Evolving evidence in the treatment of primary and recurrent posterior cruciate ligament injuries, part 2: surgical techniques, outcomes and rehabilitation.

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Abstract

[Indexed for MEDLINE] Conflict of interest statement: VM reports educational grants, consulting fees, and speaking fees from Smith & Nephew plc, educational grants from Arthrex, is a board member of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), and deputy editor-in-chief of Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA). In addition, VM has a patent Quantified injury diagnostics-U.S. Patent No. 9,949,684, Issued on April 24, 2018 issued to University of Pittsburgh. 5. Skeletal Radiol. 2021 May;50(5):945-953. doi: 10.1007/s00256-020-03645-z. Epub 2020 Oct 9. The Stieda fracture revisited. Stevens KJ(1), Albtoush OM(2), Lutz AM(3). Author information: (1)Department of Radiology, Stanford University Medical Center, Grant Building S062A, 300 Pasteur Drive, Stanford, CA, 94305, USA. kate.stevens@stanford.edu. (2)Department of Diagnostic and Interventional Radiology, University of Jordan, Queen Rania Street, Amman, 11942, Jordan. (3)Department of Radiology, Stanford University Medical Center, Grant Building S062A, 300 Pasteur Drive, Stanford, CA, 94305, USA. OBJECTIVE: This study aimed to evaluate injury patterns associated with Stieda avulsion fractures of the medial femoral condyle at the attachment of the proximal MCL. MATERIALS AND METHODS: Knee radiographs and MRI scans of 11 patients with Stieda fractures were evaluated by two fellowship-trained MSK radiologists for fracture origin, integrity of the deep and superficial components of the MCL, medial retinacular structures, posterior oblique ligament, other ligamentous injuries, meniscal tears, and osteochondral injuries. The mechanism of injury and subsequent clinical management were recorded. RESULTS: Eight Stieda fractures only involved the meniscofemoral fibers of the deep MCL, two larger Stieda fractures related to both superficial and deep layers, and one fracture only involved the superficial layer. Posteromedial retinacular structures and posterior oblique ligament were injured in all cases. Eight had high-grade ACL injuries, but none had high-grade PCL nor FCL injuries. The proximal anterolateral ligament was injured in seven, including two with associated Segond fractures. Other injuries included posterolateral corner injuries in six, meniscal injuries in seven, and additional fractures in nine, most commonly ACL-associated impaction fractures in the lateral tibiofemoral compartment. None had high-grade chondral injury. None of the Stieda fractures were treated surgically, but four underwent subsequent ACL reconstruction. CONCLUSION: Stieda fractures most commonly involved the deep fibers of the MCL and were accompanied by moderate-to-high-grade injury of other MCL components. There was a high association with other ligamentous injuries, particularly the posterior medial retinacular structures, posterior oblique ligament, and ACL, and many were associated with additional fractures. DOI: 10.1007/s00256-020-03645-z