Reconstruction of the Anterior and Posterior Cruciate Ligaments After Knee Dislocation

Abstract

We reviewed the results in 13 patients who underwent simultaneous allograft reconstruction of both the anterior and posterior cruciate ligaments after a knee dislocation (nine acute and four chronic injuries). Seven patients sustained related medial collateral ligament injuries and six patients had posterolateral complex injuries. Ligament reconstructions were performed using fresh-frozen Achilles or patellar tendon allografts. At follow-up evaluation (mean of 38 months), only one patient described the reconstructed knee as normal. Six patients had returned to unrestricted sports activities and four had returned to modified sports. The average extension loss was 3 degrees (range, 0 degree to 10 degrees) and average flexion loss was 5 degrees (range, 0 degree to 15 degrees). The KT-1000 arthrometer measurements at 133 N anterior-posterior tibial load showed a mean side-to-side difference of 4.5 mm (range, 0 to 10) at 20 degrees and 5.0 mm (range, 0 to 9) at 70 degrees. The mean Lysholm score was 88 (range, 42 to 100). International Knee Documentation Committee ratings were six nearly normal, five abnormal, and one grossly abnormal. Two patients required manipulations for knee stiffness. This study demonstrates that reconstruction of both cruciate ligaments can restore stability sufficient to allow sports activity in most patients with knee dislocations, but "normal" results are difficult to achieve.

Is the All-arthroscopic Tibial Inlay Double-bundle PCL Reconstruction a Viable Option in Multiligament Knee Injuries?

“…It is now established that for patients sustaining Grade III isolated PCL injuries and for patients sustaining high-grade PCL injuries associated with a multiligamentous knee injury, surgical intervention may lead to improved subjective outcomes, decreased side-to-side differences in stability, and decreased laxity on stress radiographs as compared with nonoperative treatment with appropriate patient selection [5,11,13,23,25,36,39,47,54]. The ideal timing of surgical treatment and the ideal surgical technique for isolated Grade III PCL injuries and PCL injuries associated with multiligamentous knee injuries remain controversial [24,35].…”

“…It is now generally accepted that patients with isolated PCL injuries with greater than 10 mm of posterior laxity or high-grade PCL injuries associated with multiligamentous knee injuries have improved subjective outcomes, side-to-side differences in stability, and decreased laxity on stress radiographs with operative intervention [5,11,13,23,25,36,39,45,47,54]. This may be the result of restoration of normal knee kinematics and a decreased propensity to develop medial compartment and patellofemoral compartment arthrosis [7,19,26,28,46,51].…”

Surgical Technique: Articulated External Fixator for Treatment of Complex Knee Dislocation

“…Strategies for treating knee dislocations have been varied and controversial [18,19,40]. Several authors have reported [9,13,41] a loss of flexion of less than 12°, improved stability, and high subjective scores with single-stage surgery of all involved stabilizing structures.…”

“…Strategies for the management of knee dislocation are varied and controversial [18,19,40]. Nonoperative treatment generally results in stiff knees with limited ROM and low functional scores [1,16,27,37].…”

Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction/repair

“…Patellar tendon, quadriceps tendon and hamstring tendons of the ipsi- or contralateral side have been used as autografts for reconstruction in traumatic knee dislocations. Several authors prefer allografts (Achilles tendon, patellar tendon, tibialis anterior tendon, hamstring tendons) as surgical time and donor site morbidity may be decreased in this complex reconstructive setting[19,23,32]. To our knowledge there is no study demonstrating the superiority of allografts in terms of clinical outcome and ligament laxity in comparison to autografts in multi-ligament injured knees.…”