ACL Reconstruction in the Multiple Ligament Injured Knee

Marx, Robert G.; Wolfe, Isabel

doi:10.1055/s-0039-3400842

Cited by 2 publications

(2 citation statements)

References 25 publications

(35 reference statements)

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“…For knee surgeons, how many structures are injured, and which structures are injured are key issues for determining the strategy for the graft selection, the surgical procedure, xation devices, xation order. Marx et al reported that preoperative planning is critical, and the order of tunnels, graft passage, and xation should be decided prior to surgery [11].…”

Section: Discussionmentioning

confidence: 99%

A proposal new classification in multi-ligament knee injuries based on both femorotibial joint and patellofemoral joint factors

Tajima

Yamaguchi

Morita

et al. 2022

Preprint

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BackgroundKnee extensor structure disruption is sometimes combined with multi-ligament knee injury (MLKI). These cases could not be classified into the previous classification for knee dislocation or MLKI. To propose a new classification of MLKI that addresses both femorotibial and patellofemoral (PF) factors.MethodsThe present study involved patients diagnosed with MLKI at our institute. Cases with two or more injured structures diagnosed clinically and by MRI and X-ray examinations were included. Details of injured structures were defined as follows: ‘cruciate ligaments’, including the ACL and PCL; ‘collateral ligaments’, including the MCL and the posterolateral corner (PLC); and the ‘PF joint factor’, including the medial patellofemoral ligament (MPFL), quadriceps tendon, and patellar tendon. A total of 65 cases met the inclusion criteria from 2007 to August 2020 and were enrolled in this study.Based on the number of injured structures, cases were categorized as: Type A, two structures injured; Type B, three structures injured; Type C, four structures injured; and Type D, five structures injured. Depending on the combination of injured structures, they were subdivided into 1 to 5 in Types A and B and into 1 to 3 in Type C. Additional injuries were subdivided as follows: MLKI with fracture was defined as X, with neurovascular injury as Y, and both fracture and neurovascular injury as Z. MLKI cases were divided into both Schenck’s KD classification and the present classification.ResultsFourteen of 65 cases (21.5%) could not be categorized using Schenck’s KD classification; two cases of PLC+MPFL (Type-A5 in new classification), ACL+PLC with periarticular fracture (Type-A1-X), and single cases of ACL+MCL+PLC (Type-B2), ACL+PCL+MCL+PLC+MPFL (Type-D), ACL+MPFL (Type-A4), ACL+MCL+MPFL (Type-B3), PCL+PLC+ patellar tendon with periarticular fracture (Type-B3-X), and PCL+ patellar tendon (Type-A4), ACL+PLC with neurovascular injury (Type-A1-Y), and three cases of PCL+PLC with complications (Type-A1-X, -Y, -Z). With the new classification for MLKI and complications, all cases were successfully assigned to each category.ConclusionIn the present classification, every combination of MLKI cases containing both tibiofemoral and patellofemoral factors, with or without complications, was successfully classified into a suitable category.

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Section: Discussionmentioning

confidence: 99%

A proposal new classification in multi-ligament knee injuries based on both femorotibial joint and patellofemoral joint factors

Tajima

Yamaguchi

Morita

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…Generally, the options of graft sources for knee ligament reconstruction are allografts, artificial ligaments, and autogenous grafts such as the semitendinosus tendon, gracilis tendon, bone-patellar tendon-bone, quadriceps tendon, and so on. [5][6][7][8][9] Unfortunately, allografts are not easily available in some countries, including Japan. Therefore, in these countries, graft selection and allocation are one of the major problems for MLKI surgery.…”

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confidence: 99%

Remnant-Preserved Single-Bundle Anterior Cruciate Ligament Augmentation in Multi-ligamentous Knee Reconstruction

et al. 2022

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This study was conducted to present remnant-preserving anterior cruciate ligament (ACL) augmentation as a useful option for partial ACL injury in multiligament knee injury (MLKI) cases, which may also contribute to conserving graft resources. The present study involved patients diagnosed with MLKI at our institute from Spring 2006 to February 2021. A total of 71 MLKI cases were provided surgery due to knee instability and disability. For every patient, an arthroscopic diagnostic was performed to ensure that ACL tear and a remnant were present. When the ACL remnant was classified into group 2, 3, or 4 of Nakamae's classification, remnant-preserved single bundle ACL augmentation was performed. Graft selection and the combination of injured ligaments were evaluated. The side-to-side difference under an anterior tibial load of 134 N with an arthrometer and the leg symmetry index at 60 degrees/s were measured. The present procedure was performed for five cases (male/female: 4/1, mean age: 33.6 years). The mean follow-up period was 26.4 months. The combination of torn ligaments was as follows: 3 cases of ACL + medial collateral ligament, one case of ACL + posterior cruciate ligament, and one case of ACL + posterolateral corner. An ACL augmentation graft was performed using an ipsilateral gracilis tendon in 2 cases, a contralateral full semitendinosus tendon in 2 cases, and the ipsilateral distal 1/2 of the semitendinosus tendon in 1 case. The mean side-to-side difference was 1.07 ± 0.4 mm. The mean leg symmetry index was 82.6 ± 12.2% in knee extension and 96.3 ± 9.9% in knee flexion. Although the present study was a small case series, the remnant-preserved single-bundle ACL augmentation for MLKI surgery provided good clinical outcome and conserved the graft resource. Even in the MLKI case, this technique is one of the useful surgical options. The level of evidence of this study is level IV (case series).

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ACL Reconstruction in the Multiple Ligament Injured Knee

Cited by 2 publications

References 25 publications

A proposal new classification in multi-ligament knee injuries based on both femorotibial joint and patellofemoral joint factors

A proposal new classification in multi-ligament knee injuries based on both femorotibial joint and patellofemoral joint factors

Remnant-Preserved Single-Bundle Anterior Cruciate Ligament Augmentation in Multi-ligamentous Knee Reconstruction

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