Anatomic Multiple Ligament Reconstructions of the Knee

Background: Multiple ligament injuries of the knee occur in a variety of settings, often from athletic activities. Multiple cruciate and collateral ligament injuries may be associated with hamstring tendon rupture, common peroneal nerve (CPN) injury, meniscus, bone, and cartilage damage. Indications...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Edward R. Floyd MS, MD, Gregory B. Carlson MD, Jill K. Monson PT, OCS, Robert F. LaPrade MD, PhD
Formato:	article
Lenguaje:	EN
Publicado:	SAGE Publishing 2021
Materias:	Sports medicine RC1200-1245 Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/501b93a7802f4320826d578d7dfe1af6
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:501b93a7802f4320826d578d7dfe1af6
record_format	dspace
spelling	oai:doaj.org-article:501b93a7802f4320826d578d7dfe1af62021-11-11T22:33:19ZAnatomic Multiple Ligament Reconstructions of the Knee2635-025410.1177/26350254211039223https://doaj.org/article/501b93a7802f4320826d578d7dfe1af62021-10-01T00:00:00Zhttps://doi.org/10.1177/26350254211039223https://doaj.org/toc/2635-0254Background: Multiple ligament injuries of the knee occur in a variety of settings, often from athletic activities. Multiple cruciate and collateral ligament injuries may be associated with hamstring tendon rupture, common peroneal nerve (CPN) injury, meniscus, bone, and cartilage damage. Indications: After evaluation for concomitant life-threatening and vascular injuries (especially of the popliteal artery), the knee is assessed through a thorough physical examination and imaging series, including varus, valgus, and posterior stress radiography, and magnetic resonance imaging (MRI). Research over the last 30 years has suggested that operative treatment in the acute setting (<3 weeks) in a single-stage procedure may have improved results to delayed/staged reconstruction. Early range of motion starting on postoperative day 1 is important to prevent development of arthrofibrosis. Technique: We describe the technique used to surgically manage a patient suffering from anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and complete posterolateral corner (PLC) rupture. Neurolysis of the CPN is performed to free the irritated nerve from scar tissue, along with biceps femoris tendon and lateral capsular repairs. Anatomic-based reconstructions are performed. The ACL reconstruction is with a single bundle using a patellar tendon autograft, PCL reconstruction is a double bundle with Achilles and tibialis anterior tendon allografts, and PLC reconstruction is accomplished with a split Achilles tendon allograft. The correct orientation of tunnel placement must be planned to avoid tunnel convergence; these angles have been determined through 3D modeling. The optimal sequence for graft tensioning has been established and follows the pattern: PCL, ACL, PLC, and then medial-sided structures if necessary. Results: Successful outcomes have been reported for both medial and lateral based injuries, and follow-up studies have also shown equivalent results between acute and chronic outcomes, and for multiligament injuries involving the ACL and PCL if anatomic reconstructions with appropriate tunnel angles, passage and tensioning sequence of grafts, and rehabilitation regimens are performed. Discussion/Conclusion: Single-stage anatomic reconstruction is the gold standard for managing multiple ligament injuries in the knee. Commencement of early 0° to 90° knee range of motion and PCL-supporting bracing are critical to prevent arthrofibrosis and protect the grafts from attenuation.Edward R. Floyd MS, MDGregory B. Carlson MDJill K. Monson PT, OCSRobert F. LaPrade MD, PhDSAGE PublishingarticleSports medicineRC1200-1245Orthopedic surgeryRD701-811ENVideo Journal of Sports Medicine, Vol 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sports medicine RC1200-1245 Orthopedic surgery RD701-811
spellingShingle	Sports medicine RC1200-1245 Orthopedic surgery RD701-811 Edward R. Floyd MS, MD Gregory B. Carlson MD Jill K. Monson PT, OCS Robert F. LaPrade MD, PhD Anatomic Multiple Ligament Reconstructions of the Knee
description	Background: Multiple ligament injuries of the knee occur in a variety of settings, often from athletic activities. Multiple cruciate and collateral ligament injuries may be associated with hamstring tendon rupture, common peroneal nerve (CPN) injury, meniscus, bone, and cartilage damage. Indications: After evaluation for concomitant life-threatening and vascular injuries (especially of the popliteal artery), the knee is assessed through a thorough physical examination and imaging series, including varus, valgus, and posterior stress radiography, and magnetic resonance imaging (MRI). Research over the last 30 years has suggested that operative treatment in the acute setting (<3 weeks) in a single-stage procedure may have improved results to delayed/staged reconstruction. Early range of motion starting on postoperative day 1 is important to prevent development of arthrofibrosis. Technique: We describe the technique used to surgically manage a patient suffering from anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and complete posterolateral corner (PLC) rupture. Neurolysis of the CPN is performed to free the irritated nerve from scar tissue, along with biceps femoris tendon and lateral capsular repairs. Anatomic-based reconstructions are performed. The ACL reconstruction is with a single bundle using a patellar tendon autograft, PCL reconstruction is a double bundle with Achilles and tibialis anterior tendon allografts, and PLC reconstruction is accomplished with a split Achilles tendon allograft. The correct orientation of tunnel placement must be planned to avoid tunnel convergence; these angles have been determined through 3D modeling. The optimal sequence for graft tensioning has been established and follows the pattern: PCL, ACL, PLC, and then medial-sided structures if necessary. Results: Successful outcomes have been reported for both medial and lateral based injuries, and follow-up studies have also shown equivalent results between acute and chronic outcomes, and for multiligament injuries involving the ACL and PCL if anatomic reconstructions with appropriate tunnel angles, passage and tensioning sequence of grafts, and rehabilitation regimens are performed. Discussion/Conclusion: Single-stage anatomic reconstruction is the gold standard for managing multiple ligament injuries in the knee. Commencement of early 0° to 90° knee range of motion and PCL-supporting bracing are critical to prevent arthrofibrosis and protect the grafts from attenuation.
format	article
author	Edward R. Floyd MS, MD Gregory B. Carlson MD Jill K. Monson PT, OCS Robert F. LaPrade MD, PhD
author_facet	Edward R. Floyd MS, MD Gregory B. Carlson MD Jill K. Monson PT, OCS Robert F. LaPrade MD, PhD
author_sort	Edward R. Floyd MS, MD
title	Anatomic Multiple Ligament Reconstructions of the Knee
title_short	Anatomic Multiple Ligament Reconstructions of the Knee
title_full	Anatomic Multiple Ligament Reconstructions of the Knee
title_fullStr	Anatomic Multiple Ligament Reconstructions of the Knee
title_full_unstemmed	Anatomic Multiple Ligament Reconstructions of the Knee
title_sort	anatomic multiple ligament reconstructions of the knee
publisher	SAGE Publishing
publishDate	2021
url	https://doaj.org/article/501b93a7802f4320826d578d7dfe1af6
work_keys_str_mv	AT edwardrfloydmsmd anatomicmultipleligamentreconstructionsoftheknee AT gregorybcarlsonmd anatomicmultipleligamentreconstructionsoftheknee AT jillkmonsonptocs anatomicmultipleligamentreconstructionsoftheknee AT robertflaprademdphd anatomicmultipleligamentreconstructionsoftheknee
_version_	1718431345870372864

Anatomic Multiple Ligament Reconstructions of the Knee

Ejemplares similares