The Multiple Ligament Injured Knee: A Practical Guide to Management

595 Pages·2019·32.545 MB·English

by  Gregory C. Fanelli

Gregory C. Fanelli
Editor
The Multiple Ligament
Injured Knee
A Practical Guide to Management
Third Edition
The Multiple Ligament Injured Knee
Gregory C. Fanelli
Editor
The Multiple Ligament
Injured Knee
A Practical Guide to Management
Third Edition
123
Editor
Gregory C. Fanelli
Department ofOrthopedic Surgery
Geisinger MedicalCenter/Health System
Danville, PA,USA
ISBN978-3-030-05395-6 ISBN978-3-030-05396-3 (eBook)
https://doi.org/10.1007/978-3-030-05396-3
LibraryofCongressControlNumber:2018963278
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3rdedition:©SpringerNatureSwitzerlandAG2019
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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, and to
Jesus Christ, Our Lord and Savior.
Preface
Our practice environment largely determines the pathways that our individual orthopedic
careers take. It hasbeen a blessingto be ina position that enabled me toexpand my surgical
techniques and research interest in the evaluation and treatment of the multiple ligament
injured knee. I believe the same situation exists for other contributors to this book. We all
share apassionandacommitment tothetreatmentofthesecomplexinstabilities oftheknee.
The purpose of this book is to provide experienced knee surgeons, general orthopedic sur-
geons,fellows,residents,medicalstudents,andotherhealthcareprofessionalswithaninterest
in the multiple ligament injured knee, a useful tool for the management of the complex
injuries.
TheMultipleLigamentInjuredKnee:APracticalGuideToManagement,ThirdEdition,is
expanded from 35 chapters in the Second Edition to 42 chapters in the Third Edition. The
Third Edition is compiled of 11 functional segments with each segment having a number of
chapters. New chapters in the Third Edition include direct nerve transfer for peroneal nerve
injury, management of extensor mechanism disruption and patellar instability, multiple liga-
ment knee injuries in professional athletes, internal bracing in multiple ligament knee
reconstruction, multiple ligament knee injuries in the United States active duty military
population,kneedislocationsinthemorbidlyobese,multipleligamentkneeinjuriesinpatients
18yearsofageandyounger,andanterolateralligamentreconstructioninthemultipleligament
injuredknee.Thechapterswereorganizedandwrittensothattheybuilduponeachother,and
also so that they are able to stand alone. This will enable the reader to leisurely explore the
topic of the multiple ligament injured knee, or to use the text as a quick, practical reference
when the need arises.
Chapter 1 presents the editor’s 28 years experience in evaluation and treatment of the
multiple ligament injured knee. Chapters 2 and 3 address anatomy and biomechanics of the
knee, while Chaps. 4 through 8 address diagnosis, initial assessment, classification, and
nonsurgical management of the acutely dislocated knee. Chapters 9 through 20 provide
multiple authors’ techniques and opinions in the surgical treatment of the ACL-based and
PCL-based multiple ligament injured knee. Chapters 21 through 40 present methods to
evaluate and manage associated complex conditions that occur in treating the multiple liga-
mentinjuredknee.Theseincludemechanicalgrafttensioning,vascularinjuries,nerveinjuries,
tendon transfers, fixed posterior tibial subluxation, revision surgery, the role of osteotomy,
fracture dislocations, articular cartilage restoration, meniscus transplantation, extensor mech-
anism disruption, multiple ligament knee injuries in professional athletes and active duty
militarypatients,internalbracinginmultipleligamentreconstruction,kneedislocationsinthe
morbidly obese, multiple ligament injuries in patients 18 years of age and younger, the
anterolateral ligament, postoperative rehabilitation, special aspects offunctional bracing, and
complications. Chapter 41 presents the results of treatment of the multiple ligament injured
kneefromanoutcomesdataperspective.Thefinalchapter,Chap.42,presents16casestudies
inthemanagementofthemultipleligamentinjuredknee.Eachcasestudypresentsadifferent
knee instability problem, and then takes the reader through the decision-making process, the
surgical treatment, and the final outcome.
vii
viii Preface
The multiple ligament injured knee is an extremely complex pathologic entity. I believe
that through research, improved surgical techniques, the use of allograft tissue, advancement
insurgicalequipment,carefuldocumentation,andexperience,weareprogressivelyimproving
ouroutcomesintreatingthisdevastatingkneeinjury.Itismypersonalhopethatthisbookwill
serveasacatalystfornewideastofurtherdeveloptreatmentplansandsurgicaltechniquesfor
posterior cruciate ligament 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, USA Gregory C. Fanelli, M.D.
Acknowledgements
I want to acknowledge the following people who have directly and indirectly contributed to
thistextbook.ConnieWalsh(DevelopmentalEditor)atSpringerPublishing,NewYorkforher
help in creating this book. Craig J. Edson, M.S., P.T./A.T.C., friend and colleague who is an
outstanding clinician and teacher. The Orthopaedic Surgery Team at Geisinger Woodbine
Lane and Geisinger Medical Center who are the best orthopedic support staff in the world.
Their dedication and drive for excellence are unequaled. To my patients and their referring
doctorswhohaveentrustedtheircaretome,andtomyorthopediccolleaguesandfriendswho
have taken time out of their busy schedules to contribute chapters to this book.
Danville, PA, USA Gregory C. Fanelli, M.D.
ix
Contents
Part I Editor’s Experience
1 PCL Based Multiple Ligament Knee Injuries: What I Have Learned
in 28 Years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Gregory C. Fanelli
Part II Anatomy and Biomechanics
2 Anatomy and Biomechanics of the Cruciate Ligaments and Their Surgical
Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Jeffrey D. Hassebrock, David E. Hartigan, Justin L. Makovicka,
and Anikar Chhabra
3 Anatomy and Biomechanics of the Lateral and Medial Sides of the Knee
and the Surgical Implications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Mitchell I. Kennedy, Andrew G. Geeslin, and Robert F. LaPrade
Part III Diagnosis and Evaluation of the Multiple Ligament Injured Knee
4 Initial Assessment in the Acute and Chronic Multiple-Ligament-Injured
Knee. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Graeme Hoit, Ujash Sheth, and Daniel B. Whelan
5 Classification of Knee Dislocations and the Surgical Implications . . . . . . . . . 67
ChristopherL.Shultz,DustinL.Richter,BryonD.Hobby,DanielC.Wascher,
and Robert C. Schenck Jr.
6 Instrumented Measurement of the Multiple-Ligament Injured Knee:
Arthrometers, Stress Radiography, and Laxiometer . . . . . . . . . . . . . . . . . . . 79
Lucas Teske, Donald D. Johnson, and Brian R. Waterman
7 MRI Imaging in the Multiple-Ligament-Injured Knee. . . . . . . . . . . . . . . . . . 91
W. James Malone and Sean C. Hostmeyer
Part IV Non-surgical Treatment
8 Selective Surgical Treatment of Knee Dislocations. . . . . . . . . . . . . . . . . . . . . 109
Marc S. Haro and K. Donald Shelbourne
Part V Surgical Treatment of the Multiple Ligament Injured Knee
9 Graft Selection in Multiple Ligament Injured Knee Surgery . . . . . . . . . . . . . 123
Natalie L. Leong, Thomas J. Kremen, and David R. McAllister
xi
xii Contents
Part VI Surgical Treatment of the ACL Based Multiple Ligament
Injured Knee
10 Surgical Treatment of Combined ACL and Medial-Sided Knee Injuries:
Acute and Chronic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Erin M. Cravez, Izuchukwu Ibe, and Michael J. Medvecky
11 Surgical Treatment of Combined Anterior Cruciate Ligament
and Lateral-Side Injures: Acute and Chronic . . . . . . . . . . . . . . . . . . . . . . . . 153
Laura A. Vogel, Cory M. Edgar, and Robert A. Arciero
12 SurgicalTreatmentofCombinedACLMedial-andLateral-SidedInjuries:
Acute and Chronic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Eric D. Wicks and Steven B. Cohen
13 Revision ACL-Based Multiple Ligament Knee Surgery . . . . . . . . . . . . . . . . . 187
Theodore S. Wolfson, Mathew John Hamula, and Michael J. Alaia
Part VII Surgical Treatment of the PCL Based Multiple Ligament
Injured Knee
14 Arthroscopic Primary Repair in the Multiple-Ligament Injured Knee . . . . . 213
Anne Jonkergouw, Jelle P. Van der List, and Gregory S. DiFelice
15 Surgical Treatment of Combined PCL/Lateral Side Injuries: Acute
and Chronic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227
Michaela Kopka and S. Mark Heard
16 Surgical Treatment of Combined PCL Medial Side Injuries: Acute
and Chronic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Jeffrey M. Tuman and Mark D. Miller
17 Surgical Treatment of Combined PCL Medial and Lateral Side Injuries:
Acute and Chronic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
James P. Stannard and Daniel Deasis
18 Surgical Treatment of Combined ACL PCL Medial Side Injuries: Acute
and Chronic. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Benjamin Freychet, Nicholas I. Kennedy, Bruce A. Levy,
and Michael J. Stuart
19 SurgicalManagementofACL,PCL,andLateral-SidedInjuries:Acuteand
Chronic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Peter B. MacDonald and Scott W. Mollison
20 Surgical Treatment of Combined PCL-ACL Medial and Lateral Side
Injuries (Global Laxity): Acute and Chronic . . . . . . . . . . . . . . . . . . . . . . . . . 295
Gregory C. Fanelli
21 Revision Surgery in the Posterior Cruciate Ligament and
Multiple-Ligament Injured Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Anthony D. Bratton, Christopher D. Harner, and Timothy L. Miller
Part VIII Other Considerations
22 Mechanical Graft Tensioning in Multiple Ligament Knee Surgery . . . . . . . . 335
Gregory C. Fanelli