Failure of a reconstructed anterior cruciate ligament (ACL) has significant morbidity in the paediatric and adolescent patient population. Untreated concomitant posterolateral corner (PLC) injury is an identified cause of failed ACL reconstruction; however, the injury pattern has yet to be defined for the paediatric population.
Magnetic resonance imaging (MRI) studies of the knee performed between 1 January 2009 and 1 January 2013 were retrospectively reviewed. Imaging reports indicating an intra-substance injury of the ACL were reviewed, and all associated injured structures were recorded. Injury patterns were categorised by age, gender, physis status and associated injuries. Logistic regression and chi-square analyses compared ACL disruptions with and without concomitant PLC injuries.
One hundred and twenty-eight patients (74 boys and 54 girls, average age 15.27 years) sustained an ACL disruption. Concomitant injury to the PLC was seen in 13.3 % of injuries. Associated PLC injuries were significantly associated with lateral meniscus injury and Segond fractures. Lateral meniscus injury was predictive of PLC injury (p = 0.05) upon logistic regression analysis.
Concomitant PLC injuries were found in 13.3 % of all ACL disruptions on MRI analysis. Lateral meniscus injuries associated with an ACL disruption were predictive of concomitant PLC injury. Combined injury of the ACL and lateral meniscus should prompt close scrutiny to PLC structures.
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Adirim TA, Cheng TL (2003) Overview of injuries in the young athlete. Sports Med 33(1):75–81
Kercher J, Xerogenanes J, Tannenbaum A, Al-Hakim R, Black JA, Zhao J (2009) Anterior cruciate ligament reconstruction in the skeletally immature: An anatomic study utilizing 3-dimensional magnetic resonance imaging reconstructions. J Pediatr Orthop 29(2):124–129
Liu RW, Farrow LD, Messerschmitt PJ, Gilmore A, Goodfellow DB, Cooperman DR (2008) An anatomical study of the pediatric intercondylar notch. J Pediatr Orthop 28(2):177–183
Dimeglio A (2006) Growth in pediatric orthopaedics. In: Morrissy RT, Weinstein SL (eds) Lovell & winter’s pediatric orthopaedics, 6th edn. Lippincott Williams & Wilkins, Philadelphia, pp 35–65
Fabricant PD, Jones KJ, Delos D, Cordasco FA, Marx RG, Pearle AD, Warren RF, Green DW (2013) Reconstruction of the anterior cruciate ligament in the skeletally immature athlete: a review of current concepts: AAOS exhibit selection. J Bone Joint Surg Am 95(5):e28
Ménétrey J, Duthon VB, Laumonier T, Fritschy D (2008) “Biological failure” of the anterior cruciate ligament graft. Knee Surg Sports Traumatol Arthrosc 16(3):224–231
Kanamori A, Sakance M, Zeminski J, Rudy TW, Woo SL (2000) In-situ force in the medial and lateral structures of intact and ACL-deficient knees. J Orthop Sci 5(6):567–571
Ranawat A, Baker CL, Henry S, Harner CD (2008) Posterolateral corner injury of the knee: evaluation and management. J Am Acad Orthop Surg 16(9):506–518
Vinson EN, Major NM, Helms CA (2008) The posterolateral corner of the knee. AJR Am J Roentgenol 190(2):449–458
Bonanzinga T, Zaffagnini AS, Grassi A, Marcheggiani Muccioli GM, Neri MP, Marcacci M (2013) Management of combined anterior cruciate ligament-posterolateral corner tears: a systematic review. Am J Sports Med 42(6):1496–1503
LaPrade RF, Johanse S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32(4):1405–1414
Kim SJ, Choi DH, Hwang BY (2012) The influence of posterolateral rotatory instability on ACL reconstruction: comparison between isolated ACL reconstruction and ACL reconstruction combine with posterolateral corner reconstruction. J Bone Joint Surg Am 94(3):253–259
LaPrade RF, Wentorf FA, Fritts H, Gundry C, Hightower CD (2007) A prospective magnetic resonance imaging study of the incidence of posterolateral and multiple ligament injuries in acute knee injuries presenting with a hemarthrosis. Arthroscopy 23(12):1341–1347
McCarroll JR, Rettig AC, Shelbourne KD (1988) Anterior cruciate ligament injuries in the young athlete with open physes. Am J Sports Med 16(1):44–47
Millett PJ, Willis AA, Warren RF (2002) Associated injuries in the pediatric and adolescent anterior cruciate ligament tears: does a delay in treatment increase the risk of meniscal tear? Arthroscopy 18(9):955–959
Samora WP, Palmer R, Klingele KE (2011) Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes. J Pediatr Orthop 31(3):272–276
Dumont GD, Hogue GD, Padalecki JR, Okoro N, Wilson PL (2012) Meniscal and chondral injuries associated with pediatric anterior cruciate ligament tears: relationship of treatment time and patient-specific factors. Am J Sports Med 40(9):2128–2133
Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee: a biomechanical study. J Bone Joint Surg Am 69(2):233–242
Helito CP, Bonadio MB, Demanqe MK, da Mota e Albuquerque RF, Pécora JR, Camanho GL, Angelini FJ (2015) Functional assessment of combined reconstruction of the anterior cruciate ligament and posterolateral corner with a single femoral tunnel: a two-year minimum follow-up. Int Orthop 39(3):543–548
Monadio MB, Helito CP, Gury LA, Demanqe MK, Pecora JR, Angelini FJ (2014) Correlation between magnetic resonance imaging and physical exam in assessment of injuries to posterolateral corner of the knee. Acta Ortop Bras 22(3):124–126
The authors thank Richard Topolski, PhD, for his assistance with statistical analysis.
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The authors declare that they have no conflicts of interest to report.
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Shaw, K.A., Dunoski, B.S., Mardis, N.J. et al. Combined posterolateral corner and acute anterior cruciate ligament injuries in an adolescent cohort: a magnetic resonance imaging analysis. International Orthopaedics (SICOT) 40, 555–560 (2016). https://doi.org/10.1007/s00264-015-3026-x