Indian Journal of Orthopaedics最新文献

{"title":"Technology Update in Management of Multi-Ligament Knee Injuries.","authors":"Sujith Sidharthan, Rajarshi Bhattacharya","doi":"10.1007/s43465-024-01281-6","DOIUrl":"10.1007/s43465-024-01281-6","url":null,"abstract":"<p><strong>Introduction: </strong>Multi-ligament knee injuries present in various combinations of structures around the knee joint, with or without involvement of neurovascular structures, posing significant challenges to the treating physician and therapists. Accurate diagnosis with appropriate surgical intervention and comprehensive rehabilitation to restore function and stability is, therefore, paramount. This article looks at the recent advancements in technology that are aiding in the management of these injuries.</p><p><strong>Method: </strong>An extensive search of literature was done in PubMed, SCOPUS, and Google Scholar on this topic and the necessary information was derived from the relevant articles for this review. The progress made in the field of diagnosis, surgical management, rehabilitation and patient education tools were explored.</p><p><strong>Discussion: </strong>A wide variety of diagnostic tools exists that are providing a more accurate evaluation of multi-ligament knee injuries both pre-operatively and post operatively. Advances in technology and techniques have aided in transforming their surgical management to a more minimally invasive approach. Patient-specific instrumentation, computer navigation and robotic-assisted surgery are in various stages of development offering enhanced precision and accuracy during ligament reconstruction procedures along with developments in digital technology and artificial intelligence.</p><p><strong>Conclusion: </strong>Advancements in technology have transformed the management of multi-ligament knee injuries, offering new tools and techniques that enhance diagnostic accuracy, surgical precision, and rehabilitation effectiveness. Artificial intelligence and its utility have widened the horizons, while at the same time bringing in the need for regulations necessary to monitor and develop these technologies.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From the Guest Editors: Unraveling the Complexities of Multiligament Knee Injuries-A Global Endeavor.","authors":"Srinivas B S Kambhampati, Prahalad Kumar Singhi, Rajagopalakrishnan Ramakanth","doi":"10.1007/s43465-024-01282-5","DOIUrl":"https://doi.org/10.1007/s43465-024-01282-5","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies for Preventing Tunnel Convergence in Multiligament Knee Injury Reconstructions.","authors":"Joseph E Nassar, Bshara Sleem, Luke V Tollefson, Evan P Shoemaker, Robert F LaPrade, Gilbert Moatshe","doi":"10.1007/s43465-024-01267-4","DOIUrl":"10.1007/s43465-024-01267-4","url":null,"abstract":"<p><strong>Background: </strong>Multiligament knee injuries (MLKIs) are complex and heterogeneous, often associated with concomitant injuries, and necessitates precise treatment strategies.</p><p><strong>Preoperative management: </strong>Effective preoperative management in MLKIs requires comprehensive evaluation, starting with a detailed patient history to identify the mechanisms of injury and prior treatments. Physical examination assesses for knee stability, while imaging techniques including magnetic resonance imaging (MRI) and radiographs detail ligament, cartilage, and meniscal injuries to identify all injured structures. Vascular evaluations are critical given the high risk of concomitant neurovascular injuries especially in dislocated knees, bicruciate injuries, and lateral-sided injuries.</p><p><strong>Avoiding tunnel convergence: </strong>Anatomic reconstruction of the torn ligaments has been biomechanically and clinically validated to improve knee stability and function. When performing multiple anatomic reconstructions, the risk of tunnel convergence is high. Therefore, surgical intervention aimed at optimizing outcomes necessitates careful planning to avoid tunnel convergence. This involves strategic tunnel placement, orientation, and techniques, such as adjusting tunnel angulation and using intraoperative imaging. These measures are vital for restoring knee functionality and minimizing future complications. Managing tunnel convergence is vital in treating MLKIs. Avoiding convergence on the medial side of the femur and tibia is more challenging due to the number of tunnels. In an MLKI involving all ligaments, 4 femoral tunnels and 4 tibial tunnels are required on the medial side, compared to 3 on the femur and 1 on the tibia for the lateral side, respectively.</p><p><strong>Conclusion: </strong>The success of a multiligament knee reconstruction depends on a precise diagnosis, thorough preoperative management, and strategic tunnel placement. A multidisciplinary approach not only enhances surgical outcomes, but also ensures long-term improvement in knee function, effectively addressing the complexities and risks associated with these injuries.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjustable Loop Fixation in Multi-ligament Knee Injuries: A Technical Note.","authors":"Adit R Maniar, Nicola D Mackay, Alan M J Getgood","doi":"10.1007/s43465-024-01273-6","DOIUrl":"10.1007/s43465-024-01273-6","url":null,"abstract":"<p><p>Adjustable Loop Fixation devices (ALD) were introduced to allow tensioning and re-tensioning while increasing flexibility of graft length in the bone tunnel. ALDs have shown comparable clinical and biomechanical results when used for anterior cruciate ligament reconstructions. We routinely use ALDs in multi-ligament knee reconstructions. In double bundle posterior cruciate ligament reconstruction, using an ALD, we can achieve differential tensioning of the anterolateral and posteromedial bundles utilizing two femoral and one tibial tunnel. When performing an anatomic posterolateral corner reconstruction using our modification of the anatomical LaPrade technique, an ALD permits differential tensioning of the fibular collateral ligament and popliteus tendon/popliteofibular ligaments with a single graft. In anatomic superficial medial collateral ligament reconstructions, ALD allows for tensioning from the femoral side, subsequent cycling, followed by re-tensioning to achieve a stable reconstruction. In conclusion, ALDs provide numerous benefits when performing multi-ligament knee reconstructions. ALDs allow for appropriate tensioning and re-tensioning which is helpful in removing creep from the graft to prevent postoperative laxity. Additionally, it permits differential tensioning which helps achieve accurate tensioning of individual bundles to help restore native knee kinematics.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Results of Isolated MCL Grade III Injury in Acute and Chronic Setting: Systematic Review and Meta-analysis.","authors":"Amit Meena, Luca Farinelli, Manish Attri, Davide Montini, Thiago Alberto Vivacqua, Riccardo D'Ambrosi, Mohit Kumar Patralekh, Sachin Tapasvi","doi":"10.1007/s43465-024-01280-7","DOIUrl":"10.1007/s43465-024-01280-7","url":null,"abstract":"<p><strong>Background: </strong>The medial collateral ligament (MCL) is frequently involved in injuries around the knee but is uncommonly treated surgically. There are various techniques to reconstruct the medial side of the knee, which have varying outcomes.</p><p><strong>Purpose/hypothesis: </strong>The purpose of the present systematic review and meta-analysis is to describe the clinical results of surgical management of acute and chronic isolated grade III MCL injury using various functional scores, such as IKDC, Lysholm, and VAS, and to ascertain complication rates associated with these interventions.</p><p><strong>Methods: </strong>A systematic review was performed according to the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, and two independent authors (L.F and A.M) conducted a comprehensive search across multiple databases (PubMed, Web of Science, and Scopus). They reviewed each article's title and abstract for studies available until April 2024. The search terms used were \"((MCL) OR (Medial collateral ligament)) AND (injuries) AND (treatment)\". The full texts of the studies were evaluated when eligibility could not be assessed from the title and abstract.</p><p><strong>Results: </strong>The pooled proportion (percentage) of complications from the three studies reporting data on surgery for the MCL acute stage was 15.3% with 95% CI [6.1% to 24.6%]. No complications were reported in studies reporting surgery in the chronic stage. Marked resolution of pain was observed with the mean VAS Score for pain at the final follow-up after surgery for MCL injury in the acute stage was 0.4 with 95% CI [-0.04 to 0.84]. The mean IKDC score at the final follow-up in the three studies reporting data on surgery for the MCL in the acute stage was 79.39 with 95% CI [67.96 to 90.82], and in the chronic stage, was 85 with 95% CI [83.02 to 86.98]. The mean Lysholm Score at the final follow-up after surgery for MCL injury in the chronic stage was 83.04 with 95% CI [75.24 to 94.84], and in the acute stage was 95 with 95% CI [91.76 to 98.24].</p><p><strong>Conclusion: </strong>This systematic review found that functional outcomes regarding IKDC and LYSHOLM scores were comparable for surgeries performed in acute and chronic MCL tears. There was a marginally increased risk of complication in surgeries performed for acute MCL tears. Compared to the acute phase, a marked resolution of pain was observed at the final follow-up after surgery for MCL injury.</p><p><strong>Study design: </strong>Systematic review; level of evidence, 4..</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Treatment Algorithm for Chronic Multiple Ligament Knee Injury.","authors":"Dinshaw N Pardiwala, Clevio Desouza, Arzan Jesia","doi":"10.1007/s43465-024-01242-z","DOIUrl":"10.1007/s43465-024-01242-z","url":null,"abstract":"<p><strong>Background: </strong>Multiple ligament knee injuries (MLKI) are a complex group of injuries ideally treated in the acute phase, though delayed presentation is common. Chronic MLKI varies in presentation, requiring individualized management strategies. This review aims to differentiate chronic MLKI types and propose an algorithm that facilitates a tailored treatment plan.</p><p><strong>Methods: </strong>Chronic MLKI is classified into three types based on knee joint status and limb alignment. Type 1 involves ligament deficiency in a reduced knee with normal alignment, treated with soft-tissue ligament reconstruction. Type 2 includes ligament deficiency with malalignment, where deformity correction precedes ligament surgery. Type 3 entails chronic unreduced knee dislocations, necessitating open reduction and extensive release prior to reconstruction.</p><p><strong>Results: </strong>Treatment depends on classification, emphasizing realignment for Type 2 and reduction for Type 3 before soft-tissue procedures. Individualized approaches are critical due to the complexity and variability of chronic MLKI.</p><p><strong>Conclusion: </strong>A treatment algorithm is essential to manage chronic MLKI. Joint reduction, limb realignment, and ligament reconstruction are important to ensure optimal functional outcomes.</p>","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical Multi-ligamentous Knee Injury (MLKI): Binary Injury with Avulsion of One Cruciate and Tear of the Other, or Bi-cruciates Avulsion with or Without Collateral Ligament Injury Following Road Traffic Accidents (RTA).","authors":"Rajagopalakrishnan Ramakanth, Silvampatti Ramasamy Sundararajan, Suchit Chavan, Kenchi Charith Nagarjun, Terence D'souza, Arumugam Palanisamy, Shanmuganathan Rajasekaran","doi":"10.1007/s43465-024-01256-7","DOIUrl":"10.1007/s43465-024-01256-7","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Multi-ligamentous knee injuries (MLKI) fall within a narrow spectrum, accounting for around 11% of all knee injuries. Atypical MLKI involve binary injury: avulsion of one cruciate and tear of the other, or both cruciates avulsion with or without collateral ligament injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;The purpose of this study is to analyse the clinical and radiological outcomes of patients diagnosed with atypical MLKI, and to assess the differences in outcomes between patients with collateral injury and those without.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;66 patients with atypical MLKI were studied and compared in this retrospective cohort. 32 of these patients did not have collateral injuries, while the remaining 34 patients did have collateral injuries. The duration of the study was from 2010 to 2022. Reconstruction for the cruciate tears and open or arthroscopic reduction and fixation (ORIF/ARIF) of the cruciate avulsion were performed. In earlier years (2010-2015), posterior cruciate ligament avulsions were open reduced and fixed using the double draping approach. However, in later years (2016-2022), the double draping method was replaced by the single draping technique. Conservative or surgical management of the collateral ligaments was determined based on factors such as intraoperative laxity, tissue quality, injury site, and chronicity. Group 1 comprised of atypical MLKI patients without collateral ligament injuries, while Group 2 included atypical MLKI patients with collateral ligament injuries and subgroup was based on the various combinations of cruciate avulsions, tears and collateral injuries. A comparative statistical analysis was conducted on the International Knee Documentation Committee (IKDC) score, Lysholm score, knee flexion range of motion (ROM), and laxity on stress radiographs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The male:female ratio were 54:12 patients. The average follow-up was 26.48 months (range 23-30 months). The average age of the patients is 37.66 (range 20-50 years). All patients had significant improvement from pre-operative scores to final follow-up scores (&lt;i&gt;P&lt;/i&gt; &lt; 0.001). There was no significant difference between the atypical MLKI with collateral and atypical MLKI without collateral injury in terms of the postoperative IKDC score (&lt;i&gt;P&lt;/i&gt; = 0.154), Lysholm score (&lt;i&gt;P&lt;/i&gt; = 0.387), knee flexion ROM (&lt;i&gt;P&lt;/i&gt; = 0.314), and laxity on radiographs with anterior stress (&lt;i&gt;P&lt;/i&gt; = 0.108) and posterior stress (&lt;i&gt;P&lt;/i&gt; = 0.272). The intergroup analysis was not statistically significant. There was no significant difference in patients' functional outcomes at final follow-up based on fixation modality. Patients recovered to their pre-injury activity levels without knee joint giving way on daily activities. None of the patients in our series had infections.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The incidence of atypical MLKI in multi-ligamentous injury was 9.53% (66/692). Atypical MLKI with cr","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554968/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Multiligament Knee Injury (MLKI) Still a Challenge in 2024?","authors":"Amit Meena, Manish Attri, Sachin Tapasvi","doi":"10.1007/s43465-024-01238-9","DOIUrl":"10.1007/s43465-024-01238-9","url":null,"abstract":"","PeriodicalId":13338,"journal":{"name":"Indian Journal of Orthopaedics","volume":null,"pages":null},"PeriodicalIF":1.1,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11555185/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}