Classification, diagnosis, and treatment system of posteromedial structure and posterolateral corner injury in knee dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HUANG Huaqiang , LI Jian ,  TANG Xin

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

TANG Xin, Email: tangxin9388@163.com

Keywords：

Knee dislocation; posteromedial structure; posterolateral corner; stage and classification; diagnosis and treatment system

DOI：

10.7507/1002-1892.201611139

Video：

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Objective To review the research progress of diagnosis and treatment system for knee dislocation (KD) based on the stage and classification of posteromedial structure and posterolateral corner injury, so as to provide guidance for clinical work. Methods The relevant literature on the classification, diagnosis and treatment was extensively reviewed. Results At present, the criterion of the stage and classification of KD mainly include classification based on the size of the injury energy, Kennedy classification, and the improved Schenck classification, but they are not perfect because of no stage and classification of multiple ligament injury and no standardized treatment of different injuries. Hua Xi Knee Dislocation and Multiple Ligament Injury (HX-KDMLI) has optimum plan for injury treatment of posteromedial structure and posterolateral corner injury in KD based on stage and classification. Conclusion At present, there is no unified opinion on stages and classifications of the posteromedial structure and posterolateral corner injury in KD as well as on diagnosis and treatment. HX-KDMLI has certain feasibility for the stage and classification of the posteromedial structure and posterolateral corner injury in KD, to a certain extent, it can be used as reference for the diagnosis and treatment of KD.

Citation： HUANG Huaqiang, LI Jian, TANG Xin. Classification, diagnosis, and treatment system of posteromedial structure and posterolateral corner injury in knee dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(5): 614-619. doi: 10.7507/1002-1892.201611139 Copy

1.	Schenck RC Jr, Richter DL, Wascher DC. Knee Dislocations: Lessons Learned From 20-Year Follow-up. Orthop J Sports Med, 2014, 2(5): 1-10.
2.	Boisgard S, Versier G, Descamps S, et al. Bicruciate ligament lesions and dislocation of the knee: mechanisms and classification. Orthop Traumatol Surg Res, 2009, 95(8): 627-631.
3.	Arom GA, Yeranosian MG, Petrigliano FA, et al. The changing demographics of knee dislocation: a retrospective database review. Clin Orthop Relat Res, 2014, 472(9): 2609-2614.
4.	Jang KM, Lee HS, Wang JH. Open reduction of irreducible posterolateral rotary knee dislocation without sectioning of incarcerated vastus medialis: a case report with video illustration. Knee, 2014, 21(2): 582-585.
5.	Polyzois VD, Stathopoulos IP, Benetos IS, et al. A Two-stage procedure for the treatment of a neglected posterolateral knee dislocation: Gradual reduction with an Ilizarov external fixator followed by arthroscopic anterior and posterior cruciate ligament reconstruction. Knee, 2016, 23(1): 181-184.
6.	Xu H, Guo R, Xu B. An irreducible posterolateral knee dislocation: diagnosis, arthroscopic view, and treatment. Am J Emerg Med, 2016, 34(11): 2256.e3-2256.e4.
7.	李箭. 膝关节脱位多发韧带损伤的华西分期分型诊治. 中国西部运动医学第一次学术会议. 成都: 2015.
8.	张承昊, 李棋, 李箭. 华西膝关节脱位多发韧带损伤分期分型诊断及对治疗的指导意义的初步研究. 中华医学会第十七届骨科学术会议暨第十届 COA 国际学术大会. 重庆: 2015.
9.	Stannard JP. Medial and posteromedial instability of the knee: evaluation, treatment, and results. Sports Med Arthrosc, 2010, 18(4): 263-268.
10.	LaPrade RF, Bernhardson AS, Griffith CJ, et al. Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med, 2010, 38(2): 331-338.
11.	Bonasia DE, Bruzzone M, Dettoni F, et al. Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results. Iowa Orthop J, 2012, 32: 173-183.
12.	Pedersen RR. The Medial and Posteromedial Ligamentous and Capsular Structures of the Knee: Review of Anatomy and Relevant Imaging Findings. Semin Musculoskelet Radiol, 2016, 20(1): 12-25.
13.	Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5): 1266-1280.
14.	Jiang KN, West RV. Management of Chronic Combined ACL Medial Posteromedial Instability of the Knee. Sports Med Arthrosc, 2015, 23(2): 85-90.
15.	Menzer H, Treme G, Wascher D. Surgical treatment of medial instability of the knee. Sports Med Arthrosc, 2015, 23(2): 77-84.
16.	孙阳, 徐刚, 王晓东. 低场磁共振在膝关节内侧副韧带损伤中的应用. 中国医药科学, 2013, 3(1): 123-124.
17.	Engebretsen L, Lind M. Anteromedial rotatory laxity. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2797-2804.
18.	Schweller EW, Ward PJ. Posterolateral Corner Knee Injuries: Review of Anatomy and Clinical Evaluation. J Am Osteopath Assoc, 2015, 115(12): 725-731.
19.	Morelli V, Bright C, Fields A. Ligamentous injuries of the knee: anterior cruciate, medial collateral, posterior cruciate, and posterolateral corner injuries. Prim Care, 2013, 40(2): 335-356.
20.	Kim YH, Purevsuren T, Kim K, et al. Contribution of posterolateral corner structures to knee joint translational and rotational stabilities: a computational study. Proc Inst Mech Eng H, 2013, 227(9): 968-975.
21.	Kovachevich R, Shah JP, Arens AM, et al. Operative management of the medial collateral ligament in the multiligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 823-829.
22.	Chahal J, Al-Taki M, Pearce D, et al. Injury patterns to the posteromedial corner of the knee in high-grade multiligament knee injuries: a MRI study. Knee Surg Sports Traumatol Arthrosc, 2010, 18(8): 1098-1104.
23.	Tibor LM, Marchant MH Jr, Taylor DC, et al. Management of medial-sided knee injuries, part2: posteromedial corner. Am J Sports Med, 2011, 39(6): 1332-1340.
24.	McAllister DR, Miller MD, Sekiya JK, et al. Posterior cruciate ligament biomechanics and options for surgical treatment. Instr Course Lect, 2009, 58: 377-388.
25.	Laprade RF, Wijdicks CA. The management of injuries to the medial side of the knee. J Orthop Sports Phys Ther, 2012, 42(3): 221-233.
26.	Smyth MP, Koh JL. A review of surgical and nonsurgical outcomes of medial knee injuries. Sports Med Arthrosc, 2015, 23(2): e15-22.
27.	Werner BC, Hadeed MM, Gwathmey FW Jr, et al. Medial injury in knee dislocations: what are the common injury patterns and surgical outcomes? Clin Orthop Relat Res, 2014, 472(9): 2658-2666.
28.	Osti L, Papalia R, Del Buono A, et al. Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc, 2010, 18(3): 312-316.
29.	Marchant MH Jr, Tibor LM, Sekiya JK, et al. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med, 2011, 39(5): 1102-1113.
30.	卢启贵, 王平, 黄东红, 等. 自体半腱肌转移解剖重建膝内侧副韧带Ⅲ度损伤的临床疗效分析. 中国骨与关节损伤杂志, 2014, 29(1): 94-95.
31.	Fanelli GC, Edson CJ. Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity): surgical technique and 2- to 18-year results. J Knee Surg, 2012, 25(4): 307-316.
32.	Bollier M, Smith PA. Anterior cruciate ligament and medial collateral ligament injuries. J Knee Surg, 2014, 27(5): 359-368.
33.	Becker EH, Watson JD, Dreese JC. Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. J Orthop Trauma, 2013, 27(4): 226-231.
34.	孙正宇, 李箭. 膝关节脱位合并多发韧带损伤患者血管神经损伤诊治的研究进展. 中国骨与关节杂志, 2015, 4(12): 978-983.
35.	Dwyer T, Whelan D. Anatomical considerations in multiligament knee injury and surgery. J Knee Surg, 2012, 25(4): 263-274.
36.	Noyes FR, Barber-Westin SD. Long-term assessment of posterolateral ligament femoral-fibular reconstruction in chronic multiligament unstable knees. Am J Sports Med, 2011, 39(3): 497-505.
37.	Levy BA, Dajani KA, Morgan JA, et al. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med, 2010, 38(4): 804-809.
38.	Geeslin AG, LaPrade RF. Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg (Am), 2011, 93(18): 1672-1683.
39.	Kim SJ, Shin SJ, Choi CH, et al. Reconstruction by biceps tendon rerouting for posterolateral rotatory instability of the knee: Modification of the Clancy technique. Arthroscopy, 2001, 17(6): 664-667.
40.	Fanelli GC. Posterolateral Instability of the Knee. J Knee Surg, 2015, 28(6): 433-434.
41.	Moulton SG, Geeslin AG, LaPrade RF. A Systematic Review of the Outcomes of Posterolateral Corner Knee Injuries, Part 2: Surgical Treatment of Chronic Injuries. Am J Sports Med, 2016, 44(6): 1616-1623.
42.	Nau T, Chevalier Y, Hagemeister N, et al. Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med, 2005, 33(12): 1838-1845.

1. Schenck RC Jr, Richter DL, Wascher DC. Knee Dislocations: Lessons Learned From 20-Year Follow-up. Orthop J Sports Med, 2014, 2(5): 1-10.
2. Boisgard S, Versier G, Descamps S, et al. Bicruciate ligament lesions and dislocation of the knee: mechanisms and classification. Orthop Traumatol Surg Res, 2009, 95(8): 627-631.
3. Arom GA, Yeranosian MG, Petrigliano FA, et al. The changing demographics of knee dislocation: a retrospective database review. Clin Orthop Relat Res, 2014, 472(9): 2609-2614.
4. Jang KM, Lee HS, Wang JH. Open reduction of irreducible posterolateral rotary knee dislocation without sectioning of incarcerated vastus medialis: a case report with video illustration. Knee, 2014, 21(2): 582-585.
5. Polyzois VD, Stathopoulos IP, Benetos IS, et al. A Two-stage procedure for the treatment of a neglected posterolateral knee dislocation: Gradual reduction with an Ilizarov external fixator followed by arthroscopic anterior and posterior cruciate ligament reconstruction. Knee, 2016, 23(1): 181-184.
6. Xu H, Guo R, Xu B. An irreducible posterolateral knee dislocation: diagnosis, arthroscopic view, and treatment. Am J Emerg Med, 2016, 34(11): 2256.e3-2256.e4.
7. 李箭. 膝关节脱位多发韧带损伤的华西分期分型诊治. 中国西部运动医学第一次学术会议. 成都: 2015.
8. 张承昊, 李棋, 李箭. 华西膝关节脱位多发韧带损伤分期分型诊断及对治疗的指导意义的初步研究. 中华医学会第十七届骨科学术会议暨第十届 COA 国际学术大会. 重庆: 2015.
9. Stannard JP. Medial and posteromedial instability of the knee: evaluation, treatment, and results. Sports Med Arthrosc, 2010, 18(4): 263-268.
10. LaPrade RF, Bernhardson AS, Griffith CJ, et al. Correlation of valgus stress radiographs with medial knee ligament injuries: an in vitro biomechanical study. Am J Sports Med, 2010, 38(2): 331-338.
11. Bonasia DE, Bruzzone M, Dettoni F, et al. Treatment of medial and posteromedial knee instability: indications, techniques, and review of the results. Iowa Orthop J, 2012, 32: 173-183.
12. Pedersen RR. The Medial and Posteromedial Ligamentous and Capsular Structures of the Knee: Review of Anatomy and Relevant Imaging Findings. Semin Musculoskelet Radiol, 2016, 20(1): 12-25.
13. Wijdicks CA, Griffith CJ, Johansen S, et al. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg (Am), 2010, 92(5): 1266-1280.
14. Jiang KN, West RV. Management of Chronic Combined ACL Medial Posteromedial Instability of the Knee. Sports Med Arthrosc, 2015, 23(2): 85-90.
15. Menzer H, Treme G, Wascher D. Surgical treatment of medial instability of the knee. Sports Med Arthrosc, 2015, 23(2): 77-84.
16. 孙阳, 徐刚, 王晓东. 低场磁共振在膝关节内侧副韧带损伤中的应用. 中国医药科学, 2013, 3(1): 123-124.
17. Engebretsen L, Lind M. Anteromedial rotatory laxity. Knee Surg Sports Traumatol Arthrosc, 2015, 23(10): 2797-2804.
18. Schweller EW, Ward PJ. Posterolateral Corner Knee Injuries: Review of Anatomy and Clinical Evaluation. J Am Osteopath Assoc, 2015, 115(12): 725-731.
19. Morelli V, Bright C, Fields A. Ligamentous injuries of the knee: anterior cruciate, medial collateral, posterior cruciate, and posterolateral corner injuries. Prim Care, 2013, 40(2): 335-356.
20. Kim YH, Purevsuren T, Kim K, et al. Contribution of posterolateral corner structures to knee joint translational and rotational stabilities: a computational study. Proc Inst Mech Eng H, 2013, 227(9): 968-975.
21. Kovachevich R, Shah JP, Arens AM, et al. Operative management of the medial collateral ligament in the multiligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 823-829.
22. Chahal J, Al-Taki M, Pearce D, et al. Injury patterns to the posteromedial corner of the knee in high-grade multiligament knee injuries: a MRI study. Knee Surg Sports Traumatol Arthrosc, 2010, 18(8): 1098-1104.
23. Tibor LM, Marchant MH Jr, Taylor DC, et al. Management of medial-sided knee injuries, part2: posteromedial corner. Am J Sports Med, 2011, 39(6): 1332-1340.
24. McAllister DR, Miller MD, Sekiya JK, et al. Posterior cruciate ligament biomechanics and options for surgical treatment. Instr Course Lect, 2009, 58: 377-388.
25. Laprade RF, Wijdicks CA. The management of injuries to the medial side of the knee. J Orthop Sports Phys Ther, 2012, 42(3): 221-233.
26. Smyth MP, Koh JL. A review of surgical and nonsurgical outcomes of medial knee injuries. Sports Med Arthrosc, 2015, 23(2): e15-22.
27. Werner BC, Hadeed MM, Gwathmey FW Jr, et al. Medial injury in knee dislocations: what are the common injury patterns and surgical outcomes? Clin Orthop Relat Res, 2014, 472(9): 2658-2666.
28. Osti L, Papalia R, Del Buono A, et al. Simultaneous surgical management of chronic grade-2 valgus instability of the knee and anterior cruciate ligament deficiency in athletes. Knee Surg Sports Traumatol Arthrosc, 2010, 18(3): 312-316.
29. Marchant MH Jr, Tibor LM, Sekiya JK, et al. Management of medial-sided knee injuries, part 1: medial collateral ligament. Am J Sports Med, 2011, 39(5): 1102-1113.
30. 卢启贵, 王平, 黄东红, 等. 自体半腱肌转移解剖重建膝内侧副韧带Ⅲ度损伤的临床疗效分析. 中国骨与关节损伤杂志, 2014, 29(1): 94-95.
31. Fanelli GC, Edson CJ. Surgical treatment of combined PCL-ACL medial and lateral side injuries (global laxity): surgical technique and 2- to 18-year results. J Knee Surg, 2012, 25(4): 307-316.
32. Bollier M, Smith PA. Anterior cruciate ligament and medial collateral ligament injuries. J Knee Surg, 2014, 27(5): 359-368.
33. Becker EH, Watson JD, Dreese JC. Investigation of multiligamentous knee injury patterns with associated injuries presenting at a level I trauma center. J Orthop Trauma, 2013, 27(4): 226-231.
34. 孙正宇, 李箭. 膝关节脱位合并多发韧带损伤患者血管神经损伤诊治的研究进展. 中国骨与关节杂志, 2015, 4(12): 978-983.
35. Dwyer T, Whelan D. Anatomical considerations in multiligament knee injury and surgery. J Knee Surg, 2012, 25(4): 263-274.
36. Noyes FR, Barber-Westin SD. Long-term assessment of posterolateral ligament femoral-fibular reconstruction in chronic multiligament unstable knees. Am J Sports Med, 2011, 39(3): 497-505.
37. Levy BA, Dajani KA, Morgan JA, et al. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med, 2010, 38(4): 804-809.
38. Geeslin AG, LaPrade RF. Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg (Am), 2011, 93(18): 1672-1683.
39. Kim SJ, Shin SJ, Choi CH, et al. Reconstruction by biceps tendon rerouting for posterolateral rotatory instability of the knee: Modification of the Clancy technique. Arthroscopy, 2001, 17(6): 664-667.
40. Fanelli GC. Posterolateral Instability of the Knee. J Knee Surg, 2015, 28(6): 433-434.
41. Moulton SG, Geeslin AG, LaPrade RF. A Systematic Review of the Outcomes of Posterolateral Corner Knee Injuries, Part 2: Surgical Treatment of Chronic Injuries. Am J Sports Med, 2016, 44(6): 1616-1623.
42. Nau T, Chevalier Y, Hagemeister N, et al. Comparison of 2 surgical techniques of posterolateral corner reconstruction of the knee. Am J Sports Med, 2005, 33(12): 1838-1845.

Chinese Journal of Reparative and Reconstructive Surgery

Classification, diagnosis, and treatment system of posteromedial structure and posterolateral corner injury in knee dislocation

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