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Child Orthopedics
Spine - Cervical
Spine - Lumbar
Spine - Thoracic

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Our college-aged son plays soccer and hockey for his school. Last winter he injured his knee and was told he could rehab it without surgery. Doesn't look like that was sound advice. A second opinion (six months later) showed from the MRIs that there is a torn cruciate ligament and damage to the back and side corner of the knee. What happens now? What treatment will be needed?

Injury to the "corners" of the knee joint are often difficult to diagnose and a real challenge to treat. Various studies have been done to determine the best way to treat these injuries. Many questions have been asked and explored. For example, is surgery even needed? If so, how can this be decided and when is the optimal time to perform the procedure? What type of surgical intervention works best? A recent report from an orthopedic surgeon at the University of Connecticut may help answer some of these questions and give you a little guidance at the same time. Treatment for any of the corner injuries requires careful and accurate diagnosis. The surgeon depends on the physical examination and imaging studies for this. In the case of a posterolateral corner (the subject of this article), the surgeon tests for ligamentous laxity of the posterior cruciate ligament (PCL), anterior cruciate ligament (ACL), and the medial collateral ligament. Identifying all of the damaged soft tissues in a knee injury is important. An isolated posterolateral (PLC) injury may not require surgery. Conservative (nonoperative) care for an isolated PLC injury has the same results as doing surgery. Surgery is only advised when PLC injuries are accompanied by damage to the cruciate ligaments as well. When surgery is needed, it should be done within three weeks of the injury. Early surgery has been shown to have better results compared with delayed procedures. And reconstruction of the corner (rather than just attempting to repair the damage) is more likely to be successful. With reconstruction, there is more knee stability, better function, improved range-of-motion, and less risk of arthrofibrosis (stiff knee from fibrous adhesions). Since it has been some time since the injury occurred, your son's injury is now considered to be chronic. The delay in treatment will likely mean reconstructive surgery is needed. There are many different techniques and treatment approaches to the repair of a posterolateral corner injury combined with a cruciate ligament tear. The basic idea behind a reconstructive procedure is to use tendon graft material (e.g., from the hamstrings muscle), thread it through tunnels placed in the bones around the knee in order to secure it to the bone. One type of screw is used to hold the graft in place. Another screw called the interference screw helps determine the amount of tension places on the graft. The position, angle, and tension of the graft material are very important in restoring the right amount of rotation, motion, and angle of the joint itself. Recovery takes many months (at least six up to one year or more) with some time in rehab. But the results are usually very good. Young athletes like your son are able to return to their sports and play/compete at a level equal to (if not better) than before the injury.


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