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Knee: Multiligament Injuries

  • Francesco M. BenazzoEmail author
  • Giacomo Zanon
  • Loris Perticarini

Abstract

Knee ligament injuries can be considered a common lesion due to increased participation in football. Multiligament knee injuries result in disruption of at least two of the major ligaments of the knee and may lead to significant chronic laxity and functional instability. Decision-making often is based on each individual’s pre-injury function and the extent of the ligament damage. Several studies have suggested that patients receiving operative treatment will result in improved functional outcomes when compared with non-operative treatment. The timing of surgery is critical, and evidence exists showing that if surgery is performed as soon as possible after the injury, the results are satisfactory.

Keywords

Multiligament injuries Sport traumatology Knee instability Elite athlete Football injuries 

References

  1. 1.
    Wascher DC, Dvirnak PC, DeCoster TA (1997) Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 11(7):525–529Google Scholar
  2. 2.
    Schenck R. (2003) Classification of knee dislocations. Oper Tech Sports Med 11(3):193–198Google Scholar
  3. 3.
    Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, Marx RG, Stuart MJ (2009) Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 17(4):197–206CrossRefPubMedGoogle Scholar
  4. 4.
    Stannard JP, Bauer KL (2012) Current concepts in knee dislocations: PCL, ACL, and medial sided injuries. J Knee Surg 25(4):287–294CrossRefPubMedGoogle Scholar
  5. 5.
    Fornalski S, McGarry MH, Csintalan RP, Fithian DC, Lee TQ (2008) Biomechanical and anatomical assessment after knee hyperextension injury. Am J Sports Med 36(1):80–84CrossRefPubMedGoogle Scholar
  6. 6.
    Fanelli GC, Harris JD (2006) Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc 14(2):78–83CrossRefPubMedGoogle Scholar
  7. 7.
    Kurzweil PR, Kelley ST (2006) Physical examination and imaging of the medial collateral ligament and posteromedial corner of the knee. Sports Med Arthrosc 14(2):67–73CrossRefPubMedGoogle Scholar
  8. 8.
    Bae JH, Choi IC, Suh SW, Lim HC, Bae TS, Nha KW, Wang JH (2008) Evaluation of the reliability of the dial test for posterolateral rotatory instability: a cadaveric study using an isotonic rotation machine. Arthroscopy 24(5):593–598. doi: 10.1016/j.arthro.2007.12.003 CrossRefPubMedGoogle Scholar
  9. 9.
    Ferrari DA, Ferrari JD, Coumas J (1994) Posterolateral instability of the knee. J Bone Joint Surg (Br) 76(2):187–192Google Scholar
  10. 10.
    Covey DC (2001) Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am 83-A(1):106–118 ah. Stannard JP, Black BS, Azbell C, Volgas DA (2012) Posteromedial corner injury in knee dislocations. J Knee Surg 25(5):429–434. doi:10.1055/s-0032-1322605Google Scholar
  11. 11.
    Duffy PS, Miyamoto RG (2010) Management of medial collateral ligament injuries in the knee: an update and review. Phys Sportsmed 38(2):48–54. doi: 10.3810/psm.2010.06.1782 CrossRefPubMedGoogle Scholar
  12. 12.
    Larsen E, Jensen PK, Jensen PR (1999) Long-term outcome of knee and ankle injuries in elite football. Scand J Med Sci Sports 9(5):285–289CrossRefPubMedGoogle Scholar
  13. 13.
    Wen DY, Propeck T, Kane SM, Godbee MT, Rall KL (2007) MRI description of knee medial collateral ligament abnormalities in the absence of trauma: edema related to osteoarthritis and medial meniscal tears. Magn Reson Imaging 25(2):209–214CrossRefPubMedGoogle Scholar
  14. 14.
    Farshad-Amacker NA, Potter HG (2013) MRI of knee ligament injury and reconstruction. J Magn Reson Imaging 38(4):757–773. doi: 10.1002/jmri.24311 CrossRefPubMedGoogle Scholar
  15. 15.
    Halinen J, Koivikko M, Lindahl J, Hirvensalo E (2009) The efficacy of magnetic resonance imaging in acute multi-ligament injuries. Int Orthop 33(6):1733–1738. doi: 10.1007/s00264-008-0689-6 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Levy BA, Dajani KA, Whelan DB, Stannard JP, Fanelli GC, Stuart MJ, Boyd JL, MacDonald PA, Marx RG (2009) Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 25(4):430–438. doi: 10.1016/j.arthro.2009.01.008 CrossRefPubMedGoogle Scholar
  17. 17.
    Liow RY, McNicholas MJ, Keating JF, Nutton RW (2003) Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg (Br) 85(6):845–851Google Scholar
  18. 18.
    Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ (2004) Surgical management of knee dislocations. J Bone Joint Surg Am 86-A(2):262–273PubMedGoogle Scholar
  19. 19.
    Tzurbakis M, Diamantopoulos A, Xenakis T, Georgoulis A (2006) Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow-up results. Knee Surg Sports Traumatol Arthrosc 14(8):739–749CrossRefPubMedGoogle Scholar
  20. 20.
    Stannard JP, Black BS, Azbell C, Volgas DA (2012) Posteromedial corner injury in knee dislocations. J Knee Surg 25(5):429–434. doi: 10.1055/s-0032-1322605 CrossRefPubMedGoogle Scholar
  21. 21.
    Fanelli GC, Stannard JP, Stuart MJ, Macdonald PB, Marx RG, Whelan DB, Boyd JL, Levy BA (2011) Management of complex knee ligament injuries. Instr Course Lect 60:523–535PubMedGoogle Scholar
  22. 22.
    Adravanti P, Jakobsen BW, Marx RG, Santone DJ, Whelan DB, Williams A (2014) How to address multi-ligament injuries? In: Zaffagnini S et al (eds) ESSKA instructional course lecture book. Springer, Heidelberg, pp 79–96CrossRefGoogle Scholar
  23. 23.
    Stannard JP, Brown SL, Farris RC, McGwin G Jr, Volgas DA (2005) The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 33(6):881–888CrossRefPubMedGoogle Scholar
  24. 24.
    Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ (2010) Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med 38(4):804–809. doi: 10.1177/0363546509352459 CrossRefPubMedGoogle Scholar
  25. 25.
    LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A (2004) An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med 32(6):1405–1414CrossRefPubMedGoogle Scholar
  26. 26.
    Geeslin AG, LaPrade RF (2011) Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg Am 93(18):1672–1683. doi: 10.2106/JBJS.J.01639 CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Francesco M. Benazzo
    • 1
    Email author
  • Giacomo Zanon
    • 1
  • Loris Perticarini
    • 1
  1. 1.Fondazione IRCCS Policlinico San Matteo PaviaPaviaItaly

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