Knee Instability

[beatle]

I have a patient who has excessive tibial external rotation, , however MRI results show ligaments are OK. The rotation laxity is continuing to be symptomatic to the patient despite rehab. Other than bracing, continued strengthening - are there any other options that might be available??

Thanks for any advice.

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[beatle]

2nd question:

can anything be done surgically for a loose joint when no specific ligaments are torn??

[ATTIreland]

Hi Beatle,

Could you give more information about the history i.e. was there a specific incident of injury or previous injury? What sort of activity/occupation has the patient?

Also what is the patients complaint (pain? instability?)as having excess rotation is just a clinical finding.

As far as the MRI goes dont forget that they are not 100% sensitive and depend largely on the ability of the radiologist reviewing them. A second opinion from a radiologist may not be a bad idea if you are still unsure of the cause.

One thing that springs to mind would be a posterio-lateral ligament complex injury as these can lead to instability and are often overlooked both by clinicians and radiologists. Maybe read up on this area and see does it relate to your clinical findings?

[beatle]

Hi ATTIreland,

Thanks for your reply. There is no one specific traumatic injury that occurred however, there have been minor repetitive twisting incidents.

The patient also has known patellofemoral pain as well as lateral knee pain. Pivoting/twisting is symptomatic of too much external rotation to the patient. Changes of direction are also a concern.

2nd opinion on the MRI is a good idea. They do have an increased laxity with LCL testing however, this is a clinical finding only.

I will read up on posterolateral ligament complex...