The multiple ligament-injured knee: When is primary repair an option?

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

doi:10.1016/j.knee.2019.11.013

Cited by 19 publications

(25 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vermeijden et al reported the short-term outcomes of a heterogeneous cohort of 48 patients with MLIK. 18 Of all patients, 27 (56%) presented with a PCL tear, of which 19 (73%) were repaired. At a mean follow-up of 2.5 years, the PCL repair failed in three patients (17%), of which two underwent ligament reconstruction and one was treated conservatively.…”

Section: Proximal Tearsmentioning

confidence: 99%

See 1 more Smart Citation

Arthroscopic Primary Repair of the Posterior Cruciate Ligament

2021

Self Cite

View full text Add to dashboard Cite

The posterior cruciate ligament (PCL) is one of the four major stabilizers of the knee joint and functions as the primary restraint to posterior tibial translation. PCL tears rarely occur in isolation and most commonly presents in the setting of multiligamentous knee injuries. Several treatment strategies for these injuries have been proposed over the last decades, including ligament reconstruction and primary repair. Arthroscopic primary PCL repair has the potential to preserve native tissue using a more minimally invasive approach, thereby avoiding donor-site morbidity and allowing early mobilization. While arthroscopic PCL repair is certainly not an effective surgical approach for all patients, this procedure may be a reasonable and less morbid alternative to PCL reconstruction in selected patients treated for proximal or distal avulsion tears, with low failure rates, good knee stability, and good to excellent subjective outcomes. The surgical indications, surgical techniques, postoperative management, and outcomes for arthroscopic primary repair of proximal and distal PCL tears will be discussed in this review.

show abstract

Section: Proximal Tearsmentioning

confidence: 99%

“…16 When taking both tear type and tissue quality into account, some studies have suggested that the eligibility for primary PCL repair in the MLIK setting is quite high, with a range from 51 to 73%. 17,18…”

Section: Indicationsmentioning

confidence: 99%

Arthroscopic Primary Repair of the Posterior Cruciate Ligament

2021

Self Cite

View full text Add to dashboard Cite

show abstract

“…There also seems to be no clear difference comparing repair to reconstruction regarding medial collateral ligaments and posteromedial corner injuries [ 42 ]. Repair is generally favoured for avulsion fractures [ 40 , 42 , 48 ] and has been advocated when ligaments are torn at their insertions [ 53 ]. A recent resurgence of interest in repair has been brought about with the introduction of internal bracing, in which primary repairs are synthetically augmented [ 40 , 54 , 55 ].…”

Section: Repair Versus Reconstructionmentioning

confidence: 99%

Current concepts in the assessment and management of multiligament injuries of the knee

Scheepers

Khanduja

Held

2021

SICOT-J

View full text Add to dashboard Cite

Multiligament knee injuries (MLKIs), though rare, pose significant challenges to the patient and surgeon. They often occur in the setting of high-velocity trauma and are frequently associated with concomitant intra- and extra-articular injuries, the most immediately devastating of which is vascular compromise. A detailed evaluation is required when acute or chronic MLKIs are suspected, and stress radiography, MRI and angiography are valuable adjuncts to a thorough clinical examination. Surgical treatment is widely regarded as superior to non-surgical management and has been demonstrated to improve functional outcome scores, return to work, and return to sport rates, though the incidence of post-traumatic osteoarthritis remains high in affected knees. However, acceptable results have been obtained with conservative management in populations where surgical intervention is not feasible. Early arthroscopic single-stage reconstruction is currently the mainstay of treatment for these injuries, but some recent comparative studies have found no significant differences in outcomes. Recent trends in the literature on MLKIs seem to favour early surgery over delayed surgery, though both methods have distinct advantages and disadvantages. Due to the heterogeneity of the injury and the diversity of patient factors, treatment needs to be individualised, and a single best approach with regards to the timing of surgery, repair versus reconstruction, surgical technique and surgical principles cannot be advocated. There is much controversy in the literature surrounding these topics. Early post-operative rehabilitation remains one of the most important positive prognostic factors in surgical management and requires a dedicated team-based approach. Though outcomes of MLKIs are generally favourable, complications are abundant and precautionary measures should be implemented where possible. Low resource settings are faced with unique challenges, necessitating adaptability and pragmatism in tailoring a management strategy capable of achieving comparable outcomes.

show abstract

“…[24,25] Yet, bony avulsions form an exception for which repair is favored [26] and some suggest to repair ligaments acutely when they are torn at their insertions. [27] Furthermore, collateral ligaments have an acceptable healing capacity although with distinct differences for the medial and lateral side. For the lateral side of the knee, the results for primary repair alone are poor with a recent study showing a 38% failure rate for lateral repair with delayed cruciate reconstruction.…”

Section: Techniques Repairmentioning

confidence: 99%

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

Held

North

Bormann

et al. 2020

JASSM

View full text Add to dashboard Cite

Recent advances in the management of multiligament knee injuries have led to improvements in diagnosis and management and allowed enhanced understanding of the biomechanics of ligament reconstructions. Most studies arise from subspecialist knee centers in high-income countries and can inform global strategies, but each patient encounter and environment is unique and not all recommendations may be feasible in every setting. For ligamentous injuries, the gold standard is acute arthroscopic, single-stage ligament reconstruction, although this is not always possible in the limited resource setting (LRS). For these circumstances, non-operative management, although rarely promoted, may be preferred in selected patients. Furthermore, acute surgery relies on adequate post-operative physiotherapy, otherwise a delayed surgical approach should be considered. Reconstruction remains the gold standard, but acute repair is an option for medial collateral and posterior cruciate ligaments and for avulsion fractures. For a vascular examination, a careful clinical assessment and routine angiography should be done in LRS. Due to the heterogeneity of injury and patient profile, outcomes vary widely and need to be interpreted in the context of the surgical setup. The main complications of these injuries are stiffness, residual laxity, and surgical site infections. Future trends will need to include a global perspective and provide solutions for surgeons in various parts of the world.

show abstract

The multiple ligament-injured knee: When is primary repair an option?

Cited by 19 publications

References 63 publications

Arthroscopic Primary Repair of the Posterior Cruciate Ligament

Arthroscopic Primary Repair of the Posterior Cruciate Ligament

Current concepts in the assessment and management of multiligament injuries of the knee

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

Contact Info

Product

Resources

About