Dataset Information

Multiligament Repair With Suture Augmentation in a Knee Dislocation With Medial-Sided Injury.

ABSTRACT: Knee dislocations often result in a severe multiligament injured knee (MLIK) with complex instability. Multiligament reconstruction can successfully restore knee stability and is commonly recommended, although surgical morbidity is induced by graft harvesting and tunnel drilling, and convergence of multiple tunnels can complicate the surgery. Therefore, as an alternative, primary repair of knee ligaments is currently reconsidered. The main advantages of primary repair consist of tissue preservation and decrease of surgical morbidity, which might improve knee functionality. Techniques in which avulsed ligaments are reapproximated to their anatomic origin have resulted in good clinical outcomes in selected patients over the past decade. More recently, repaired ligaments have been augmented with suture tape, to protect them from excessive stretch, which can improve healing and allows early rehabilitation. The surgical technique of primary repair in the multiligament injured knee has not yet been described. The purpose of this Technical Note is to explain suture augmented primary repair in KDIII-M injury, including the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament.

SUBMITTER: Jonkergouw A

PROVIDER: S-EPMC6112193 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Multiligament Repair With Suture Augmentation in a Knee Dislocation With Medial-Sided Injury.

Jonkergouw Anne A van der List Jelle P JP DiFelice Gregory S GS

Arthroscopy techniques 20180716 8

Knee dislocations often result in a severe multiligament injured knee (MLIK) with complex instability. Multiligament reconstruction can successfully restore knee stability and is commonly recommended, although surgical morbidity is induced by graft harvesting and tunnel drilling, and convergence of multiple tunnels can complicate the surgery. Therefore, as an alternative, primary repair of knee ligaments is currently reconsidered. The main advantages of primary repair consist of tissue preservat ...[more]

PMID: 30167362

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Project description:BackgroundDifferent surgical techniques have been described for the treatment of knee dislocation (KD). Nonoperative approaches are frequently combined with surgical reconstruction using auto- or allograft.PurposeTo evaluate the midterm results of primary surgical repair and suture augmentation to treat KD.Study designCase series; Level of evidence, 4.MethodsA total of 22 patients (5 women, 17 men; mean age, 45 ± 15 years) with KD were evaluated at a mean of 49 ± 16 months after surgical treatment that included primary repair and suture augmentation. Magnetic resonance imaging, stress radiographs, and outcome scores were obtained at the follow-up. Clinical examination including hop tests and force measurements for flexion and extension was performed.ResultsThe mean difference in pre- to postinjury Tegner scores was -2 ± 1. The outcome scores showed mean values of 84 ± 15 (Lysholm), 73 ± 15 (International Knee Documentation Committee) and 65 ± 25 (Anterior Cruciate Ligament-Return to Sport after Injury scale). Compared with the uninjured knee, the range of motion of the injured knee was reduced by 21° ± 12°. Twelve patients felt fit enough to perform hop tests and showed a mean deficit of 7% ± 17%° compared with the uninjured leg. The mean force deficit was 19% ± 18% for extension and 8% ± 16% for flexion. Stress radiographs revealed an 11 ± 7-mm higher anteroposterior translation on the injured side. Four patients had secondary ligament reconstructions due to persistent instability and 7 underwent arthroscopic arthrolysis due to stiffness. A significant increase of osteoarthritis was found for the medial, lateral, and patellofemoral compartments (P = .007, .004, and .006, respectively).ConclusionPrimary repair and suture augmentation of KD led to satisfactory clinical midterm results despite persistent radiological instability and a significant increase in osteoarthritis. This technique allows the return to activities of daily living without subjective instability in most nonathletic patients. Secondary ligament reconstructions should be performed if relevant instability persists to decrease the risk of secondary meniscal and cartilage damage.

Project description:Incomplete healing and/or functional failure following rotator cuff tear repair remains a challenging problem for both patients and surgeons. Augmentation strategies are growing to increase healing through biologic and mechanical mechanisms to improve functional results after arthroscopic rotator cuff repair. The majority of currently described augmentation techniques use allograft tissue. An alternative, low-cost, autograft option for augmentation is the use of the long head of biceps tendon autograft as a free functional graft. Here, we describe the use of autograft biceps tendon as a viable option for augmentation of double-row rotator cuff repair with knotless all-suture suture anchors. Technique Video Video 1 Arthroscopic repair of a right shoulder rotator cuff repair, subpectoral open biceps tenodesis, and autograft biceps graft augmentation is performed in a beach-chair position. We begin with a diagnostic arthroscopy viewing the subacromial space through the posterolateral portal. The rotator cuff tear is evaluated using a grasper through the lateral portal. The rotator cuff is repaired using a knotless configuration double row transosseous-equivalent beginning with all-suture anchors being placed, creating a medial row. These sutures are then passed through the rotator cuff tear and brought to a lateral row where the final construct is visualized. Next, we perform a mini-open subpectoral biceps tenodesis using a low axillary incision. The proximal biceps tendon is harvested and placed on the back table to be measured for autograft augmentation. The biceps autograft is placed in a compression plate and loaded into the press, where it is “smashed.” Sutures are put into all 4 corners of the graft and loaded onto the delivery device. The patch is inserted into the shoulder through a cannulated lateral portal into the subacromial space and deployed over the rotator cuff repair. The patch is fixated medially using a PLGA tissue tack device and laterally with two anchors. The final repair construct is demonstrated by the autograft patch augmentation lying flush over the rotator cuff repair.

Dataset Information

Multiligament Repair With Suture Augmentation in a Knee Dislocation With Medial-Sided Injury.

Publications

Multiligament Repair With Suture Augmentation in a Knee Dislocation With Medial-Sided Injury.

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