Evaluation and treatment of the multiligament-injured knee.

A dislocated knee with tearing of both cruciate ligaments and one or both of the collateral ligaments is a severe injury that can result from high-or low-energy trauma. Vascular injuries (especially of the popliteal artery), nerve injuries, associated fractures, functional instability, and posttraumatic arthrosis all can occur with this injury complex. Most of these ligament injuries require surgical treatment, although some low-grade medial collateral ligament complex injuries can be treated with bracing. The timing of surgical treatment of acute multiple ligament injuries depends on the ligaments injured, the vascular status and skin condition of the injured extremity, the degree of knee instability, and the patient's overall health. It is important to correct all components of instability. Delaying reconstruction for 2 to 3 weeks may decrease the incidence of arthrofibrosis. Allograft tissue generally is preferred for these complex surgical procedures. Currently, there is no conclusive evidence that double-bundle posterior cruciate ligament reconstruction provides better results than single-bundle posterior cruciate ligament reconstruction in the knee with injuries to multiple ligaments.

Posterior cruciate ligament and posterolateral corner reconstruction.

The keys to successful posterior cruciate ligament reconstruction are to identify and treat all pathology, use strong graft material, accurately place tunnels in anatomic insertion sites, minimize graft bending, use a mechanical graft-tensioning device, use primary and backup graft fixation, and employ the appropriate postoperative rehabilitation program. Adherence to these technical points results in successful single and double bundle arthroscopic transtibial tunnel posterior cruciate ligament reconstruction documented with stress radiography, arthrometer, knee ligament rating scales, and patient satisfaction measurements.