study was to evaluate the treatment of patients with chronic lesions in the posterolateral corner of the knee with reconstruction of the fibular collateral ligament, popliteus tendon and popliteofibular ligament and with autografts of the biceps femoris and fascia lata. METHOD: A total of 129 patients with injuries of the posterolateral corner of the knee that lasted for more than three weeks and were associated with the lesion of at least one of the cruciate ligaments were included. All of the patients were operated on consecutively in the same hospital between March 2004 and April 2009. Clinical evaluation using the Lyshom scale and the International Knee Documentation Committee (IKDC, item 4, assessment ligament) protocol was performed in 114 patients for whom there were complete data available. RESULTS: There was significant improvement in the Lyshom score and improved stability according to the IKDC protocol in the pre- compared to postoperative varus stress test at 30 degrees and the posterolateral rotation test. CONCLUSIONS: Surgical reconstruction of the posterolateral corner of the knee with biceps femoris tendon and fascia lata autografts is effective in stabilizing the posterolateral corner of the knee

Trapezoidal osteochondral autologous plug singleblock graft for treating chondral lesions of the knee: clinical and functional medium-term results in an observational study

OBJECTIVE: To evaluate the clinical and functional results of autologous trapezoidal plug single-block grafts fixed with absorbable chondral darts in patients with osteochondral knee lesions of varying sizes. METHODS: Twenty-five patients underwent surgery from February 2000 to June 2008. Seventy-two percent of the patients were male, and the mean age was 29 years. RESULTS: The right side (56%) and the medial condyle (92%) were most affected. The lesions had an average area of 5.28 cm², and the mean follow-up was 59 months. All of the variables other than instability showed significant improvements (p<0.05), as shown by the increase in the mean Lysholm score from 55 points preoperatively to 92 points (p<0.001) postoperatively. There was no loosening or collapse of the osteochondral graft. All of the patients had patellofemoral crepitation and pain for an average of six months. CONCLUSION: Autologous trapezoidal plug single-block grafts are a therapeutic option for defects of varying sizes and provide good clinical results and low morbidity at the donor site in the medium term

Pretensioning of quadruple flexor tendon grafts in two types of femoral fixation: quasi-randomised controlled pilot study

Pretensioning of the flexor tendon graft of the knee is used to improve the stability of anterior cruciate ligament (ACL) reconstructions. The objective was to demonstrate the pretensioning of grafts of the semitendinosus and gracilis in situ with range of flexion and extension of 0–110°, and determine the appropriate number of cycles in two types of femoral fixation. ACL reconstruction was performed in 60 patients, aged 16–48 years, 90% male, with 50% right knees and 50% left knees, divided into two groups of 30 patients: One with the femur fixed using interference screws (direct form) and the other with the transcondylar cross-pin screw (from a distance). Total length of the grafts, their circumference and the measurements on the radiographs of length of the grafts submitted to pretensioning and the measurements with ten, 25 and 50 cycles of flexion and extension were determined. There was no significant difference in relation to the total tendon lengths and their circumferences. The lengths of the portions submitted to pretensioning were significantly different: 7.90 cm for the interference and 10.92 cm for the transcondylar (mean). After tensioning, in the interference and transcondylar groups, respectively, lengthening was 3.57 mm/3.97 mm with ten, 6.30 mm/7.03 mm with 25, and 6.83 mm/7.7 mm with 50 cycles. The greater the length of the graft, the greater the lengthening on pretensioning throughout the substance; the shorter the length, the earlier the end of the lengthening was achieved, close to 25 cycles; more than ten cycles were necessary, 25 being sufficient