One-Stage Posterior Cruciate Ligament Inlay Reconstruction Combining Anterior Cruciate Ligament Reconstruction Following Knee Dislocation

Chuang, Tai Yuan; Ho, Wan‐Ling; Hsieh, Pang‐Hsin; Yu, Shang Won; Chen, Yeung Jen; Chen, Chih-Hwa

doi:10.1016/j.arthro.2005.11.012

Cited by 11 publications

(10 citation statements)

References 26 publications

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“…In view of reports of cases of redislocation of the knee immediately after reconstruction of the central pivot (26), we opted, in our case, to treat initially only the MCL, leaving out the ACL and PCL. Other Authors have described a two-step surgical procedure, generally consisting of a first arthroscopic debridement of soft tissues followed by second open stage to suture damaged ligaments (33). In accordance with the literature (14, 26), we hypothesized that the initial instability could compromise the reconstruction of the cruciate ligaments and therefore decided to treat the latter in a second step.…”

Section: J Ointsmentioning

confidence: 63%

“…In the literature, there is no universal agreement as to whether and when lesions of the cruciate ligaments should be repaired. A one-step reduction method combining arthroscopic cruciate ligament reconstruction is described (29,33). In this kind of lesion, Bistolfi et al (29) confirmed that lateral and rotational stability must be achieved immediately by reconstruction or suture of the peripheral structures, while reconstruction of the cruciate ligaments can be postponed and even avoided in elderly patients or those not professionally engaged in high level sports.…”

Section: J Ointsmentioning

confidence: 99%

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Irreducible posterolateral dislocation of the knee: a case report

Solarino¹,

Notarnicola²,

Maccagnano³

et al. 2015

Joints

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Irreducible posterolateral dislocations of the knee are rare lesions, generally caused by high-energy trauma inducing rotational stress and a posterior and lateral displacement of the tibia. In these conditions, the interposition of abundant soft tissue inside the enlarged medial joint space prevents spontaneous reduction or non-surgical treatment by manipulation of the dislocation. Surgical treatment is therefore compulsory. We report the clinical case of a woman who suffered a subluxation of the knee while jogging. The case we describe is of interest because it shows that even less severe knee dislocations, like this subluxation caused by a low-velocity sports trauma, may present in an irreducible form requiring open surgery. Clinicalinstrumental monitoring did not reveal any signs of vascular or nerve injury. Owing to the irreducibility of the lesion we were obliged to perform open surgery in order to free the joint from the interposed muscle tissue and repair medial capsule-ligament lesions. Repair of the damaged cruciate ligaments was deferred to a second stage, but ultimately rendered necessary by the persistence of joint instability and the need to address the patient's functional needs. In the literature, different one-and two-step surgical options, performed by arthroscopy or arthrotomy, are reported for such related problems. The Authors discuss these various options and examine and discuss their own decision taken during the surgical work-up of this case.Key Words: knee, posterolateral, dislocation, anterior cruciate ligament, injury. IntroductionDislocation of the knee is a rare orthopaedic emergency that requires appropriate monitoring and treatment. It has a low estimated annual incidence, accounting for less than 0.01% of trauma episodes, even if the true number of cases is unknown because many dislocations reduce spontaneously already at the site of the traumatic event (1). Most lesions of this kind are caused by high-velocity sports traumas (2), in which traumatic forces produce stress in the sagittal plane of the knee in the anteroposterior direction and in the frontal plane in varus-valgus angulation (3), inducing a rotational dislocation of the tibia in relation to the femoral condyles. This causes lesions of the ligament structures, also involving the popliteal artery in 20% of cases and the common peroneal or tibial nerve in 19% (4). In the literature, the role of non-surgical "closed" reduction is emphasized (5), while surgical treatment should be reserved for irreducible cases or those in which vesselnerve complications arise or there are signs of immediate joint instability (6). Case reportA healthy 51-year-old woman suffered a traumatic sprain of her left knee when she fell while jogging. Unable to stand or walk, she was immediately transfer-

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Section: J Ointsmentioning

confidence: 63%

Section: J Ointsmentioning

confidence: 99%

Irreducible posterolateral dislocation of the knee: a case report

Solarino¹,

Notarnicola²,

Maccagnano³

et al. 2015

Joints

View full text Add to dashboard Cite

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“…Graft materials are another topic widely discussed in relevant publications [16]. The majority of authors refrain from using only hamstring autografts in the single-stage of ACL/PCL reconstruction, as they fear this might weaken knee flexors - and thus, delay rehabilitation [3], [5], [8], [11], [12]. Articles regarding the operative technique which was used in single-stage ACL/PCL reconstruction with hamstring autografts only, have reported no serious complications resulting from the graft being harvested from an uninjured limb [11], [12], [14], [17].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopically Assisted Combined Anterior and Posterior Cruciate Ligament Reconstruction with Autologous Hamstring Grafts–Isokinetic Assessment with Control Group

Piontek

Ciemniewska-Gorzela

Szulc³

et al. 2013

PLoS ONE

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ObjectiveThe aim of the study was to: 1) evaluate the differences in pre-post operative knee functioning, mechanical stability, isokinetic knee muscle strength in simultaneous arthroscopic patients after having undergone an anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) with hamstring tendons reconstruction, 2) compare the results of ACL/PCL patients with the control group.DesignControlled Laboratory Study.Materials and MethodsResults of 11 ACL/PCL patients had been matched with 22 uninjured control participants (CP). Prior to surgery, and minimum 2 years after it, functional assessment (Lysholm and IKDC 2000), mechanical knee joint stability evaluation (Lachman and “drawer” test) and isokinetic tests (bilateral knee muscle examination) had been performed. Different rehabilitation exercises had been used: isometric, passive exercises, exercises increasing the range of motion and proprioception, strength exercises and specific functional exercises.ResultsAfter arthroscopy no significant differences had been found between the injured and uninjured leg in all isokinetic parameters in ACL/PCL patients. However, ACL/PCL patients had still shown significantly lower values of strength in relative isokinetic knee flexors (p = 0.0065) and extensors (p = 0.0171) compared to the CP. There were no differences between groups regarding absolute isokinetic strength and flexors/extensors ratio. There was statistically significant progress in IKDC 2000 (p = 0.0044) and Lysholm (p = 0.0044) scales prior to (44 and 60 points respectively) and after the reconstruction (61 for IKDC 2000 and 94 points for Lysholm).ConclusionsAlthough harvesting tendons of semitendinosus and/or gracilis from the healthy extremity diminishes muscle strength of knee flexors in comparison to the CP, flexor strength had improved. Statistically significant improvement of the knee extensor function may indicate that the recreation of joint mechanical stability is required for restoring normal muscle strength. Without restoring normal muscle function and strength, surgical intervention alone may not be sufficient enough to ensure expected improvement of the articular function.

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“…Compared with EA ligament repair or reconstruction, ACL/PCL reconstruction had continuously been a hotter topic in the literature for the past decade, 13 14 15 16 17 18 which might lead to a misunderstanding that the intraarticular ligaments were more essential stabilizers than the EA ligaments for the knee. However, biomechanical studies have confirmed that PMC, PLC and posterior capsule are the primary restraints to varus-valgus and rotational displacement near to knee extension, whereas ACL/PCL becomes the primary restraint to anterior-posterior displacement and secondary restraint to rotational stability.…”

Section: Discussionmentioning

confidence: 99%

Results of multiple ligament injured knees operated by three different strategies

Sun

Mao

et al. 2016

IJOO

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Background:Multiple ligament injured knee is generally described for a scenario when at least 2 of the 4 major ligaments are ruptured. The most effective treatment for these injuries remains controversial. This study presents the clinical outcome of 3 surgical strategies based on personalized treatment.Materials and Methods:Thirty two patients with multiple ligament injured knee were treated by 3 surgical strategies in the acute phase. (1) One-stage: Twelve patients treated by repair and reconstruction of all ruptured ligaments in a single operation. (2) Staged: Eleven patients treated by repair or reconstruction of the extraarticular (EA) ligaments and then intraarticular ligaments in 2nd stage. (3) EA ligament repair: Nine patients underwent only EA ligaments repair.Results:The patients were followed up for an average of 34.7 ± 12.1 months. Significant improvements in knee stabilities (P < 0.01), Lysholm score (P < 0.01) and International Knee Documentation Committee grade (P < 0.01) were noticed in all groups. Of the 32 patients, none had gross mal alignment or gait abnormalities at the latest followup. Comparing the 3 groups, a significant difference in Lysholm score was shown between the one stage group and the EA repair group (P = 0.040); additionally, significant differences were found in 2 subscales of knee injury and osteoarthritis outcome score (P < 0.05).Conclusion:Satisfactory clinical and functional outcomes could be achieved adopting the 3 surgical strategies based on personalized treatment. However, a combination of EA repair and intraarticular repair or reconstruction might be more reasonable options for the young and active patients.

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One-Stage Posterior Cruciate Ligament Inlay Reconstruction Combining Anterior Cruciate Ligament Reconstruction Following Knee Dislocation

Cited by 11 publications

References 26 publications

Irreducible posterolateral dislocation of the knee: a case report

Irreducible posterolateral dislocation of the knee: a case report

Arthroscopically Assisted Combined Anterior and Posterior Cruciate Ligament Reconstruction with Autologous Hamstring Grafts–Isokinetic Assessment with Control Group

Results of multiple ligament injured knees operated by three different strategies

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