APEX Knee Navigating Pearls and Pitfalls-Multiple Ligament Reconstruction: How Do I Approach?

Video Transcription

Video Summary

The presentation provides a comprehensive overview of multiple ligament knee reconstruction, focusing on management, surgical approach, and rehabilitation. Initial care emphasizes stabilizing the limb, especially considering potential knee dislocations, which often involve multiple ligaments and require urgent vascular and neurological evaluation. The classification of injuries guides surgical decisions. The surgical approach prioritizes vascular status, repairs within two to four weeks, and often single-stage reconstructions. Central pivot (ACL and PCL) tunnels are drilled first, using autografts for the ACL and allografts for the PCL, with careful protection of the peroneal nerve during posterolateral corner repair. Medial side injuries may involve modified Bosworth or Achilles allografts. Rehabilitation begins with immobilization, progressing to controlled motion and weight-bearing, balancing mobility and stability. Recent literature notes uncertainty between autograft and allograft outcomes, common meniscal root tears, accelerated rehab trends, and high complication risks, including reoperations and blood clots. The speaker stresses patient counseling on these risks.

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Marc Tompkins, M.D.

Keywords

multiple ligament knee reconstruction

surgical approach

rehabilitation

vascular and neurological evaluation

autograft vs allograft

complication risks