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Surgical Management of ACL, PCL, and Lateral-Sided Injuries: Acute and Chronic

  • Peter B. MacDonaldEmail author
  • Scott W. Mollison
Chapter

Abstract

Although rare, multi-ligament injuries to the knee pose great challenges to both patients and treating surgeons. Historically, these injuries were treated non-operatively with bracing and gradual rehabilitation to regain motion once the knee had become stiff and stable. Higher patient and surgeon expectations, together with advancing reconstruction techniques and a high failure rate with surgical repair alone, have led a shift toward surgical management with ligament reconstruction (Geeslin et al., Am J Sport Med. 44:1336–1342, 2015 [5]. The goals of surgical intervention are to provide the patient with a stable, well-aligned knee that allows for ambulation. In the treatment of these complex injuries involving the ACL, PCL, and postero-lateral structures, many unanswered questions still remain. The optimal timing of surgery, repair versus reconstruction, alignment, and graft choice will be addressed briefly in this chapter; however, the goal of this section will be to focus on surgical technique for repairing and reconstructing the knee with an acute and chronic combined ACL, PCL, and PLC injury.

Keywords

Multiligament Knee dislocation ACL PCL Posterolateral corner Reconstruction Graft Acute Chronic Technique guide Allograft Autograft Fixation Tunnels 

Abbreviations

ACL

Anterior cruciate ligament

PCL

Posterior cruciate ligament

PLC

Posterolateral corner

PM

Posteromedial

PL

Posterolateral

AL

Anterolateral

AM

Anteromedial

ALL

Anterolateral ligament

IT

Iliotibial band

PL

Popliteus muscle

PFL

Popliteo-fibular ligament

References

  1. 1.
    Kennedy JC. Complete dislocation of the knee joint. J Bone Joint Surg Am. 1963;45:889–904.CrossRefGoogle Scholar
  2. 2.
    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.CrossRefGoogle Scholar
  3. 3.
    LaPrade RF, Muench C, Wentorf F, Lewis JL. The effect of injury to the posterolateral structures of the knee on force in a posterior cruciate ligament graft: a biomechanical study. Am J Sports Med. 2002;30(2):233–8.CrossRefGoogle Scholar
  4. 4.
    LaPrade RF, Resig S, Wentorf F, Lewis JL. The effects of grade III posterolateral knee complex injuries on anterior cruciate ligament graft force. A biomechanical analysis. Am J Sports Med. 1999;27(4):469–75.CrossRefGoogle Scholar
  5. 5.
    Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, Part 1. Surgical treatment of acute injuries. Am J Sport Med. 2015;44(5):1336–42.CrossRefGoogle Scholar
  6. 6.
    Fanelli GC, Stannard JP, Stuart MJ, et al. Management of complex knee ligament injuries. J Bone Joint Surg Am. 2010;92(12):2235–46.Google Scholar
  7. 7.
    Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ. Repair versus reconstruction of the fibular collateral ligament and postero- lateral corner in the multiligament-injured knee. Am J Sports Med. 2010;38(4):804–9.CrossRefGoogle Scholar
  8. 8.
    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.CrossRefGoogle Scholar
  9. 9.
    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.CrossRefGoogle Scholar
  10. 10.
    Harner CD, Irrgang JJ, Paul J, Dearwater S, Fu FH. Loss of motion after anterior cruciate ligament reconstruction. Am J Sports Med. 1992;20(5):499–506.CrossRefGoogle Scholar
  11. 11.
    Mohtadi NG, Webster-Bogaert S, Fowler PJ. Limitation of motion following anterior cruciate ligament reconstruction. A case-control study. Am J Sports Med. 1991;19(6):620–4. Discussion 4–5.CrossRefGoogle Scholar
  12. 12.
    Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M. Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med. 1991;19(4):332–6.CrossRefGoogle Scholar
  13. 13.
    Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy. 1996;12(5):521–30.CrossRefGoogle Scholar
  14. 14.
    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.CrossRefGoogle Scholar
  15. 15.
    Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86-A(2):262–73.CrossRefGoogle Scholar
  16. 16.
    Tzurbakis M, Diamantopoulos A, Xenakis T, Georgoulis A. Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow-up results. Knee Surg Sports Traumatol Arthrosc. 2006;14(8):739–49.CrossRefGoogle Scholar
  17. 17.
    Wascher DC, Becker JR, Dexter JG, Blevins FT. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med. 1999;27(2):189–96.CrossRefGoogle Scholar
  18. 18.
    Noyes FR, Barber-Westin SD, Albright JC. An analysis of the causes of failure in 57 consecutive posterolateral operative procedures. Am J Sports Med. 2006;34(9):1419–30.CrossRefGoogle Scholar
  19. 19.
    Fanelli GC, Edson CJ, Reinheimer KN. Evaluation and treatment of the multiligament-injured knee. Instr Course Lect. 2009;58:389–95.Google Scholar
  20. 20.
    Shelbourne KD, Porter DA, Clingman JA, McCarroll JR, Rettig AC. Low-velocity knee dislocation. Orthop Rev. 1991;20(11):995–1004.PubMedGoogle Scholar
  21. 21.
    Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med. 2005;33(6):881–8.CrossRefGoogle Scholar
  22. 22.
    Indelicato PA, Linton RC, Huegel M. The results of fresh-frozen patellar tendon allografts for chronic anterior cruciate ligament deficiency of the knee. Am J Sports Med. 1992;20(2):118–21.CrossRefGoogle Scholar
  23. 23.
    Noyes FR, Barber-Westin SD. Reconstruction of the anterior cruciate ligament with human allograft. Comparison of early and later results. J Bone Joint Surg Am. 1996;78(4):524–37.CrossRefGoogle Scholar
  24. 24.
    Cole BJ, Harner CD. The multiple ligament injured knee. Clin Sports Med. 1999;18(1):241–62.CrossRefGoogle Scholar
  25. 25.
    Barrett GR, Luber K, Replogle WH, Manley JL. Allograft anterior cruciate ligament reconstruction in the young, active patient: Tegner activity level and failure rate. Arthroscopy. 2010;26(12):1593–601.CrossRefGoogle Scholar
  26. 26.
    Reinhardt KR, Hetsroni I, Marx RG. Graft selection for anterior cruciate ligament reconstruction: a level I systematic review comparing failure rates and functional outcomes. Orthop Clin North Am. 2010;41(2):249–62.CrossRefGoogle Scholar
  27. 27.
    Romanini E, D’Angelo F, De Masi S, et al. Graft selection in arthroscopic anterior cruciate ligament reconstruction. J Orthop Traumatol. 2010;11(4):211–9.CrossRefGoogle Scholar
  28. 28.
    Gao K, Chen S, Wang L, et al. Anterior cruciate ligament reconstruction with LARS artificial ligament: a multicenter study with 3- to 5-year follow-up. Arthroscopy. 2010;26(4):515–23.CrossRefGoogle Scholar
  29. 29.
    Li B, Wen Y, Wu H, Qian Q, Wu Y, Lin X. Arthroscopic single-bundle posterior cruciate ligament reconstruction: retrospective review of hamstring tendon graft versus LARS artificial ligament. Int Orthop. 2009;33(4):991–6.CrossRefGoogle Scholar
  30. 30.
    Sonnery-Cottet B, Thaunat M, Freychet B, Pupim BHB, Murphy CG, Claes S. Outcome of a combined anterior cruciate ligament and anterolateral ligament reconstruction technique with a minimum 2-year follow-up. Am J Sports Med. 2015;43(7):1598–605.CrossRefGoogle Scholar
  31. 31.
    Cruz RS, Mitchell JJ, Dean CS, Chahla J, Moatshe G, LaPrade RF. anatomic posterolateral corner reconstruction. Arthrosc Tech. 2016;5(3):e563–72.CrossRefGoogle Scholar
  32. 32.
    Moulton SG, Geeslin AG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, Part 2: Surgical treatment of chronic injuries. Am J Sport Med. 2015;44(6):1616–23.CrossRefGoogle Scholar
  33. 33.
    Prokuski L. Prophylactic antibiotics in orthopaedic surgery. J Am Acad Orthop Surg. 2008;16(5):283–93.CrossRefGoogle Scholar
  34. 34.
    Konan S, Haddad FS. Femoral fracture following knee ligament reconstruction surgery due to an unpredictable complication of bioabsorbable screw fixation: a case report and review of literature. J Orthop Traumatol. 2009;11(1):51–5.CrossRefGoogle Scholar
  35. 35.
    LaPrade RF, Ly TV, Griffith C. The external rotation recurvatum test revisited: reevaluation of the sagittal plane tibiofemoral relationship. Am J Sports Med. 2008;36(4):709–12.CrossRefGoogle Scholar
  36. 36.
    Hughston JC, Degenhardt TC. Reconstruction of the posterior cruciate ligament. Clin Orthop Relat Res. 1982;164:59–77.Google Scholar
  37. 37.
    Hughston JC, Norwood LA Jr. The posterolateral drawer test and external rotational recurvatum test for posterolateral rotatory instability of the knee. Clin Orthop Relat Res. 1980;147:82–7.Google Scholar
  38. 38.
    Harner CD, Xerogeanes JW, Livesay GA, et al. The human posterior cruciate ligament complex: an interdisciplinary study. Ligament morphology and biomechanical evaluation. Am J Sports Med. 1995;23(6):736–45.CrossRefGoogle Scholar
  39. 39.
    Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg Br. 2005;87(5):664–7.CrossRefGoogle Scholar
  40. 40.
    LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A. An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med. 2004;32(6):1405–14.CrossRefGoogle Scholar
  41. 41.
    LaPrade RF, Johansen S, Agel J, Risberg MA, Moksnes H, Engebretsen L. Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am. 2010;92(1):16–22.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Orthopedic Surgery, Pan Am ClinicUniversity of ManitobaWinnipegCanada

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