Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Goyal, Ankit; Tanwar, Milind; Joshi, Deepak; Chaudhary, Deepak

doi:10.4103/ortho.ijortho_228_17

Cited by 15 publications

(15 citation statements)

References 68 publications

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“…These results were optimistic compared to those of the literature could be related to short duration of follow-up. Ankit G and al [9] , Charles L et al [8] noted in their metaanalyzes a superiority of surgical treatment compared to nonsurgical treatment for follow-up of more than 5 years. They report, however, the lack of difference between the two treatments when considering the loss of pain, knee stability and the resumption of the level of previous activities.…”

Section: Discussionmentioning

confidence: 99%

“…These controversies concerns the choice between nonsurgical or surgical treatment, ligament repair or reconstruction, the use of an autologous graft or an allograft and the operating time. For this purpose several publications have been made to propose decision trees to surgeons [8,9] . Although surgical treatment has taken place over orthopedic treatment, conditions are sometimes unavailable for this surgery [2] , especially in developing countries where the technical platform is precarious and the operating equipment inadequate.…”

Section: Introductionmentioning

confidence: 99%

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Non-surgical treatment of knee ligamentous lesions

Kolima¹,

Ayouba²,

Hodabalo³

et al. 2018

Int. J. Orthop. Sci.

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Introduction: Knee trauma is very common and sometimes compromises its stability. The treatment of these lesions is more and more surgical, but nonsurgical treatment remain having an importance in the management. The purpose of this study was to determine the results of nonsurgical treatment of ligamentous knee injuries in soldiers deployed in northern Mali during a stabilization mission. Materials and methods: It was a prospective study concerning ligamentous lesions of the knee, treated by orthopedic means in Togo's level 2 hospital and followed for a period of at least 6 months. The International Knee Score (IKS) was used to determine our results. Patient satisfaction was determined by taking into account pain, knee stability and resumption of previous activities.Results: Twenty-one (21) patients were treated. They were 18 men (85.7%) and 3 women (14.3%). The average age of the patients was 32.43 years old. We found 7 cases (33.4%) of benign sprain, 9 cases (42.8%) of medium severity sprain and 5 cases (23.8%) of severe sprain. After administration of the analgesic, immobilization was made by a knee brace and sometimes a plaster splint. Rehabilitation was started at the end of immobilization. The control after 6 months of follow-up allowed to find 57,1% of excellent result and 9,5% of bad result Conclusion: Nonsurgical treatment of ligamentous lesions gives good results when properly conducted. When a surgical treatment is decided for these lesions, it is recommended to make the rehabilitation of the knee before the operation to improve the results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Non-surgical treatment of knee ligamentous lesions

Kolima¹,

Ayouba²,

Hodabalo³

et al. 2018

Int. J. Orthop. Sci.

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“…Consensus is lacking on the use of staged or single-stage procedures, repair or reconstruction of ligaments, type of reconstruction for each ligament, the timing of surgery, graft options, the sequence of reconstruction, and postoperative rehabilitation [9]. Different treatment options have been proposed in different studies [2,7,10,[12][13][14]. These studies focus on the acute treatment of knee dislocation and multiligament injuries.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

Goyal

Paul

Banerjee

et al. 2021

Knee Surg & Relat Res

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Purpose This article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts. Methods All patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up. Results A total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty. Conclusion Single-stage surgical reconstruction for chronic MKI has favourable functional outcomes. Level of evidence Level IV, case series.

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“…Based on clinical research, Loh et al showed that there was a good knee stability following anterior cruciate ligament reconstruction on PCL injury patients 12 . However, the presence of graft in the tunnel fixed invalid distance results in graft tunnel horizontal and vertical relative motion in a "wiper effect" (windshield wiper effect) and a "bungee effect" 13 . Despite that, the angle between the tunnel and the graft is less than 90º, which further leads to thinning of the grafts at the tunnel portal, decrease in tension, and the gradul relaxation ("killer turn" effect) 14,15 .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Reconstruction of Posterior Cruciate Ligament with Embedded Tibial Tendon Bolt

Zhang

et al. 2021

Orthopaedic Surgery

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Objective To evaluate the effect of newly designed arthroscopic reconstruction of posterior cruciate ligament (PCL) using tibial tendon bolt. Methods The effects of embedded tendon pin were observed by X‐ray of knee joint. From October 2010 to September 2015, 51 PCL injury patients who met the inclusion criteria were enrolled in this retrospective study. The arthroscopically assisted reconstruction of the PCL with tibial tendon bolt was performed on all patients. Visual Analog Scale (VAS) pain score, Tegner activity score, Lysholm score, International Knee Documentation Committee (IKDC) assessment, posterior drawer test (PDT), and KT‐1000 activity score were evaluated preoperatively and at 1‐year postoperative and 3‐year postoperative. Results The preoperative, 1‐year postoperative, and 3‐year postoperative IKDC score (15.8% ± 14.8%, 89.6% ± 5.8%, and 86.8% ± 5.4%), Lysholm score (17.4 ± 10.7, 91.2 ± 2.8, and 88.2 ± 3.1), VAS score (5.8 ± 1.2, 1.3 ± 0.5, and 0.6 ± 0.5), Tegner activity score (1.2 ± 0.8, 8.1 ± 0.8, and 7.4 ± 0.8), and KT‐1000 score (15.6 ± 3.6, 4.5 ± 2.4, and 5.4 ± 1.8) were obtained. There were significant differences in these outcomes among preoperative, 1‐year postoperative, and 3‐year postoperative (all P < 0.0001). After 1‐ and 3‐year surgery, 31 (60.8%) and 26 (51.0%) patients had the negative PDT, indicating that the PCL injury was improved. There were no postoperative complications. Conclusion The application of tendon pin fixed by tibial inlay 8‐shaped tibial tunnel to reconstruct PCL was an effective, simple, and safe surgical procedure for PCL injury.

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Practice Guidelines for the Management of Multiligamentous Injuries of the Knee

Cited by 15 publications

References 68 publications

Non-surgical treatment of knee ligamentous lesions

Non-surgical treatment of knee ligamentous lesions

Outcomes of one-stage reconstruction for chronic multiligament injuries of knee

Arthroscopic Reconstruction of Posterior Cruciate Ligament with Embedded Tibial Tendon Bolt

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