AANA Fellowship Education - Multiligament Injuries to the Knee-Presentation (PDF)

Presentation (PDF)

Pdf Summary

The "Multiligament Injuries to the Knee" webinar, held in March 2021, featured expert discussions by orthopedic surgeons Bruce A. Levy, MD, Brian R. Waterman, MD, George Rich Hatch III, MD, and Gregory C. Fanelli, MD on complex knee injuries involving multiple ligament damage. <br /><br />Dr. Levy focused on posterior cruciate ligament (PCL) injuries, emphasizing the efficacy of both non-operative and surgical treatments. Notably, long-term non-operative outcomes show good activity levels and knee function, but surgical reconstruction is indicated in combined ligament injuries, failed conservative treatment, or avulsion injuries. He advocates an "all-inside" PCL reconstruction technique that minimizes tunnel convergence risk and allows tension-retension graft fixation, improving stability. Studies show no significant clinical outcome difference between transtibial and inlay reconstructions but highlight benefits of anatomic, all-inside techniques including less tunnel widening.<br /><br />Dr. Waterman reviewed medial knee injuries, including the medial collateral ligament (MCL) and posteromedial corner (PMC). He highlighted anatomy, biomechanics, and clinical evaluation principles, stressing indications for surgery such as persistent valgus instability, rotatory instability, or avulsions. Surgical management options range from repair to anatomic reconstruction, with a preferred double-bundle reconstruction technique that aims to restore native ligament function. Early versus delayed surgery considerations, rehabilitation protocols, and augmentation strategies like internal bracing were also addressed.<br /><br />Dr. Hatch presented on lateral collateral ligament (LCL) and posterolateral corner (PLC) injuries, underscoring that anatomic reconstruction yields better outcomes than repair alone, particularly in multiligament knee injuries. He described surgical techniques including the LaPrade anatomical PLC reconstruction addressing the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. The use of internal brace augmentation improves graft protection and allows early mobilization. Case examples illustrated management strategies for complex lateral injuries often involving peroneal nerve palsy.<br /><br />Dr. Fanelli contributed case reviews illustrating decision-making complexities in these varied injury patterns.<br /><br />Overall, the webinar emphasized a comprehensive, anatomy-based, staged surgical approach to multiligament knee injuries incorporating modern reconstruction techniques with graft augmentation and individualized rehabilitation to optimize outcomes in these rare but challenging limb-threatening patterns.

Keywords

Multiligament knee injuries

Posterior cruciate ligament (PCL)

Non-operative treatment

Surgical reconstruction

Medial collateral ligament (MCL)

Posteromedial corner (PMC)

Lateral collateral ligament (LCL)

Posterolateral corner (PLC)

Anatomic reconstruction

Internal brace augmentation