Multiple Ligament Knee Injuries

Abstract

The posterior cruciate ligament (PCL)-based multiple ligament injury, or dislocated knee, is often part of a multisystem injury complex that not only includes the knee ligaments, but may also include blood vessels, skin, nerves, fractures, and other organ system trauma. These factors must be considered in the scope of treating this complex knee injury. These complex knee ligament injuries can result in significant functional instability for the affected individual. This article will discuss multiple ligament knee injuries evaluation, treatment, and special considerations in the pediatric and adolescent population.

Keywords

knee dislocation - allograft - mechanical graft tensioning - multiple ligament knee injuries - adolescent - open growth plates - posterior cruciate ligament

• References

• 1 Fanelli GC. The multiple ligament injured knee: what I have learned. In: Fanelli GC. , ed. The Multiple Ligament Injured Knee. A Practical Guide to Management. 2nd ed. New York: Springer-Verlag; 2013: 3-14
• 2 Fanelli GC. Posterior cruciate ligament injuries: what I have learned. In: Fanelli GC. , ed. Posterior Cruciate Ligament Injuries. A Practical Guide to Management. 2nd ed. New York: Springer; 2015: 3-18
• 3 Kennedy JC. Complete dislocations of the knee joint. J Bone Joint Surg Am 1963; 45: 889-904
• 4 Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004; 56 (06) 1261-1265
• 5 Stuart MJ. Evaluation and treatment principles of knee dislocations. Oper Tech Sports Med 2001; 9 (02) 91-95
• 6 Fanelli GC, Feldmann DD. Management of combined anterior cruciate ligament/posterior cruciate ligament/posterolateral complex injuries of the knee. Oper Tech Sports Med 1999; 7 (03) 143-149
• 7 Fanelli GC, Harris JD. Surgical treatment of acute medial collateral ligament and posteromedial corner injuries of the knee. Sports Med Arthrosc Rev 2006; 14 (02) 78-83
• 8 Fanelli GC, Harris JD. Late MCL (medial collateral ligament) reconstruction. Tech Knee Surg 2007; 6 (02) 99-105
• 9 Fanelli GC, Giannotti BF, Edson CJ. The posterior cruciate ligament arthroscopic evaluation and treatment. Arthroscopy 1994; 10 (06) 673-688
• 10 LaPrade RF. Arthroscopic evaluation of the lateral compartment of knees with grade 3 posterolateral knee complex injuries. Am J Sports Med 1997; 25 (05) 596-602
• 11 Greulich WW, Pyle SI. Radiographic Atlas of Skeletal Development of the Hand and Wrist. Stanford, CA: Stanford University Press; 1959
• 12 Tanner JM, Whitehouse RH. Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Arch Dis Child 1976; 51 (03) 170-179
• 13 Kocher MS, Shore B, Nasreddine AY, Heyworth BE. Treatment of posterior cruciate ligament injuries in pediatric and adolescent patients. J Pediatr Orthop 2012; 32 (06) 553-560
• 14 Shea KG, Polousky JD, Jacobs Jr JC, Ganley TJ. Anatomical dissection and CT imaging of the posterior cruciate and lateral collateral ligaments in skeletally immature cadaver knees. J Bone Joint Surg Am 2014; 96 (09) 753-759
• 15 Warme WJ, Mickelson D. All-epiphyseal semitendinosus PCL reconstruction in a 10-year-old child. J Pediatr Orthop 2010; 30 (05) 465-468
• 16 Solayar GN, Kapoor H. PCL tibial avulsion with an associated medial meniscal tear in a child: a case report on diagnosis and management. J Pediatr Orthop B 2012; 21 (04) 356-358
• 17 Kwon OS, Park MJ, Kelly IV JD. Arthroscopic treatment of a PCL avulsion fracture in a skeletally immature patient. Orthopedics 2011; 34 (02) 137
• 18 Anderson AF, Anderson CN. Posterior cruciate and posterolateral ligament reconstruction in an adolescent with open physes. A case report. J Bone Joint Surg Am 2007; 89 (07) 1598-1604
• 19 Bovid KM, Salata MJ, Vander Have KL, Sekiya JK. Arthroscopic posterior cruciate ligament reconstruction in a skeletally immature patient: a new technique with case report. Arthroscopy 2010; 26 (04) 563-570
• 20 Accadbled F, Knörr J, Sales de Gauzy J. All inside transtibial arthroscopic posterior cruciate ligament reconstruction in skeletally immature: surgical technique and a case report. Orthop Traumatol Surg Res 2013; 99 (03) 361-365
• 21 Stadelmaier DM, Arnoczky SP, Dodds J, Ross H. The effect of drilling and soft tissue grafting across open growth plates. A histologic study. Am J Sports Med 1995; 23 (04) 431-435
• 22 MacDonald PB, Black B, Old J, Dyck M, Davidson M. Posterior cruciate ligament injury and posterolateral instability in a 6-year-old child. A case report. Am J Sports Med 2003; 31 (01) 135-136
• 23 Shen HC, Yang JJ, Chang JH, Wang SJ. Surgical treatment of injury of the posterior cruciate ligament and posterolateral instability in the knee of a 5-year-old child: a case report. Am J Sports Med 2007; 35 (05) 831-834
• 24 Wegmann H, Tschauner S, Singer G, Marterer R, Eberl R, Sorantin E. The pediatric knee: diagnosis and management of ligament injuries. Semin Musculoskelet Radiol 2014; 18 (05) 489-497
• 25 Tanwar YS, Jaiswal A, Lal H, Rajput A. Compound posterior cruciate ligament and popliteal artery injury due to dog bite: a case report. Acta Orthop Traumatol Turc 2017; 51 (06) 499-502
• 26 Sørensen OG, Faunø P, Christiansen SE, Lind M. Posterior cruciate ligament reconstruction in skeletal immature children. Knee Surg Sports Traumatol Arthrosc 2017; 25 (12) 3901-3905
• 27 Fanelli GC, Fanelli DG. Knee dislocations and PCL-based multiligament knee injuries in patients aged 18 years and younger: surgical technique and outcomes. J Knee Surg 2016; 29 (04) 269-277
• 28 Fanelli GC, Fanelli DG. Posterior cruciate ligament reconstruction in patients eighteen years of age and younger. In: Fanelli GC. , ed. Posterior Cruciate Ligament Injuries. A Practical Guide to Management. 2nd ed. New York: Springer; 2015: 231-244
• 29 Fanelli GC. Surgical treatment of combined PCL ACL medial and lateral side injuries (global laxity): acute and chronic. In: Fanelli GC. , ed. The Multiple Ligament Injured Knee. A Practical Guide to Management. 2nd ed. New York: Springer-Verlag; 2013: 281-301
• 30 Fanelli GC. Mechanical graft tensioning in multiple ligament knee surgery. In: Fanelli GC. , ed. The Multiple Ligament Injured Knee. A Practical Guide to Management. 2nd ed. New York: Springer-Verlag; 2013: 323-330
• 31 Fanelli GC. Arthroscopic transtibial tunnel posterior cruciate ligament reconstruction. In: Fanelli GC. , ed. Posterior Cruciate Ligament Injuries. A Practical Guide to Management. 2nd ed. New York: Springer; 2015: 111-122
• 32 Fanelli GC. Combined PCL, ACL, posteromedial, and posterolateral reconstruction. In: Fanelli GC. , ed. Posterior Cruciate Ligament Injuries. A Practical Guide to Management. 2nd ed. New York: Springer; 2015: 173-188
• 33 Fanelli GC. Mechanical graft tensioning in posterior cruciate ligament reconstruction. In: Fanelli GC. , ed. Posterior Cruciate Ligament Injuries. A Practical Guide to Management. 2nd ed. New York: Springer; 2015: 263-270
• 34 Levy BA, Dajani KA, Whelan DB. , et al. Decision making in the multiligament-injured knee: an evidence-based systematic review. Arthroscopy 2009; 25 (04) 430-438
• 35 Levy BA, Fanelli GC, Whelan DB. , et al; Knee Dislocation Study Group. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg 2009; 17 (04) 197-206
• 36 Fanelli GC, Stannard JP, Stuart MJ. , et al. Management of complex knee ligament injuries. J Bone Joint Surg Am 2010; 92 (12) 2235-2246
• 37 Mayer S, Albright JC, Stoneback JW. Pediatric knee dislocations and physeal fractures about the knee. J Am Acad Orthop Surg 2015; 23 (09) 571-580
• 38 Fanelli GC, Beck JD, Edson CJ. Double bundle posterior cruciate ligament reconstruction: surgical technique and results. Sports Med Arthrosc Rev 2010; 18 (04) 242-248
• 39 Fanelli GC, Beck JD, Edson CJ. Combined PCL-ACL lateral and medial side injuries: treatment and results. Sports Med Arthrosc Rev 2011; 19 (02) 120-130
• 40 Fanelli GC. Rationale and Surgical Technique for PCL and Multiple Knee Ligament Reconstruction. 3rd ed. Warsaw, IN: Biomet Sports Medicine; 2012
• 41 Fanelli GC, Beck JD, Edson CJ. Single compared to double-bundle PCL reconstruction using allograft tissue. J Knee Surg 2012; 25 (01) 59-64
• 42 Edson CJ, Fanelli GC, Beck JD. Postoperative rehabilitation of the posterior cruciate ligament. Sports Med Arthrosc Rev 2010; 18 (04) 275-279
• 43 Edson CJ, Fanelli GC, Beck JD. Rehabilitation after multiple-ligament reconstruction of the knee. Sports Med Arthrosc Rev 2011; 19 (02) 162-166
• 44 Edson CJ, Fanelli GC. Postoperative rehabilitation of the multiple ligament injured knee. In: Fanelli GC. , ed. The Multiple Ligament Injured Knee. A Practical Guide to Management. 2nd ed. New York: Springer-Verlag; 2013: 437-442
• 45 Edson CJ. Rehabilitation following PCL reconstruction: scientific and theoretical basis. In: Fanelli GC. , ed. Posterior Cruciate Ligament Injuries. A Practical Guide to Management. 2nd ed. New York; Springer; 2015: 311-320
• 46 Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985; (198) 43-49
• 47 Windsor RE, Insall JN, Warren RF, Wickiewicz TL. The hospital for special surgery knee ligament rating form. Am J Knee Surg 1988; 1: 140-145
• 48 Daniel DM, Akeson W, O'Conner J. , eds. Knee Ligaments-Structure, Function, Injury, and Repair. New York: Raven; 1990: 421-447
• 49 The Multiple Ligament Injured Knee. In: Fanelli GC. , ed. A Practical Guide to Management. 2nd ed. New York: Springer-Verlag; 2013
• 50 Posterior Cruciate Ligament Injuries. In: Fanelli GC. , ed. A Practical Guide to Management. 2nd ed. New York; Springer; 2015

• Recommended Readings

• 1 The Multiple Ligament Injured Knee. In: Fanelli GC. , ed. A Practical Guide to Management. 2nd ed. New York: Springer-Verlag; 2013
• 2 Posterior Cruciate Ligament Injuries. In: Fanelli GC. , ed. A Practical Guide to Management. 2nd ed. New York: Springer; 2015