[Optimal treatment of complex ligament injuries and biomechanical aspects]

Certain guidelines may be established for surgical treatment of complex lesions of genicular ligaments. Preferential treatment should be given to the central stabilizers, anterior and posterior cruciate ligaments. Suturing with autologous augmentation is the rule for the anterior cruciate ligament, whereas the posterior cruciate ligament should be stabilised by both suturing and relief, using a transosseous PDS cord. The main peripheral ligaments, internal and external ligaments as well as arcuatum complex, have to be sutured, once instability has been confirmed. In cases of complex injuries, lateral structures are more important than median peripheral structures. Sutures should be tied for good stability. Non-absorbable material is used in cases in which stability of anchorage should enable no-plaster after-care. Sutured ligaments should be tension-adjusted close to stretching position (Lachman position, for main ligaments) and with neutral rotation. Sutures in shortened position may undergo rupture and thus jeopardize suturing at all. Only sutures for the posterior cruciate ligament should be strained close to rectangular position, since this actually represents maximum tension of the posterior cruciate ligament. Knee joint luxation is usually based on damage to all three ligaments, though two-ligament injuries are possible. Surgery is the optimum approach, since it is the only way to accomplish mechanically favourable adaptation of the central stabilizers.