A multidisciplinary approach to the evaluation, reconstruction and rehabilitation of the multi-ligament injured athlete.

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Abstract

[Indexed for MEDLINE] 15. J Orthop Case Rep. 2023 Dec;13(12):159-164. doi: 10.13107/jocr.2023.v13.i12.4118. Multiligament Knee Reconstruction of the ACL, PLC, and ALL in a Floating Knee: A Case Report. Kollmorgen R(1), Singleton A(2), Eaddy S(2), Phillips S(2). Author information: (1)Department of Orthopaedic Surgery, UCSF Fresno Center for Medical Education and Research, Fresno, California 93721, USA. (2)Department of Orthopaedics and Sports Medicine, Mercy Health St. Vincent Medical Center, Toledo, Ohio 43608, USA. INTRODUCTION: Ipsilateral fracture of the femur and tibia, known by the moniker "floating knee," is a serious injury that primarily results from high-energy trauma. Up to 53% of patients with floating knee injuries have concurrent ligamentous injuries, with the anterior cruciate ligament (ACL) as the most commonly affected ligament. Approximately 10% of multi-ligament knee injuries consist of injuries to both the ACL and posterolateral corner (PLC); however, the literature reporting the management of this patient population is sparse, particularly, with a lack of consensus on the timing and protocol of surgical treatment. Well-characterized treatment guidelines are needed for patients with concomitant floating knee and multi-ligament knee injuries. CASE REPORT: A 26-year-old, previously healthy male involved in a high-speed motor vehicle collision presented with upper and lower extremity, skull, and facial fractures, sacropelvic dissociation, and epidural hematoma. Here we describe a rare instance of a floating knee with a multi-ligament knee injury treated through early reconstruction of the ACL, PLC, and anterolateral ligament following stabilization of long bone fractures. Post-injury day 18, the patient underwent single-stage reconstruction of his multi-ligament knee injury. The timing of this was chosen to allow for capsular scar formation to aid in arthroscopy. CONCLUSION: Our surgical algorithm consists of allograft reconstruction using an all-inside ACL technique and a modified anatomical PLC technique. We recommend early (1-3 weeks) surgical treatment of multi-ligament knee injuries for patients without a closed head injury; however, an individualized treatment approach should be sought, considering the severity of ligamentous injuries, pre-injury activity level, extent of soft-tissue damage, and the activity goals of the patient post-injury. In patients with floating knee injuries, the proposed surgical algorithm here may be utilized for successful multi-ligament knee injury reconstruction. Copyright: © Indian Orthopaedic Research Group. DOI: 10.13107/jocr.2023.v13.i12.4118 PMCID: PMC10753671