الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
The stability of the knee joint depends largely on
the action of the powerful ligaments, i.e. crucuates and colla-teral ligaments (Kapandji, 1970). Each ligament has its role
in maintaining the functional stability of the knee joint, while the collateral ligaments are responsible for the trans-verse stability of the knee during extension the cruciates stabilize the knee in the antero-posterior direction.
The medial ligament is considered functionally to be formed of four parts:
The medial collateral anterior and posterior which are considered the superficial portions of the medial ligament are the principal stabilizer of the medial side of the joint against valgus. and rotatory stress.
The deep portion of the medial liganent also provides valgus stability and greater stability to internal-external rotation and drawer motions.
The posterior oblique part provides moderate vaigus, internal.xotatioh and drawer stability to the knee in extension. The lateral ligament is relaxed in flexion therefore it cannot exert any control over abduction, adduction or rotatory move-ments in flexion. But in extension it provides varus stability to the knee as well as moderate rotational and drawer stability
The anterior cruciate ligament is responsible for the control of forward gliding of the tibia on the femur, also control the lateral rotation of the tibia in the final phase of extension.
The posterior cruciate ligament has its primary func-tion of drawer stability. It assists in preventing hyperexten-sion and hyper flexIon, it offers very little varus, valgus and rotational stability also it controls medial rotation of the tibia in flexion (Smiliie, 1978).
Injuries of the meidal collateral ligament is the most potentially disabling of all ligamentous injuries of the knee. These injuries are either sprain (no solution of continuity) or complete rupture of the ligament.
Management of the sprained medial ligament is mainly conservative in the form of cylinder cast in full extensio;: Quadriceps exercise should be begun immediatley and the cast
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is retained for four to six weeks.
Complete rupture of the medial ligament should be treated surgically after being diagnosed early otherwise serious ins-tability may result. Oftenly rupture of the medial ligament
is accompanied in varying degrees by rupture of the anterior cruciate ligament and tharing of the medial meniscus. A combi-nation that O’Donoghue (1950) had called it the ”unhappy triad”
He also emphasized the importance of early repair, the more serious the injury the more important is the early repair, he added that once the decision has been made to undertake operative repair the procedure should not be differed as the
surgery will never be easier than immediately after the injury.
Smillie (1978) stressed on that every successive day that operation is postponed detracts from thesuccess of the procedure.
The operative management will depend on whether the med-ial collateral ligament is ruptured alone or it is a complex one including the anterior cruciate and the medial meniscus.
In this complex type of injury, the sequence of repair is as follows; the anterior cruciate,reattachmInt of the meniscus to the deep portion of the ligament, the medial collateral ligament then the capsule.
Injuries of the anterior cruciate ligament is of great importance because it is inevitably. ruptured with
rupture of the medial supporting structures of the knee. Some authors Kennedy et al., (1974), Wang et ai, (1975) reported
that isofeted anterior cruciate ligament rupture may also occur. There is -a great difference of opinions amongst orthopaedic surgeons as regard the surgical repair of a torn anterior cruc-iate ligament. Smillie (1970) stated that rupture of the anterior cruciate ligament alone is not a serious disability
provided that the quadriceps apparatus is adequate to the demands upon the joint as the quadriceps in its indirect fun-ction as a lateral rotator of the tibia can stabilize the joint in extension and compensate for the absence of the anterior cruciate ligament. On the other hand many orthopaedic surgeons e.g. O’Donohue (1950) stressed on the fact that a torn cruc-iate ligament should be sutured as soon as possible otherwise within a few weeks , it will undergo resorption making suture impossible and the patient will suffer a definite disability. The fractured tibial spine should be anatomically reduced: repositioning, suturing (Lee, 1937), internal fixation (Zari-cznyj et al., 1977), all had been described with satisfactory results. O’Donoghue (1950) described a good repair of a tear of the ligament at the superior attachment by.suturing it through drill holes into the lateral condyle of the femur.
Tears through the substance of the ligament require no more than sutures avoiding suturing the ligament under too much tension otherwise the circulation of the ligament may be impaired (Campbell, 1971).
s4njuries to the posterior cruciate ligament is believed to be uncommon except with severe general ligament rupture and dislocation of the knee joint, (Trickey, 1968).
Kennedy (1967) stated that the posterior cruciate liga-ment is twice as strong as either the anterior cruciate or
medial collateral ligament and this may account for the small number of injuries to this vital structure. However, Smillie (1978) stated ;that the impression of rarity as regard injuries of the posterior cruciate is due to the frequency with which
it is missed or misdiagnosed in the recent injury.
Repair of the posterior cruciate can be achieved by screwing an avulsed bone fragment if big enough or by suturing it through drill holes in the tibia. Staple fixation had been used by Torisu (1977) with good results.