Repair and Augmentation with Internal Brace in the Multiligament Injured Knee

Dabis, John; Wilson, Adrian

doi:10.1016/j.csm.2018.11.008

Cited by 34 publications

(29 citation statements)

References 33 publications

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“…13b. Distal ACL repair), with internal brace augmentation, using high tension sutures with independent fixation [18,49] or use biological augmentation with autografts ( Fig. 14. ACL repair and Biological augmentation) ( Fig.…”

Section: Controversies In Diagnosis and Treatmentmentioning

confidence: 99%

Controversies in acute multiligamentary knee injuries (MLKI)

Mosquera¹,

Jaramillo

Gil

et al. 2020

J EXP ORTOP

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Multiligament injuries of the knee (MLKI), remain an infrequent pathology especially in developed countries compared to mono-ligament lesions. In Colombia, MLKI is frequent due to the high accident rate on motorcycles. In the city of Bogota alone, about 160 motorcycle accidents have been estimated daily, being one of the cities that proportionately use this means of transport less compared to small cities. The term MLKI, include all ruptures of two or more major ligaments and therefore it has a broad spectrum of clinical presentation which creates a great challenge for the orthopedists and the surgeons envolved in this topic. The literature is rich in studies level IV but very poor in level I and level II, which generates controversies and little consensus in the diagnosis and treatment of this pathology. However there has been a gradual and better understanding of all factors involved in the treatment of MLKI that has improved the functional results of these knees in our patients, in fact we currently are more precise to achieve accurate diagnosis, evolved from not surgical approach to operate most, applying new anatomical and biomechanical concepts, with specialized and skill surgical techniques with more stable and biocompatible fixation implants, which allow in most cases to initiate an early integral rehabilitation program. Nevertheless due to the complexity and severity of the lesions, in some patients the functional results are poor. The goal of this revision is to identify the most frequent controversies in the diagnosis and treatment of MLKI, defining which of them are agreed according to what is reported in the literature and share some concepts based from the experience of more than 25 years of the senior author (MM) in the management of these injuries. Level of Evidence: V-Expert Opinion.

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Section: Controversies In Diagnosis and Treatmentmentioning

confidence: 99%

Controversies in acute multiligamentary knee injuries (MLKI)

Mosquera¹,

Jaramillo

Gil

et al. 2020

J EXP ORTOP

View full text Add to dashboard Cite

show abstract

“…The proposed advantages are that smaller tunnels are needed, native anatomy is preserved, and donor site morbidity is eliminated without the need of autografts. [28,29] However, the literature consists largely of surgical techniques and case series, [30] with limited biomechanical or clinical evidence supporting their use. Future trends will therefore likely further explore the treatment of MLKIs with repair and internal bracing, especially for MCL and PCL injuries.…”

Section: Techniques Repairmentioning

confidence: 99%

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

Held

North

Bormann

et al. 2020

JASSM

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Recent advances in the management of multiligament knee injuries have led to improvements in diagnosis and management and allowed enhanced understanding of the biomechanics of ligament reconstructions. Most studies arise from subspecialist knee centers in high-income countries and can inform global strategies, but each patient encounter and environment is unique and not all recommendations may be feasible in every setting. For ligamentous injuries, the gold standard is acute arthroscopic, single-stage ligament reconstruction, although this is not always possible in the limited resource setting (LRS). For these circumstances, non-operative management, although rarely promoted, may be preferred in selected patients. Furthermore, acute surgery relies on adequate post-operative physiotherapy, otherwise a delayed surgical approach should be considered. Reconstruction remains the gold standard, but acute repair is an option for medial collateral and posterior cruciate ligaments and for avulsion fractures. For a vascular examination, a careful clinical assessment and routine angiography should be done in LRS. Due to the heterogeneity of injury and patient profile, outcomes vary widely and need to be interpreted in the context of the surgical setup. The main complications of these injuries are stiffness, residual laxity, and surgical site infections. Future trends will need to include a global perspective and provide solutions for surgeons in various parts of the world.

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“…31 Internal braces have been shown to act as secondary stabilizers of ligaments during reconstructive procedures of the anterior cruciate ligament, medial collateral ligament, and ulnar collateral ligament. 2,7 Support is growing for their use as a novel technique in foot and ankle, sports, and hand procedures, with some studies reporting a quicker return to activity and better outcomes in athletes. 1,4,11,19 These data contribute to the growing body of literature suggesting that current surgical repair constructs for syndesmotic injuries, although effective, may not functionally restore the native biomechanical environment.…”

Section: Clinical Impact: Redefining Ideal Constructsmentioning

confidence: 99%

Normal Kinematics of the Syndesmosis and Ankle Mortise During Dynamic Movements

Hogg-Cornejo

Hunt

Bartolomei

et al. 2020

Foot & Ankle Orthopaedics

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Background: Documenting the healthy articulation of the syndesmosis and talocrural joints, and measurement of 3D medial and lateral clear spaces may improve diagnostic and treatment guidelines for patients suffering from severe syndesmotic injury or chronic instability. This study aimed to define the range of motion (ROM) and displacement of the fibula and talus during static and dynamic activities, and measure the 3D movement in the tibiofibular (syndesmosis) and medial clear space. Methods: Six healthy volunteers performed dynamic weightbearing motions on a single-leg: heel-rise, squat, torso twist, and box jump. Participants posed in a nonweightbearing neutral stance as well as weightbearing neutral standing, plantarflexion, and dorsiflexion. High-speed stereoradiography measured 3D rotation and translation of the fibula and talus throughout each task. Medial clear space and tibiofibular gap distances were measured under each condition. Results: Total ROM for the fibula was greatest in internal-external rotation (9.3 ± 3.5 degrees), and anteroposterior (3.3 ± 2.2 mm) and superior-inferior (2.5 ± 0.9 mm) translation, rather than lateral widening (1.7 ± 1.0 mm). The total rotational ROM of the talus was greatest in dorsiflexion-plantarflexion (34.7 ± 12.9 degrees) and internal-external rotation (15.0 ± 3.4 degrees). Single-leg squatting increased the lateral clear space ( P = .045) and widened the medial tibiofibular joint, whereas single-leg heel-rises decreased the lateral clear space ( P = .001) and widened the tibiotalar space. Gap spaces in the tibiofibular and medial clear spaces did not exceed 2.3 ± 0.9 mm and 2.7 ± 1.2 mm, respectively. Conclusion: These data support a potential shift in the clinical understanding of fibula displacements during dynamic activities and how implant device constructs might be developed to restore physiologic mechanics. Clinical Relevance: Syndesmosis stabilization and rehabilitation should consider restoration of normal physiologic rotation and translation of the fibula and ankle mortise rather than focusing solely on the restriction of lateral translation.

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Repair and Augmentation with Internal Brace in the Multiligament Injured Knee

Cited by 34 publications

References 33 publications

Controversies in acute multiligamentary knee injuries (MLKI)

Controversies in acute multiligamentary knee injuries (MLKI)

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

Normal Kinematics of the Syndesmosis and Ankle Mortise During Dynamic Movements

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