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J Knee Surg 2020; 33(05): 431-439
DOI: 10.1055/s-0039-3402768
Special Focus Section
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Medial-Sided Injuries in the Multiple Ligament Knee Injury

Gilbert Moatshe
1   Orthopaedic Clinic, Oslo University Hospital and University of Oslo, Oslo, Norway
2   Oslo Sports Trauma Research Center, The Norwegian School of Sports Sciences, Oslo, Norway
3   Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Ontario, Canada
,
Alexander R. Vap
5   Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, Virginia
,
Alan Getgood
3   Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Ontario, Canada
,
Robert F. LaPrade
4   Twin Cities Orthopaedics, Edina, Minnesota
,
Lars Engebretsen
1   Orthopaedic Clinic, Oslo University Hospital and University of Oslo, Oslo, Norway
2   Oslo Sports Trauma Research Center, The Norwegian School of Sports Sciences, Oslo, Norway
› Institutsangaben
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Publikationsverlauf

23. November 2019

27. November 2019

Publikationsdatum:
19. Februar 2020 (online)

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Abstract

Multiligament knee injuries (MLKI) are complex and challenging to treat. The posteromedial corner (PMC) structures are commonly torn in MLKI. A thorough and systematic evaluation is imperative to avoid a missed diagnosis and for planning treatment. With several structures injured, the treatment method (operative vs. nonoperative, repair vs. reconstruction), availability of allografts, timing of surgery, and rehabilitation are some of the factors that have to be considered in the decision-making. Persistent valgus instability because of untreated or not healed medial collateral ligament (MCL) tears will increase graft forces on the cruciate ligament grafts, thus increasing the risk of reconstruction graft failure. In recent years, there has been a growing body of literature on the anatomy and biomechanics of the medial structures that has aided in the development of biomechanically and clinically validated anatomic PMC reconstructions. Despite good healing potential of the MCL, in MLKI, surgical treatment is recommended for grade III PMC injuries to aid early rehabilitation and reduce the risk of surgical failure. Several studies have reported satisfactory outcomes after surgical treatment of MLKI involving the medial side. Early functional rehabilitation is imperative to reduce the risk of arthrofibrosis.

Keywords

multiligament knee injuries - medial collateral ligament - posteromedial corner - knee dislocation - knee ligament