Complications Associated with Treatment
This chapter reviews the complications that may result from treatment of the multiple ligament injured/dislocated knee, rather than those directly resulting from the injury. The treatment of these complex and potentially devastating injuries presents the possibility of certain complications that are not typically encountered when one is treating injury to the individual ligaments. The timing of treatment may be a major determinant of the risk of these various complications. It is important to identify the specific complications engendered by the acute treatment of a multiligament injured/dislocated knee, as well as those that may be faced in a more chronic situation. Early recognition of the extent of injury is crucial for early identification of certain injuries, particularly vascular injuries. One should always approach a multiple ligament injured knee with the caution employed in the management of the dislocated knee.1,2 Failure to recognize the extent of all the ligaments involved may result in an inadequate treatment plan. Magnetic resonance imaging (MRI) is a valuable diagnostic tool to identify the injured structures and to define an appropriate treatment schema.3 In a study of the multiligament injured/dislocated knee, Twaddle et al.4 revealed that clinical examination alone had significant inaccuracies (53–82% correct) while MRI scan was more accurate (85–100% correct). We routinely obtain an MRI scan early on in all our patients with acute polyligament knee injuries, (Figure 15.1) to most accurately identify all injured structures. Planning for the treatment program is then based on the combination of clinical examination and MRI findings.
KeywordsAnterior Cruciate Ligament Reconstruction Posterior Cruciate Ligament Compartment Syndrome Peroneal Nerve Medial Collateral Ligament
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