Arthroscopic Primary Repair in the Multiple-Ligament Injured Knee

Jonkergouw, Anne; List, Jelle P. van der; DiFelice, Gregory S.

doi:10.1007/978-3-030-05396-3_14

Cited by 3 publications

(3 citation statements)

References 64 publications

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“… 33 Repair for MLKI has also recently demonstrated viability, especially in the setting of internal bracing, and offers specific advantages over the use of a graft such as preserving native tissues, reducing incidence of osteoarthritis, and minimizing recovery time. 34 Though our findings do not reveal any significance between repair and/or reconstruction with and without internal brace, it does highlight that continued research is needed in this area of orthopaedic research and that future studies should continue to explore the treatment of these high-risk injuries.…”

Section: Discussioncontrasting

confidence: 61%

Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

Fathi,

Thompson,

Bolia

et al. 2024

ORR

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Purpose To compare the patient-reported outcomes between patients with posterior cruciate ligament (PCL) reconstruction or repair alone versus PCL reconstruction or repair with internal bracing (IB) in the context of multi-ligament knee injuries (MLKI). Methods All patients who underwent surgical management of MLKI at two institutions between 2006 and 2020 were retrospectively identified and offered participation in the study. Patient reported outcomes were measured via three instruments: Lysholm Knee score, Multiligament Quality of Life (ML-QOL), and the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing (CAT). The postoperative outcomes and reoperation rates were compared between the internal bracing and non-internal bracing groups. Results Fifty-two patients were analyzed; 34 were included in the IB group (17.6% female; age 33.1 ±1.60 years), and 18 were included in the non-IB group (11.1% female; age 34.1 ±3.72 years). Mean follow-up time of the entire cohort was 1.44 ± 0.22 years (IB: 1.21 ± 0.18; non-IB: 2.1 ±0.65). There were no significant differences between PROMIS CAT [PROMIS Pain (54.4 ±1.78 vs 51.7 ±1.70, p=0.319), Physical Function (44.3 ±2.27 vs 47.9 ±1.52, p=0.294), Mobility (44.0 ±1.71 vs 46.1 ±2.10, p=0.463)], ML-QOL [ML-QOL Physical Impairment (40.7 ±4.21 vs 41.7±5.10, p=0.884), Emotional Impairment (49.2 ±4.88 vs 44.7±5.87, p=0.579), Activity Limitation (43.5 ±4.56 vs 31.5±3.62, p=0.087), Societal Involvement (44.9 ±4.96 vs 37.5 ±5.30, p=0.345)] and Lysholm knee score (61.8 ±4.55 vs 61.0 ±4.95, p=0.916) postoperatively compared to the non-IB group. Conclusion In this group of patients, function and patient-reported outcomes between patients treated with PCL reconstruction and repair without internal brace versus those with additional internal brace augmentation were not significantly different. Further research encompassing a larger patient sample is necessary to investigate the efficacy of the internal brace for PCL injury in the context of MLKI injuries.

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Section: Discussioncontrasting

confidence: 61%

Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

Fathi,

Thompson,

Bolia

et al. 2024

ORR

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“…8,64 To determine if the ACL is possible to repair, the ligament is visualized through standard anterior medial and lateral arthroscopic portals. 65,66 If repair is indicated in both ACL and PCL, the ACL repair is prioritized as this may help to facilitate PCL repair. 66 Excellent clinical outcomes following repair have been reported in patients with tears of the proximal region of the ACL, as opposed to mid-substance tears.…”

Section: Lclmentioning

confidence: 99%

“…65,66 If repair is indicated in both ACL and PCL, the ACL repair is prioritized as this may help to facilitate PCL repair. 66 Excellent clinical outcomes following repair have been reported in patients with tears of the proximal region of the ACL, as opposed to mid-substance tears. 67 PCL Surgical repair of the PCL is not recommended as a systematic review by Levy et al concluded that PCL repairs result in worse clinical outcomes when compared to PCL reconstructions.…”

Section: Lclmentioning

confidence: 99%

An Evidence-Based Approach to Multi-Ligamentous Knee Injuries

et al. 2022

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Multi ligament knee injuries (MLKIs) are highly complex injuries with associated complications and often present with difficult management strategies. MLKIs may affect the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (or posteromedial corner (PMC)), and lateral collateral ligament (or posterolateral corner (PLC)) in addition to other structures including the menisci, common peroneal nerve, and popliteal artery. MLKIs are highly associated with the male sex and are commonly seen in high-velocity motor vehicle accidents and low-velocity sports injuries. Given the multiple planes of movement in the knee and various primary and secondary stabilizers throughout those planes, there is great heterogeneity in an injury pattern and most involve the ACL and PCL. Initial evaluation of this injury includes assessment of lower extremity sensation, distal pulses, and ankle-brachial index (ABI). If vascular compromise is suspected, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) are indicated to evaluate the vasculature. As opposed to CTA, MRA offers visualization of the soft-tissue structures that are commonly damaged in MLKIs. Initial management typically includes closed reduction of the knee with subsequent external fixation. Classification systems guide initial assessments; however, further management is unclear and leads the surgical team to decide the best, individualized management option for each patient. As a result, optimal surgical and postoperative treatment options remain complicated, and clinical outcomes remain difficult to predict. The purpose of this review is to consolidate the most up-to-date practices of the diagnostic workup, management, and treatment of MLKIs.

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Primary repair of multiligament knee injury with InternalBrace ligament augmentation

et al. 2022

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Multiligament injury of the knee usually occurs as a result of high-energy trauma causing tibiofemoral dislocation. These are rare but potentially limb-threatening injuries, frequently involving nerve or arterial damage and often leading to severe complex instability. Management generally favours surgical reconstruction of the affected ligaments, with controversy regarding optimal treatment. We present a severe multiligament knee injury (Schenk classification KD-IV involving both cruciate and both collateral ligaments) in a competitive showjumper. A combined arthroscopic/open technique of single-stage surgical repair and suture augmentation was used, repairing all affected ligaments. The patient made an excellent recovery, returning to work after 12 weeks and riding after 22 weeks. After 5-year follow-up, she has regained her previous level of competition without subsequent injury. Multiligament repair with suture augmentation is a viable approach to the management of knee dislocation injuries. We propose that this could provide superior outcomes to traditional reconstruction techniques using autograft or synthetic reconstruction.

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Arthroscopic Primary Repair in the Multiple-Ligament Injured Knee

Cited by 3 publications

References 64 publications

Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

Patient Reported Clinical Outcomes Following PCL Suture Augmentation in Patients with Multiligamentous Knee Injury: A Retrospective Observational Study

An Evidence-Based Approach to Multi-Ligamentous Knee Injuries

Primary repair of multiligament knee injury with InternalBrace ligament augmentation

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