The Multiple Ligament Injured Knee
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- Marvin Bailey
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2 The Multiple Ligament Injured Knee
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4 Gregory C. Fanelli Editor The Multiple Ligament Injured Knee A Practical Guide to Management Second Edition
5 Editor Gregory C. Fanelli Geisinger Health System Orthopaedics 115 Woodbine Lane, Danville, Pennsylvania , USA ISBN ISBN (ebook) DOI / Springer New York Heidelberg Dordrecht London Library of Congress Control Number: Springer Science+Business Media New York 2013 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 micro fi lms 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. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied speci fi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (
6 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.
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8 Preface Our practice environment largely determines the pathways that our individual orthopaedic careers 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 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 instabilities of the knee. The purpose of this book is to provide experienced knee surgeons, general orthopaedic surgeons, fellows, residents, medical students, and other health-care professionals with an interest in the multiple ligament injured knee, a useful tool for the management of the complex injuries. The Multiple Ligament Injured Knee : A Practical Guide To Management, Second Edition, is expanded from 18 chapters in the First Edition to 35 chapters in the Second Edition. The Second Edition is composed of nine functional segments with each segment having a number of chapters. New topics in the Second Edition include the addition of ACL-based multiple ligament knee injury chapters, mechanical graft tensioning, fracture dislocations, articular cartilage restoration, meniscus transplantation, extensor mechanism restoration, outcomes data, and the editor s 21-year evolutionary experience in the evaluation and treatment of the multiple ligament injured knee. The chapters were organized and written so that they build upon each other, and also 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 21-year experience in the 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, classi fi cation, and non-surgical 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 33 present methods to evaluate and manage associated complex conditions that occur in treating the multiple ligament injured knee. These include vascular injuries, nerve injuries, tendon transfers, fi xed posterior tibial subluxation, revision surgery, the role of osteotomy, fracture dislocations, articular cartilage restoration, meniscus transplantation, extensor mechanism disruption, postoperative rehabilitation, special aspects of functional bracing, and complications. Chapter 34 presents the results of treatment of the multiple ligament injured knee from an outcomes data perspective. The final chapter, 35, presents seven case studies in the management of the multiple ligament injured knee. Each case study presents a different knee instability problem, and then takes the reader through the decision-making process, the surgical treatment, and the fi nal outcome. 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 in surgical equipment, careful documentation, and experience, we are progressively improving our outcomes in treating this devastating knee injury. It is my personal hope that this book will serve as a launch pad for new ideas to further develop treatment plans and surgical techniques for the multiple ligament injured knee. Danville, Pennsylvania, USA Gregory C. Fanelli, M.D. vii
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10 Acknowledgments I want to acknowledge the following people who have directly and indirectly contributed to this textbook. Connie Walsh (Developmental Editor) at Springer New York for her 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 orthopaedic 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 orthopaedic colleagues and friends who have taken time out of their busy schedules to contribute chapters to this book. ix
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12 Contents Part I Editor s Experience 1 PCL-Based Multiple Ligament Knee Injuries: What I Have Learned... 3 Gregory C. Fanelli Part II Anatomy and Biomechanics 2 Anatomy and Biomechanics of the Cruciate Ligaments and Their Surgical Implications Christopher Kweon, Evan S. Lederman, and Anikar Chhabra 3 Anatomy and Biomechanics of the Lateral and Medial Sides of the Knee and the Surgical Implications Andrew G. Geeslin and Robert F. LaPrade Part III Diagnosis and Evaluation of the Multiple Ligament Injured 4 Initial Assessment in the Acute and Chronic Multiple-Ligament-Injured Knee Christopher Peskun and Daniel B. Whelan 5 Classification of Knee Dislocations and the Surgical Implications Bryon D. Hobby, Daniel C. Wascher, and Robert C. Schenck Jr. 6 Instrumented Measurement of the Multiple-Ligament-Injured Knee: Arthrometry, Stress Radiography, Rotationometry, and Computer Navigation Sasha Carsen and Donald Johnson 7 MRI Imaging in the Multiple-Ligament-Injured Knee W. James Malone, Faiz I. Syed, and Peter R. Bolos Part IV Non-Surgical Treatment 8 Nonoperative Treatment of the Dislocated Knee John David Beck, Kaan Irgit, and John T. Riehl Part V Surgical Treatment of the Multiple Ligament Injured Knee 9 Graft Selection in Multiple Ligament Injured Knee Surgery Thomas J. Kremen and David R. McAllister 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 Michael J. Medvecky xi
13 xii Contents 11 Surgical Treatment of Combined ACL and Lateral Side Injuries: Acute and Chronic Julienne Lippe and Robert A. Arciero 12 Surgical Treatment of Combined ACL Medial and Lateral Side Injuries: Acute and Chronic Bradley R. Wasserman and Robin V. West 13 Revision ACL-Based Multiple Ligament Knee Surgery Seth A. Cheatham and Darren L. Johnson Part VII Surgical Treatment of the PCL-Based Multiple Ligament Injured Knee 14 Arthroscopic Primary Cruciate Repair in the Multiligament Injured Knee Micah Lissy, Christopher J. Dy, Anil S. Ranawat, and Gregory S. DiFelice 15 Surgical Treatment of Combined PCL/Lateral-Sided Injuries: Acute and Chronic M. Mustafa Gomberawalla and Jon K. Sekiya 16 Surgical Treatment of Combined PCL Medial Side Injuries: Acute and Chronic Jeffrey M. Tuman and Mark D. Miller 17 Surgical Treatment of Combined PCL Medial and Lateral Side Injuries: Acute and Chronic James P. Stannard and Hyun Min Mike Kim 18 ACL, PCL, and Medial-Sided Injuries of the Knee Bruce A. Levy and Michael J. Stuart 19 Surgical Management of ACL, PCL, and Lateral-Sided Injuries: Acute and Chronic Jonathan P. Marsh and Peter B. MacDonald 20 Surgical Treatment of Combined PCL-ACL Medial and Lateral Side Injuries (Global Laxity): Acute and Chronic Gregory C. Fanelli 21 Revision Surgery in the Posterior Cruciate Ligament and Multiple Ligament Injured Knee Christopher D. Harner and Timothy L. Miller Part VIII Other Considerations 22 Mechanical Graft Tensioning in Multiple Ligament Knee Surgery Gregory C. Fanelli 23 Management of Arterial and Venous Injuries in the Dislocated Knee John L. Gray and Matt Cindric 24 Drop Foot After Knee Dislocation: Evaluation and Treatment Gerard J. Cush, Patrick J. Maloney, and Kaan Irgit 25 The Role of Osteotomy Claude T. Moorman III and Katherine J. Coyner 26 Management of Chronic Tibial Subluxation in the Multiple-Ligament Injured Knee Travis G. Maak and Thomas L. Wickiewicz 27 Fracture-dislocations: Evaluation and Treatment Andrew L. Merritt, Kyle F. Chun, and Christopher J. Wahl 28 Articular Cartilage Restoration in the Multiple Ligament Injured Knee Kevin F. Bonner and Carly Rachel Noel
14 Contents xiii 29 Meniscus Transplant in the Multiple Ligament Injured Knee LTC Steven J. Svoboda, Travis C. Burns, Jeffrey R. Giuliani, and LTC Brett D. Owens 30 Extensor Mechanism Injury in Multiple Ligament Injured Knee Laura Scordino and Thomas M. DeBerardino 31 Brace Considerations in PCL Instability and the Multiple Ligament Injured Knee Andrew A.R. Lehman and Bruce Williams 32 Postoperative Rehabilitation of the Multiple Ligament Injured Knee Craig J. Edson and Gregory C. Fanelli 33 Complications Associated with the Treatment of the Multiple Ligament Injured Knee Toribio T. Natividad and Daniel C. Wascher Part IX Outcomes Data 34 Results of Treatment of the Multiple-Ligament-Injured Knee Sommer Hammoud, Moira McCarthy, and Robert G. Marx Part X Clinical Case Studies 35 Selected Case Studies in the Treatment of the Multiple-Ligament-Injured Knee Gregory C. Fanelli Index
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