Skip to main content
SpringerLink
Log in

Surgical Treatment of Combined ACL Medial and Lateral Side Injuries: Acute and Chronic

  • Chapter
  • First Online:
Book cover The Multiple Ligament Injured Knee

Abstract

The assessment of a patient with a multiple-ligament-injured knee requires a careful history and clinical evaluation. Missed concomitant ligament disruptions in the setting of an anterior cruciate ligament (ACL) tear can increase the failure rate of the ACL graft. Additionally, unrecognized and/or untreated posterolateral corner (PLC) or medial-sided knee injuries can lead to chronic disability. A thorough history and physical examination, combined with proper imaging studies, can facilitate an accurate diagnosis. These complex injuries require a systematic approach for treatment. Acute grade one or two medial collateral ligament (MCL) tears in the setting of an ACL tear can often be treated with bracing of the MCL, depending on the location, followed by ACL reconstruction. Combined ACL and PLC injuries are best treated acutely with ACL reconstruction and primary repair of the posterolateral knee injuries. However, the vascular status, soft tissue swelling, and medical comorbidities must be taken into account when determining the optimal time for surgical intervention. Chronic ACL and PLC tears are best treated with anatomic ACL and PLC reconstructions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jari S, Shelbourne K. Nonoperative or delayed surgical treatment of combined cruciate ligaments and medial side knee injuries. Sports Med Arthrosc Rev. 2001;9:185–92.

    Article  Google Scholar 

  2. Rosenberg TD, Paulos LE, Parker RD, Coward DB, Scott SM. The forty-five-degree posteroanterior flexion weight-bearing radiograph of the knee. J Bone Joint Surg Am. 1988;70(10):1479–83.

    PubMed  CAS  Google Scholar 

  3. Warren LF, Marshall JL. The supporting structures and layers on the medial side of the knee: an anatomical analysis. J Bone Joint Surg Am. 1979;61(1):56–62.

    PubMed  CAS  Google Scholar 

  4. LaPrade RF, Engebretsen AH, Ly TV, Johansen S, Wentorf FA, Engebretsen L. The anatomy of the medial part of the knee. J Bone Joint Surg Am. 2007;89(9):2000–10.

    Article  PubMed  Google Scholar 

  5. Singhal M, Patel J, Johnson D. Medial ligament injuries. Delee and Drez’s orthopaedic sports medicine. Principles and practice. 3rd ed. 2010. p. 1624–1637.

    Google Scholar 

  6. Borden PS, Kantaras AT, Caborn DNM. Medial collateral ligament reconstruction with allograft using a double-bundle technique. Arthroscopy. 2002;18(4):E19.

    PubMed  Google Scholar 

  7. Fanelli GC, Stannard JP, Stuart MJ, et al. Management of complex knee ligament injuries. J Bone Joint Surg Am. 2010;92(12):2235–46.

    PubMed  Google Scholar 

  8. Halinen J, Lindahl J, Hirvensalo E, Santavirta S. Operative and nonoperative treatments of medial collateral ligament rupture with early anterior cruciate ligament reconstruction: a prospective randomized study. Am J Sports Med. 2006;34(7):1134–40.

    Article  PubMed  Google Scholar 

  9. Stannard JP, Volgas DA, Azbell CH. Posteromedial corner injury in knee dislocations. Paper presented at: 35th annual meeting of the American orthopaedic society for sports medicine; Jul 9–12, 2009; Keystone, CO.

    Google Scholar 

  10. Robins AJ, Newman AP, Burks RT. Postoperative return of motion in anterior cruciate ligament and medial collateral ligament injuries. The effect of medial collateral ligament rupture location. Am J Sports Med. 1993;21(1):20–5.

    Article  PubMed  CAS  Google Scholar 

  11. Miyasaka K, Daniel D, Stone M. The incidence of knee ligament injuries in the general population. Am J Knee Surg. 1991;4:3–8.

    Google Scholar 

  12. LaPrade RF, Hamilton C, Engebretsen L. Treatment of acute and chronic combined anterior cruciate ligament and posterolateral knee ligament injuries. Sports Med Arthrosc Rev. 1997;5:91–9.

    Article  Google Scholar 

  13. LaPrade RF, Terry GC. Injuries to the posterolateral aspect of the knee. Association of anatomic injury patterns with clinical instability. Am J Sports Med. 1997;25(4):433–8.

    Article  PubMed  CAS  Google Scholar 

  14. Noyes FR, Stowers SF, Grood ES, Cummings J, VanGinkel LA. Posterior subluxations of the medial and lateral tibiofemoral compartments. An in vitro ligament sectioning study in cadaveric knees. Am J Sports Med. 1993;21(3):407–14.

    Article  PubMed  CAS  Google Scholar 

  15. LaPrade RF, Ly TV, Wentorf FA, Engebretsen L. The posterolateral attachments of the knee: a qualitative and quantitative morphologic analysis of the fibular collateral ligament, popliteus tendon, popliteofibular ligament, and lateral gastrocnemius tendon. Am J Sports Med. 2003;31(6):854–60.

    PubMed  Google Scholar 

  16. LaPrade RF, Gilbert TJ, Bollom TS, Wentorf F, Chaljub G. The magnetic resonance imaging appearance of individual structures of the posterolateral knee. A prospective study of normal knees and knees with surgically verified grade III injuries. Am J Sports Med. 2000;28(2):191–9.

    PubMed  CAS  Google Scholar 

  17. Krukhaug Y, Mølster A, Rodt A, Strand T. Lateral ligament injuries of the knee. Knee Surg Sports Traumatol Arthrosc. 1998;6(1):21–5.

    Article  PubMed  CAS  Google Scholar 

  18. Kannus P. Nonoperative treatment of grade II and III sprains of the lateral ligament compartment of the knee. Am J Sports Med. 1989;17(1):83–8.

    Article  PubMed  CAS  Google Scholar 

  19. Baker CL, Norwood LA, Hughston JC. Acute posterolateral rotatory instability of the knee. J Bone Joint Surg Am. 1983;65(5):614–8.

    PubMed  Google Scholar 

  20. Baker CL, Norwood LA, Hughston JC. Acute combined posterior cruciate and posterolateral instability of the knee. Am J Sports Med. 1984;12(3):204–8.

    Article  PubMed  Google Scholar 

  21. DeLee JC, Riley MB, Rockwood CA. Acute posterolateral rotatory instability of the knee. Am J Sports Med. 1983;11(4):199–207.

    Article  PubMed  CAS  Google Scholar 

  22. Hughston JC, Jacobson KE. Chronic posterolateral rotatory instability of the knee. J Bone Joint Surg Am. 1985;67(3):351–9.

    PubMed  CAS  Google Scholar 

  23. Stannard JP, Brown SL, Farris RC, McGwin G, Volgas DA. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med. 2005;33(6):881–8.

    Article  PubMed  Google Scholar 

  24. Covey DC. Injuries of the posterolateral corner of the knee. J Bone Joint Surg Am. 2001;83-A(1):106–18.

    PubMed  CAS  Google Scholar 

  25. Schechinger SJ, Levy BA, Dajani KA, Shah JP, Herrera DA, Marx RG. Achilles tendon allograft reconstruction of the fibular collateral ligament and posterolateral corner. Arthroscopy. 2009;25(3):232–42.

    Article  PubMed  Google Scholar 

  26. Terry GC, LaPrade RF. The posterolateral aspect of the knee. Anatomy and surgical approach. Am J Sports Med. 1996;24(6):732–9.

    Article  PubMed  CAS  Google Scholar 

  27. LaPrade RF, Johansen S, Wentorf FA, Engebretsen L, Esterberg JL, Tso A. An analysis of an anatomical posterolateral knee reconstruction: an in vitro biomechanical study and development of a surgical technique. Am J Sports Med. 2004;32(6):1405–14.

    Article  PubMed  Google Scholar 

  28. LaPrade RF, Johansen S, Agel J, Risberg MA, Moksnes H, Engebretsen L. Outcomes of an anatomic posterolateral knee reconstruction. J Bone Joint Surg Am. 2010;92(1):16–22.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Sports Medicine, Winthrop Orthopaedic Associates, 1300 Franklin Avenue, Suite UL3A, Garden City, NY, 11530, USA

    Bradley R. Wasserman M.D.

  2. Division of Sports Medicine, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3200 South Wate Street, Pittsburgh, PA, 15203, USA

    Robin V. West M.D.

Authors
  1. Bradley R. Wasserman M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robin V. West M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bradley R. Wasserman M.D. .

Editor information

Editors and Affiliations

  1. GHS Orthopaedics, Woodbine Lane 115, Danville, 17822-5212, Pennsylvania, USA

    Gregory C. Fanelli

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Wasserman, B.R., West, R.V. (2013). Surgical Treatment of Combined ACL Medial and Lateral Side Injuries: Acute and Chronic. In: Fanelli, G. (eds) The Multiple Ligament Injured Knee. Springer, New York, NY. https://doi.org/10.1007/978-0-387-49289-6_12

Download citation

  • DOI: https://doi.org/10.1007/978-0-387-49289-6_12

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-0-387-49287-2

  • Online ISBN: 978-0-387-49289-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation