AANA25 Knee Access Pass-CONCURRENT SESSION 1H: Multi-Ligament Knee Injuries

Video Transcription

Video Summary

The session on Multi-Ligament Knee Injuries covered comprehensive current approaches to diagnosis, surgical management, and rehabilitation of complex knee dislocations involving multiple ligament disruptions. Leaders presented updated treatment algorithms emphasizing individualized care based on injury patterns and tissue quality, promoting early single-stage surgery to optimize outcomes and minimize scar formation. Repair with augmentation is preferred when tissue quality permits, but reconstruction remains standard, especially for ligament tears with poor reparability, with recent biomechanical data supporting augmentation techniques to offload repaired ligaments.<br /><br />Medial-sided injuries are prone to fibrosis; thus, timing and patient counseling about possible arthrofibrosis and need for staged procedures are critical. Lateral-sided injuries have better outcomes with reconstruction than repair alone, and meticulous surgical technique with fluoroscopy is advised to avoid tunnel convergence in multi-ligament reconstructions. Technical pearls included careful planning of tunnel trajectory, use of flip cutters to reduce injury risk near vascular grafts, and identification of nervous structures via MRI.<br /><br />Neurovascular status requires diligent monitoring, especially for popliteal artery and peroneal nerve injuries, which significantly impact prognosis. Rehabilitation remains individualized, with ongoing trials investigating early versus delayed protocols. Arthrofibrosis, a common complication (12-40% incidence), requires early detection and a stepwise approach including anti-inflammatories, corticosteroid injections, manipulation under anesthesia, and possible lysis of adhesions. Off-label medications like anakinra show promise but require further study.<br /><br />Complex cases with vascular bypasses or morbid obesity highlight the need for multidisciplinary planning, cautious surgical approaches, and possible staging. Overall, the session reinforced advances in personalized management, technical expertise, and complication prevention to optimize functional recovery in these challenging injuries.

Asset Caption

Moderator: Bruce A. Levy, M.D
Fidelius von Rehingen-Prinz, M.D. | Michael J. Alaia, M.D. | Michael A. Zacchili, M.D. | Brian R. Waterman, M.D., FAANA | Craig H. Bennett, M.D.

Keywords

Multi-Ligament Knee Injuries

Diagnosis

Surgical Management

Rehabilitation

Single-Stage Surgery

Repair with Augmentation

Reconstruction Techniques

Arthrofibrosis

Neurovascular Monitoring

Fluoroscopy Guidance

Multidisciplinary Planning