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MINERVA ORTOPEDICA E TRAUMATOLOGICA
A Journal on Orthopedics and Traumatology
Minerva Ortopedica e Traumatologica 2007 February;58(1):65-80
The multiple ligament injured knee
Fanelli G. C., Edson C. J., Reinheimer K. N.,Garofalo R.
Danville, PA, USA
The multiple ligament-injured knee is a complex problem in orthopaedic surgery. Most dislocated knees involve tears of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and at least one collateral ligament complex. Careful assessment of the extremity vascular status is essential because of the possibility of arterial and/or venous compromise. These complex injuries require a systematic approach to evaluation and treatment. Physical examination and imaging studies enable the surgeon to make a correct diagnosis and to formulate a treatment plan. Arthroscopically assisted combined ACL/PCL reconstruction is a reproducible procedure. Knee stability is improved postoperatively when evaluated using knee ligament rating scales, arthrometer testing, and stress radiographic analysis. Acute medial collateral ligament tears when combined with ACL/PCL tears may, in certain cases, be treated with bracing. Posterolateral corner injuries combined with ACL/PCL tears are best treated with primary repair as indicated combined with reconstruction using a post of strong autograft (split biceps tendon, biceps tendon, semitendinosus), or allograft (Achilles tendon, bone patellar tendon bone) tissue. Surgical timing depends upon the ligaments injured, the vascular status of the extremity, reduction stability, and the overall health of the patient. We prefer the use of allograft tissue for reconstruction in these cases because of the strength of these large grafts, and the absence of donor site morbidity.