Article

Knowledge of the mechanisms of bicruciate lesions and dislocation of the knee
enables analysis and classification in terms of injuries' location and type,
guiding surgery and facilitating assessment. Careful history taking and clinical
examination shed light on the mechanism involved, but exact identification of the
lesion further requires examination under anesthesia and static and dynamic
X-rays and MRI, which together enable precise determination of lesion type and
location. There are two types of mechanism: gaping, causing ligament tear; and
translation, causing detachment. When a single mechanism is involved, the lesion
is said to be "simple". Simple gaping causes bicruciate lesions without medial,
lateral or posterior dislocation. Simple translation causes pure anterior or
posterior dislocation. Gaping and translation may also occur in combination,
causing dislocation with peripheral tearing. There are two types of
classification: descriptive, based on X-ray findings--i.e., static
classification; and physiopathological, based on clinical and dynamic X-ray
findings. MRI further explores ligament detachment and bone lesions that are
inaccessible to clinical and conventional X-ray examination. Physiopathological
assessment-based techniques enable surgical procedure to be refined, defining the
surgical approach according to lesion location and differentiating between
lesions requiring repair (tears) and those with a good likelihood of spontaneous
healing (capsuloperiosteal detachment). The classification advocated here is
largely inspired by that of Neyret and Rongieras, extended to include dislocation
with single bicruciate ligament lesion. It covers peripheral lesions completely,
specifying type (tear or detachment) and including all bicruciate lesions as well
as dislocations.

Langue : FRANCAIS