فهرست مطالب ariel rodriguez

Anterior cruciate ligament (ACL) tears are a common orthopaedic injury, particularly in athletic populations. Primary ACL reconstructions (ACLR) have fairly successful outcomes; however, there is a subset of patients who experience failure or re-injury and require a technically challenging revision ACLR procedure. Knowledge of the clinically relevant ACL anatomy and biomechanics, including closely associated meniscal, ligament, and osseous structures, is fundamental for an anatomic revision ACLR. Comprehensive evaluation and diagnosis are also critical to identify the causes of primary ACLR failure and determine appropriate treatment(s). Although outcomes have improved over time, revision ACLR patients still experience sub-optimal outcomes compared to primary ACLR patients. This review will highlight the current concepts of anatomy, biomechanics, clinical evaluation, treatment, outcomes, and post-operative rehabilitation to optimize outcomes for revision ACLR procedures. Level of evidence: V

Multiligament knee injuries are complex injuries that must be addressed with a comprehensive diagnostic workup andtreatment plan. Multiligament injuries are commonly observed with concomitant meniscal, chondral, and neurovascularinjuries, requiring a thorough clinical assessment and radiographic evaluation. Due to the higher failure rates associatedwith knee ligament repair following multiligament knee injury, the current literature favors single-stage anatomic kneereconstructions. Recent studies have also optimized graft sequencing and reconstruction tunnel orientation to preventgraft elongation and reduce the risk of tunnel convergence. In addition, anatomic-based ligament reconstructiontechniques and the usage of suture anchors now allow for early postoperative knee motion without the risk of stretchingout the graft. Rehabilitation following multiligament knee reconstruction should begin on postoperative day one andtypically requires 9-12 months. The purpose of this article is to review the latest principles of the surgically relevantanatomy, biomechanics, evaluation, treatment, rehabilitation, and outcomes of multiligament knee injuries.Level of evidence: V

Medial knee injuries are prevalent, especially in young athletes. A detailed history and physical examination areneeded to accurately diagnose injuries to the superficial medial collateral ligament (sMCL), deep medial collateralligament (dMCL), and posterior oblique ligament (POL). The mechanism of medial knee injury often involves acoupled valgus and external rotation force with pain and tenderness across the medial joint line. Valgus stressradiographs assist with the diagnosis of medial knee injuries based on the quantitative extent of medial jointgapping. Specifically, 3.2 mm of increased medial gapping is observed with an isolated grade-III sMCL injury andgreater than 9.8 mm of gapping indicates a complete medial knee injury. Nonoperative treatment is recommendedfor grade-I and II medial knee injuries. Patients with chronic medial knee instability, or a complete tear of the medialknee structures, may require operative treatment. Anatomic surgical techniques have proven to be highly effectivein restoring functional knee stability. 

A foundational knowledge of the anatomy and biomechanics of meniscal root tears is warranted for proper repair of meniscal root tears and for preventing some of their commonly described iatrogenic causes. Meniscal root tears are defined as either a radial tear occurring within one cm of the root attachment site of the meniscus or a complete bony or soft tissue avulsion of the root attachment altogether. Meniscal root tears disrupt the protective biomechanical function of the native meniscus. Biomechanical analyses of the current techniques for meniscal root repair highlight the importance of restoring menisci to their correct anatomic orientation, thereby restoring their biomechanical function. A comprehensive understanding of the clinical and radiographic presentations of these injuries is critical to preventing their underdiagnosis. The poor long-term outcomes associated with conservative treatment measures, namely, ipsilateral compartment osteoarthritis, warrants the surgical repair of meniscal root tears whenever possible. While excellent patient-reported outcomes exist for the various surgical repair techniques, adherence to stringent post-operative rehabilitation protocols is critical for patients to avoid damaging the integrity of a repaired root. This review will focus on current concepts pertaining to the anatomy, biomechanics, diagnosis, treatment, and postoperative rehabilitation for meniscal root tears.