Radiographic and intraoperative intercondylar notch width measurements in men and women with unilateral and bilateral anterior cruciate ligament tears

The purpose of this study was to compare the measurements of the intercondylar notch width (NW) in men and women radiographically and intraoperatively, and to determine if the radiograph would demonstrate a difference in the patients with unilateral and bilateral anterior cruciate ligament (ACL) tears compared with non-injured patients. The control groups consisted of 100 men and 100 women from our young adult clinic population without a history of knee injury or clinical evidence of ligamentous deficiency. The study group consisted of 90 men with bilateral and 297 with unilateral ACL reconstructions (mean age 25.1 years, range 13–53 years) and 41 women with bilateral and 129 with unilateral ACL reconstructions (mean age 22.3 years, range 13–48 years). On 45° flexion weight-bearing radiographs, we measured the intercondylar NW in controls and patients at one-half notch height from the lateral edge of the articular margin of the medial femoral condyle to the apex of the intercondylar notch. Intraoperatively, the surgeon took a direct measurement at the same site with sterile calipers. The surgeon was unaware of the radiographic measurement. The mean radiographic NW measurements for women were 12.8 mm in the bilateral group, 13.8 mm in the unilateral group, and 14.5 mm in the control group (P < 0.05) and, for men, 15.3 mm in the bilateral group, 15.8 mm in the unilateral group, and 16.9 mm in the control group (P < 0.05). The preoperative radiographic NW measurements correlated with actual intraoperative measurements (r = 0.72, P < 0.01). We conclude that the intercondylar NW of the femur is narrower in women than men, and, in both men and women, the NW is narrower in patients who sustain ACL tears compared with controls. Received: 7 March 1997 Accepted: 30 June 1997     

Simultaneous anterior and posterior cruciate ligament reconstruction in chronic knee instabilities: surgical concepts and clinical outcome

The purpose of this study was to evaluate the clinical results of simultaneous arthroscopically assisted reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) using autogenous tendon grafts in chronic knee injuries. Nineteen patients (17 men and 2 women) with chronic multi-ligamentous injuries underwent one-stage ACL and PCL reconstruction. ACL, PCL and medial collateral ligament were reconstructed in seven knees, and ACL, PCL and posterolateral structure were reconstructed in two knees. Function of the operated knee was evaluated according to the International Knee Documentation Committee (IKDC) and Lysholm scale. Anterior and posterior knee laxity was examined with a KT-2000 arthrometer. Eighteen of 19 patients were able to return for follow-up and were evaluated objectively and subjectively. The average patient age at surgery was 30.5 years, and the average postoperative follow-up was 3.5 years. No patients showed loss of knee extension more than 5 degrees , while three patients revealed loss of knee flexion more than 16 degrees . The mean postoperative total anterior-posterior side-to-side difference was 1.9 +/- 1.5 mm at 20 degrees and 2.1 +/- 1.9 mm at 70 degrees . The average of the Lysholm score was 95.1 points at the final follow-up. At the IKDC evaluation, three patients were grade A, 11 were grade B, 3 were grade C, and 1 patient was grade D. The results showed the effectiveness and safety of one-stage reconstruction of combined ligamentous injuries of the knee that can adequately restore satisfactory stability.     

Correlation between the morphometric parameters of the anterior cruciate ligament and the intercondylar width: gender and age differences

The study was conducted on 50 cadavers (32 male and 18 female, aged 15–53 years; mean 34; SD 11) with intact anterior cruciate ligament (ACL), without diagnosed gonarthrosis of the knee joint. The following anatomical parameters of the ACL were measured: the length of anteromedial and posterolateral bundle, the mean length and the width of the ligament, the length and width of tibial insertion, the length and width of femoral insertion. The intercondylar width was measured at the level of popliteal groove. The width of male intercondylar notch (22 mm) was statistically significantly greater (P < 0.05) than the width of female intercondylar notch (18 mm). The width of the male ACL (12 mm) was significantly greater (P < 0.05) than the width of the female ACL (10 mm). The length of the male ACL femoral insertion (14 mm) was statistically significantly greater (P < 0.05) than in the female ACL femoral insertion (12 mm). Accordingly, with greater width of intercondylar notch, men have wider ACL than women. ACL width is in positive correlation with the male intercondylar notch width but it is not in correlation with the female intercondylar notch width. The width of male intercondylar notch correlates with the length and width of ACL femoral insertion. Taking into account the length and width of femoral insertion in examined cadaver knees, double bundle reconstruction would theoretically be possible in 76% of cases.     

Intercondylar notch width measurement differences between African American and white men and women with intact anterior cruciate ligament knees

BACKGROUND: A recent report of professional women's basketball found that white European American female players were 6.5 times more likely to tear their anterior cruciate ligament than their nonwhite European American counterparts. African Americans accounted for 95% of the nonwhite European American group. HYPOTHESIS: African American men and women have wider intercondylar notches than white men and women. STUDY DESIGN: Cohort study (prevalence); Level of evidence, 2. METHODS: We obtained 45 degrees flexed weightbearing posteroanterior radiographs on 517 patients who had knee problems other than an anterior cruciate ligament injury or arthrosis. One experienced observer measured the intercondylar notch width with no knowledge of race or gender, and the measurements were analyzed based on race and gender. RESULTS: The mean intercondylar notch width was 15.5 mm (SD = 2.8; range, 9-22) for African American women and 14.1 mm (SD = 2.5; range, 8-21) for white women; this difference was statistically significant (P = .009). Similarly, the mean intercondylar notch width was 18.0 mm (SD = 3.6; range, 10-27) for African American men and 16.9 mm (SD = 3.1; range, 9-27) for white men; these values were statistically significantly different (P = .003). CONCLUSION: We conclude that African Americans have statistically significantly wider intercondylar notch widths on 45 degrees flexed weightbearing posteroanterior radiographs than whites of the same gender. This relationship may offer an explanation for the difference between races with regard to risk of anterior cruciate ligament tears.     

关节镜下应用LARS人工韧带同时重建前、后交叉韧带

目的 探讨关节镜下应用LARS人工韧带重建前交叉韧带(ACL)、后交叉韧带(PCL)同时损伤的方法及疗效. 方法 关节镜下同时重建13例ACL、PCL损伤的患者,重建材料采用LARS人工韧带.术后随访12～36个月,采用国际膝关节文件编制委员会(IKDC)韧带标准评价表和Lysholm膝关节功能评分表评估患膝功能,通过KT-1000检查膝关节前后松弛度.结果 术后无膝关节感染发生;均无伸膝受限,屈膝活动度105°～125°,平均117°.术后随访时IKDC评分:A类10例(77%),B类3例(23%).屈膝25°位KT-1000检查:双侧膝关节前向松弛度差异＜2 mm 12例,3～5 mm 1例;屈膝70°位检查:＜2 mm 12例,2～4 mm 1例.术前Lysholm膝关节功能评分为(63.8 ±2.9)分(49～69分),终末随访时为(91.1±2.7)分(88～95分),差异有统计学意义(P＜0.01). 结论 关节镜下同时重建膝关节ACL、PCL是目前治疗ACL、PCL同时损伤的一种微创、安全、有效的手术方法,近期疗效佳.     

The Gore-Tex prosthetic ligament as a salvage procedure in deficient knees

The purpose of this study was to evaluate the results of prosthetic ligament replacement of the anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) with the Gore-Tex polytetrafluorethyene prosthesis (W.L.Gore and Co., Flagstaff, Ariz.) in 52 patients (54 knees). All patients sustained multiple (failed) knee operations or had knees with gross instability. Twenty-eight (29 knees) of the ¶52 patients (54%) in whom the Goretex prosthesis was still in situ were available at a minimum follow-up of 5 years (mean 9 years, range 5–11 years). The mean age at examination was 39 years (range 30–57 years); there were 15 men and 13 women. The results of the procedure were compared with the results of the same patients at a mean follow-up of 3 years. Eighty-one percent of the patients of the whole group complained about pain. This was 78% for the patients with an ACL reconstruction and 75% for the patients with a PCL reconstruction. The Tegner activity score and the Lysholm knee score showed a statistically significant difference over time. The anterior instability pattern improved in only 43% of the knees and the posterior instability in 41% of the knees. The Lachman test showed also a significant difference over time. In all patients X-ray showed an increase in degenerative changes. In conclusion, the PTFE prosthetic ligament in the reconstruction of the ACL and the PCL in the (chronically) unstable knee seems to deteriorate over time.     

Comparing in vivo kinematics of anterior cruciate-retaining and posterior cruciate-retaining total knee arthroplasty

The purpose of this study was to compare knee kinematics in patients with bi-cruciate preserving total knee arthroplasty and posterior cruciate ligament (PCL) preserving total knee arthroplasty. Five knees received PCL-retaining arthroplasty and nine knees received both cruciate-retaining arthroplasty (ACL/PCL knees). We studied treadmill gait, stair stepping, and maximum flexion activities using lateral fluoroscopy and shape matching. For maximum flexion, the ACL/PCL knees showed 6 mm more posterior translation of the lateral condyle (p < 0.05). For the stair activity, posterior translations of the lateral condyle were significantly greater in the ACL/PCL knees from 30° to 70° flexion (p < 0.05). Both condyles in the ACL/PCL knees showed greater posterior translation in the stance and swing phases of gait than in the PCL knees (p < 0.05). Preserving both cruciate ligaments in total knee arthroplasty appears to maintain some basic features of normal knee kinematics in these activities.     

Normal and acutely torn posterior cruciate ligament of the knee at US evaluation: preliminary experience

PURPOSE: To determine the ultrasonographic (US) findings of normal and acutely torn posterior cruciate ligament (PCL) of the knee and evaluate the usefulness of US in the injured PCL. MATERIALS AND METHODS: US images were obtained in 30 knees in 15 asymptomatic volunteers as a control group and in 35 patients clinically suspected of having an acute PCL injury. Only the distal half of the PCL was evaluated. Of the 35 patients, 28 had their PCL status confirmed: 13 had a normal PCL at magnetic resonance (MR) imaging plus clinical examination, and 15 had a torn PCL at either MR imaging and surgery or MR imaging and clinical follow-up. RESULTS: Normal PCLs were homogeneously hypoechoic, with a well-defined posterior border. Torn PCLs were heterogeneously hypoechoic (12 [80%] of 15 patients), with an indistinct posterior margin (11 [73%] of 15 patients). Torn PCLs were significantly thicker (range, 12.0-20.0 mm; mean, 15.6 mm +/- 2.5 [SD]; P <.01), as compared with normal PCLs in 13 patients (range, 3.8-5.8 mm; mean, 4.6 mm +/- 1.0; P <.01) and in the volunteers (range, 3.7-6.2 mm; mean, 4.5 mm +/- 1.2; P <.01). CONCLUSION: An acutely torn PCL thickens (>10 mm), loses its sharply defined posterior border, and has a heterogeneously hypoechoic appearance. US may be useful as a screening examination for patients suspected of having PCL injury and for deciding whether to perform more expensive MR imaging or surgical intervention.     

Multidetector computed tomography in acute knee injuries: assessment of cruciate ligaments with magnetic resonance imaging correlation

Purpose: To evaluate whether non-contrast multidetector computed tomography (MDCT) for suspected acute knee fractures can also be used to evaluate cruciate ligament pathology.

Material and Methods: A total of 42 patients (17-65 years) underwent four-section MDCT. The images were independently evaluated at clinical workstations by four radiologists. They assessed the integrity (normal or torn) and the best slice direction (axial, sagittal, or coronal) for visualization of the cruciate ligaments. Magnetic resonance imaging (MRI), performed within 4 weeks (mean 6 days) in relation to MDCT, was considered the gold standard.

Results: Ligament integrity at MDCT: the mean interobserver proportion of agreement for a normal anterior cruciate ligament (ACL) was 0.73, for a torn ACL 0.41, for a normal posterior cruciate ligament (PCL) 0.96, and for a torn PCL 0.54. Interobserver variation for ACL was significant (P = 0.0136-0.0260), but insignificant for PCL (P = 0.3389-0.7212). Intra-observer variation was insignificant. Visualization was best in the axial and sagittal direction for ACL and PCL, respectively. At MRI, 29 normal, one partially, and 12 completely torn ACLs, and 37 normal, four partially and one completely torn PCL were found.

Conclusion: MDCT can detect an intact ACL and PCL with good specificity, accuracy, and negative predictive value. The assessment of torn ligaments is unreliable.     

膝关节内侧副韧带、前交叉韧带、后交叉韧带联合损伤的手术治疗

目的探讨关节镜下膝关节前交叉韧带(ACL)、后交叉韧带(PCL)、内侧副韧带联合损伤(Ⅲ度膝关节外翻伤)的手术治疗方法。方法关节镜下同时联合重建ACL、PCL并修复内侧副韧带和内侧关节囊，8例交叉韧带重建材料来源于自体双侧髌腱中1／3骨-腱-骨结构，8例采用同种异体髌腱重建，交叉韧带重建的同时进行膝关节内侧副韧带和关节囊的修补。术后佩戴可调式卡盘支具3个月，并给予严格的康复训练。结果术后随访6～18个月，所有患者主观感觉以及膝关节稳定程度恢复良好，均进行正常生活与工作，同种异体髌腱移植重建比自体髌腱移植重建前后交叉韧带手术时间短，效果更好，没有发现明显的排异反应和感染传染性疾病的现象。结论1期行关节镜手术治疗膝关节内侧副韧带、前交叉韧带／后交叉韧带联合损伤，使用安全，效果满意；同种异体髌腱是重建物是一个可以选择的来源，效果优于自体髌腱移植重建。     

Surgical treatment of ACL/PCL/ medial-side knee injuries

The medial cruciate ligament (MCL), anterior cruciate ligament (ACL), and posterior oblique ligament (POL) frequently are injured by a combination of valgus and external rotation forces. Grade I or II MCL injuries alone or in combination with ACL or posterior cruciate ligament (PCL) injuries are treated nonoperatively, with cruciate ligament reconstruction delayed 3 to 6 weeks. Treatment of acute grade III ACL/PCL medial knee injuries remains controversial. Recommendations have included nonoperative treatment of the MCL and reconstruction of the ACL and PCL, acute reconstruction of the MCL and nonoperative treatment of the ACL, and treatment of all grade III injuries with acute repair. For chronic ACL/PCL/medial knee injuries, magnetic resonance imaging and examination under anesthesia are followed by endoscopic ACL/PCL reconstruction. Severe valgus laxity usually requires tightening of the MCL in addition to the posterior capsule, the posterior oblique area of the posteromedial capsule, and the midmedial capsular ligament. Thorough preoperative planning is essential to determine what procedures will be necessary for each patient.     

后交叉韧带指数在诊断前交叉韧带损伤中的临床价值研究

目的:测量后交叉韧带指数(posterior cruciate ligament index,PCLindex)并观察其与关节稳定性的关系,评估其诊断前交叉韧带(anterior cruciate ligament,ACL)断裂的临床价值。方法:在ACL完全断裂、部分断裂、完整的受试者膝关节正规MRI矢状位片上,测量其后交叉韧带止点的直线距离(X)和该直线到后交叉韧带弧顶的距离(Y),计算PCL指数(X/Y)。利用KT2000,在屈膝30°和90°位分别给于15磅、20磅、30磅和最大拉力,测量双侧胫骨前移的距离,计算双膝的位移差值。分析PCL指数与KT2000位移差值的相关性,评价PCL指数的临床诊断价值。结果:ACL完整患者的PCL指数为5.0953±0.6029,ACL部分断裂患者的PCL指数为3.5867±0.5276,ACL完全断裂患者的PCL指数为3.4217±0.5532。PCL指数与最大拉力时的KT2000位移差值呈负相关。结论:PCL指数可以作为前交叉韧带断裂的临床诊断参考指标。     

膝关节弯曲位3T 磁共振成像的临床分析

目的：探讨3 TMR膝关节弯曲位成像的优越性。方法58例临床怀疑膝关节损伤的患者行3 TMRI检查,58例患者同时行常规成像和弯曲位成像。采用双盲法对2种方法得出的常规图像和弯曲位图像按照韧带显示程度和对病变的显示能力进行评价。结果58例膝关节常规成像中,前后交叉韧带同时完整显示19例,显示韧带损伤25例（前交叉韧带损伤9例,后交叉韧带损伤16例）。58例膝关节弯曲位成像中,前后交叉韧带同时完整显示45例,Wrisberg韧带完整显示7例,显示韧带损伤28例（前交叉韧带损伤11例,后交叉韧带损伤16例,Wrisberg 韧带损伤1例）。结论膝关节弯曲位成像的交叉韧带、Wrisberg韧带和病变显示程度明显优于常规方法。     

膝关节韧带损伤与胫骨平台骨折Schatzker及AO分型的相关性分析

目的分析膝关节韧带损伤与胫骨平台骨折Schatzker分型及AO分型的相关性。方法选取2018年1月至2019年6月厦门大学附属福州第二医院骨科收治的28例胫骨平台骨折合并膝关节韧带损伤患者作为研究对象,根据Schatzker分型及AO分型系统对胫骨平台骨折进行分型,同时判定前交叉韧带(anterior cruciate ligament,ACL)、后交叉韧带(posterior cruciate ligament,PCL)、内侧副韧带(medial collateral ligament,MCL)及后外侧角(posterior lateral corner,PLC)的损伤情况,并采用Spearman相关系数分析膝关节韧带损伤与胫骨平台骨折Schatzker分型及AO分型的相关性。结果Schatzker分型与AO分型(仅以关节外、部分关节内和完全关节内3种类型计算)对应分析结果显示,两者具有显著相关性(P=0.000)。Schatzker分型及AO分型与韧带损伤类型Spearman相关分析结果显示,Schatzker分型及AO分型与ACL、MCL及PLC损伤均呈显著相关性(r=-0.465、-0.639、0.756,P=0.013、0.000、0.000;r=-0.588、-0.420、0.532,P=0.001、0.026、0.004),但若AO分型以关节外、部分关节内和完全关节内3种类型计算,则仅与ACL损伤呈显著相关性(r=-0.465,P=0.013)。结论膝关节损伤时膝关节相关韧带之间有一定协同作用,故胫骨平台骨折多合并膝关节韧带损伤,且随着Schatzker分型与AO分型等级的增高,ACL、MCL及PLC损伤的可能性均增大。     

Sonography of injury of the posterior cruciate ligament of the knee

OBJECTIVE: To describe the sonographic appearance of injury of the posterior cruciate ligament (PCL) of the knee. DESIGN AND PATIENTS: Eleven patients (6 men, 5 women) with an average age of 36 years (range 17-70 years), referred for magnetic resonance (MR) imaging evaluation of knee pain, had PCL injury according to standard MR imaging criteria. Sonography was performed after the MR examination by the author, who was aware of the MR findings. Both the affected and contralateral asymptomatic PCL were scanned sonographically in the longitudinal plane with a curvilinear transducer, and their diameters were measured on the scanner using electronic calipers. Bilateral PCL sonography and measurement were also performed on 12 patients with other acute knee injuries but normal PCLs according to MR imaging ("non-PCL-injured knee cohort"), and on 10 normal volunteers. RESULTS: All PCLs were hypoechoic, regardless of injury. The injured PCLs had an average diameter of 0.88 cm (range 0.54-1.21 cm), while the contralateral PCLs had an average diameter of 0.51 cm (range 0.30-0.84 cm) (signed rank test, P<0.001). One patient also had focal discontinuity of the PCL. There was no statistical difference between the diameters of the right and left PCLs of the non-PCL-injured knee cohort (signed rank test, P=0.1) nor between those of the volunteers (signed rank test, P=0.6). The average difference in diameter between the injured and contralateral PCLs was statistically significant versus the difference between the non-PCL-injured knee cohort's PCLs (Mann-Whitney test, P=0.0001) and versus the difference between the volunteers' PCLs (Mann-Whitney test, P=0.0001). CONCLUSION: PCL injury is manifested sonographically either as enlargement of the entire ligament, appreciated by comparison with the contralateral normal PCL, or by focal disruption of the ligament.     

膝关节韧带损伤的MRI诊断价值

目的:探讨膝关节韧带损伤的MRI表现特点。方法:回顾性分析50例损伤的膝关节韧带的MRI表现。结果:本组50例87根韧带损伤,其中前交叉韧带15根(17.2%),后交叉韧带18根(26.7%),外侧副韧带15根(17.2%),内侧副韧带39根(44.8%)。50例中复合韧带损伤16例37根,其中前交叉+后交叉+外侧副韧带3例9根,前交叉+后交叉+内侧副韧带2例6根,前交叉+内侧副韧带3例6根,后交叉+内侧副韧带3例6根,后交叉+外侧副韧带3例6根,前交叉+外侧副韧带2例4根。单一韧带损伤34例50根,其中前交叉韧带5根,后交叉韧带7根,外侧副韧带7根,内侧副韧带31根。韧带完全横断撕裂7根,其中前交叉韧带1根,后交叉韧带2根,内侧副韧带3根,外侧副韧带1根。87根中部分纵行撕裂80根;7根完全断裂中3根交叉韧带MRI表现为韧带的连续性中断,断端回缩,局部或弥漫性肿胀,PDWI上呈中等信号,T2WI和脂肪抑制序列呈高信号;4根侧副韧带MRI表现为韧带连续性中断或韧带肿胀增粗,PDWI上呈中等信号,T2WI和脂肪抑制序列呈高信号。80根部分纵行撕裂MRI表现为韧带连续性完整,韧带增粗,PD-WI上呈中等信号,T2WI和脂肪抑制序列呈高信号。经手术关节镜检查21例33根,与MRI诊断相符31根,不符合2根,符合率为93.9%。54根经保守治疗后30~40天MRI复查见韧带原异常高信号而恢复至正常低信号,韧带形态类似正常,33根经关节镜下行韧带重建修复术,30~40天MR复查见原异常高信号而恢复至正常低信号,但局部成角或形态仍不规则。结论:MRI对软组织有极高的分辨率,不仅能较清楚显示膝关节韧带损伤,并能显示半月板损伤和骨挫伤,具有较高的实用价值。     

Computed arthrotomographic evaluation of chronic lesions of the cruciate ligaments

The high incidence of cruciate ligament injuries as a result of acute knee trauma with hemarthrosis and abuse of diagnostic arthroscopies call for a suitable radiological imaging of the central pivot. Computed Arthrotomography (CAT) was used to examine the knee joint in 20 cases of clinically suspected chronic cruciate ligament injury. The images were correlated with arthroscopic and/or arthrotomic findings. Thirteen lesions of the anterior cruciate ligament (ACL) (65%) were found, plus 1 lesion of the posterior cruciate ligament (PCL) (5%), 2 associated lesions of ACL + PCL (10%), and 4 normal cases. Confirmation of pathology was available in all cases but one by arthroscopy and/or surgery. The central pivot diseases were classified as follows: absence, detachment, partial or complete tear. CAT findings of cruciate ligament injuries are emphasized and the role of the technique as compared to arthroscopy is discussed. CAT is useful in 3-D evaluation of central pivot and detection of different cruciate ligament injuries, with high sensitivity-specificity for ACL and high specificity-moderate sensitivity for PCL. In the evaluation of the chronic unstable knee, CAT is highly accurate and gives the surgeon useful information towards the planning of therapeutic procedures. CAT is almost non-invasive, well tolerated and easy to perform in out-patients, which make it a first-choice procedure in the screening of chronic ligament injuries.     

Posterior horn lateral meniscal tears simulating meniscofemoral ligament attachment in the setting of ACL tear: MRI findings

PURPOSE: We have noted apparent far lateral meniscal attachment of the meniscofemoral ligament (MFL) with an anterior cruciate ligament (ACL) tear. This study evaluates MFL attachment and association with posterior horn lateral meniscus (PHLM) tear. MATERIALS AND METHODS: Nine months of knee arthroscopy reports were reviewed to classify the PHLM and ACL as torn or normal. After excluding those with prior knee surgery, MR images were reviewed by two radiologists to determine the number of images lateral to PCL, which showed the ligaments of Humphrey and Wrisberg visible as structures separate from the PHLM. Any patient with abnormal PHLM surface signal not continuous with the MFL was excluded. MRI findings were compared with arthroscopy using Student's t test and Fisher's exact test. RESULTS: Of the 54 participants, 5 had PHLM tears and 49 were normal. Twenty-one had ACL tears; all those with an PHLM tear had an ACL tear. The ligament of Humphrey inserted on average 0.9 consecutive images lateral to the PCL without an PHLM tear and 4.7 with an PHLM tear; the ligament of Wrisberg inserted on average 3.0 consecutive images without an PHLM tear and 4.5 with an PHLM tear (slice thickness/gap = 3 mm/0.5 mm). There was a significant association between PHLM tear and number of images (p = 0.0028), and between ACL tear and this type of PHLM tear (p = 0.0064). CONCLUSION: Apparent far lateral meniscal extension of a meniscofemoral ligament (greater than or equal to four images lateral to the PCL) should be considered as a possible PHLM tear, especially in the setting of an ACL tear.     

Increasing the distance between the posterior cruciate ligament and the popliteal neurovascular bundle by a limited posterior capsular release during arthroscopic transtibial posterior cruciate ligament reconstruction: a cadaveric angiographic study

BACKGROUND: During arthroscopic transtibial posterior cruciate ligament reconstruction, popliteal vessel injury is the most serious complication, and it rarely occurs. PURPOSE: To evaluate the distance change between the posterior cruciate ligament and the neurovascular bundle by limited release of the posterior capsule during arthroscopic posterior cruciate ligament reconstruction. STUDY DESIGN: Controlled laboratory study. METHODS: The authors performed an arthroscopic posterior cruciate ligament reconstruction procedure on 10 fresh-frozen cadaveric knees. The experimental procedure included 4 steps. Before the procedure and just after each step, angiographic lateral radiographs were checked to find the relationship and the distances between the popliteal artery and the posterior cruciate ligament. Changes in the distances at each step were compared and analyzed by ANOVA with Bonferroni correction. RESULTS: The mean distance between the popliteal artery and the tibial insertion of the posterior cruciate ligament increased significantly (from 4.4 +/- 3.2 mm to 14.7 +/- 4.1 mm) after limited posterior capsular release (P < .01). The distance from the popliteal artery to the midsubstance of the posterior cruciate ligament at the level of the posterior trans-septal portal significantly increased (from 11.3 +/- 3.9 mm to 17.6 +/- 4.0 mm) just after distension of the knee joint with a pump (P < .01). CONCLUSION: This study showed a significant increase in the distance from the popliteal artery to the posterior cruciate ligament through arthroscopic limited posterior capsular release during arthroscopic transtibial posterior cruciate ligament reconstruction. CLINICAL RELEVANCE: The results of this study support the claim that risk of iatrogenic popliteal vessel injury could be reduced by limited posterior capsular release during arthroscopic transtibial posterior cruciate ligament reconstruction.