Development and Assessment of Novel Multiligament Knee Injury Reconstruction Graft Constructs and Techniques

2020 ◽  
Author(s):  
James L. Cook ◽  
Cristi R. Cook ◽  
Chantelle C. Bozynski ◽  
Will A. Bezold ◽  
James P. Stannard
Keyword(s):  
Knee Injury ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Lateral Collateral Ligament ◽  
Surgical Reconstruction ◽  
Collateral Ligament ◽  
Element Analysis ◽  
Posterior Oblique Ligament ◽  
Computed Tomographic ◽  
Multiligament Knee Injury

AbstractMultiligament knee injury (MLKI) typically requires surgical reconstruction to achieve the optimal outcomes for patients. Revision and failure rates after surgical reconstruction for MLKI can be as high as 40%, suggesting the need for improvements in graft constructs and implantation techniques. This study assessed novel graft constructs and surgical implantation and fixation techniques for anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), posterior medial corner (PMC), and posterior lateral corner (PLC) reconstruction. Study objectives were (1) to describe each construct and technique in detail, and (2) to optimize MLKI reconstruction surgical techniques using these constructs so as to consistently implant grafts in correct anatomical locations while preserving bone stock and minimizing overlap. Cadaveric knees (n = 3) were instrumented to perform arthroscopic-assisted and open surgical creation of sockets and tunnels for all components of MLKI reconstruction using our novel techniques. Sockets and tunnels with potential for overlap were identified and assessed to measure the minimum distances between them using gross, computed tomographic, and finite element analysis-based measurements. Percentage of bone volume spared for each knee was also calculated. Femoral PLC-lateral collateral ligament and femoral PMC sockets, as well as tibial PCL and tibial PMC posterior oblique ligament sockets, were at high risk for overlap. Femoral ACL and femoral PLC lateral collateral ligament sockets and tibial popliteal tendon and tibial posterior oblique ligament sockets were at moderate risk for overlap. However, with careful planning based on awareness of at-risk MLKI graft combinations in conjunction with protection of the socket/tunnel and trajectory adjustment using fluoroscopic guidance, the novel constructs and techniques allow for consistent surgical reconstruction of all major ligaments in MLKIs such that socket and tunnel overlap can be consistently avoided. As such, the potential advantages of the constructs, including improved graft-to-bone integration, capabilities for sequential tensioning of the graft, and bone sparing effects, can be implemented.

scholarly journals Evaluation of Anterior Cruciate Ligament Surgical Reconstruction Through Finite Element Analysis

2021 ◽  
Author(s):  
Konstantinos Risvas ◽  
Dimitar Stanev ◽  
Lefteris Benos ◽  
Konstantinos Filip ◽  
Dimitrios Tsaopoulos ◽  
...  
Keyword(s):  
Finite Element ◽  
Anterior Cruciate Ligament ◽  
Reference Model ◽  
Numerical Models ◽  
Cruciate Ligament ◽  
Surgical Techniques ◽  
Surgical Reconstruction ◽  
Modeling Framework ◽  
Element Analysis ◽  
Anterior Cruciate

Abstract Anterior Cruciate Ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the OpenKnee project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that a) increasing graft pretension and radius reduces relative knee displacement, b) the correlation of graft radius and tension should not be neglected, c) graft fixation angle of 20 degrees can reduce knee laxity, and d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.

scholarly journals Result of single stage early surgical treatment of high-grade multiligamentous knee injuries (Schenck Type III, IV and V)

2020 ◽  
Vol 8 (9_suppl7) ◽  
pp. 2325967120S0051
Author(s):  
Arvind Prasad Gupta
Keyword(s):  
Surgical Treatment ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Weight Bearing ◽  
Single Stage ◽  
High Grade ◽  
Collateral Ligament ◽  
Multiligament Knee Injury ◽  
Early Surgical Treatment

Introduction: The Multiligament Knee Injury is a complex knee problem and mostly associated with subluxation or dislocation of knee joint. Failure to diagnose and treat them appropriately can leads to devastating outcome particularly high-grade injury (Schenck Type 3,4 and 5). We favor single stage early surgical treatment of high grade Multiligament knee injury which leads to good functional outcome and return to work. Hypotheses: Single stage early surgical treatment of high grade Multiligament knee injury will leads to good functional outcome with higher IKDC and Lysholm score and helps the patients to in return early to work with higher satisfaction rate. Methods: From June 2013 to January 2020, 42 patients with age from 18 years to 56 years with acute (< 6 weeks) Multiligament knee injury included in surgical treatment. Patients with neurovascular injury were not included in study. From 42 patients, 28 patients was type 3,8 patients was type 4 and 6 patients was type 5 in this study. In all 42 patients, single stage treatment first Intraarticular ligament (anterior cruciate ligament ACL, posterior cruciate ligament PCL or both) reconstruction done by arthroscopic method then Extraarticular ligament (medial collateral ligament MCL, lateral collateral ligament LCL, Posterolateral corner PLC) treated with repair/augmentation/reconstruction depending upon status of ligaments by open method. We used only autograft (hamstring and peroneal longus tendon) of same limb or contralateral limb. Patient evaluation done with IKDC and Lyshlom score both in preoperative and postoperative period. Patient limb was kept in full extention in brace and started with aggressive physiotherapy with passive ROM at 2 weeks in post operative period . Follow up done at 2 weeks then every 6 weeks interval till 6 months then every 3 months interval. Partial weight bearing started at 6 weeks and full weight bearing usually between 10 weeks to 12 weeks. Results: Road traffic accident was the most common cause of Multiligament knee injury. Average follow up was 4 years (range 2 to 6.5 years) .40 % has excellent ,40% has good and 20% has average result. There was a significant improvement in both outcome scores as compared with the preoperative scores. Postoperatively average IKDC was 78 and Lyshlom was 86. Terminal restriction of knee movement was in 19% patients particularly those associated with medial side injury was the major complication in our study. Manipulation under anaesthesia was done in 4 cases and implant removal in 1 case and arthroscopic synovectomy and long term antibiotic in 1 case who develop early infection. Gade 1 posterior laxity and grade 1 varus stress was observed in 10 patints.Recovery after surgery takes 9 to 12 months of rehabilitation prior to returning to full activities. Conclusion: Proper evaluation and full diagnosis is key in Multiligament injury of knee. Failure to treat all injured structure can lead to change in knee kinematics and poorer outcome and increased risk for graft failure.Operative treatment with proper rehabilitation yields good functional and clinical outcome with early return to work and sports activity.

scholarly journals The Role of Magnetic Resonance Imaging in Traumatic Knee Injury

2020 ◽  
Vol 5 (1) ◽  
pp. 53-61
Author(s):  
Madan Thapa ◽  
Subash Thapa ◽  
Pramod Kumar Chhetri
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Knee Injury ◽  
Wide Spectrum ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Lateral Collateral Ligament ◽  
Bone Bruise ◽  
Resonance Imaging ◽  
Collateral Ligament

Introduction: Magnetic Resonance Imaging (MRI) as a non-invasive modality plays a vital role in assessment of a wide spectrum of internal knee derangements. This study focuses on the commonest anatomical derangement and reveals the importance of MRI to characterize the pattern of derangement in the assessment of the patient with knee injury. Methods: This is the hospital based prospective study conducted among 65 patients referred to department of radiology with first presentation of knee injury during two years period from August, 2013 to August, 2015. Patient fulfilling the inclusion criteria underwent Magnetic Resonance Imaging knee in SIEMENS MAGNETOM C 0.35 Tesla MRI machine, after taking written informed consent. Descriptive analysis of data was analyzed using SPSS 20.0 program Result: Of the total 65 patients with knee injury, Sport injuries were the most common mode of knee injury. 63 cases with trauma had findings on MRI. Most of the cases presented with joint effusion (59 cases). Anterior Cruciate Ligament (ACL) tear is the commonest injury (37 cases) during knee trauma followed by Medial Collateral Ligament (MCL), Medial Meniscus, Posterior Cruciate Ligament (PCL), Lateral Meniscus and Lateral Collateral Ligament(LCL) injuries. Conclusion: MRI as a high-contrast soft-tissue imaging technique can be used as a noninvasive modality to assess a wide spectrum of internal knee derangements in a patient with knee injury. Specific pattern of bone bruise can guide us to narrow our diagnosis.

Incidence of Associated Knee Lesions with Torn Anterior Cruciate Ligament: Retrospective Cohort Assessment

1998 ◽  
Vol 7 (1) ◽  
pp. 1-8 ◽  
Author(s):  
George A. Arangio ◽  
Edward W. Cohen
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Lateral Collateral Ligament ◽  
Collateral Ligament ◽  
Posterior Oblique Ligament ◽  
Anterior Cruciate Ligament Injuries ◽  
Arcuate Ligament ◽  
Anterior Cruciate

The records of 141 consecutive patients with confirmed complete anterior cruciate ligament injuries were reviewed retrospectively. One hundred and sixty-two associated injuries were divided into 25 injury complexes. Isolated injuries to the anterior cruciate ligament occurred in 40 cases (28.4%). Injuries of the medial meniscus occurred in 62 cases (38.2%), while injuries of the lateral meniscus occurred in 37 cases (22.8%). Injuries to the medial collateral ligament complex occurred in 42 cases (25.9%). Injuries to the lateral collateral ligament, posterior deep popliteus-arcuate ligament complex, and posterior cruciate ligament were found to be positively correlated (rho = .81, p = .001, and rho = .77, p = .001, N = 141, respectively). Injuries to the medial collateral ligament and the posterior oblique ligament were likewise positively correlated (rho = .45, p = .001, N = 141).

scholarly journals Short-Term Outcome of Multi-Ligament Knee Injury among Sudanese Patients

2019 ◽  
Vol 7 (9) ◽  
pp. 1486-1493 ◽  
Author(s):  
Amin Ahmed Ali ◽  
Mohamed Babiker Abdelwahab
Keyword(s):  
Functional Outcome ◽  
Knee Injury ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
The Body ◽  
University Hospital ◽  
Collateral Ligament ◽  
Term Outcome ◽  
Knee Ligaments ◽  
Excellent Outcome

BACKGROUND: Multi-ligament knee injury is the state of having two or more of the major knee ligaments, namely: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), the lateral collateral ligament (LCL), the posteromedial corner (PMC), and the posterolateral corner (PLC). The knee is a hinge joint; this dictates two direction movements on the y-axis plane. The knee joints carry the weight load of the body uniquely. The role of the knee ligaments is not conserved only to maintain knee in a rigid position while standing, but also orchestrates the biomechanics of knee motion in harmony. Multi-ligament knee injury is very rare (incidence < 10:10,000 of trauma cases). Patients with multiple ligaments injuries of the knee become disabled for a long period. This disability rises from the pain and stiffness of the knee joint. A disability that might be associated with increased frequencies of sick leave from work, or much more dire consequences, such as quitting a job or being relieved of duty. AIM: To assess the functional outcome of the knee of patients with a multi-ligament knee injury after treatment using a standard scoring system and to determine the recovery rates of each treatment option to a multi-ligament knee injury. METHODS: it is a cross-sectional study conducted from January 2018 to January 2019. All patients with multi-ligament knee injuries that were diagnosed by MRI, and underwent reconstruction surgeries or on the waiting list, at Ribat University Hospital and Alyaa Specialized Hospital, Alkuwiti specialised hospital, and Haj Alsafi Hospital for the past 2 years were included. Lyshlome knee scoring scale was used to assess the functional outcome of each patient. RESULTS: 24 patients were enrolled in this study (16 had reconstruction surgery, 8 did not). 3 had excellent outcome (LKSS = 95 – 100), 8 of them had good score (LKSS = 84-94), 5 had fair outcome (LKSS = 65-83). All those who did not have reconstruction had a poor score (LKSS < 64). CONCLUSION: Reconstruction of multi-ligament knee injury shows a good outcome than it was left alone. Post-operative physiotherapy increases the potential of reconstruction. While our data is limited because of the rare condition, we plan to expand our study area to include a larger sample size. We also recommend extending the post-operative physiotherapy to improve the outcome of a multi-ligament knee injury.

Reconstruction of the Lateral Collateral Ligament of the Knee With Patellar Tendon Allograft

1998 ◽  
Vol 26 (5) ◽  
pp. 656-662 ◽  
Author(s):  
Harrison A. Latimer ◽  
James E. Tibone ◽  
Neal S. ElAttrache ◽  
Patrick J. McMahon
Keyword(s):  
Posterior Cruciate Ligament ◽  
Patellar Tendon ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Surgical Reconstruction ◽  
Ligament Injuries ◽  
Collateral Ligament ◽  
Lachman Test ◽  
Test Result

This is a retrospective study of 10 patients with combined cruciate ligament and posterolateral instability who underwent surgical reconstruction between 1991 and 1994. All knees had at least 20° increased external rotation at 30° of knee flexion and from 1 to 3 varus instability. Five knees with posterior cruciate ligament ruptures had at least a 2 Lachman test result. (One knee had both anterior and posterior cruciate ligament injuries.) In all cases the lateral collateral ligament was reconstructed with a bone-patellar tendon-bone allograft secured with interference screws. Fixation tunnels were placed in the fibular head and at the isometric point on the femur. The cruciate ligaments were reconstructed with autograft or allograft material. The average follow-up was 28 months. Excessive external rotation at 30° of flexion was corrected in all but one knee. Six patients had no varus laxity, and four patients had 1 varus laxity at 30° of flexion. The posterior drawer test result decreased, on average, to 1 , and the Lachman test result decreased to between 0 and 1 . The average Tegner score was 4.6, with five patients returning to their preinjury level of activity and four returning to one level lower. These results indicate that this is a promising new procedure for patients with instability resulting from lateral ligament injuries of the knee.

Biomechanical Properties of the Stifle Joint Lateral Collateral Ligament in Dogs

1992 ◽  
Vol 05 (04) ◽  
pp. 158-162 ◽  
Author(s):  
D. Blackketter ◽  
J Harari ◽  
J. Dupuis
Keyword(s):  
Mechanical Properties ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Biomechanical Properties ◽  
Fibular Head ◽  
Joint Stability ◽  
Collateral Ligament ◽  
Cranial Cruciate Ligament ◽  
Stifle Joint

Bone/lateral collateral ligament/bone preparations were tested and structural mechanical properties compared to properties of cranial cruciate ligament in 15 dogs. The lateral collateral ligament has sufficient stiffness to provide stifle joint stability and strength to resist acute overload following fibular head transposition.

scholarly journals Imaging Findings of Knee Trauma on Magnetic Resonance Imaging

2022 ◽  
Vol 8 (1) ◽  
pp. 12-23
Author(s):  
Poonam Ohri ◽  
Shreeji Goya ◽  
Niveditha C ◽  
Manasi Kohli
Keyword(s):  
Anterior Cruciate Ligament ◽  
Imaging Modality ◽  
Cruciate Ligament ◽  
Age Groups ◽  
Lateral Collateral Ligament ◽  
Cost Effective ◽  
Collateral Ligament ◽  
Imaging Evaluation ◽  
Young Males ◽  
Anterior Cruciate

Background: Knee is one of the major joints involved in kinesis. With increasing involvement in sports related activities especially in young people, Trauma related knee pathologies have increased. An accurate diagnosis regarding the type and extent of injuries is essential for early operative as well as non-operative treatment. Methods:This prospective study included total of 82 cases. The patients were referred to the department of Radiodiagnosis from indoor and outdoor departments of Guru Nanak Dev Hospital, Amritsar with suspicion of internal derangement of the knee and with history of knee trauma.Results:The most common age group involved was young males between 15-34 years. In all age groups most of the patients were males. Most common ligament to be injured was Anterior Cruciate Ligament (ACL). Partial tears were more common than complete tears. Posterior Cruciate Ligament (PCL) tears were less common. Medial Collateral Ligament (MCL) tears outnumbered Lateral Collateral Ligament (LCL) tears and grade 2 tears were more common in both. Among the meniscal injuries Medial Meniscus (MM) tears were more common than LM and grade 3 signal was more common in both. Most of the patellar retinaculum injuries were associated with Anterior Cruciate Ligament ACL tears.Conclusions:Post-traumatic pre-arthroscopic MR imaging evaluation has proved to be cost-effective. MRI is an accurate imaging modality complementing the clinical evaluation and providing a global intra-articular and extra-articular assessment of the knee.

Posterior Cruciate Ligament Reconstruction in the Multiple Ligament Injured Knee

2020 ◽  
Vol 33 (05) ◽  
pp. 421-430
Author(s):  
Michelle E. Kew ◽  
Mark D. Miller
Keyword(s):  
Posterior Cruciate Ligament ◽  
Knee Injury ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Knee Injuries ◽  
Surgical Reconstruction ◽  
Nonsurgical Management ◽  
Injured Knee ◽  
Tibial Inlay ◽  
Low Activity

AbstractMultiligamentous knee injuries are challenging to treat and diagnose. Posterior cruciate ligament (PCL) injuries are commonly found in the constellation of injuries included in a multiligamentous knee injury and are caused by a posteriorly directed force on the proximal tibia with relation to the femoral condyles. A thorough history and physical examination should be performed to evaluate for associated neurovascular injuries and associated ligamentous, chondral, or bony injuries. Nonsurgical management is reserved for patients who are critically ill or have very low activity demands. Surgical reconstruction is recommended for most patients with multiligamentous knee injuries. The PCL reconstruction can be undertaken with several different graft options and reconstruction techniques, including the transtibial, arthroscopic tibial inlay, and open tibial inlay approach. The literature has a paucity of data regarding outcomes among the various reconstructive options, so the optimal surgical technique has not been established.

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