Quinn Courtney, Ignozzi Anthony J, Taleghani Eric, Miller Mark
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Department of Orthopedic Sports Medicine, Inova Medical Group, Fairfax, Virginia, USA.
Video J Sports Med. 2022 Dec 6;2(6):26350254221126537. doi: 10.1177/26350254221126537. eCollection 2022 Nov-Dec.
Multiligament knee injury (MLKI) is a rare, complex injury that requires surgical intervention. However, there is a lack of consensus regarding optimal timing, staging, and graft choice for ligament reconstruction.
Delayed, single-stage reconstruction offers the advantage of attaining improved preoperative range of motion and potential healing of extra-articular ligaments and may be necessary in the setting of multitrauma.
A hamstring graft was harvested and diagnostic arthroscopy performed. Three posterior portals were made for posterior cruciate ligament (PCL) reconstruction. Femoral and tibial pins were placed for both PCL and anterior cruciate ligament (ACL) tunnels, positions confirmed with fluoroscopy, and tunnels drilled over the pins. The Achilles allograft was shuttled through the femoral and tibial PCL tunnels in anterograde fashion and fixed with a metal interference screw on the femoral side. The hamstring autograft was passed through the ACL tunnels and suspended on the femoral side. Tibial fixation of both grafts was achieved with biocomposite interference. Medial collateral ligament reconstruction was performed through the medial incision from hamstring harvesting. The semitendinosis allograft was passed and fixed with screws and spiked washers. Fluoroscopy confirmed that screw trajectory did not interfere with the ACL or PCL tunnels.
Bagherifard et al reported a study of 41 consecutive patients with MLKI who underwent single-stage reconstruction with autograft and/or allograft. Mean postoperative Lysholm and International Knee Documentation Committee (IKDC) scores were 86.9 and 70, respectively, and only 7 patients experienced restricted range of motion. Billieres et al reported a study of 23 patients with MLKIs who underwent single-stage reconstruction with allograft only. Mean postoperative Lysholm and IKDC scores were 77.3 and 67.2, respectively, and 19 patients returned to sport. Goyal et al reported a study of 27 patients with MLKI who underwent single-stage reconstruction greater than 6 weeks after injury. At 2 years, there were significant improvements in Visual Analog Scale, IKDC, and Lysholm scores, and no patients had residual laxity of the knee joint.
DISCUSSION/CONCLUSION: Single-stage reconstruction of MLKIs is an effective intervention that has been supported in literature; however, further studies are necessary to determine optimal surgical timing and graft type.The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
膝关节多韧带损伤（MLKI）是一种罕见的复杂损伤，需要手术干预。然而，对于韧带重建的最佳时机、分期和移植物选择，目前尚无共识。
延迟一期重建具有改善术前活动范围以及关节外韧带可能愈合的优势，在多发伤情况下可能是必要的。
取腘绳肌移植物并进行诊断性关节镜检查。制作三个后内侧入路用于后交叉韧带（PCL）重建。为PCL和前交叉韧带（ACL）隧道置入股骨和胫骨定位针，通过透视确认位置，然后在定位针上钻孔。将跟腱同种异体移植物以顺行方式穿过股骨和胫骨PCL隧道，并在股骨侧用金属挤压螺钉固定。自体腘绳肌移植物穿过ACL隧道并悬吊于股骨侧。通过生物复合材料挤压实现两个移植物的胫骨固定。通过取自腘绳肌的内侧切口进行内侧副韧带重建。将半腱肌同种异体移植物穿过并用螺钉和带刺垫圈固定。透视确认螺钉轨迹未干扰ACL或PCL隧道。
巴盖里法德等人报告了一项对41例连续接受自体移植物和/或同种异体移植物一期重建的MLKI患者的研究。术后平均Lysholm评分和国际膝关节文献委员会（IKDC）评分分别为86.9和70，只有7例患者活动范围受限。比利埃雷斯等人报告了一项对23例仅接受同种异体移植物一期重建的MLKI患者的研究。术后平均Lysholm评分和IKDC评分分别为77.3和67.2，19例患者恢复运动。戈亚尔等人报告了一项对27例受伤后超过6周接受一期重建的MLKI患者的研究。在2年时，视觉模拟评分、IKDC评分和Lysholm评分有显著改善，没有患者存在膝关节残余松弛。
讨论/结论：MLKI的一期重建是一种有效的干预措施，已有文献支持；然而，需要进一步研究以确定最佳手术时机和移植物类型。作者证明已获得本出版物中出现的任何患者的同意。如果个体可识别，作者已随本投稿包含患者的豁免声明或其他书面批准形式以供发表。
