This study suggests that unrepaired posteromedial meniscocapsular lesions will allow abnormal meniscal and tibiofemoral laxity to persist postoperatively, predisposing the knee to meniscal and articular damage.
While injury to the posterolateral corner is accepted as a relatively common occurrence associated with rupture of the anterior cruciate ligament, posteromedial meniscocapsular injury has not previously been recognised as such. In a prospective assessment of 183 consecutive reconstructions of the anterior cruciate ligament this injury was observed in 17 cases, giving it an incidence of 9.3%. Clinically, it was associated with a mild anteromedial rotatory subluxation and it is important not to confuse this with posterolateral rotatory subluxation. In no case was this injury identified by MRI. The possible long-term clinical relevance is discussed.
The declaration of a special interest in sports medicine and particularly an interest in sports orthopaedics reveals a referral base which includes knee injury as the most common presentation. Over the next four journal issues, this series will examine the general pattern of acute injuries followed by the more specific topics of instability, patellar dislocation, patellar tendon lesions, meniscal injury, and articular cartilage defects. By way of introduction, the first article highlights the magnitude of the problem, the common diagnostic inaccuracy, and the need for a regional referral structure. It was written by Steve Bollen, who completed an overseas fellowship in sports orthopaedics and has subsequently been a consultant in knee and ankle surgery at a district general hospital for eight years. He is involved in the production of Best practice guidelines in ACL reconstruction on behalf of the British Orthopaedic Association, and has treated many elite athletes mainly from the sports of soccer, rugby, and ballet.
Injury to the A2 pulley of the flexor sheath, resulting in bow-stringing of the flexor tendons, would appear to be fairly common in rock climbers performing at the present limits of difficulty. A typical case is described.
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