J Korean Orthop Assoc.
1975 Jun;10(2):167-174. 10.4055/jkoa.1975.10.2.167.
Clinical Study for Ligamentous Injuries of the Knee
- Affiliations
-
- 1Department of Orthopedic Surgery, Catholic Medical College, Seoul, Korea.
- KMID: 2471389
- DOI: http://doi.org/10.4055/jkoa.1975.10.2.167
Abstract
- In 1938, Palmer pointed out the essential pathological features of acute ligamentous injuries of the knee, and since then many authors have presented the mechanisms of injuries, anatomical details, diagnostic tests and methods of treatment. Recently. Hughston (1971) attempted to separate the "posterior oblique ligament" from previous anatomical interpretations of its being a posterior portion of the tibial collateral ligament and described the structural and functional importances of this ligament in the knee at 60 degrees of flexion when compared with the knee at 15 degrees of flexion. Hughston and Ellers (1973) stated "With the knee at 60 degrees of flexion, the distance between the femoral and tibial attachment of the posterior oblique ligament is consistently at least 0.5 centimeter less than it was at 15 degrees of flexion. These findings suggest that repair and subsequent immobilization of the posterior oblique ligament with the knee at 60 degrees of flexion would allow 0.5 centimeter more shortening of the ligament than would be possible with the knee held at 15 degrees of flexion. Repair of the ligament and immobilization of the knee at 15 or 30 degrees of flexion, as commonly recommended, would therefore result in at least 0-5 centimeter of "˜play' or looseness of the posterior oblique ligament when the knee is as 60 degrees of flexion". They also stated, "In acute complete tears of the medial collateral ligament, proper repair of the posterior oblique ligament with the knee in a position of 60 degrees of flexion will demonstrate no medial opening of the joint space on an abduction stress test done with the knee at 30 degrees or more even before the torn tibial collateral ligament has been reapproximated". Authors presented 35 cases of ligamentous injuries of the knee treated at the Orthopedic Department of St. Mary's Hospital, Catholic Medical Center from January 1971 to April 1973. Among 35 tears in 32 knees, 21(60.0%) had medial collateral ligament tear: 10(25.8%). lateral collateral ligament tear: 4 (11.4%), anterior cruciate ligament tear. Of 31 patients, 23 were male and 8 were female. One had boch knee injuries. The ages of the patients were from 13 to 63 years and most of the patients were below the age of 40 years. Of 21 knees with medial collateral ligament tear. 13 knees were immobilized at 15 degrees of flexion and 8 knees at 60 degrees of flexion; of 10 knees with lateral collateral liga knees were immobilized at 15 degrees of flexion and 4 knees at 30 degrees of flexion. The knees immobilized at 30 or 60 degrees of flexion gained better stability than the knees at 15 degrees of flexion. Thus, in acute complete tears of the medial collateral ligament, repair of the posterior oblique ligament and immobilization with the knee at 60 degrees of flexion is more desirable.
