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Review
. 2017 Sep;10(3):328-345.
doi: 10.1007/s12178-017-9425-4.

Current Concepts and Controversies in Rehabilitation After Surgery for Multiple Ligament Knee Injury

Andrew D Lynch  1 , Terese Chmielewski  2 , Lane Bailey  3 , Michael Stuart  4 , Jonathan Cooper  5 , Cathy Coady  6 , Terrance Sgroi  7 , Johnny Owens  8 , Robert Schenck  9 , Daniel Whelan  10 , Volker Musahl  11 , James Irrgang  11 ; STaR Trial Investigators
Affiliations
Review

Current Concepts and Controversies in Rehabilitation After Surgery for Multiple Ligament Knee Injury

Andrew D Lynch et al. Curr Rev Musculoskelet Med. 2017 Sep.

Abstract

Purpose of review: The purpose of this manuscript is twofold: (1) to review the literature related to rehabilitation after surgery for multiple ligament knee injury (MLKI) and after isolated surgery for the posterior cruciate ligament (PCL), posterolateral corner (PLC), and medial side of the knee and (2) to present a hierarchy of anatomic structures needing the most protection to guide rehabilitation.

Recent findings: MLKIs continue to be a rare but devastating injury. Recent evidence indicates that clinicians may be providing too much protection from early weight bearing and range of motion, but an accelerated approach has not been rigorously tested. Consideration of the nature and quality of surgical procedures (repair and reconstruction) can help clinicians determine the structures needing the most protection during the rehabilitation period. The biomechanical literature and prior clinical experience can aid clinicians to better structure rehabilitation after surgery for MLKI and improve clinical outcome for patients.

Keywords: Early range of motion; Early weight bearing; Knee dislocation; Multiple ligament knee injury; Post-surgical rehabilitation.

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Conflict of interest statement

Conflict of Interest

All of the authors report a Clinical Trial Development Award from the Department of Defense’s Congressionally Directed Medical Research Program through the Peer-Reviewed Orthopedic Research Program (PRORP Clinical Trial Development Award; Grant Number W81XWH-15-1-065.

The following authors, including members of the STaR Trial Investigators, report the following additional conflicts of interest:

Johnny Owens reports personal fees from Delfi Medical Innovations, Inc. and Major Extremity Trauma Research Consortium, outside of the submitted work.

Volker Musahl reports a pending PIVOT Shift patent.

Travis Burns reports personal fees from Depuy Mitek, outside of the submitted work.

Anthony Johnson is a member of the steering committee of Medical Research and Matériel Command (JPC-6). He is also a consultant for Nexus Medical Consulting, LLC.

Brett Owns reports consultancy fees from Conmed MTF and Mitek.

Anil Ranawat is on the Speaker Bureau for Stryker Mako and Arthrex. He is a paid consultant for Stryker Mako, Arthrex, and Moximed. Dr. Ranawat also reports research support for Arthrex and Depuy Mitek. He reports stock with Confromis. Dr. Ranawat reports royalties from Saunders and Springer. He is the editor-in-chief of Current Reviews in Musculoskeletal Medicine.

Robert Marx is the deputy editor of sports medicine for the Journal of Bone and Joint Surgery. He reports royalties from Demos Health and Springer.

Brucy Levy reports consultancy fees and royalties from Arthrex. He also reports consultancy fees from Smith and Nephew.

Bradley Nelson reports research support for Histogenics and Zimmer, outside of the submitted work.

Robert Arciero reports grants from Arthrex and Depuy Mitek and stock options from Biorez, outside of the submitted work.

John Grant reports personal fees from Ossur Inc., outside of the submitted work.

Jeffrey Macalena reports consultancy fees from Vericel outside of the submitted work, and he is a Medical Board Member of MTF.

Daniel Wascher reports fellowship support from Arthrex and Smith and Nephew and personal fees from the Prthopaedic Journal of Sports Medicine, outside of the submitted work.

Mark Miller is a consultant for Arthrex, outside of the submitted work.

Matthew Matava reports grants from Arthrex and Breg, Inc., outside of the submitted work.

Matthew Smith reports personal fees from Arthrex, outside of the submitted work.

Aaron Nauth reports personal fees from Stryker and grants from OTA, CIHR, PSIF, Synthes, Zimmer, and Conmed, outside of the submitted work.

Alan Getgood reports grants and personal fees from Smith & Nephew and consultancy fees from Ossur, outside of the submitted work.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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