Abstract
Anatomical knowledge and identification of multiple ligament knee injuries have considerably
evolved during the last decade. Consecutively, a trend for anatomical reconstruction
of these injuries emerged. These procedures are challenging and require precise planning.
Moreover, the planning itself is made difficult by the variety of techniques, whose
descriptions are scattered throughout the literature. The objective is to reference
and categorize the different ligament reconstruction techniques to provide free planning
assistance software using a standardized graphic chart.
The search for ligament reconstruction techniques on nine different databases produced
1,536 articles. After reviewing for relevance, the authors included the full papers
of the remaining 306 articles. From the reference lists of the selected articles reviewed,
96 studies describing original techniques were retrieved. Techniques were extracted,
drawn following the same graphics chart, and classified into conceptual categories.
After selection, 10, 4, 28, 28, and 26 articles described anterior cruciate ligament,
posterior cruciate ligament, posteromedial corner, posterolateral corner, and anterolateral
corner procedures for reconstruction, respectively. Early techniques often used tenodesis
while nowadays various grafts are fixed to isometric points or anatomic landmarks.
An interactive tool was created. It allows the visualization of selected reconstructions
on axial, frontal, and sagittal representations of the knee. Tunnel position, preferred
transplant type, and fixation mode are represented. The freeware is available at:
https://apps.medecine.u-paris.fr/multilig/.
The techniques described for the reconstruction of an isolated ligament or corner
cannot always be extrapolated for multiple ligament knee injuries treatment. Bone
stock and tunnel convergence are two main concerns to consider during planning. Sometimes,
it could be necessary to sacrifice a potentially biomechanically superior approach
if simpler reconstructions provide equivalent knee kinematics. Surgical options are
multiple and scattered throughout the literature. Our study provides an open-source
and clinician-accessible research tool for multiple ligament injuries planification
using a standardized graphic chart.
Keywords
multiligament - reconstruction - technique
