Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Complex Knee Ligament Surgery 14 articles


Surgical Technique: Aperture Fixation in PCL Reconstruction: Applying Biomechanics to Surgery

Thomas J. Gill MD, Samuel K. Velde MD, Kaitlin M. Carroll BS, William J. Robertson MD, Benton E. Heyworth MD

Biomechanical studies suggest reducing the effective graft length during transtibial posterior cruciate ligament (PCL) reconstruction by augmenting the distal tibial fixation with a proximal screw near the tibial tunnel aperture could increase graft stiffness and provide a more stable reconstruction. However, it remains unknown to what extent this mechanical theory influences in vivo graft performance over time.

Surgical Technique: Articulated External Fixator for Treatment of Complex Knee Dislocation

Maurilio Marcacci MD, Stefano Zaffagnini MD, Tommaso Bonanzinga MD, Andrea Pizzoli MD, Mario Manca MD, Enzo Caiaffa MD

Knee dislocation is a severe but relatively uncommon injury caused by violent trauma that can result in long-term complications, such as arthrofibrosis, stiffness, instability, and pain. Perhaps owing in part to its rarity, treatment of this injury is controversial. We therefore describe a treatment approach for these complex cases involving a novel dynamic knee external fixator.

Surgical Technique: Development of an Anatomic Medial Knee Reconstruction

Robert F. LaPrade MD, PhD, Coen A. Wijdicks PhD

The main static stabilizers of the medial knee are the superficial medial collateral and posterior oblique ligaments. A number of reconstructive techniques have been advocated including one we describe here. However, whether these reconstructions restore function and stability is unclear.

Posterior Cruciate Ligament and Posterolateral Corner Deficiency Results in a Reverse Pivot Shift

Frank A. Petrigliano MD, Clayton G. Lane MD, Eduardo M. Suero MD, Answorth A. Allen MD, Andrew D. Pearle MD

As measured via static stability tests, the PCL is the dominant restraint to posterior tibial translation while the posterolateral corner is the dominant restraint to external tibial rotation. However, these uniplanar static tests may not predict multiplanar instability. The reverse pivot shift is a dynamic examination maneuver that may identify complex knee instability.

Surgical Technique: When to Arthroscopically Repair the Torn Posterior Cruciate Ligament

Gregory S. DiFelice MD, Micah Lissy MD, Paul Haynes MD

Posterior cruciate ligament injuries can occur as isolated ligament ruptures or in association with the multiligament-injured knee. Delayed reconstruction, at 2–3 weeks post-injury, is predominantly recommended for posterior cruciate ligament tears in the multiligament-injured knee. While acute bone and soft tissue avulsion patterns of injury can be amenable to repair, the described techniques have been associated with some difficulties attaching the avulsed ligament.

Surgical Technique: Does Mini-invasive Medial Collateral Ligament and Posterior Oblique Ligament Repair Restore Knee Stability in Combined Chronic Medial and ACL Injuries?

Gian Luigi Canata MD, Alfredo Chiey MD, Tommaso Leoni MD

Residual laxity remains after ACL reconstruction in patients with combined chronic ACL and medial instability. The question arises whether to correct medial capsular and ligament injuries when Grade II and III medial laxity is present.

Can Stress Radiography of the Knee Help Characterize Posterolateral Corner Injury?

F. Winston Gwathmey MD, Marc A. Tompkins MD, Cree M. Gaskin MD, Mark D. Miller MD

Conventional MRI is limited for characterizing the posterolateral corner of the knee due to the region’s anatomic variability and complexity; further, MRI is a static study and cannot demonstrate pathologic laxity. Stress radiography may provide additional information about instability.

Risk Factors for Peroneal Nerve Injury and Recovery in Knee Dislocation

Christopher J. Peskun MD, Jas Chahal MD, Zvi Y. Steinfeld BSc, Daniel B. Whelan MD

Acute knee dislocation is rare but has a high rate of associated neurovascular injuries and potentially limb-threatening complications. These include the substantial morbidity associated with peroneal nerve injury: neuropathic pain, decreased mobility, and considerably reduced function, which not only impairs patient function but complicates treatment.

Revision ACL Reconstruction in Skeletally Mature Athletes Younger Than 18 Years

Keith R. Reinhardt MD, Sommer Hammoud MD, Andrea L. Bowers MD, Ben-Paul Umunna BA, Frank A. Cordasco MD

Young, active, skeletally mature patients have higher failure rates after various surgical procedures, including stabilization for shoulder instability and primary ACL reconstruction. It is unclear whether young, active, skeletally mature patients share similarly high failure rates after revision ACL reconstruction.

Surgical Technique: Revision ACL Reconstruction With a Rectangular Tunnel Technique

Konsei Shino MD, Tatsuo Mae MD, Norimasa Nakamura MD

We developed the rectangular tunnel ACL reconstruction (RT ACLR) using a 10-mm wide bone-patellar tendon-bone (BTB) graft through rectangular tunnels with a rectangular aperture to reduce tunnel size: the cross-sectional area of the tunnels of 50 mm(5 × 10 mm) in RT ACLR is less than that of 79 mmin a conventional 10-mm round tunnel technique presuming the technique would be more suitable in revision ACLR with previous improperly placed tunnels.

Surgical Technique: Medial Collateral Ligament Reconstruction Using Achilles Allograft for Combined Knee Ligament Injury

Robert G. Marx MD, MSc, FRCSC, Iftach Hetsroni MD

Previous approaches for medial collateral ligament (MCL) reconstruction have been associated with extensive exposure, risk of donor site morbidity with autografts, loss of motion, nonanatomic graft placement, and technical complexity with double-bundle constructs. Therefore, we implemented a technique that uses Achilles allograft, small incisions, and anatomic insertions to reconstruct the MCL.

Single- versus Double-bundle ACL Reconstruction: Is There Any Difference in Stability and Function at 3-year Followup?

Alberto Gobbi MD, Vivek Mahajan MD, Georgios Karnatzikos MD, Norimasa Nakamura MD, PhD

Despite a number of studies comparing postoperative stability and function after anatomic double-bundle and single-bundle anterior cruciate ligament reconstruction (ACLR), it remains unclear whether double-bundle reconstruction improves stability or function.

Partial Tibial Nerve Transfer to the Tibialis Anterior Motor Branch to Treat Peroneal Nerve Injury After Knee Trauma

Jennifer L. Giuffre MD, Allen T. Bishop MD, Robert J. Spinner MD, Bruce A. Levy MD, Alexander Y. Shin MD

Injuries to the deep peroneal nerve result in tibialis anterior muscle paralysis and associated loss of ankle dorsiflexion. Nerve grafting of peroneal nerve injuries has led to poor function; therefore, tendon transfers and ankle-foot orthotics have been the standard treatment for foot drop.