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Mechanical Graft Tensioning in Multiple Ligament Knee Surgery

  • Gregory C. FanelliEmail author
Chapter

Abstract

The principles of reconstruction in the multiple ligament-injured knee are to identify and treat all pathology, accurate tunnel placement, anatomic graft insertion sites, utilize strong graft material, mechanical graft tensioning, secure graft fixation, and a deliberate postoperative rehabilitation program. This chapter will concentrate on my experience using a mechanical graft tensioning boot during posterior cruciate ligament reconstruction, and anterior cruciate ligament reconstruction, in the case of the multiple ligament-injured knee. The use of the graft tensioning boot, the PCL and ACL reconstruction surgical techniques, the cyclic dynamic method of graft tensioning, and the comparative results using the graft tensioning boot will be presented in this chapter.

Keywords

Posterior cruciate ligament reconstruction Mechanical graft tensioner Allograft tissue Transtibial PCL and ACL reconstruction Results 

References

  1. 1.
    Fanelli GC. Mechanical graft tensioning in multiple ligament knee surgery. In Gregory C, Fanelli, MD, editors. The multiple ligament injured knee. A practical guide to management. 2nd ed. New York: Springer-Verlag; 2013. p. 323–30.CrossRefGoogle Scholar
  2. 2.
    Fanelli GC. Rationale and surgical technique for PCL and multiple knee ligament reconstruction. 3rd ed. Warsaw, Indiana: Biomet Sports Medicine; 2012.Google Scholar
  3. 3.
    Fanelli GC, Beck JD, Edson CJ. Double bundle posterior cruciate ligament reconstruction. Surgical technique and results. Sports Med Arthros Rev 2010;18(4):242–8.CrossRefGoogle Scholar
  4. 4.
    Fanelli GC, Beck JD, Edson CJ. Combined PCL ACL lateral and medial side injuries: treatment and results. Sports Med Arthrosc Rev. 2011;19(2):120–30.CrossRefGoogle Scholar
  5. 5.
    Fanelli GC, Boyd J. How I manage PCL injuries. Oper Tech Sports Med. 2009;17(3):175–93.CrossRefGoogle Scholar
  6. 6.
    Fanelli GC, Beck JD, Edson CJ. How I manage the multiple ligament injured (dislocated) knee. Oper Techn Sports Med. 2010;18(4):198–210.CrossRefGoogle Scholar
  7. 7.
    Levy B, Dajani KA, Whalen DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG. Decision making in the multiple ligament injured knee: an evidence based systematic review. Arthroscopy. 2009;25(4):430–8.CrossRefGoogle Scholar
  8. 8.
    Fanelli GC, Stannard JP, Stuart MJ, MacDonald PB, Marx RG, Whelan DB, Boyd JL, Levy BA. Management of complex knee ligament injuries. J Bone Joint Surg. 2010;92-A(12):2235–46.Google Scholar
  9. 9.
    Levy B, Fanelli GC, Whalen D, Stannard J, MacDonald P, Boyd J, Marx R, Stuart M. Modern perspectives for the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009;17(4):197–206.CrossRefGoogle Scholar
  10. 10.
    Fanelli GC. Surgical treatment of combined PCL ACL medial and lateral side injuries (global laxity): acute and chronic. In: Gregory C, Fanelli, MD, editors. The multiple ligament injured knee: a practical guide to management, 2nd edn. Chapter 20 (currently in production).Google Scholar
  11. 11.
    Fanelli GC, Beck JD, Edson CJ. Arthroscopic trans tibial double bundle PCL reconstruction. J Knee Surg. 2010;23(2):89–94.CrossRefGoogle Scholar
  12. 12.
    Fanelli GC, Edson CJ. Combined posterior cruciate ligament—posterolateral reconstruction with Achilles tendon allograft and biceps femoris tendon tenodesis: 2–10 year follow-up. Arthroscopy. 2004;20(4):339–45.CrossRefGoogle Scholar
  13. 13.
    Fanelli GC, Edson CJ, Orcutt DR, Harris JD, Zijerdi D. Treatment of combined ACL PCL medial lateral side injuries of the knee. J Knee Surg. 2005;28(3):240–8.CrossRefGoogle Scholar
  14. 14.
    Fanelli GC, Edson CJ. Arthroscopically assisted combined ACL/PCL reconstruction. 2–10 year follow-up. Arthroscopy 2002;18(7):703–14.Google Scholar
  15. 15.
    Fanelli GC, Beck JD, Edson CJ. Single compared to double bundle PCL reconstruction using allograft tissue. J Knee Surg. 2012;25(1):59–64.CrossRefGoogle Scholar
  16. 16.
    Fanelli GC, Edson CJ. Surgical treatment of combined PCL, ACL, medial, and lateral side injuries (global laxity): surgical technique and 2–18 year results. J Knee Surg. 2012;25(4):307–16.CrossRefGoogle Scholar
  17. 17.
    Fanelli GC, Sousa P, Edson CJ. Long term follow-up of surgically treated knee dislocations: stability restored, but arthritis is common. Clin Orthop Relat Res. 2014;472(9):2712–7.CrossRefGoogle Scholar
  18. 18.
    Fanelli GC, Fanelli DG. Management of chronic combined posterior cruciate ligament and posteromedial instability of the knee. Sports Med Arthrosc Rev. 2015;23(2):96–103.CrossRefGoogle Scholar
  19. 19.
    Levy B, Fanelli GC, Miller MD, Stuart MJ. Advances in posterior cruciate ligament reconstruction. Am Acad Orthop Surg Instr Course Lect. 2015;64:543–54.Google Scholar
  20. 20.
    Fanelli GC. Arthroscopic transtibial tunnel posterior cruciate ligament reconstruction. Oper Tech Sports Med. 2015;23(4):289–97.CrossRefGoogle Scholar
  21. 21.
    Fanelli GC, Fanelli DG. Knee dislocations in patients 18 years of age and younger. Surgical technique and outcomes. J Knee Surg 2016;29(4):269–77.CrossRefGoogle Scholar
  22. 22.
    Fanelli GC, Fanelli DG. Multiple ligament knee injuries in the pediatric population. J Knee Surg 2018;34(1) (In production).Google Scholar
  23. 23.
    Fanelli GC, Fanelli DG. Management of PCL injuries in pediatric and adolescent patients. Current Reviews in Musculoskeletal Medicine. 2018 (In production).Google Scholar
  24. 24.
    Fanelli GC. Knee dislocations and multiple ligament injuries of the knee. Sports Med Arthrosc Rev 2018;26(4). (In production).Google Scholar
  25. 25.
    Fanelli GC, Fanelli DG, Edson CJ, Fanelli MG. Combined anterior cruciate ligament and posterolateral reconstruction of the knee using allograft tissue in chronic knee injuries. J Knee Surg. 2014;27(5):353–8.CrossRefGoogle Scholar
  26. 26.
    Fanelli GC, Fanelli DG, Fanelli MG. Revision posterior cruciate ligament reconstruction. Sports Med Arthrosc Rev. 2017;25(1):30–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryGeisinger Medical Center/Health SystemDanvilleUSA

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