ACL Reconstruction in the Multiple Ligament Injured Knee

Abstract

Multiple ligament knee injuries are complex and can result from sports injuries or high energy trauma. The proper diagnosis and treatment of multiple ligament knee injuries are essential, and careful evaluation and planning are required to achieve successful outcomes. Anterior cruciate ligament (ACL) reconstruction in the multiple ligament injured knee is complicated by several factors, necessitating additional technical considerations. Patient selection, surgical timing, graft selection, and surgical technique require consideration specific to the ACL component of these injuries. We present a summary of the current knowledge with respect to the treatment of ACL injuries in the context of the multiple ligament injured knee.

Keywords

anterior cruciate ligament reconstruction - knee dislocation - posterior cruciate ligament - medial collateral ligament

• References

• 1 Wilson SM, Mehta N, Do HT, Ghomrawi H, Lyman S, Marx RG. Epidemiology of multiligament knee reconstruction. Clin Orthop Relat Res 2014; 472 (09) 2603-2608
• 2 Levy BA, Fanelli GC, Whelan DB. , et al; Knee Dislocation Study Group. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 2009; 17 (04) 197-206
• 3 Levy BA, Dajani KA, Whelan DB. , et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 2009; 25 (04) 430-438
• 4 Delos D, Warren RF, Marx RG. Multiligament knee injuries and their treatment. Oper Tech Sports Med 2010; 18 (04) 219-226
• 5 Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86 (02) 262-273
• 6 Bin SI, Nam TS. Surgical outcome of 2-stage management of multiple knee ligament injuries after knee dislocation. Arthroscopy 2007; 23 (10) 1066-1072
• 7 Ohkoshi Y, Nagasaki S, Shibata N, Yamamoto K, Hashimoto T, Yamane S. Two-stage reconstruction with autografts for knee dislocations. Clin Orthop Relat Res 2002; (398) 169-175
• 8 Edson C. Postoperative rehabilitation of the multiple-ligament reconstructed knee. Oper Tech Sports Med 2003; 11: 294-301
• 9 Warren RF, Veltri DM. Arthroscopically assisted posterior cruciate ligament reconstruction. Oper Tech Sports Med 1993; 1: 136-142
• 10 Kaeding CC, Pedroza AD, Reinke EK. , et al; MOON Knee Group. Change in anterior cruciate ligament graft choice and outcomes over time. Arthroscopy 2017; 33 (11) 2007-2014
• 11 Shapiro MS, Freedman EL. Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med 1995; 23 (05) 580-587
• 12 Chhabra A, Cha PS, Rihn JA. , et al. Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg Am 2005; 87 (Pt 1, Suppl 1): 1-21
• 13 Stuart MJ. Surgical treatment of ACL/PCL/lateral-side knee injuries. Oper Tech Sports Med 2003; 11: 257-262
• 14 Ibrahim SA, Ahmad FH, Salah M, Al Misfer AR, Ghaffer SA, Khirat S. Surgical management of traumatic knee dislocation. Arthroscopy 2008; 24 (02) 178-187
• 15 Lynch AD, Chmielewski T, Bailey L. , et al; STaR Trial Investigators. Current concepts and controversies in rehabilitation after surgery for multiple ligament knee injury. Curr Rev Musculoskelet Med 2017; 10 (03) 328-345
• 16 Fanelli GC, Giannotti BF, Edson CJ. Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy 1996; 12 (01) 5-14
• 17 Wasserstein D, Sheth U, Cabrera A, Spindler KP. A systematic review of failed anterior cruciate ligament reconstruction with autograft compared with allograft in young patients. Sports Health 2015; 7 (03) 207-216
• 18 Hudgens JL, Gillette BP, Krych AJ, Stuart MJ, May JH, Levy BA. Allograft versus autograft in posterior cruciate ligament reconstruction: an evidence-based systematic review. J Knee Surg 2013; 26 (02) 109-115
• 19 Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med 2002; 30 (05) 718-727
• 20 Hendel MD, Liu JN, Levy BA, Jakobsen BW, Marx RG. ACL reconstruction in the multiligament knee. In: Nakamura N, Zaffagnini S, Marx RG, Musahl V. (Eds.) Controversies in the Technical Aspects of ACL Reconstruction: An Evidence-Based Medicine Approach. Berlin Heidelberg: Springer; 2017: 389-391
• 21 Harner CD, Vogrin TM, Höher J, Ma CB, Woo SL. Biomechanical analysis of a posterior cruciate ligament reconstruction. Deficiency of the posterolateral structures as a cause of graft failure. Am J Sports Med 2000; 28 (01) 32-39
• 22 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 (06) 845-851
• 23 Noyes FR, Barber-Westin SD. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis. Am J Sports Med 1997; 25 (06) 769-778