Chapter FM.qxd 2/7/06 11:37 AM Page i Posterolateral Knee Injuries Anatomy, Evaluation, and Treatment Chapter FM.qxd 2/7/06 11:37 AM Page ii Chapter FM.qxd 2/7/06 11:37 AM Page iii Posterolateral Knee Injuries Anatomy, Evaluation, and Treatment Robert F. LaPrade, M.D., Ph.D. Professor Department of Orthopaedic Surgery University of Minnesota Minneapolis, Minnesota Thieme New York• Stuttgart Chapter FM.qxd 2/7/06 11:37 AM Page iv Thieme Medical Publishers, Inc. 333 Seventh Ave. New York, NY 10001 Executive Editor: Esther Gumpert Associate Editor: Owen Zurhellen IV Vice President, Production and Electronic Publishing: Anne T. Vinnicombe Production Editor: Print Matters, Inc. Sales Manager: Ross Lumpkin Chief Financial Officer: Peter van Woerden President: Brian D. Scanlan Compositor: Thomson Digital Services Printer: Maple-Vail Library of Congress Cataloging-in-Publication Data LaPrade, Robert F. Posterolateral knee injuries: anatomy, evaluation, and treatment/Robert F. LaPrade. p.; cm. Includes bibliographical references and index. ISBN 1-58890-303-6 (US: hc.) – ISBN 3-13-140311-X (GTV:hc.) 1. Knee–Wounds and injuries. 2. Knee–Wounds and injuries–Treatment. I. Title. [DNLM: 1. Knee Injuries–diagnosis. 2. Knee Injuries–history. 3. Knee Injuries–therapy. 4. Knee Joint–anatomy & histology. WE 870 L317p 2006] RD561.L34 2006 617.5’82044–dc22 2005046718 Copyright ©2006 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation without the publisher's consent is illegal and liable to prosecution. This applies in particular to photostat reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfilms, and electronic data processing and storage. Important note: Medical knowledge is ever-changing. 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Printed in the United States 5 4 3 2 1 TMP ISBN 1-58890-303-6 GTV ISBN 3 13 140311 X Chapter FM.qxd 2/7/06 11:37 AM Page v To my wife, Sandy, and sons, Christopher, Matthew, and Jeffrey Chapter FM.qxd 2/7/06 11:37 AM Page vi Chapter FM.qxd 2/7/06 11:37 AM Page vii Contents FFoorreewwoorrdd .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..iixx Lars Engebretsen, M.D., Ph.D. PPrreeffaaccee .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..xxii AAcckknnoowwlleeddggmmeennttss .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..xxiiiiii Chapter 1 Introduction and Incidence of Posterolateral Knee Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 Chapter 2 History of the Nomenclature and Study of the Anatomy of the Posterolateral Knee . . . . . . . . . . . . . . . . . .9 Chapter 3 Comprehensive Anatomy of the Structures of the Posterolateral Knee . . . . . . . . . . . . . . . . . . . . . . . . . .50 Chapter 4 Mechanism and Presenting History of Posterolateral Knee Injuries . . . . . . . . . . . . . . . . . . . . . .75 Chapter 5 Clinical Examination of Posterolateral Knee Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .79 Chapter 6 Clinically Relevant Biomechanics of Posterolateral Knee Injuries . . . . . . . . . . . . . . . . . . . . . . .105 Chapter 7 Treatment of Posterolateral Knee Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141 Chapter 8 Rehabilitation of Posterolateral Corner Knee Injuries and Related Surgeries . . . . . . . . . . . . . . . .197 Chapter 9 Complications Associated with Posterolateral Knee Injuries . . . . . . . . . . . . . . . . . . . . . . . .214 IInnddeexx . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .227 vii Chapter FM.qxd 2/7/06 11:37 AM Page viii Chapter FM.qxd 2/7/06 11:37 AM Page ix Foreword Posterolateral knee injuries are important for two main reasons. Grade 3 lesions do not usually heal on their own, and in combined knee injuries the postero- lateral lesions are often the main problem for the patient as well as for the treating physician. Furthermore, failure to diagnose a grade 3 injury in the acute phase results in a chronic injury, which often leads to significant func- tional limitations during minor activities, to meniscal tears, and, if untreated, to a high incidence of arthritis over time. Similar to other areas of the body, the posterolateral anatomy of the knee has evolved through the years. Whereas our forefather-physicians Hippocrates and Galen did all their dissections in various animals, the well-known Italian anatomist and surgeon Morgagni from the University of Padova in Italy led the way in describing human anatomy and in a scientific approach to surgery. His many case studies are filled with detailed descriptions at autopsy of human anatomy, unknown to most surgeons up to that time. This book also falls into the tradition of the famous British naturalist and physician John Hunter, who practiced surgery in London at the time that the American Declaration of Independence was written in 1776. His scientific approach to dissections led to new ways of performing surgery, and he is the one who introduced the expression “clinical scientist.” With references stretching from J. B. Winslow's book in 1733 to work car- ried out as recently as 2003, this very first book on the posterolateral structures of the knee encompasses centuries of anatomic, biomechanical, and clinical accomplishments. It spans developments over three centuries in France, Italy, England, Germany, and Australia, in addition to the United States, and as such is written in a true international style. The author, groomed into the Hughston philosophy of anatomic restoration in human surgery, is a true clinical scientist in the best John Hunter tradition. First, he recognizes a major clinical problem through epidemiologic studies. Second, he follows the Hunter tradition with extensive dissection studies. These studies lead to trials on repair and recon- structions on cadaver specimens followed by laboratory studies on various reconstruction procedures. Then clinical studies are carried out. Thus, this book ix