Skip to main content
SpringerLink
Log in
Book cover

The Knee Joint pp 443–455Cite as

The multiple-ligament injured knee

  • Chapter

Abstract

The multiple-ligament injured knee is a complex problem in orthopedic 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 (MCL) 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.

This is a preview of subscription content, 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   189.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   329.99
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

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Butler DL, Noyes FR, Grood ES (1980) Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. JBJS 62A:259–270

    Google Scholar 

  2. Wilson SA, Vigorita VJ, Scott WN (1994) Anatomy. In: Scott WN, editor. The knee. St. Louis, MO: Mosby books

    Google Scholar 

  3. Van Dommelen BA, Fowler PJ (1989) Anatomy of the posterior cruciate ligament. A review. AJSM 17:24–29

    Google Scholar 

  4. Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterior lateral corner and cruciate ligaments in the stability of the human knee. A biomechanical study. JBJS 69A:233–242

    Google Scholar 

  5. Seebacher JR, Inglis AE, Marshall JL, et al. (1982) The structure of the posterolateral aspect of the knee. JBJS 64A:536–541

    Google Scholar 

  6. Fanelli GC, Gianotti BF, Edson CJ (1996) Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction. Arthroscopy 12(1):5–14

    Article  PubMed  CAS  Google Scholar 

  7. Fanelli GC, Gianotti BF, Edson CJ (1996) Arthroscopically assisted combined posterior cruciate ligament/posterior lateral complex reconstruction. Arthroscopy 12(5):521–530

    Article  PubMed  CAS  Google Scholar 

  8. Fanelli GC, Gianotti BF, Edson CJ (1994) The posterior cruciate ligament arthroscopic evaluation and treatment. Arthroscopy 10(6):673–688

    Article  PubMed  CAS  Google Scholar 

  9. Ghalambor N, Vangsness CT (1995) Traumatic dislocation of the knee: a review of the literature. Bull Hosp Joint Dis 54(1):19–24

    CAS  Google Scholar 

  10. Good L, Johnson RJ (1995) The dislocated knee. JAAOS 3(5):284–292

    Google Scholar 

  11. Shelbourne KD, Porter DA, Clingman JA, et al. (1991) Low-velocity knee dislocation. Orthop Rev 20:995–1004

    PubMed  CAS  Google Scholar 

  12. Wascher DC, Dvirnak PC, Decoster TA (1997) Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma 11(7):525–529

    Article  PubMed  CAS  Google Scholar 

  13. Frassica FJ, Sim FH, Staeheli JW, et al. (1991) Dislocation of the knee. CORR 263:200–205

    Google Scholar 

  14. Green A, Allen BL (1977) Vascular injuries associated with dislocation of the knee. JBJS 59A:236–239

    Google Scholar 

  15. Wand JS (1989) A physical sign denoting irreducibility of a dislocated knee. JBJS 71B:862

    Google Scholar 

  16. Kennedy JC (1963) Complete dislocation of the knee joint. JBJS 45A:889–904

    Google Scholar 

  17. Shields L, Mital M, Cave EF (1969) Complete dislocation of the knee: experience at the Massachusetts General Hospital. J Trauma 9:192–215

    Article  PubMed  CAS  Google Scholar 

  18. Meyers MH, Harvey JP, Jr. (1971) Traumatic dislocation of the knee joint: a study of eighteen cases. JBJS 53A:16–29

    Google Scholar 

  19. Girgis FG, Marshall JL, Monajem A (1975) The cruciate ligaments of the knee joint. CORR 106:216–231

    Article  Google Scholar 

  20. Roman PD, Hopson CN, Zenni EJ, Jr. (1987) Traumatic dislocation of the knee: a report of 30 cases and literature review. Orthop Rev 16:917–924

    PubMed  CAS  Google Scholar 

  21. Sisto DJ, Warren RF (1985) Complete knee dislocation: a follow-up study of operative treatment. CORR 198:94–101

    Google Scholar 

  22. Meyers MH, Moore TM, Harvey JP, Jr. (1975) Traumatic dislocation of the knee joint. JBJS 57A:430–433

    Google Scholar 

  23. Welling RE, Kakkasseril J, Cranley JJ (1981) Complete dislocations of the knee with popliteal vascular injury. J Trauma 21:450–453

    PubMed  CAS  Google Scholar 

  24. Almekinders LC, Logan TC (1991) Results following treatment of traumatic dislocation of the knee joint. CORR 284:203–207

    Google Scholar 

  25. Shapiro MS, Freedman EL (1995) Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. AJSM 23(5):580–587

    CAS  Google Scholar 

  26. Ashworth EM, Dalsing MC, Glover JL, et al. (1988) Lower extremity vascular trauma: a comprehensive, aggressive approach. J Trauma 28:329

    Article  PubMed  CAS  Google Scholar 

  27. Rich NM, Hobson RW, Wright CB (1974) Repair of lower extremity venous trauma: a more aggressive approach required. J Trauma 14:639

    Article  PubMed  CAS  Google Scholar 

  28. Cone JC (1989) Vascular injury associated with fracturedislocations of the lower extremity. CORR 243:30–35

    Google Scholar 

  29. Grimley RP, Ashton F, Slaney G, et al. (1981) Popliteal arterial injuries associated with civil knee trauma. Injury 13:1–6

    Article  PubMed  CAS  Google Scholar 

  30. O’Donnell TF Jr, Brewster DC, Darling RC, et al. (1977) Arterial injuries associated with fractures and/or dislocations of the knee. J Trauma 17:775–784

    Article  Google Scholar 

  31. Savage R (1980) Popliteal artery injury associated with knee dislocation: improved outlook? Am Surg 46:627–632

    PubMed  CAS  Google Scholar 

  32. Rich NM, Hobson RW, Collins GJ, et al. (1976) The effect of acute popliteal venous interruption. Ann Surg 183:365–368

    Article  PubMed  CAS  Google Scholar 

  33. Wright DG, Covey DC, Born CT, et al. (1995) Open dislocation of the knee. J Orthop Trauma 9(2):135–140

    Article  PubMed  CAS  Google Scholar 

  34. Malizos KN, Xenakis T, Mavrodontidis AN, et al. (1997) Knee dislocations and their management. Acta Orthop Scand (Suppl 275) 68:80–83

    Google Scholar 

  35. McCoy GF, Hannon DG, Barr RJ, et al. (1987) Vascular injury associated with low-velocity dislocations of the knee. JBJS 69B:285–287

    Google Scholar 

  36. Moore TM (1981) Fracture-dislocation of the knee. CORR 156:450–453

    Google Scholar 

  37. Hill JA, Rana NA: Complications of posterolateral dislocation of the knee: case report and literature review. CORR 154:212–215.

    Google Scholar 

  38. Applebaum R, Yellin AE, Weaver FA, et al. (1990) Role of routine arteriography in blunt lower-extremity trauma. Am J of Surg 160:221–225

    Article  CAS  Google Scholar 

  39. Fanelli GC (1999) American Academy of Orthopaedic Surgeons 66th Annual Meeting. February 4–9, 1999. Anaheim, CA.

    Google Scholar 

  40. Trieman GS, Yellin AE, Weaver FA, et al. (1992) Evaluation of the patient with a knee dislocation: the case for selective arteriography. Arch Surg 127(9):1056–1063

    Article  Google Scholar 

  41. Myles JW (1967) Seven cases of traumatic dislocation of the knee. Proc R Soc Med 60:279

    PubMed  CAS  Google Scholar 

  42. Taylor AR, Arden GP, Rainey MA (1972) Traumatic dislocations of the knee: a report of forty three cases with special reference to conservative treatment. JBJS 54B:94

    Google Scholar 

  43. Noyes FR, Barber-Westin SD (1997) Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. AJSM 25(6):769

    CAS  Google Scholar 

  44. Fanelli GC. PCL injuries in trauma patients. Arthroscopy 9:291–294

    Google Scholar 

  45. Fanelli GC, Edson CJ (1995) PCL injuries in trauma patients, part II. Arthroscopy 11:526–529

    Article  PubMed  CAS  Google Scholar 

  46. Fanelli GC, Feldmann DD (1998) The use of allograft tissue in knee ligament reconstruction. In: Parisien JS, editor. Current techniques in arthroscopy, 3rd ed. New York: Thieme

    Google Scholar 

  47. Fanelli GC (1999) American Academy of Orthopaedic Surgeons 66th Annual Meeting. February 4–9, 1999. Anaheim, CA

    Google Scholar 

  48. Wang CJ, Chen HS, Huang TW, Yuan LJ (2002) Outcome of surgical reconstruction for PCL and PLC instabilities of the Knee. Injury 33(9):815–821

    Article  PubMed  Google Scholar 

  49. Ohkoshi Y, Nagasaki S, Shibat N, et al. (2002) Two-stage reconstruction with autografts for knee dislocations. CORR 398:169–175

    Article  Google Scholar 

  50. Mariani PP, Margheritini F, Camillieri G (2001) One-stage arthroscopically assisted anterior and posterior cruciate ligament reconstruction. Arthroscopy 17(7):700–707

    Article  PubMed  CAS  Google Scholar 

  51. Richter M, Bosch U, Wipperman B, et al. (2002) Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med 30(5):718–727

    PubMed  Google Scholar 

  52. Harner C, Waltrip R, Bennett C, et al. (2004) Surgical management of knee dislocations. JBJS (AM) 86 (2):262–273

    Google Scholar 

  53. Fanelli GC, Edson CJ (2002) Arthroscopically assisted combined ACL/PCL reconstruction. 2–10 year follow-up. Arthroscopy 18(7):703–714

    Article  PubMed  Google Scholar 

  54. Fanelli GC, Edson CJ (2004) Combined posterior cruciate ligament-posterolateral reconstruction with Achilles tendon allograft and biceps femoris tendon tenodesis:2–10 year follow-up. Arthroscopy 20(4):339–345

    Article  PubMed  Google Scholar 

  55. Fanelli GC, Orcutt DR, Edson CJ (2005) Current concepts. The multiple ligament injured knee: evaluation, treatment, and results. Arthroscopy 21(4):471–486

    Article  PubMed  Google Scholar 

  56. Fanelli GC, Edson CJ, Orcutt DR, et al. (2005) Treatment of combined anterior posterior cruciate ligament medial lateral side knee injuries. J Knee Surg 18(3):240–248

    PubMed  Google Scholar 

  57. Sanchez M, Azofra J, Aizpurua B, et al. (2003) Application of growth factor rich autologous plasma in arthroscopic surgery. Cuadernos de Arthroscopia 10:12–19

    Google Scholar 

  58. Weiler A, Forster C, Hunt P, et al. (2004) The influence of locally applied platelet derived growth factor BB on free tendon graft remodeling after anterior cruciate ligament reconstruction. Am J Sports Med 4:881–891

    Article  Google Scholar 

  59. Yasuda K, Tomita F, Yamazaki S, et al. (2004) The effect of growth factors on biomechanical properties of the bone patellar tendon bone graft after anterior cruciate ligament reconstruction. Am J Sports Med 4:870–880

    Article  Google Scholar 

Recommended readings

  1. Fanelli GC, editor (2001) Posterior cruciate ligament injuries: a practical guide to management. New York: Springer-Verlag

    Google Scholar 

  2. Fanelli GC, editor (2004) The multiple ligament injured knee: a practical guide to management. New York: Springer-Verlag

    Google Scholar 

Download references

Authors
  1. G. C. Fanelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. C. J. Edson
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag France, Paris

About this chapter

Cite this chapter

Fanelli, G.C., Edson, C.J. (2012). The multiple-ligament injured knee. In: The Knee Joint. Springer, Paris. https://doi.org/10.1007/978-2-287-99353-4_38

Download citation

  • DOI: https://doi.org/10.1007/978-2-287-99353-4_38

  • Publisher Name: Springer, Paris

  • Print ISBN: 978-2-287-99352-7

  • Online ISBN: 978-2-287-99353-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation