Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri.
Thompson Laboratory for Regenerative Orthopaedics, University of Missouri, Columbia, Missouri.
J Knee Surg. 2022 Mar;35(4):456-465. doi: 10.1055/s-0040-1716355. Epub 2020 Sep 17.
Multiligament 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 ( = 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.
多韧带膝关节损伤（MLKI）通常需要手术重建才能达到患者的最佳效果。MLKI 手术后的翻修和失败率可高达 40%，这表明需要改进移植物结构和植入技术。本研究评估了用于前交叉韧带（ACL）、后交叉韧带（PCL）、后内侧角（PMC）和后外侧角（PLC）重建的新型移植物结构和手术植入及固定技术。研究目的是：(1) 详细描述每种结构和技术；(2) 使用这些结构优化 MLKI 重建手术技术，以便在正确的解剖位置一致地植入移植物，同时保留骨量并最大限度地减少重叠。使用我们的新型技术，对 3 个尸体膝关节进行了仪器操作，以进行关节镜辅助和开放式手术，为 MLKI 重建的所有组件创建套接和隧道。识别和评估具有重叠潜力的套接和隧道，使用大体、计算机断层扫描和基于有限元分析的测量来测量它们之间的最小距离。还计算了每个膝关节的骨体积保留百分比。股骨 PLC-外侧副韧带和股骨 PMC 套接以及胫骨 PCL 和胫骨 PMC 后斜韧带套接存在高重叠风险。股骨 ACL 和股骨 PLC 外侧副韧带套接以及胫骨髌腱和胫骨后斜韧带套接存在中度重叠风险。然而，通过根据在 MLKI 中具有高风险的移植物组合的意识进行仔细规划，并结合使用荧光透视引导保护套接/隧道和调整轨迹，新型结构和技术可以使所有主要韧带在 MLKI 中进行一致的手术重建，从而可以一致避免套接和隧道重叠。因此，可以实现结构的潜在优势，包括改善移植物与骨的整合、对移植物进行顺序拉紧的能力以及保骨效果。
