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Rethinking the Schenck Classification for Multiligament Knee Injuries: Evaluating Whether the Schenck KD Grade Is Associated With the Presence of Vascular or Neurological Injuries in a Multicenter Study With 144 Patients
(SAGE Publications, 2025-03)
Enrique Sanchez-Munoz
;
Beatriz Lozano Hernanz
;
Renato Andrade
;
Cristina Valente
;
João Espregueira-Mendes
1Scopus© Citations 3
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Accuracy of Magnetic Resonance Imaging in the Diagnosis of Multiple Ligament Knee Injuries: A Multicenter Study of 178 Patients
(2023)
Enrique Sanchez-Munoz
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Beatriz Lozano Hernanz
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Jacco A.C. Zijl
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Luís Eduardo Passarelli Tirico
;
Fabio Janson Angelini
<jats:sec><jats:title>Background:</jats:title><jats:p> Magnetic resonance imaging (MRI) has shown limited diagnostic accuracy for multiple ligament knee injuries (MLKIs), especially posterolateral corner (PLC) injuries. </jats:p></jats:sec><jats:sec><jats:title>Hypothesis:</jats:title><jats:p> The diagnostic accuracy of MRI for MLKIs will only be moderate for some knee structures. Patient-related factors and injury patterns could modify the diagnostic accuracy of MRI. </jats:p></jats:sec><jats:sec><jats:title>Study Design:</jats:title><jats:p> Cohort study; Level of evidence, 3. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> All patients with MLKIs surgically treated between January 2014 and December 2020 in the centers participating in the study were reviewed. We recorded sex, age, mechanism of injury, time from injury to MRI, and vascular and neurological associated lesions. Lesions to the anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, lateral collateral ligament (LCL), popliteus tendon, popliteofibular ligament, iliotibial band, biceps tendon, medial and lateral meniscus, and articular cartilage from MRI reports and surgical records were also collected. The sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, diagnostic odds ratio, positive and negative likelihood ratio, and intraclass correlation coefficient of MRI were calculated for each knee structure. With logistic regression, associations between patient and injury characteristics and MRI accuracy were assessed. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> A total of 178 patients (127 male; mean age, 33.1 years) were included. High-energy trauma was the most common mechanism of injury (50.6%), followed by sports trauma (38.8%) and low-energy trauma (8.4%). The ACL was the structure with the best diagnostic accuracy, diagnostic odds ratio, and positive predictive value (94.4%, 113.2, and 96.8%, respectively). PLC structures displayed the worst diagnostic accuracy among knee ligaments (popliteus tendon: 76.2%; LCL: 80.3%) and diagnostic odds ratio (popliteus tendon: 9.9; LCL: 17.0; popliteofibular ligament: 17.5). MRI was more reliable in detecting the absence of meniscal and chondral lesions than in identifying them. Logistic regression found that the diagnostic accuracy was affected by the Schenck classification, with higher Schenck grades having worse diagnostic accuracy for peripheral structures (iliotibial band, popliteus tendon, and biceps tendon) and improved diagnostic accuracy for the ACL and posterior cruciate ligament. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> The diagnostic accuracy of MRI for MLKIs largely varied among knee structures, with many of them at risk of a misdiagnosis, especially PLC, meniscal, and chondral lesions. The severity of MLKIs lowered the diagnostic accuracy of MRI for peripheral structures. </jats:p></jats:sec>
6Scopus© Citations 12
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Vancomycin presoaking of hamstring autografts to prevent infection in anterior cruciate ligament reconstruction: a narrative review
(2021)
FIGUEROA BERRIOS, FRANCISCO JAVIER
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Alex Vaisman
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CALVO RODRIGUEZ, RAFAEL
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David Figueroa
;
João Espregueira-Mendes
<jats:p> Hamstring autograft use has been linked to an increased risk of infection after anterior cruciate (ACL) reconstruction compared to other grafts. The absolute reason for this remains unclear, with contamination after harvesting and preparation of the graft being the most accepted hypothesis. Using the rationale that a contaminated graft could be the main factor in postoperative septic arthritis and in an effort to maximize the antibiotic efficacy of the graft, the Vancomycin presoaking technique was developed. It has shown success in decreasing the infection rate in ACL reconstruction. In recent years, an important number of research articles using this protocol have appeared, but the technique is still not widely implemented. Recent literature shows that Vancomycin presoaking of the graft has shown a successful decrease in the infection rate after hamstring autograft ACL reconstruction. It has also shown efficacy decreasing the infection rate in other types of grafts (patellar tendon, quadriceps tendon, allograft) and also in patients with concomitant ligament procedures or open surgeries. Despite the positive effects of Vancomycin presoaking reducing the infection rate after ACL reconstruction, the lack of prospective randomized control trials and the heterogeneity of the different studies mean it is not feasible to recommend Vancomycin presoaking of the graft universally for every ACL reconstruction patient. </jats:p><jats:p> Cite this article: EFORT Open Rev 2021;6:211-216. DOI: 10.1302/2058-5241.6.200059 </jats:p>
1Scopus© Citations 7
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Posterolateral corner knee injuries: a narrative review
(2021)
FIGUEROA BERRIOS, FRANCISCO JAVIER
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FIGUEROA POBLETE, DAVID HUMBERTO
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Sven Putnis
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Rodrigo Guiloff
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Patricio Caro
<jats:p>Limited knowledge of the anatomy and biomechanics of the posterolateral corner (PLC) of the knee, coupled with poor patient outcomes with non-operative management, resulted in the PLC often being labelled as the ‘dark side’ of the knee. In the last two decades, extensive research has resulted in a better understanding of the anatomy and function of the PLC, and has led to the development of anatomic reconstructions that have resulted in improved patient outcomes. Despite considerable attention in the clinical orthopaedic literature (nearly 400 articles published in the last decade), a standardized algorithm for the diagnosis and treatment of the PLC is still lacking, and much controversy remains. Considering the literature review, there is not a reconstruction technique that clearly prevails over the others. As anatomic, biomechanical, and clinical knowledge of PLC injuries continues to progress, finding the balance between re-creating native anatomy and safely performing PLC reconstruction provides a big challenge. Treatment decisions should be made on a case-by-case basis.</jats:p><jats:p>Cite this article: EFORT Open Rev 2021;6:676-685. DOI: 10.1302/2058-5241.6.200096</jats:p>
16Scopus© Citations 23
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Graft choice in combined anterior cruciate ligament and medial collateral ligament reconstruction
(2020)
FIGUEROA BERRIOS, FRANCISCO JAVIER
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David Figueroa
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CALVO RODRIGUEZ, RAFAEL
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Alex Vaisman
;
João Espregueira-Mendes
<jats:p> There is a concern regarding which grafts should be used in combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) reconstructions, with a paucity of recommendations focused on this specific topic. Expert opinions suggest the use of allograft-only reconstructions to limit donor-site morbidity or using at least one allograft and one autograft. When a hamstring tendon autograft is harvested, techniques that maintain both the integrity of the sartorius fascia and the gracilis are recommended because of the role that the ST-G-S (semitendinosus-gracilis-sartorius) complex plays in valgus stability in the setting of an MCL-deficient knee. </jats:p><jats:p> Cite this article: EFORT Open Rev 2020;5:221-225. DOI: 10.1302/2058-5241.5.190049 </jats:p>
2Scopus© Citations 10
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Meniscus allograft transplantation: indications, techniques and outcomes
(2019)
FIGUEROA BERRIOS, FRANCISCO JAVIER
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FIGUEROA POBLETE, DAVID HUMBERTO
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CALVO RODRIGUEZ, RAFAEL
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Alex Vaisman
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João Espregueira-Mendes
<jats:p> New indications for meniscal allograft transplantation (MAT) are being added, but the general expert opinion is that it is still a procedure reserved for symptomatic meniscal loss. Lateral MAT has better clinical outcomes and less failure risk compared to medial MAT. Ideal conditions (low-grade chondral lesions) make MAT a more survivable and successful procedure. Meniscal extrusion after MAT is common and does not seem to alter results. Midterm survivorship of a MAT is reported to be 85–90%, while long-term survivorship decreases to 50–70% depending on chondral status and concomitant procedures. Even if the procedure is a success, there are high possibilities of not being able to resume sports activities. </jats:p><jats:p> Cite this article: EFORT Open Rev 2019;4:115-120. DOI: 10.1302/2058-5241.4.180052 </jats:p>
2Scopus© Citations 55
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Return to sport soccer after anterior cruciate ligament reconstruction: ISAKOS consensus
(2022)
FIGUEROA POBLETE, DAVID HUMBERTO
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Guillermo Arce
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João Espregueira-Mendes
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Rodrigo Maestu
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Manuel Mosquera
18Scopus© Citations 23
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Hamstring autograft size importance in anterior cruciate ligament repair surgery
(2018)
Francisco Figueroa
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David Figueroa
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João Espregueira-Mendes
<jats:p> Graft size in hamstring autograft anterior cruciate ligament (ACL) surgery is an important factor directly related to failure. Most of the evidence in the field suggests that the size of the graft in hamstring autograft ACL reconstruction matters when the surgeon is trying to avoid failures. The exact graft diameter needed to avoid failures is not absolutely clear and could depend on other factors, but newer studies suggest than even increases of 0.5 mm up to a graft size of 10 mm are beneficial for the patient. There is still no evidence to recommend the use of grafts > 10 mm. Several methods – e.g. folding the graft in more strands – that are simple and reproducible have been published lately to address the problem of having an insufficient graft size when performing an ACL reconstruction. Due to the evidence presented, we think it is necessary for the surgeon to have them in his or her arsenal before performing an ACL reconstruction. There are obviously other factors that should be considered, especially age. Therefore, a larger graft size should not be taken as the only goal in ACL reconstruction. </jats:p><jats:p> Cite this article: EFORT Open Rev 2018;3:93-97. DOI: 10.1302/2058-5241.3.170038 </jats:p>
17Scopus© Citations 55

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