Abstract:The risk of tunnel convergence with the ACL and PCL femoral tunnels can be reduced by adjusting the orientation of the FCL and PLT tunnels and the sMCL and POL tunnels, respectively.
“…This approach allows for early mobilization of the knee to reduce the risk of arthrofibrosis, reduce surgery time, and reduce the risk of tunnel convergence if the PCL is reconstructed concurrently. 22 Previous studies have reported on an increased risk of arthrofibrosis and joint stiffness in medial-sided injuries 23,24 ; therefore, some authors have advocated for nonoperative management of medial tears and late reconstruction in those patients with persistent instability.…”
Section: Nonoperative Management Of Medial Structuresmentioning
Multiligament knee injuries (MLKI) are complex and challenging to treat. The posteromedial corner (PMC) structures are commonly torn in MLKI. A thorough and systematic evaluation is imperative to avoid a missed diagnosis and for planning treatment. With several structures injured, the treatment method (operative vs. nonoperative, repair vs. reconstruction), availability of allografts, timing of surgery, and rehabilitation are some of the factors that have to be considered in the decision-making. Persistent valgus instability because of untreated or not healed medial collateral ligament (MCL) tears will increase graft forces on the cruciate ligament grafts, thus increasing the risk of reconstruction graft failure. In recent years, there has been a growing body of literature on the anatomy and biomechanics of the medial structures that has aided in the development of biomechanically and clinically validated anatomic PMC reconstructions. Despite good healing potential of the MCL, in MLKI, surgical treatment is recommended for grade III PMC injuries to aid early rehabilitation and reduce the risk of surgical failure. Several studies have reported satisfactory outcomes after surgical treatment of MLKI involving the medial side. Early functional rehabilitation is imperative to reduce the risk of arthrofibrosis.
“…This approach allows for early mobilization of the knee to reduce the risk of arthrofibrosis, reduce surgery time, and reduce the risk of tunnel convergence if the PCL is reconstructed concurrently. 22 Previous studies have reported on an increased risk of arthrofibrosis and joint stiffness in medial-sided injuries 23,24 ; therefore, some authors have advocated for nonoperative management of medial tears and late reconstruction in those patients with persistent instability.…”
Section: Nonoperative Management Of Medial Structuresmentioning
Multiligament knee injuries (MLKI) are complex and challenging to treat. The posteromedial corner (PMC) structures are commonly torn in MLKI. A thorough and systematic evaluation is imperative to avoid a missed diagnosis and for planning treatment. With several structures injured, the treatment method (operative vs. nonoperative, repair vs. reconstruction), availability of allografts, timing of surgery, and rehabilitation are some of the factors that have to be considered in the decision-making. Persistent valgus instability because of untreated or not healed medial collateral ligament (MCL) tears will increase graft forces on the cruciate ligament grafts, thus increasing the risk of reconstruction graft failure. In recent years, there has been a growing body of literature on the anatomy and biomechanics of the medial structures that has aided in the development of biomechanically and clinically validated anatomic PMC reconstructions. Despite good healing potential of the MCL, in MLKI, surgical treatment is recommended for grade III PMC injuries to aid early rehabilitation and reduce the risk of surgical failure. Several studies have reported satisfactory outcomes after surgical treatment of MLKI involving the medial side. Early functional rehabilitation is imperative to reduce the risk of arthrofibrosis.
“…(B) A 2.7-mm drill-tipped pin is positioned into the anterior fifth of the popliteal sulcus. With combined anterior cruciate ligament and posterolateral corner reconstruction, it is recommended to aim 35° anteriorly 16 and 30° proximally 17 to avoid tunnel collision with the femoral tunnel of an anatomic ACL reconstruction or entry into the intercondylar notch. A 25-mm deep, 6-mm diameter socket is then drilled.…”
Section: Surgical Techniquementioning
confidence: 99%
“…A 2.7-mm drill-tipped pin is positioned at this point. With combined ACL and PLC reconstruction, it is recommended to aim 35° anteriorly 16 and 30° proximally 17 to avoid tunnel collision with the femoral tunnel of an anatomic ACL reconstruction or entry into the intercondylar notch. A socket with a depth of 25 mm and a diameter of 6 mm is then created with the drill.Fig 6Right knee, lateral side, 90° of flexion.…”
The original description of the LaPrade technique for anatomic posterolateral corner reconstruction addresses the 3 main stabilizing structures: the fibular collateral ligament, the popliteus, and the popliteofibular ligament. The use of two separate grafts (originally described with a tendo-Achilles allograft) may restrict the utility of the technique when sources of allograft may be limited and autografts must be used, particularly in the context of multiligament reconstruction. We present a modification of the technique, in which an adjustable cortical button is used for tibial fixation, which allows for the use of a single graft while maintaining the ability to independently tension the popliteus, popliteofibular ligament, and fibular collateral ligament limbs of the graft.
“…Over the last decade, there has been an increased interest in primary repair of the knee ligaments which has the advantage of preserving the native tissues and avoidance of more invasive reconstruction surgery that can require multiple tunnels and grafts with the associated donor site morbidity and the risk of tunnel convergence [14][15][16]. As a result of this less invasive surgery, primary repair is thought to have a quicker return of range of motion and could potentially reduce the incidence of postoperative stiffness [17].…”
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