RESUMO
The multiple ligament injured knee is a complex problem in orthopedic surgery. These injuries may or may not present as acute knee dislocations, and careful assessment of the extremity vascular and neurological status is essential because of the possibility of arterial and/or venous compromise, and nerve injury. These complex injuries require a systematic approach to evaluation and treatment. Physical examination and imaging studies enable the surgeon to make a correct diagnosis and formulate a treatment plan. Knee stability is improved postoperatively when evaluated with knee ligament rating scales, arthrometer testing, and stress radiographic analysis. Surgical timing depends upon the injured ligaments, vascular status of the extremity, reduction stability, and the overall health of the patient. The use of allograft tissue is preferred because of the strength of these large grafts, and the absence of donor site morbidity.
Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Ligamento Colateral Médio do Joelho/lesões , Traumatismo Múltiplo/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Ligamento Cruzado Posterior/lesões , Tendão do Calcâneo/transplante , Humanos , Instabilidade Articular/cirurgia , Luxação do Joelho/diagnóstico , Luxação do Joelho/etiologia , Luxação do Joelho/terapia , Traumatismo Múltiplo/classificação , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/etiologia , Exame Físico , Artéria Poplítea/lesões , Ligamento Cruzado Posterior/cirurgia , Tempo para o Tratamento , Resultado do TratamentoRESUMO
The purpose of this paper is to present an overview of the progress in treatment of knee dislocations and posterior cruciate ligament (PCL)-based multiple ligament knee injuries over the past 25 years. The perspectives of where we were 25 years ago, where we are today, and where we will be in the future will be explored.
Assuntos
Luxação do Joelho/terapia , Procedimentos Ortopédicos/tendências , Ligamento Cruzado Posterior/lesões , Lesões dos Tecidos Moles/terapia , Humanos , Lesões dos Tecidos Moles/cirurgiaRESUMO
La luxacion tibioperonea proximal es poco comun, se relaciona con lesiones deportivas, como consecuencia de un trauma en rotacion con el pie en inversion y flexion plantar, la rodilla en flexion y la pierna en rotacion externa simultaneamente. Provoca dolor en la region lateral de la rodilla y la pierna, con arcos de movilidad completos de la rodilla, pero dolorosos. El diagnostico es clinico y radiologico. Es una entidad que pasa inadvertida en el Servicio de Urgencias (60%), con consecuencias funcionales y biomecanicas si no se diagnostica oportunamente. El objetivo es describir la experiencia diagnostica y el tratamiento ortopedico de una entidad inusual en trauma de rodilla. Se presenta a un paciente de 23 anos que sufrio una caida patinando y refiere protuberancia proximal en la cara lateral de la pierna izquierda, edema, dolor y limitacion para extender la rodilla. Nivel de Evidencia: IV
Proximal tibiofibular dislocation is uncommon, and it is related to sport injuries as a result of an external rotation trauma with the knee in fully flexed position, and foot pointing inwards and downwards. It causes pain in the anterolateral aspect of the knee, motion is complete but painful. Diagnosis is clinical and radiological. This entity goes unnoticed in the emergency department (60%), with functional and biomechanic consequences if diagnosis is no immediate. The objective is to describe diagnostic experience and orthopedic treatment of an unusual knee condition. We present a 23-year-old patient who fell while skating. He refers a proximal protuberance in the lateral face of the left leg, edema, pain, and limitation for knee extension. Level of Evidence: IV
Assuntos
Adulto , Fraturas da Tíbia , Luxação do Joelho/diagnóstico , Luxação do Joelho/terapia , Luxação do Joelho/diagnóstico por imagem , Redução Fechada , Doença AgudaRESUMO
A luxação traumática isolada da articulação tibiofibular proximal é rara. Esta lesão pode não ser reconhecida ou diagnosticada no atendimento inicial. A ausência de suspeita clínica pode causar problemas para o diagnóstico. O diagnóstico necessita de história precisa do mecanismo e sintomas da lesão, avaliação clínica e radiográfica adequada de ambos joelhos. Casos não reconhecidos são fonte de alterações crônicas. O tratamento é feito por redução fechada e imobilização ou, em casos irredutíveis ou instáveis, redução aberta com fixação interna temporária. Um caso raro de luxação tibiofibular proximal isolada em um jogador de basquetebol é relatado para ilustrar essa lesão.
The isolated traumatic dislocation of the proximal tibiofibular joint is rare. The injury could go unrecognized or be misdiagnosed at the initial presentation. Lack of clinical suspicion can cause diagnostic problems. The diagnosis requires accurate history of the mechanism and symptoms of the injury, and adequate clinical and radiographic evaluation of the both knees. Overlooked injuries are a source of potentially chronic changes. The treatment is closed reduction and immobilization or, in case of a failed or unstable reduction, open reduction with temporary internal fixation. A rare case of acute isolated anterolateral dislocation of the proximal tibiofibular joint in a basketball player was described to illustrate this injury.
Assuntos
Humanos , Masculino , Adulto , Basquetebol , Fíbula/lesões , Luxação do Joelho/classificação , Luxação do Joelho , Luxação do Joelho/terapiaRESUMO
BACKGROUND: Review the most relevant aspects of the posterolateral corner anatomy of the knee, based on the analysis of papers that throughout the years have made important contributions to the knowledge of these structures. Last et al rejected the idea that the popliteal tendon is an isolated structure, suggesting rather that its variants are closely linked to other anatomical structures. The studies by Tria et al contributed the features of the tendon as it attaches to the lateral condyle, just to mention a couple of examples. CASE REPORT: This is the case of a 48 year-old female patient with a knee injury caused by an external rotation mechanism. Clinical features included pain, a protruding sensation in the lateral aspect of the knee, and voluntary pseudoblocking resulting from external rotation maneuvers. Knee arthroscopy was performed and dislocation of the popliteal tendon anterior to the lateral condyle was diagnosed, besides a longitudinal tear. The tendon was repositioned, radiofrequency was applied to both the tendon and the popliteal hiatus, and the former was kept in place with a plaster cast worn for 6 weeks. DISCUSSION: Even though the isolated tear or avulsion of the tendon has already been reported, the dislocation or instability of the popliteal tendon as it relates to the lateral femoral condyle has apparently not been approached yet. As we did in this case, other authors have also confirmed the diagnosis arthroscopically, Naver in 1985, Rose in 1988, and Burstein in 1990.