Skip to main content
SpringerLink
Log in
Book cover

The Multiple Ligament Injured Knee pp 193–210Cite as

Arthroscopic Primary Cruciate Repair in the Multiligament Injured Knee

  • Chapter
  • First Online:

Abstract

Multiligamentous injuries of the knee (MLIK) are rare and devastating injuries. The literature regarding the optimal management of MLIK is both inconsistent and confusing, thus creating numerous controversies regarding the best treatment strategies for the MLIK. One of the most controversial topics is the role of acute repair versus reconstruction of the damaged ligaments. While allograft reconstructive techniques are the most widely used for the majority of patients, repair techniques can be very effective in selected situations. Despite the many benefits of primary repair, recent trends are moving in favor of reconstruction for all injuries. Our experience with arthroscopic primary repair of the cruciate ligaments has been very promising in strictly indicated patients. Patients with avulsion injuries of the ACL or PCL from the femoral or tibial footprint are the most likely to benefit from acute primary arthroscopic repair. It is not advisable to utilize repair for cruciate ligaments with midsubstance injuries. The described technique can and should be used as one tool in the surgical armamentarium used to treat the MLIK. Patient outcomes will be dependent on the prudent management of associated bony, articular, soft tissue, and collateral ligament injuries. The surgeon must apply appropriate surgical indications, demonstrate the technical ability to perform this challenging surgery, and communicate closely with the patient and physical therapist postoperatively to optimize results.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Engebretsen L, Risberg MA, Robertson B, Ludvigsen TC, Johansen S. Outcome after knee dislocations: a 2–9 years follow-up of 85 consecutive patients. Knee Surg Sports Traumatol Arthrosc. 2009;17(9):1013–26.

    Article  PubMed  Google Scholar 

  2. Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee. Injury. 2011;42:1198–204.

    Article  PubMed  Google Scholar 

  3. Levy BA, Dajani KA, Whelan DB, et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy. 2009;25(4):430–8.

    Article  PubMed  Google Scholar 

  4. Rihn JA, Groff YJ, Harner CD, Cha PS. The acutely dislocated knee: evaluation and management. J Am Acad Orthop Surg. 2004;12(5):334–46.

    PubMed  Google Scholar 

  5. Liow RY, McNicholas MJ, Keating JF, Nutton RW. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br. 2003;85(6):845–51.

    PubMed  CAS  Google Scholar 

  6. Mariani PP, Santoriello P, Iannone S, Condello V, Adriani E. Comparison of surgical treatments for knee dislocation. Am J Knee Surg. 1999;12(4):214–21.

    PubMed  CAS  Google Scholar 

  7. Noyes FR, Barber-Westin SD. Treatment of complex injuries involving the posterior cruciate and posterolateral ligaments of the knee. Am J Knee Surg. 1996;9(4):200–14.

    PubMed  CAS  Google Scholar 

  8. Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med. 2002;30(5):718–27.

    PubMed  Google Scholar 

  9. Hammoud S, Reinhardt KR, Marx RG. Outcomes of posterior cruciate ligament treatment: a review of the evidence. Sports Med Arthrosc. 2010;18(4):280–91.

    Article  PubMed  Google Scholar 

  10. Cross MJ, Powell JF. Long-term followup of posterior cruciate ligament rupture: a study of 116 cases. Am J Sports Med. 1984;12(4):292–7.

    Article  PubMed  CAS  Google Scholar 

  11. Dandy DJ, Pusey RJ. The long-term results of unrepaired tears of the posterior cruciate ligament. J Bone Joint Surg Br. 1982;64(1):92–4.

    PubMed  CAS  Google Scholar 

  12. Fowler PJ, Messieh SS. Isolated posterior cruciate ligament injuries in athletes. Am J Sports Med. 1987;15(6):553–7.

    Article  PubMed  CAS  Google Scholar 

  13. Keller PM, Shelbourne KD, McCarroll JR, Rettig AC. Nonoperatively treated isolated posterior cruciate ligament injuries. Am J Sports Med. 1993;21(1):132–6.

    Article  PubMed  CAS  Google Scholar 

  14. Shelbourne KD, Davis TJ, Patel DV. The natural history of acute, isolated, nonoperatively treated posterior cruciate ligament injuries. A prospective study. Am J Sports Med. 1999;27(3):276–83.

    PubMed  CAS  Google Scholar 

  15. Torisu T. Isolated avulsion fracture of the tibial attachment of the posterior cruciate ligament. J Bone Joint Surg Am. 1977;59(1):68–72.

    PubMed  CAS  Google Scholar 

  16. Poehling GG, Curl WW, Lee CA, et al. Analysis of outcomes of anterior cruciate ligament repair with 5-year follow-up: allograft versus autograft. Arthroscopy. 2005;21(7):774–85.

    PubMed  Google Scholar 

  17. Chen CH, Chen WJ, Shih CH. Arthroscopic posterior cruciate ligament reconstruction with quadriceps tendon-patellar bone autograft. Arch Orthop Trauma Surg. 1999;119(1–2):86–8.

    Article  PubMed  CAS  Google Scholar 

  18. Chen CH, Chuang TY, Wang KC, Chen WJ, Shih CH. Arthroscopic posterior cruciate ligament reconstruction with hamstring tendon autograft: results with a minimum 4-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2006;14(11):1045–54.

    Article  PubMed  CAS  Google Scholar 

  19. Fox JM, Sherman OH, Markolf K. Arthroscopic anterior cruciate ligament repair: preliminary results and instrumented testing for anterior stability. Arthroscopy. 1985;1(3):175–81.

    Article  PubMed  CAS  Google Scholar 

  20. Kim SJ, Shin SJ, Choi NH, Cho SK. Arthroscopically assisted treatment of avulsion fractures of the posterior cruciate ligament from the tibia. J Bone Joint Surg Am. 2001;83-A(5):698–708.

    PubMed  CAS  Google Scholar 

  21. Yerys P. Arthroscopic posterior cruciate ligament repair. Arthroscopy. 1991;7(1):111–4.

    Article  PubMed  CAS  Google Scholar 

  22. Strand T, Molster A, Hordvik M, Krukhaug Y. Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15–23 years postoperatively. Arch Orthop Trauma Surg. 2005;125(4):217–21.

    Article  PubMed  CAS  Google Scholar 

  23. Meyers MH, Moore TM, Harvey Jr JP. Traumatic dislocation of the knee joint. J Bone Joint Surg Am. 1975;57(3):430–3.

    PubMed  CAS  Google Scholar 

  24. Hughston JC, Bowden JA, Andrews JR, Norwood LA. Acute tears of the posterior cruciate ligament. Results of operative treatment. J Bone Joint Surg Am. 1980;62(3):438–50.

    PubMed  CAS  Google Scholar 

  25. Moore HA, Larson RL. Posterior cruciate ligament injuries. Results of early surgical repair. Am J Sports Med. 1980;8(2):68–78.

    Article  PubMed  CAS  Google Scholar 

  26. Pournaras J, Symeonides PP. The results of surgical repair of acute tears of the posterior cruciate ligament. Clin Orthop Relat Res. 1991;267:103–7.

    PubMed  Google Scholar 

  27. Strand T, Molster AO, Engesaeter LB, Raugstad TS, Alho A. Primary repair in posterior cruciate ligament injuries. Acta Orthop Scand. 1984;55(5):545–7.

    Article  PubMed  CAS  Google Scholar 

  28. Stannard JP, Brown SL, Farris RC, McGwin Jr G, Volgas DA. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med. 2005;33(6):881–8.

    Article  PubMed  Google Scholar 

  29. Levy BA, Fanelli GC, Whelan DB, et al. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009;17(4):197–206.

    PubMed  Google Scholar 

  30. Odensten M, Lysholm J, Gillquist J. Suture of fresh ruptures of the anterior cruciate ligament. A 5-year follow-up. Acta Orthop Scand. 1984;55(3):270–2.

    Article  PubMed  CAS  Google Scholar 

  31. Schultz RA, Miller DC, Kerr CS, Micheli L. Mechanoreceptors in human cruciate ligaments. A histological study. J Bone Joint Surg Am. 1984;66(7):1072–6.

    PubMed  CAS  Google Scholar 

  32. Owens BD, Neault M, Benson E, Busconi BD. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma. 2007;21(2):92–6.

    Article  PubMed  Google Scholar 

  33. Richmond JC. Complications associated with treatment of multiligament-injured/dislocated knee. Sports Med Arthrosc Rev. 2001;9:255–60.

    Article  Google Scholar 

  34. Bellelli A, Mancini P, Polito M, David V, Mariani PP. Magnetic resonance imaging of posterior cruciate ligament injuries: a new classification of traumatic tears. Radiol Med. 2006;111(6):828–35.

    Article  PubMed  CAS  Google Scholar 

  35. Gross ML, Grover JS, Bassett LW, Seeger LL, Finerman GA. Magnetic resonance imaging of the posterior cruciate ligament. Clinical use to improve diagnostic accuracy. Am J Sports Med. 1992;20(6):732–7.

    Article  PubMed  CAS  Google Scholar 

  36. Sonin AH, Fitzgerald SW, Hoff FL, Friedman H, Bresler ME. MR imaging of the posterior cruciate ligament: normal, abnormal, and associated injury patterns. Radiographics. 1995;15(3):551–61.

    PubMed  CAS  Google Scholar 

  37. Peterson 2nd CA, Warren RF. Management of acute and chronic posterior cruciate ligament injuries. New approaches. Am J Knee Surg. 1996;9(4):172–84.

    PubMed  Google Scholar 

  38. Inoue M, Yasuda K, Kondo E, Saito K, Ishibe M. Primary repair of posterior cruciate ligament avulsion fracture: the effect of occult injury in the midsubstance on postoperative instability. Am J Sports Med. 2004;32(5):1230–7.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Orthopaedic Surgery, Department of Surgery, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Micah Lissy M.D., M.S., P.T., A.T.C. & Gregory S. DiFelice M.D.

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Cornell Medical College, New York, NY, USA

    Christopher J. Dy M.D., M.S.P.H., Anil S. Ranawat M.D. & Gregory S. DiFelice M.D.

Authors
  1. Micah Lissy M.D., M.S., P.T., A.T.C.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christopher J. Dy M.D., M.S.P.H.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anil S. Ranawat M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gregory S. DiFelice M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory S. DiFelice M.D. .

Editor information

Editors and Affiliations

  1. GHS Orthopaedics, Woodbine Lane 115, Danville, 17822-5212, Pennsylvania, USA

    Gregory C. Fanelli

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Lissy, M., Dy, C.J., Ranawat, A.S., DiFelice, G.S. (2013). Arthroscopic Primary Cruciate Repair in the Multiligament Injured Knee. In: Fanelli, G. (eds) The Multiple Ligament Injured Knee. Springer, New York, NY. https://doi.org/10.1007/978-0-387-49289-6_14

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-49289-6_14

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-49287-2

  • Online ISBN: 978-0-387-49289-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation