Abstract
The multiple ligament injured knee is a severe injury that may also involve neurovascular
injuries, fractures, and other systemic injuries. Surgical treatment offers good functional
results documented in the literature by physical examination, arthrometer testing,
stress radiography, and knee ligament rating scales. Mechanical tensioning devices
are helpful with cruciate ligament tensioning. Some low grade medial collateral ligament
(MCL) complex injuries may be amenable to brace treatment, while high grade medial
side injuries require combined surgical repair–reconstruction. Lateral posterolateral
injuries are most successfully treated with combined surgical repair–reconstruction.
Surgical timing in acute multiple ligament injured knee cases depends on the ligaments
injured, injured extremity vascular status, skin condition of the extremity, degree
of instability, and the patients overall health. Allograft tissue is preferred for
these complex surgical procedures. Delayed reconstruction of 2 to 3 weeks may decrease
the incidence of arthrofibrosis, and it is important to address all components of
the instability. Currently, there is no conclusive evidence that double-bundle posterior
cruciate ligament (PCL) reconstruction provides superior results to single-bundle
PCL reconstruction in the multiple ligament injured knee. The purpose of this article
is to discuss G.F.'s surgical technique for combined PCL and anterior cruciate ligament,
medial, and lateral side reconstructions in acute and chronic multiple ligament injured
knees with global laxity. This article will focus on recognizing and defining the
instability pattern, the use of external fixation, surgical timing, graft selection
and preparation, G.F.'s preferred surgical technique, mechanical graft tensioning,
perioperative antibiotics, specialized operating teams, postoperative rehabilitation,
and our results of treatment in these complex surgical cases.
Keywords
multiple ligament knee injury - mechanical graft tensioner - allograft - transtibial
PCL reconstruction - inside to outside PCL femoral tunnels
