Anatomic Multiple Ligament Reconstructions of the Knee.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Reconstruction

Background:

• Multiple ligament knee injuries often result from athletic activities.
• These injuries can involve cruciate ligaments, collateral ligaments, and associated damage to meniscus, bone, cartilage, and nerves.

Purpose of the Study:

• To describe a surgical technique for managing combined anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and posterolateral corner (PLC) ruptures.
• To highlight the importance of anatomic reconstruction and early rehabilitation in achieving successful outcomes.

Main Methods:

• Surgical technique involves neurolysis of the common peroneal nerve (CPN), tendon repairs, and anatomic-based ligament reconstructions.
• Utilized autografts and allografts for ACL, PCL, and PLC reconstruction with precise tunnel placement and graft tensioning sequence.
• Emphasized 3D modeling for optimal tunnel orientation and established graft tensioning order (PCL, ACL, PLC).

Main Results:

• Anatomic single-stage reconstruction has shown successful outcomes for various multiligament knee injuries.
• Equivalent results reported for acute versus chronic injuries and different injury patterns when anatomic principles are followed.
• Early range of motion and specific bracing protocols are crucial for preventing complications.

Conclusions:

• Single-stage anatomic reconstruction is the gold standard for complex knee ligament injuries.
• Early knee range of motion (0°-90°) and PCL-bracing are vital post-operatively to prevent arthrofibrosis and graft stretching.