TY - JOUR
T1 - Injuries of the posteromedial bundle of the posterior cruciate ligament after knee hyperextension trauma
T2 - A new clinical entity based on an original case series
AU - Mouton, Caroline
AU - Ibañez, Maximiliano
AU - Hoffmann, Felix
AU - Monllau, Joan Carles
AU - Seil, Romain
N1 - ACKNOWLEDGEMENTS
We would like to thank Charles Pioger, MD, Renaud Siboni, MD and Giulio Vittone, MD, for the research assistance for data gathering. The authors have no funding to report.
Publisher Copyright:
© 2024 The Author(s). Journal of Experimental Orthopaedics published by John Wiley & Sons Ltd on behalf of European Society of Sports Traumatology, Knee Surgery and Arthroscopy.
PY - 2024/7
Y1 - 2024/7
N2 - Purpose: This original case series aims to describe an uncommon triad of clinical signs in patients presenting with persistent pain and inability to resume physical activities after knee hyperextension trauma. Methods: Patient history, clinical examination, arthroscopic findings and investigations of 12 patients who consulted with the senior author are presented. Results: Twelve patients (seven males/five females) presented with persistent pain after knee hyperextension trauma either in sport or a traffic accident. They had a median age of 18.5 and a median body mass index of 23 kg/m2. All had medical visits and at least one magnetic resonance imaging (MRI) before visiting the senior author's institution but the cause of their problems could not be explained. The clinical examination of the injured knee appeared normal except for an uncommon triad of clinical signs with the knee close to extension: (1) a grade 1+ anterior–posterior laxity around 10–20° of knee flexion with a firm end-point (pseudo-Lachman sign), (2) a grade 1+ tibiofemoral step-off sign with a posterior drawer at 10–20° of knee flexion and (3) an increased knee hyperextension compared to the contralateral side. Arthroscopy of eight patients confirmed the pseudo-Lachman sign with a grade I posterior drawer close to knee extension, normal posterior laxity at 90° of knee flexion and an intact anterior cruciate ligament. Conclusion: Patients displayed an increased hyperextension and posterior laxity close to knee extension which normalised at 90° of knee flexion. In patients with a history of knee hyperextension trauma associated with persistent pain, inability to resume physical activities, inconclusive MRIs and a standard clinical examination, clinicians should consider extending their investigations with the knee close to extension to identify this clinical triad consistent with a lesion to the posteromedial bundle of the posterior cruciate ligament. Level of evidence: Level IV.
AB - Purpose: This original case series aims to describe an uncommon triad of clinical signs in patients presenting with persistent pain and inability to resume physical activities after knee hyperextension trauma. Methods: Patient history, clinical examination, arthroscopic findings and investigations of 12 patients who consulted with the senior author are presented. Results: Twelve patients (seven males/five females) presented with persistent pain after knee hyperextension trauma either in sport or a traffic accident. They had a median age of 18.5 and a median body mass index of 23 kg/m2. All had medical visits and at least one magnetic resonance imaging (MRI) before visiting the senior author's institution but the cause of their problems could not be explained. The clinical examination of the injured knee appeared normal except for an uncommon triad of clinical signs with the knee close to extension: (1) a grade 1+ anterior–posterior laxity around 10–20° of knee flexion with a firm end-point (pseudo-Lachman sign), (2) a grade 1+ tibiofemoral step-off sign with a posterior drawer at 10–20° of knee flexion and (3) an increased knee hyperextension compared to the contralateral side. Arthroscopy of eight patients confirmed the pseudo-Lachman sign with a grade I posterior drawer close to knee extension, normal posterior laxity at 90° of knee flexion and an intact anterior cruciate ligament. Conclusion: Patients displayed an increased hyperextension and posterior laxity close to knee extension which normalised at 90° of knee flexion. In patients with a history of knee hyperextension trauma associated with persistent pain, inability to resume physical activities, inconclusive MRIs and a standard clinical examination, clinicians should consider extending their investigations with the knee close to extension to identify this clinical triad consistent with a lesion to the posteromedial bundle of the posterior cruciate ligament. Level of evidence: Level IV.
KW - hyperextension
KW - partial tears
KW - persistent knee pain
KW - posterior cruciate ligament
KW - posteromedial bundle
UR - http://www.scopus.com/inward/record.url?scp=85197528333&partnerID=8YFLogxK
UR - https://pubmed.ncbi.nlm.nih.gov/38974050/
U2 - 10.1002/jeo2.12052
DO - 10.1002/jeo2.12052
M3 - Article
C2 - 38974050
AN - SCOPUS:85197528333
SN - 2197-1153
VL - 11
JO - Journal of Experimental Orthopaedics
JF - Journal of Experimental Orthopaedics
IS - 3
M1 - e12052
ER -