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Semin Musculoskelet Radiol 2005; 09(1): 5-16
DOI: 10.1055/s-2005-867100
Copyright © 2005 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001 USA.

Knee Instability: The Orthopedic Approach

Jeffrey R. Cummings1 , 2 , 3 , Robert A. Pedowitz1 , 2
  • 1San Diego Arthroscopy and Sports Medicine Fellowship, University of California San Diego, San Diego, California
  • 2Department of Orthopaedic Surgery, University of California San Diego, San Diego, California
  • 3Tahoe Fracture and Orthopedic Clinic, Tahoe, California
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Publication History

Publication Date:
05 April 2005 (online)

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ABSTRACT

Clinical management of knee ligament injuries ranges from simple observation to complex multiligament reconstruction. Radiographic evaluation, including magnetic resonance imaging, is an important part of the diagnostic regimen that may significantly alter the treatment plan. This article reviews the clinical presentation and evaluation of isolated and combined knee ligament injuries and presents the indications, utility, and clinical impact of radiographic imaging on surgical management.

KEYWORDS

Knee - instability - ligament - injury - magnetic resonance imaging

REFERENCES

  • 1 Markolf K L, Mensch J S, Amstutz H C. Stiffness and laxity of the knee-the contribution of the supporting structures. A quantitative in vitro study.  J Bone Joint Surg Am. 1976;  58 583-594
    CrossrefPubMedGoogle Scholar
  • 2 Larson R L, Taillon M. Anterior cruciate ligament insufficiency: principle and treatment.  J Am Acad Orthop Surg. 1994;  2 26-35
    PubMedGoogle Scholar
  • 3 Pedowitz R A, O’Connor J J, Akeson W H. Daniel’s Knee Injuries. 2nd ed. Philadelphia, PA; Lippincott, Williams & Wilkins 2003
    Google Scholar
  • 4 Fu F H, Bennett C H, Ma C B, Menetrey J, Lattermann C. Current trends in anterior cruciate ligament reconstruction.  Am J Sports Med. 2000;  28 124-130
    CrossrefPubMedGoogle Scholar
  • 5 Boden B P, Dean G S, Feagin Jr J A, Garrett Jr W E. Mechanisms of anterior cruciate ligament injury.  Orthopedics. 2000;  23 573-578
    PubMedGoogle Scholar
  • 6 Noyes F R, Matthews D S, Mooar P A, Grood E S. The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals.  J Bone Joint Surg Am. 1983;  65 163-174
    PubMedGoogle Scholar
  • 7 Daniel D M, Stone M L, Dobson B E, Fithian D C, Rossman D J, Kaufman K R. Fate of the ACL injured patients: A prospective outcome study.  Am J Sports Med. 1994;  22 632-644
    CrossrefPubMedGoogle Scholar
  • 8 Grood E S, Noyes F R, Butler D L et al.. Ligamentous and capsular restraint preventing straight medial and lateral laxity in intact human cadaver knees.  J Bone Joint Surg Am. 1981;  63 1257-1269
    Google Scholar
  • 9 Hunter S C, Marsascalco R, Hughston J C. Disruption of the vastus medialis obliquus with medial knee ligament injuries.  Am J Sports Med. 1983;  11 427-431
    PubMedGoogle Scholar
  • 10 Hughston J C, Andrews J R, Cross M J, Moschi A. Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments.  J Bone Joint Surg Am. 1976;  58 159-172
    CrossrefPubMedGoogle Scholar
  • 11 Derscheid G L, Garrick J G. Medial collateral ligament injuries in football. Nonoperative management of grade I and grade II sprains.  Am J Sports Med. 1981;  9 365-368
    PubMedGoogle Scholar
  • 12 Holden D L, Eggert A W, Butler J E. The nonoperative treatment of grade I and grade II medial collateral ligament injuries to the knee.  Am J Sports Med. 1983;  11 340-344
    PubMedGoogle Scholar
  • 13 Reider B, Sathy M R, Talkington J, Blyznak N, Kollias S. Treatment of isolated medial collateral ligament injuries in athletes with early functional rehabilitation. A five-year follow up study.  Am J Sports Med. 1994;  22 470-477
    CrossrefPubMedGoogle Scholar
  • 14 Markolf K L, Wascher D C, Finerman G A. Direct in vitro measurement of force in the cruciate ligaments, II. The effect of section of the posterolateral structures.  J Bone Joint Surg Am. 1993;  75 387-394
    PubMedGoogle Scholar
  • 15 Gollehon D L, Torzilli P A, Warren R F. The role of the posterolateral and cruciate ligaments in the stability in the human knee. A biomechanical study.  J Bone Joint Surg Am. 1987;  69 233-242
    CrossrefPubMedGoogle Scholar
  • 16 DeLee J C, Riley M B, Rockwood Jr C A. Acute posterolateral rotatory instability of the knee.  Am J Sports Med. 1983;  11 199-207
    CrossrefPubMedGoogle Scholar
  • 17 DeLee J C, Riley M B, Rockwood Jr C A. Acute straight lateral instability of the knee.  Am J Sports Med. 1983;  11 404-411
    PubMedGoogle Scholar
  • 18 Harner C D, Xerogeanes J W, Livesay G A et al.. The human posterior cruciate ligament complex: an interdisciplinary study: ligament morphology and biomechanical evaluation.  Am J Sports Med. 1995;  23 736-745
    CrossrefPubMedGoogle Scholar
  • 19 Fanelli G C, Edson C J. Posterior cruciate ligament injuries in trauma patients: part 2.  Arthroscopy. 1995;  11 526-529
    CrossrefPubMedGoogle Scholar
  • 20 Clancy Jr W G, Shelbourne K D, Zoellner G B, Keene J S, Reider B, Rosenberg T D. Treatment of knee joint instability secondary to rupture of the posterior cruciate ligament: report of a new procedure.  J Bone Joint Surg Am. 1983;  65 310-322
    PubMedGoogle Scholar
  • 21 Fowler P J, Messieh S S. Isolated posterior cruciate injuries in athletes.  Am J Sports Med. 1987;  15 553-557
    CrossrefPubMedGoogle Scholar
  • 22 Fanelli G C, Giannotti B F, Edson C J. The posterior cruciate ligament arthroscopic evaluation and treatment.  Arthroscopy. 1994;  10 673-688
    CrossrefPubMedGoogle Scholar
  • 23 Johnson D H, Fanelli G C, Miller M D. PCL 2002: Indications, double bundle versus inlay technique and revision surgery.  Arthroscopy. 2002;  18 40-52
    PubMedGoogle Scholar
  • 24 Seika J K, Giffin J R, Harner C D. Posterior cruciate ligament injuries: isolated and combined patterns. In: Schenck RC Multiple Ligamentous Injuries of the Knee in the Athlete, Monograph Series Rosemont, Illinois; American Academy of Orthopedic Surgeons 2002: 73-90
    Google Scholar
  • 25 Harner C D, Hoher J. Evaluation and treatment of posterior cruciate ligament injuries.  Am J Sports Med. 1998;  26 471-481
    PubMedGoogle Scholar
  • 26 Veltri D M, Deng X H, Torzilli P A, Warren R F, Maynard M J. The role of the cruciate and the posterolateral ligaments in stability of the knee.  Am J Sports Med. 1995;  23 436-443
    CrossrefPubMedGoogle Scholar
  • 27 La Prade R F, Terry G C. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability.  Am J Sports Med. 1997;  25 433-438
    CrossrefPubMedGoogle Scholar
  • 28 Veltri D M, Warren R F. Isolated and combined posterior cruciate ligament injuries.  J Am Acad Orthop Surg. 1993;  1 67-75
    PubMedGoogle Scholar
  • 29 Green A, Allen B L. Vascular injuries associated with dislocation of the knee.  J Bone Joint Surg Am. 1977;  59 236-239
    PubMedGoogle Scholar
  • 30 Welling R E, Kakkasseril J, Cranley J J. Complete dislocation of the knee with popliteal vascular injury.  J Trauma. 1981;  21 450-453
    PubMedGoogle Scholar
  • 31 Kennedy J C. Complete dislocation of the knee joint.  J Bone Joint Surg Am. 1963;  45 889-904
    CrossrefPubMedGoogle Scholar
  • 32 Meyers M H, Moore T M, Harvey Jr J P. Traumatic dislocation of the knee joint.  J Bone Joint Surg Am. 1975;  57 430-433
    CrossrefPubMedGoogle Scholar
  • 33 Montgomery T J, Savoie F H, White J L, Robert T S, Hughes J L. Orthopedic management of knee dislocations: Comparison of surgical reconstruction and immobilization.  Am J Knee Surg. 1995;  8 97-103
    PubMedGoogle Scholar
  • 34 Alberty R E, Goodried G, Boyden A M. Popliteal artery injury with fractural dislocation of the knee.  Am J Surg. 1981;  142 36-40
    CrossrefPubMedGoogle Scholar
  • 35 Lynch K, Johansen K. Can Doppler pressure measurement replace “exclusion” arteriography in the diagnosis of occult extremity arterial trauma?.  Ann Surg. 1991;  214 737-741
    CrossrefPubMedGoogle Scholar
  • 36 Dennis J W, Jagger C, Butcher J L, Menawat S S, Neel M, Frykberg E R. Reassessing the role of arteriograms in the management of posterior knee dislocations.  J Trauma. 1993;  35 692-697
    CrossrefPubMedGoogle Scholar
  • 37 Kendall R W, Taylor D C, Salvian A J, O’Brien P J. The role of arteriography in assessing vascular injury in associated dislocations of the knee.  J Trauma. 1993;  35 875-878
    CrossrefPubMedGoogle Scholar
  • 38 Halbrecht J L, Jackson D W. Acute Dislocations of the Patella. The Patellofemoral Joint. New York; McGraw-Hill 1993: 123-134
    Google Scholar
  • 39 Boden B P, Pearsall A W, Garrett Jr W E, Feagin J A. Patellofemoral instability. Evaluation and management.  J Am Acad Orthop Surg. 1997;  5 47-57
    PubMedGoogle Scholar
  • 40 Fulkerson J P, Shea K P. Disorders of patellofemoral alignment.  J Bone Joint Surg Am. 1990;  72 1424-1429
    PubMedGoogle Scholar
  • 41 Fulkerson J P. Patellofemoral pain disorders. Evaluation and management.  J Am Acad Orthop Surg. 1994;  2 124-132
    PubMedGoogle Scholar
  • 42 Sallay P T, Poggi J, Speer K P et al.. Acute dislocation of the patella: a correlative pathoanatomic study.  Am J Sports Med. 1996;  24 52-60
    CrossrefPubMedGoogle Scholar

Jeffrey CummingsM.D. 

Tahoe Fracture and Orthopedic Clinic

1139 Third St., South Lake Tahoe, CA 96150