Posterior Cruciate Ligament Injuries: A Practical Guide to Management PDF
Preview Posterior Cruciate Ligament Injuries: A Practical Guide to Management
Posterior Cruciate Ligament Injuries Gregory C. Fanelli, MD Editor Posterior Cruciate Ligament Injuries A Practical Guide to Management Second Edition Editor Gregory C. Fanelli, MD GHS Orthopaedics Danville Pennsylvania USA ISBN 978-3-319-12071-3 ISBN 978-3-319-12072-0 (e-Book) DOI 10.1007/978-3-319-12072-0 Library of Congress Control Number: 2014960067 Springer Cham Heidelberg New York Dordrecht London © Springer International Publishing Switzerland 2015 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) To my wife Lori, and my children Matthew, David, and Megan who all have a tireless work ethic, and are a never-ending source of inspiration to me. v Preface Our practice environment largely determines the pathways that our individual orthopedic ca- reers take. It has been a blessing to be in a position that enabled me to expand my surgical techniques and research interest in the evaluation and treatment of posterior cruciate ligament (PCL) injuries and the multiple-ligament-injured knee. I believe the same situation exists for other contributors to this book. We all share a passion and a commitment to the treatment of complex knee ligament instabilities. The purpose of this book is to provide experienced knee surgeons, general orthopedic surgeons, fellows, residents, medical students, and other health care professionals with an interest in PCL injuries and the PCL-based multiple ligament in- jured knee, a useful tool for the management of these complex injuries. Posterior Cruciate Ligament Injuries: A Practical Guide to Management, Second Edition, is expanded from 19 chapters in the First Edition to 29 chapters in the Second Edition. The Second Edition is composed of eight functional segments with each segment having a number of chapters. New topics in the Second Edition include chapters addressing osteotomy, me- chanical graft tensioning, articular cartilage restoration, meniscus transplantation, new cutting edge surgical techniques of PCL reconstruction, outcomes data, selected case studies, and the editor’s 25-year evolutionary experience in the evaluation and treatment of PCL injuries and the PCL-based multiple-ligament-injured knee. The chapters were organized and written so that they build upon each other, and also so that they are able to stand alone. This will enable the reader to leisurely explore the topic of the PCL injured knee, or to use the text as a quick, practical reference when the need arises. Chapter 1 presents the editor’s 25-year experience in evaluation and treatment of PCL in- juries and the PCL-based multiple-ligament injured knee. Chapters 2 and 3 address anatomy and biomechanics of the knee, while Chaps. 4 through 7 address diagnosis, clinical examina- tion, instrumented measurement, MRI imaging, and nonsurgical treatment of the PCL injured knee. Chapters 8 through 20 provide multiple authors’ advanced surgical techniques for PCL reconstruction. Topics in these chapters include graft selection, arthroscopic PCL primary repair, arthroscopic PCL reconstruction techniques, tibial inlay PCL reconstruction surgical techniques, PCL-based multiple knee ligament surgical techniques, PCL reconstruction in pa- tients 18 years of age and younger, and revision PCL reconstruction. Chapters 21 through 27 address topics that are often encountered when treating PCL in- juries. These include mechanical graft tensioning, the role of osteotomy, articular cartilage restoration, meniscus transplantation, postoperative rehabilitation, functional bracing, and complications in PCL injuries and reconstruction. Chapter 28 presents the results of treatment of PCL surgery from an outcomes data per- spective. The final chapter, 29, presents nine case studies in the management of PCL injuries and the PCL-based multiple-ligament-injured knee. Each case study presents a different knee instability problem, and then takes the reader through the decision making process, the surgi- cal treatment, and the final outcome. vii viii Preface The PCL injured knee and the PCL based multiple ligament injured knee are extremely complex pathologic entities. I believe that through research, improved surgical techniques, the use of allograft tissue, advancement in surgical equipment, careful documentation, and experi- ence, we are progressively improving our outcomes in treating this devastating knee injury. It is my personal hope that this book will serve as a catalyst for new ideas to further develop treatment plans and surgical techniques for PCL and related injuries, and that God and His Son Jesus Christ will continue to guide us in the care and treatment of these patients. Danville, PA Gregory C. Fanelli, M.D. Acknowledgements I want to acknowledge the following people who have directly and indirectly contributed to this textbook. Connie Walsh (Developmental Editor) at Springer-Verlag, New York for her help in creating this book. Craig J. Edson, M.S., P.T./A.T.C., friend, colleague, and outstand- ing clinician and teacher. The Orthopedic Surgery Team at Geisinger Woodbine Lane and Geisinger Medical Center are the best orthopedic support staff in the world. Their dedication and drive for excellence are unequaled. To my patients and their referring doctors who have entrusted their care to me, and to my orthopedic colleagues and friends who have taken time out of their busy schedules to contribute chapters to this book. Danville, PA Gregory C. Fanelli, M.D. ix Contents Part I Editor’s Experience 1 Posterior Cruciate Ligament Injuries and Reconstruction: What I Have Learned ................................................................................................. 3 Gregory C. Fanelli Part II Anatomy and Biomechanics 2 A natomy and Biomechanics of the Posterior Cruciate Ligament and Their Surgical Implications ................................................................................ 19 Christopher G. Stevens, Keith Jarbo, Kostas Economopoulos and Anikar Chhabra 3 A natomy and Biomechanics of the Posterolateral and Posteromedial Corners of the Knee and Their Surgical Implications ................... 33 Evan W. James, Christopher M. LaPrade, Adam M. Johannsen and Robert F. LaPrade Part III Diagnosis and Evaluation 4 Clinical and Arthroscopic Evaluation of the Posterior-Cruciate-Ligament-Injured Knee ............................................................. 49 Brian M. Devitt and Daniel B. Whelan 5 Instrumented Measurement of the Multiple-Ligament-Injured Knee: Arthrometry, Stress Radiography, Rotationometry, and Computer Navigation .......................................................................................... 65 Sasha Carsen, Robert Timothy Deakon and Don Johnson 6 MRI of PCL, Posteromedial, and Posterolateral Corner Injuries of the Knee ..... 75 W. James Malone, Satre Stuelke, Robert R. Snowden and Joel S. Salesky Part IV Non-Surgical Treatment 7 Nonoperative Treatment and Natural History of Posterior Cruciate Ligament Injuries ................................................................... 89 K. Donald Shelbourne xi xii Contents Part V Surgical Treatment 8 G raft Selection in Posterior Cruciate Ligament Surgery...................................... 101 Natalie L. Leong, Nima Kabir and David R. McAllister 9 Arthroscopic Transtibial Tunnel Posterior Cruciate Ligament Reconstruction .......................................................................................... 111 Gregory C. Fanelli 10 O pen Tibial Inlay Graft for Posterior Cruciate Ligament Reconstruction ......... 123 S. Mark Heard and Meagan Heard 11 All-Arthroscopic Tibial Inlay Double-Bundle Posterior Cruciate Ligament Reconstruction .......................................................................... 137 Alexander E. Weber and Jon K Sekiya 12 A ll-Inside Posterior Cruciate Ligament Reconstruction ....................................... 147 William M. Engasser, Paul L. Sousa, Michael J. Stuart and Bruce A. Levy 13 T he All-Inside Technique: Surgical Technique and Outcomes ............................. 157 Ranjodh Dhami, Robby S. Sikka, Ryan P. Dunlay and Joel L. Boyd 14 A rthroscopic Primary Repair of Posterior Cruciate Ligament Injuries ............. 165 Dominique D. Nieves, Micah J. Lissy and Gregory S. DiFelice 15 Combined PCL, ACL, Posteromedial, and Posterolateral Reconstruction ......... 173 Gregory C. Fanelli 16 Surgical Treatment of Combined PCL/Lateral-Sided Injuries ............................ 189 Christopher J. Wahl and Paul C. Chin 17 Combined Posterior Cruciate Ligament and Posteromedial Reconstruction ..... 209 Adnan Saithna and Peter B. MacDonald 18 Combined PCL, Posteromedial Corner, and Posterolateral Corner Reconstruction ............................................................................................. 219 Clayton W. Nuelle and James P. Stannard 19 Posterior Cruciate Ligament Reconstruction in Patients 18 Years of Age and Younger ................................................................................................... 231 Gregory C. Fanelli and David G. Fanelli 20 Revision Surgery in Posterior Cruciate Ligament Reconstruction ...................... 245 Kevin N. Jiang, Scott R. Kling, Timothy L. Miller and Christopher D. Harner Part VI Other Considerations 21 Mechanical Graft Tensioning in Posterior Cruciate Ligament Reconstruction ......................................................................................... 263 Gregory C. Fanelli
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