Dataset Information

Surgical Management of the Multiple-Ligament Knee Injury.

ABSTRACT: The management of multiligament knee injury is a complex process starting with the adequate identification of the injury. A detailed physical and radiographic examination with a thorough understanding of knee anatomy is crucial to assess all damaged structures: anterior cruciate ligament, posterior cruciate ligament, posteromedial corner including the medial collateral ligament, and posterolateral corner including the lateral collateral ligament. Several surgical techniques have been developed throughout the years to adequately address these ligament insufficiencies. In this surgical technique description, we describe a reproducible method for the assessment and surgical management of a knee dislocation (KDIV) injury. Our approach includes using anatomic single-bundle cruciate ligament reconstructions with modified Bosworth technique for medial-side injuries and a combination of Müller popliteal bypass and Larson figure-of-8 techniques for posterolateral corner injuries. The orders of surgical steps is described concisely, and technical controversies such as graft choice, tunnel positioning, and sequence of graft fixation are discussed in detail.

SUBMITTER: Buyukdogan K

PROVIDER: S-EPMC5851650 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Surgical Management of the Multiple-Ligament Knee Injury.

Buyukdogan Kadir K Laidlaw Michael S MS Miller Mark D MD

Arthroscopy techniques 20180201 2

The management of multiligament knee injury is a complex process starting with the adequate identification of the injury. A detailed physical and radiographic examination with a thorough understanding of knee anatomy is crucial to assess all damaged structures: anterior cruciate ligament, posterior cruciate ligament, posteromedial corner including the medial collateral ligament, and posterolateral corner including the lateral collateral ligament. Several surgical techniques have been developed t ...[more]

PMID: 29552481

Similar Datasets

Project description:OBJECTIVE:Several studies have been published regarding the treatment of medial ulnar collateral ligament (MUCL) injuries for professional overhead athletes. However, there is a paucity of data regarding non-professional athletes. The aim of this systematic review was to compare the rate of outcome scores and complications of conservative versus operative treatments both in non-professional athletes and in non-sport-related trauma patients with MUCL lesions. METHODS:A systematic review of the published literature was performed by applying the PRISMA guidelines. A search was conducted using three databases: Medline, Science Direct, and Web of Science. The keywords used were "ulnar collateral ligament injury," "elbow," "surgery," and "conservative treatment". Patients were divided into three groups: patients who underwent conservative treatment (C-group), surgical treatment (S-group), and surgery after a failed conservative treatment (C&S-group). Clinical outcomes were analyzed: Disability of Arm, Shoulder and Hand (DASH), Conway scale, Carson score, and Kerlan-Jobe Orthopaedic Clinic score (KJOC). RESULTS:A total of 15 studies were included, evaluating 513 patients. Although good and excellent outcomes were found for most patients during daily and/or sport activities, independently of the type of treatment, the C-group had better results. Excellent results were found in 98.8% of the C-group, in 88.1% of the S-group, and in 87.7% of the C&S-group. The complication rate in the C-group was statistically higher compared to the S and C&S groups (P < 0.001). However, its complication rate was higher with lower patient satisfaction. CONCLUSIONS:There is insufficient evidence to establish statistically significant differences in the effects of conservative versus surgical treatments on the functional outcomes of patients with MUCL lesions. However, a period of rehabilitation therapy and the functional request of the single injured subject are useful to discern which patients genuinely require MUCL surgical repair.

Project description:Anterior cruciate ligament (ACL) injury predisposes individuals to early-onset knee joint osteoarthritis (OA). Abnormal joint loading is apparent after ACL injury and reconstruction. The relationship between altered joint biomechanics and the development of knee OA is unknown.Altered knee joint kinetics and medial compartment contact forces initially after injury and reconstruction are associated with radiographic knee OA 5 years after reconstruction.Case-control study; Level of evidence, 3.Individuals with acute, unilateral ACL injury completed gait analysis before (baseline) and after (posttraining) preoperative rehabilitation and at 6 months, 1 year, and 2 years after reconstruction. Surface electromyographic and knee biomechanical data served as inputs to an electromyographically driven musculoskeletal model to estimate knee joint contact forces. Patients completed radiographic testing 5 years after reconstruction. Differences in knee joint kinetics and contact forces were compared between patients with and those without radiographic knee OA.Patients with OA walked with greater frontal plane interlimb differences than those without OA (nonOA) at baseline (peak knee adduction moment difference: 0.00 ± 0.08 N·m/kg·m [nonOA] vs -0.15 ± 0.09 N·m/kg·m [OA], P = .014; peak knee adduction moment impulse difference: -0.001 ± 0.032 N·m·s/kg·m [nonOA] vs -0.048 ± 0.031 N·m·s/kg·m [OA], P = .042). The involved limb knee adduction moment impulse of the group with osteoarthritis was also lower than that of the group without osteoarthritis at baseline (0.087 ± 0.023 N·m·s/kg·m [nonOA] vs 0.049 ± 0.018 N·m·s/kg·m [OA], P = .023). Significant group differences were absent at posttraining but reemerged 6 months after reconstruction (peak knee adduction moment difference: 0.02 ± 0.04 N·m/kg·m [nonOA] vs -0.06 ± 0.11 N·m/kg·m [OA], P = .043). In addition, the OA group walked with lower peak medial compartment contact forces of the involved limb than did the group without OA at 6 months (2.89 ± 0.52 body weight [nonOA] vs 2.10 ± 0.69 body weight [OA], P = .036).Patients who had radiographic knee OA 5 years after ACL reconstruction walked with lower knee adduction moments and medial compartment joint contact forces than did those patients without OA early after injury and reconstruction.

Project description:PurposeThe purpose of this study was to investigate how different techniques of single-bundle anterior cruciate ligament (ACL) reconstruction affect subjective knee function via the Knee injury and Osteoarthritis Outcome Score (KOOS) evaluation 2 years after surgery. It was hypothesized that the surgical techniques of single-bundle ACL reconstruction would result in equivalent results with respect to subjective knee function 2 years after surgery.MethodsThis cohort study was based on data from the Swedish National Knee Ligament Register during the 10-year period of 1 January 2005 through 31 December 2014. Patients who underwent primary single-bundle ACL reconstruction with hamstrings tendon autograft were included. Details on surgical technique were collected using a web-based questionnaire comprised of essential AARSC items, including utilization of accessory medial portal drilling, anatomic tunnel placement, and visualization of insertion sites and landmarks. A repeated measures ANOVA and an additional linear mixed model analysis were used to investigate the effect of surgical technique on the KOOS4 from the pre-operative period to 2-year follow-up.ResultsA total of 13,636 patients who had undergone single-bundle ACL reconstruction comprised the study group for this analysis. A repeated measures ANOVA determined that mean subjective knee function differed between the pre-operative time period and at 2-year follow-up (p < 0.001). No differences were found with respect to the interaction between KOOS4 and surgical technique or gender. Additionally, the linear mixed model adjusted for age at reconstruction, gender, and concomitant injuries showed no difference between surgical techniques in KOOS4 improvement from baseline to 2-year follow-up. However, KOOS4 improved significantly in patients for all surgical techniques of single-bundle ACL reconstruction (p < 0.001); the largest improvement was seen between the pre-operative time period and at 1-year follow-up.ConclusionSurgical techniques of primary single-bundle ACL reconstruction did not demonstrate differences in the improvement in baseline subjective knee function as measured with the KOOS4 during the first 2 years after surgery. However, subjective knee function improved from pre-operative baseline to 2-year follow-up independently of surgical technique.

Project description:The purpose of this study was to compare fear and certainty of reinjury between follow-up time points and treatment groups (no anterior cruciate ligament [ACL] reconstruction [no ACLR], pre-ACLR, post-ACLR) and to identify prognostic factors for fear of reinjury at 3 and 12 months following injury or ACLR. An exploratory analysis of the Natural Corollaries and Recovery After ACL-injury multicenter longitudinal cohort study was conducted. Patients (n = 275) with primary ACL injury and 15 to 40 years of age received usual care (initial physical therapist-supervised rehabilitation, before considering ACLR). Fear of reinjury (as measured with the Anterior Cruciate Ligament Quality of Life instrument [ACL-QOL] item 31 and the Anterior Cruciate Ligament Return to Sport After Injury instrument [ACL-RSI] item 9) and certainty of reinjury (as measured with the Knee Self-Efficacy Scale item D2) were evaluated at baseline and at 3, 6, and 12 months following ACL injury or ACLR. Comparisons were performed with linear mixed models. Linear regression assessed potential prognostic factors (age, sex, preinjury activity, baseline knee function, baseline general self-efficacy, and expected recovery time) for fear of reinjury (ACL-QOL item 31) at the 3- and 12-month follow-up assessments. Fear of reinjury was common regardless of ACL treatment. Fear of reinjury decreased between 3 and 6 months and 3 and 12 months (mean difference: ACL-QOL = 9 [95% CI = 2 to 15]; ACL-RSI = 21 [95% CI = 13 to 28]) after injury. This improvement was not observed in patients who later underwent ACLR, who reported worse fear of reinjury at 3 months (ACL-QOL = 10 [95% CI = 3 to 18]) and at 12 months (ACL-RSI = 22 [95% CI = 2 to 42]) postinjury compared with those who did not proceed to ACLR. Following ACLR, fear of reinjury decreased between the 3- and 12-month follow-up assessments (ACL-QOL = 10 [95% CI = 4 to 16]; ACL-RSI = 12 [95% CI = 5 to 19]). Greater baseline general self-efficacy was associated with reduced fear of reinjury at 12 months after injury (adjusted coefficient = 1.7 [95% CI = 0.0 to 3.5]). Female sex was related to more fear of reinjury 3 months after ACLR (-14.5 [95% CI = -25.9 to -3.1]), and better baseline knee function was related to reduced fear of reinjury 12 months after ACLR (0.3 [95% CI = 0.0 to 0.7]). People who had ACLR reported worse fear of reinjury before surgery than those who did not proceed to ACLR. Different prognostic factors for fear of reinjury were identified in people treated with ACLR and those treated with rehabilitation alone. Fear of reinjury is a concern following ACL injury. Clinicians should evaluate and address reinjury fears. These results may assist in identifying individuals at risk of fear of reinjury following surgical and nonsurgical management of ACL injury.

Dataset Information

Surgical Management of the Multiple-Ligament Knee Injury.

Publications

Surgical Management of the Multiple-Ligament Knee Injury.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets