Peroneal intraneural ganglion cysts (IGCs) are nonneoplastic lesions. They are responsible for a small number of footdrop cases, which occur after additional nerve damage. The earliest patient ...symptom related to IGCs is knee pain.
A 17-year-old boy developed pain in the left knee, which progressively worsened over 14 months. He did not seek any medical assistance during this time. The patient subsequently was involved in a bicycle accident, and 3 months later he was unable to raise his left foot and was referred to our clinic for footdrop. Surgery was performed, but the weakness persisted. We could not detect any functional reinnervation on electromyography 12 months after surgery.
The most important factors in determining the prognosis of IGCs are the extent of the nerve trauma and the early diagnosis and treatment of the IGC. Detection of almost complete functional denervation on electromyography may indicate that it is too late for surgery.
•Trauma may play a role in IGC prognosis but not in IGC etiology.•Increased activity in adolescents often leads to peroneal nerve injury.•IGC should be in differential diagnosis of adolescent knee pain, and imaging should be performed immediately.•With delayed diagnosis, IGC trauma causes irreversible nerve destruction, which cannot be remedied surgically.
Regular exercise is vital for overall health, and key to the maintenance of joint health. However, whilst people are encouraged to participate in sport and exercise, many are unaware that they could ...be at risk of developing post-traumatic osteoarthritis (PTOA) in the years following sport-related injury. Younger adults (< 40 years) with PTOA can experience declining quality of life, comorbid health conditions, and symptoms that place a chronic burden on health services. Conserving knee health through careful self-management in the latency period between injury and the onset of PTOA may help to delay disease progression. In this regard, the development of self-management interventions can be facilitated by understanding the post-injury experiences of young adults and their attitudes towards joint health.
Semi-structured interviews were conducted with 13 young adults following a sport-related knee injury to explore their experiences of injury, and their attitudes and perceptions of self-managing knee health. The interviews were audio-recorded, transcribed and analysed systematically using an inductive approach.
Four themes pertaining to participants' experiences were identified: 1 perceptions of current care provision; 2 long-term impact of knee injury; 3 motivation to conserve knee health; and 4 opportunities for supplementary support. The expression "Nobody says to you 'come back in six months and we'll see how you're doing'" personifies the long-term impact of knee injury on young adults and a paucity of care provision.
Participants did not perceive that they had adequate care in the aftermath of knee injury, leading to a sense of frustration and uncertainty. This had implications for continued participation in sport and exercise, negatively impacting their athletic identity and sense of wellbeing. Activity tracking, symptom monitoring, advice provision and peer support were identified as tools to enable individuals to self-manage knee health.
Purpose To compare the forces exerted on the cruciate ligaments and the contact stresses on the tibiofemoral (TF) and patellofemoral (PF) joints with respect to 3 different tibial- and fibular-based ...posterolateral corner (PLC) reconstructions under dynamic loading conditions. Methods A subject-specific finite element knee model was developed by using 3-dimensional anatomic data from motion captures in gait and squat activities, including in vivo knee joint kinematics and muscle forces for the single subject. Cruciate ligament forces and contact stresses on the TF and PF joints under 3 PLC reconstruction techniques (tibial-based, TBR; modified fibular-based, mFBR; conventional fibular-based, cFBR) and PLC-deficient models were compared with those of the intact model in gait and squat loading conditions. Results The cruciate ligament forces in the 3 surgical models differed from those in the intact model. The greatest differences in ligament forces from the intact model were found in the cFBR model, whereas there were no remarkable differences between the TBR and mFBR models in both gait and squat loading conditions. Contact stresses on the lateral TF and PF joints of the 3 surgical models were greater than those of the intact model under the squat loading condition. Conclusions The biomechanical effects achieved using the anatomic reconstruction technique were found to be improved compared with those using nonanatomic reconstruction techniques. However, the ligament forces and contact stresses under normal conditions could not be restored through any of the 3 techniques. Clinical Relevance Anatomic TBR and FBR for grade III PLC injuries could restore better biomechanics in the knee joint compared with nonanatomic reconstruction. However, discrepancy with the normal condition requires further modification of surgical techniques.
Evaluate whether intraoperatively repaired lateral meniscus injuries impact midterm patient-reported outcomes in those undergoing operative fixation of tibial plateau fracture.
Retrospective cohort ...study.
Level I trauma center.
All patients (n = 207) who underwent operative fixation of a tibial plateau fracture from 2016 to 2021 with a minimum of 10-month follow-up.
The Patient-Reported Outcomes Measurement Information System Physical Function, Knee Injury and Osteoarthritis Outcome Score, and the PROMIS-Preference health utility score.
Overall, 207 patients were included with average follow-up of 2.9 years. Seventy-three patients (35%) underwent intraoperative lateral meniscus repair. Gender, age, body mass index, Charlson comorbidity index, days to surgery, ligamentous knee injury, open fracture, vascular injury, polytraumatic injuries, Schatzker classification, and Orthopaedic Trauma Association classification were not associated with meniscal repair ( P > 0.05). Rates of reoperation (42% vs. 31%, P = 0.11), infection (8% vs. 10%, P = 0.60), return to work (78% vs. 75%, P = 0.73), and subsequent total knee arthroplasty (8% vs. 5%, P = 0.39) were also similar between those who had a meniscal repair and those without a meniscal injury, respectively. There was no difference in Patient-Reported Outcomes Measurement Information System Physical Function (46.3 vs. 45.8, P = 0.707), PROMIS-Preference (0.51 vs. 0.50, P = 0.729), and all Knee Injury and Osteoarthritis Outcome Score domain scores at the final follow-up between those who had a meniscal repair and those without a meniscal injury, respectively.
In patients with an operatively treated tibial plateau fracture, the presence of a concomitant intraoperatively identified and repaired lateral meniscal tear results in similar midterm PROMs and complication rates when compared with patients without meniscal injury.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Diminished hip-muscle performance has been proposed to contribute to various knee injuries.
To determine the association between hip-extensor muscle strength and sagittal-plane trunk posture and the ...relationships among hip-extensor muscle strength and hip- and knee-extensor work during running.
Descriptive laboratory study.
Musculoskeletal biomechanical laboratory.
A total of 40 asymptomatic recreational runners, 20 men (age = 27.1 ± 7.0 years, height = 1.74 ± 0.69 m, mass = 71.1 ± 8.2 kg) and 20 women (age = 26.2 ± 5.8 years, height = 1.65 ± 0.74 m, mass = 60.6 ± 6.6 kg), participated.
Maximum isometric strength of the hip extensors was assessed using a dynamometer. Sagittal-plane trunk posture (calculated relative to the global vertical axis) and hip- and knee-extensor work (sum of energy absorption and generation) during the stance phase of running were quantified while participants ran over ground at a controlled speed of 3.4 m/s. We used Pearson product moment correlations to examine the relationships among hip-extensor strength, mean sagittal-plane trunk-flexion angle, hip-extensor work, and knee-extensor work.
Hip-extensor strength was correlated positively with trunk-flexion angle (r = 0.55, P < .001) and hip-extensor work (r = 0.46, P = .003). It was correlated inversely with knee-extensor work (r = -0.39, P = .01). All the correlations remained after adjusting for sex.
Our findings suggest that runners with hip-extensor weakness used a more upright trunk posture. This strategy led to an overreliance on the knee extensors and may contribute to overuse running injuries at the knee.
The anterolateral ligament (ALL) is a controversial ligament in the knee that may play a significant role in knee stability. It is difficult to identify on magnetic resonance imaging (MRI) imaging ...and is often injured in conjunction with other ligaments, such as the anterior cruciate ligament (ACL) and medial collateral ligament.
This is a unique case of an isolated ALL tear in a 48-year-old woman who presented with severe left knee pain, swelling, and inability to bear weight during a yoga session. Physical examination showed swelling and tenderness at the lateral aspect of the femoral condyle, with increased pain on varus stress testing. Radiographs revealed normal osseous structures with the absence of traumatic bone lesions. MRI revealed an intact meniscus, cruciate, and collateral ligaments, but a rupture of the ALL at its femoral origin. Diagnosis of isolated ALL rupture of the left knee was made, and the patient was treated conservatively with icing, rest, and non-steroidal anti-inflammatory drugs. Physiotherapy was started 2 weeks post-injury, and return to sports was allowed at the sixth week. Upon last follow-up, the patient had excellent functional outcomes and was satisfied with the treatment. Physical examination showed a stable knee with negative Lachman and pivot shift tests. To the best of the authors' knowledge, this is the first case of isolated ALL rupture to be reported.
The paper highlights the rarity of isolated ALL injuries and the difficulty in diagnosing them. Conservative treatment can be successful for isolated ALL injuries, with physiotherapy playing an essential role in rehabilitation.In conclusion, isolated ALL injuries are rare and can be challenging to diagnose. Conservative treatment with physiotherapy can lead to successful outcomes. Further research is needed to understand the role of the ALL in knee stability and to determine optimal treatment options.
Abstract Objectives The purpose of this study was to investigate the injury characteristics of medial patellofemoral ligament (MPFL), and to analyse the correlations between the injury patterns of ...MPFL and articular cartilage lesions of the lateral femoral condyle in children and adolescents with acute lateral patellar dislocation (LPD). Methods Magnetic resonance (MR) images were prospectively obtained in 127 consecutive children and adolescents with acute LPD. Images were acquired using standardised protocols and these were independently evaluated by two radiologists. Results Fifty-four cases of partial MPFL tear and 69 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 47 cases, an isolated femoral attachment (FEM) in 41 cases and an isolated mid-substance (MID) in four cases. More than one site of injury to the MPFL (COM) was identified in 31 cases. The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 23.4% (11/47) and 29.8% (14/47) in the PAT subgroup, 7.3% (3/41) and 9.8% (4/41) in the FEM subgroup and 25.8% (8/31) and 32.3% (10/31) in the COM subgroup, respectively. The PAT and COM subgroups showed significantly higher prevalence rate of chondral and osteochondral lesions in the lateral femoral condyle when compared with the FEM subgroup. The prevalence rate of chondral and osteochondral lesions of the lateral femoral condyle were 17.4% (12/69) and 30.4% (21/69) in the complete MPFL tear subgroup and 20.4% (11/54) and 13% (7/54) in the partial MPFL tear subgroup, respectively. The subgroup of the complete MPFL tear showed significantly higher prevalence rate of osteochondral lesions in the lateral femoral condyle when compared with the subgroup of the partial MPFL tear. Conclusions Firstly, the MPFL is most easily injured at the PAT, and secondly at the FEM in children and adolescents after acute LPD. The complete MPFL tear is more often concomitant with osteochondral lesions of the lateral femoral condyle than the partial MPFL tear. The isolated patellar-sided MPFL tear and the combined MPFL tear are more easily concomitant with chondral lesions and osteochondral lesions of the lateral femoral condyle than the isolated femoral-sided MPFL tear.
Although the risk of osteoarthritis development after acute knee injury has been widely studied, the long-term consequences of knee overuse injury are not well understood.
To identify the ...relationship between gait-related risk factors associated with osteoarthritis and the development of iliotibial band syndrome (ITBS) in members of a single University Army Reserve Officers' Training Corps unit.
Prospective cohort study.
Biomechanics laboratory.
Sixty-eight cadets undergoing standardized physical fitness training.
Three-dimensional lower extremity kinematics (240 Hz) and kinetics (960 Hz) were collected for 3 bilateral trials during shod running at 4.0 m/s ± 10%. Injury tracking was conducted for 7 months of training.
Biomechanical variables, including varus thrust and knee-adduction moment, were compared between the injured and control groups.
Twenty-six cadets with no history of overuse injury served as the control group, whereas 6 cadets (7 limbs) who developed ITBS that required them to modify their training program or seek medical care (or both) served as the injured group. Maximum varus velocity was higher ( P = .006) and occurred sooner during stance ( P = .04) in the injured group than in the control group, indicating greater varus thrust. Maximum knee-varus angle and maximum knee-adduction moment were higher ( P = .02 and P = .002, respectively) and vertical stiffness was lower ( P = .03) in the injured group.
Measures of dynamic varus stability appeared to be altered in individuals who developed ITBS. Biomechanical knee variables previously identified as increasing the risk for knee osteoarthritis were also associated with the development of ITBS in healthy adults.
This study investigates the results of closed manipulations performed under anesthesia (MUA) to evaluate whether it is an effective means to treat posttraumatic knee arthrofibrosis.
Retrospective ...review.
Level I trauma center.
Twenty-two patients with a mean age of 40 underwent closed MUA for posttraumatic knee arthrofibrosis. Injuries included fractures of the femur, tibia, and patella as well as ligamentous injuries and traumatic arthrotomies. The mean time from treatment to manipulation was 90 days. Mean follow-up after manipulation was 7 months.
Closed knee MUA.
Improvement of knee range of motion (ROM) arc was the primary outcome. Patient demographics were correlated with manipulation success using a 2-sample t test. A delay in manipulation of 90 days or greater was also evaluated in this fashion with regard to its role in predicting the benefit of MUA.
The mean premanipulation ROM arc was 59 ± 25 degrees. The mean intraoperative arc of motion, achieved at the time of the manipulation was 123 ± 14 degrees. No complications occurred during the MUA procedure. At the most recent follow-up, the mean ROM arc was 110 ± 19 degrees. Tobacco use, associated injuries, elevated body mass index, open fracture, and advanced age did not impact manipulation efficacy. Additionally, manipulations performed 90 days or more after surgical treatment provided a benefit equaling those performed more acutely (P = 0.12).
MUA is a safe and effective method to increase knee ROM in the setting of posttraumatic arthrofibrosis. Improvement in ROM was noted in all patients. A 90-day window between fracture fixation and manipulation did not impact ROM at final follow-up and may prevent fracture displacement during the MUA.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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