Joseph E Nassar, Bshara Sleem, Luke V Tollefson, Evan P Shoemaker, Robert F LaPrade, Gilbert Moatshe
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引用次数: 0
Abstract
Background: Multiligament knee injuries (MLKIs) are complex and heterogeneous, often associated with concomitant injuries, and necessitates precise treatment strategies.
Preoperative management: Effective preoperative management in MLKIs requires comprehensive evaluation, starting with a detailed patient history to identify the mechanisms of injury and prior treatments. Physical examination assesses for knee stability, while imaging techniques including magnetic resonance imaging (MRI) and radiographs detail ligament, cartilage, and meniscal injuries to identify all injured structures. Vascular evaluations are critical given the high risk of concomitant neurovascular injuries especially in dislocated knees, bicruciate injuries, and lateral-sided injuries.
Avoiding tunnel convergence: Anatomic reconstruction of the torn ligaments has been biomechanically and clinically validated to improve knee stability and function. When performing multiple anatomic reconstructions, the risk of tunnel convergence is high. Therefore, surgical intervention aimed at optimizing outcomes necessitates careful planning to avoid tunnel convergence. This involves strategic tunnel placement, orientation, and techniques, such as adjusting tunnel angulation and using intraoperative imaging. These measures are vital for restoring knee functionality and minimizing future complications. Managing tunnel convergence is vital in treating MLKIs. Avoiding convergence on the medial side of the femur and tibia is more challenging due to the number of tunnels. In an MLKI involving all ligaments, 4 femoral tunnels and 4 tibial tunnels are required on the medial side, compared to 3 on the femur and 1 on the tibia for the lateral side, respectively.
Conclusion: The success of a multiligament knee reconstruction depends on a precise diagnosis, thorough preoperative management, and strategic tunnel placement. A multidisciplinary approach not only enhances surgical outcomes, but also ensures long-term improvement in knee function, effectively addressing the complexities and risks associated with these injuries.
期刊介绍：
IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.
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