Beruflich Dokumente
Kultur Dokumente
Christoph Domnick
Michael J Raschke
Mirco Herbort
EPIDEMIOLOGY
LCL
MCL 7-16% of all knee ligament
most commonly injured injuries when combined with
ligament of the knee lateral ligamentous complex
injuries
ANTERIOR CRUCIATE LIGAMENT
ANATOMY
• 32mm length x 7-12mm width in size
• goes from LFC to the anterior tibia (tibial insertion is broad
and irregular and inserts just anterior and between the
intercondylar eminences of the tibia)
• two bundles : anteromedial bundle and posterolateral
bundle
FUNCTION
• provides 85% of the stability to prevent anterior translation
of the tibia relative to the femur
• acts as a secondary restraint to tibial rotation and
varus/valgus rotation
ANTERIOR CRUCIATE LIGAMENT
ANTERIOR CRUCIATE LIGAMENT
PRESENTATION
• 70% hear or feel a "pop"
• pain deep in the knee
• immediate swelling (70%) / hemarthrosis
PHYSICAL EXAM
PHYSICAL EXAM
IMAGING
• Segond fracture (avulsion fracture of the proximal
lateral tibia) is pathognomonic for an ACL tear :
represents bony avulsion by the anterolateral
ligament (ALL)associated with ACL tear 75-100% of the
RADIOGRAPHS time
• deep sulcus (terminalis) sign : depression on the lateral
femoral condyle at the terminal sulcus, a junction
between the weight bearing tibial articular surface and
the patellar articular surface of the femoral condyle.
ANATOMY
• Origin : posterior tibial sulcus below the articular surface
• Insertion : anterolateral medial femoral condyle, broad, crescent-shaped
footprint
• Dimensions : 38 mm in length x 13 mm in diameter, PCL is 30% larger
than the ACL
• PCL has two bundles : anterolateral bundle and posteromedial bundle
PATHOPHYSIOLOGY
• Mechanism : direct blow to proximal tibia with a flexed knee (dashboard
injury), noncontact hyperflexion with a plantar-flexed foot,
hyperextension injury
• Pathoanatomy : PCL is the primary restraint to posterior tibial
translation, functions to prevent hyperflexion/sliding, isolated injuries
cause the greatest instability at 90° of flexion
CLASSIFICATION
Nonoperative
• protected weight bearing & rehab
• relative immobilization in extension for 4 weeks
Operative
• PCL repair of bony avulsion fractures or
reconstruction
• high tibial osteotomy
MEDIAL COLLATERAL LIGAMENT
• Primary and secondary valgus stabilizer of the knee also
known as the tibial collateral ligament
• Valgus and external rotation force to the lateral knee
• Concomitant ligamentous injuries (95% are ACL) occur in 20%
of grade I, 52% of grade II, and 78% of grade III injuries
PRESENTATION
History
• "pop" reported at time of injury
Symptoms
• medial joint line pain
• difficulty ambulating due to pain or instability
Physical exam
• inspection and palpation : tenderness along medial aspect of knee,
ecchymosis, knee effusion
• ROM & stability : valgus stress testing at 30 degrees knee flexion,
valgus stressing at 0 degrees knee extension
IMAGING
RADIOGRAPH MRI
• Recommended : AP • Coronal T2- weighted image
and lateral showing a medial collateral
• Optional view : stress ligament tear with
radiographs in skeletally surrounding oedema and
immature patient, may
indicate gapping through joint effusion.
physeal fracture
• Findings : usually normal
calcification at the medial
femoral insertion
site (Pellegrini-Stieda
Syndrome)
TREATMENT
CHARACTERISTICS
• tubular, cordlike structure
• Dimensions : 3-4 mm diameter, 66 mm length
• Origin : lateral femoral epicondyle, posterior and proximal to insertion
of popliteus
FUNCTION
• primary restraint to varus stress at 5° and 25° of knee flexion (provides 55% of
restraint at 5°, provides 69% of restraint at 25°)
• secondary restraint to posterolateral rotation with <50° flexion
• resists varus in full extension along with ACL and PCL
PRESENTATION
• instability near full knee extension
• difficulty ascending and descending stairs
• difficulty with cutting or pivoting activities
Symptoms • lateral joint line pain and swelling
COMPLICATION
MCL LCL
Pellegrini-Stieda Syndrome Progressive varus
Loss of motion Peroneal nerve injury
Saphenous nerve injury
WHAT IS SPRAIN?
Acute ligament injury
Grade I sprains
partial tears with mild rupture or stretching of the collagen fibers and no
apparent instability of the joint when the ligament is stressed
Grade II sprains
partial but more severe, and there is some laxity on stressing of the joint