Gwilt Matthew S, Groothoff Jonathan D, Puckett Caleb D, van der List Jelle P, Fiegen Anthony P, Waterman Brian R
Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
Department of Orthopaedic Surgery and Rehabilitation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA.
Video J Sports Med. 2025 Feb 19;5(1):26350254241301445. doi: 10.1177/26350254241301445. eCollection 2025 Jan-Feb.
Multiligamentous knee injuries (MLKIs) are complex, often highly traumatic injuries that require broad surgical techniques to restore joint stability. This study outlines novel surgical techniques for posterolateral corner (PLC) reconstruction with suture augmentation in the context of bicruciate reconstruction.
Reconstruction is indicated in complete tears of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and PLC due to joint instability. Allografts augmented with suture augmentation may be implemented at surgeon and patient discretion for enhanced long-term graft viability and have the benefits of lower donor morbidity with allografts along with suture augmentation to prevent stretching of allografts.
The ACL was reconstructed with all-inside tunnels and allograft usage, and the same was performed for single-bundle allograft PCL reconstruction. The PLC reconstruction consisted of a modified open Arciero technique in which the lateral collateral ligament (LCL) and popliteus were reconstructed using 1 continuous allograft, and additional suture augmentation was performed for the LCL to prevent stretching. The PCL was fixed first, after which the ACL and the PLC were fixed.
At 6 weeks postoperatively, the patient continues to progress in restoring passive range of motion and tolerance of partial weightbearing. Barring any potential complications, a full recovery is expected in approximately 9 to 12 months, as is consistent with the MLKI recovery protocol.
DISCUSSION/CONCLUSION: This study describes the surgical management of a Schenck knee dislocation class III-L injury with concomitant Arciero open PLC reconstruction in a 65-year-old man. The ideal strategy for reconstruction of MLKIs is unclear and warrants further evidence to help guide treatment in the context of concomitant injuries.
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.
多韧带膝关节损伤（MLKIs）是复杂的、通常具有高度创伤性的损伤，需要广泛的手术技术来恢复关节稳定性。本研究概述了在双交叉韧带重建背景下，采用缝线增强技术进行后外侧角（PLC）重建的新型手术技术。
由于关节不稳定，前交叉韧带（ACL）、后交叉韧带（PCL）和PLC完全撕裂时需进行重建。可根据外科医生和患者的判断采用缝线增强同种异体移植物，以提高移植物的长期存活率，其优点是同种异体移植物供体发病率较低，同时采用缝线增强可防止同种异体移植物拉伸。
采用全关节镜下隧道技术和同种异体移植物重建ACL，单束同种异体移植物PCL重建也采用同样方法。PLC重建采用改良的开放Arciero技术，其中外侧副韧带（LCL）和腘肌使用1根连续同种异体移植物进行重建，并对LCL进行额外的缝线增强以防止拉伸。先固定PCL，然后固定ACL和PLC。
术后6周，患者在恢复被动活动范围和部分负重耐受性方面持续取得进展。除非出现任何潜在并发症，预计约9至12个月可完全康复，这与MLKI恢复方案一致。
讨论/结论：本研究描述了一名65岁男性Schenck III-L级膝关节脱位伴Arciero开放PLC重建的手术治疗。MLKIs重建的理想策略尚不清楚，需要进一步的证据来指导合并损伤情况下的治疗。
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。
