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Review
. 2020 Mar 2;5(3):145-155.
doi: 10.1302/2058-5241.5.190012. eCollection 2020 Mar.

Management of multiligament knee injuries

Jimmy Wui Guan Ng  1 , Yulanda Myint  1 , Fazal M Ali  1
Affiliations
Review

Management of multiligament knee injuries

Jimmy Wui Guan Ng et al. EFORT Open Rev. .

Abstract

Up to 18% of multiligament knee injuries (MLKI) have an associated vascular injury.All MLKI should be assessed using the ankle brachial pressure index (ABPI) with selective arteriography if ABPI is < 0.9.An ischaemic limb following knee dislocation must be taken to the operating theatre immediately for stabilization and re-vascularization.Partial common peroneal nerve (CPN) injury following MLKI has better recovery than complete palsy.Posterior tibial tendon transfer is offered to patients with complete CPN palsy if there is no recovery at six months.Operative treatment with acute or staged reconstructions provides the best outcome in MLKI.Effective repair can only be performed within three weeks of injury.There is no difference between repair and reconstruction of medial collateral ligament and posteromedial corner.Posterolateral corner reconstruction has a lower failure rate than repair.Early mobilization following MLKI surgery results in fewer range-of-motion deficits. Cite this article: EFORT Open Rev 2020;5:145-155. DOI: 10.1302/2058-5241.5.190012.

Keywords: knee dislocation; multiligament knee injuries.

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Conflict of interest statement

ICMJE Conflict of interest statement: The authors declare no conflict of interest relevant to this work.

Figures

Fig. 1
Fig. 1
Anatomy of the knee. Source. With permission from Ng JWG, Price K, Deepak S. Knee pain in children. Paediatrics and Child Health 2019;29:521–527.
Fig. 2
Fig. 2
Radiograph of knee dislocation. Source. Case courtesy of Andrew Murphy, Radiopaedia.org, rID: 48228. Murphy A. Lateral knee dislocation. Radiology Case. https://radiopaedia.org/cases/lateral-knee-dislocation-1
Fig. 3
Fig. 3
Management flow chart for vascular injuries. Note. ABPI, ankle brachial pressure index; CT, computed tomography.
Fig. 4
Fig. 4
Sequence of events for management of ischaemic limb following knee dislocation.
Fig. 5
Fig. 5
Fibular sling reconstruction with one femoral tunnel (Larson). Source. With permission from Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 1: Surgical treatment of acute injuries. Am J Sports Med 2016;44:1336–1342.
Fig. 6
Fig. 6
Fibular sling reconstruction with two femoral tunnels (non-anatomic). Source. With permission from Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 1: Surgical treatment of acute injuries. Am J Sports Med 2016;44:1336–1342.
Fig. 7
Fig. 7
Anatomic posterolateral corner reconstruction as described by LaPrade. Source. With permission from Geeslin AG, Moulton SG, LaPrade RF. A systematic review of the outcomes of posterolateral corner knee injuries, part 1: Surgical treatment of acute injuries. Am J Sports Med 2016;44:1336–1342.
See this image and copyright information in PMC

References

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