Adjustable Loop Fixation in Multi-ligament Knee Injuries: A Technical Note.

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Abstract

Conflict of interest statement: Conflict of interestAG is a Consultant for Smith & Nephew. AM and NM have no conflict of interest. 8. Indian J Orthop. 2024 Sep 14;58(11):1566-1578. doi: 10.1007/s43465-024-01252-x. eCollection 2024 Nov. A Modern-Day Algorithm for the Treatment of Multi-Ligament Knee Injuries. von Rehlingen-Prinz F(#)(1)(2), Rilk S(#)(1)(3), Beckers V(1), O'Brien R(1)(4)(3), DiFelice GS(1). Author information: (1)Orthopaedic Sports Medicine and Trauma Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, NewYork-Presbyterian, Weill Medical College of Cornell University, 535 E. 70th Street, New York, NY 10021 USA. (2)Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany. (3)Medical University of Vienna, Vienna, Austria. (4)Boston University Chobanian & Avedisian School of Medicine, Boston, MA USA. (#)Contributed equally INTRODUCTION: Multiligament knee injuries (MLKI) are rare and complex, significantly impacting long-term outcomes, with risks of osteoarthritis, joint stiffness, and reduced activity levels. OBJECTIVE: To explore the evolution of MLKI treatment protocols, comparing historical and modern approaches, and to present a patient-tailored, preservation-first algorithm. METHODS: This article reviews the literature on MLKI management, focusing on surgical timing, techniques, and rehabilitation protocols. The proposed algorithm categorizes MLKIs based on tear location and tissue quality, incorporating options, such as primary ligament repair, augmentation, and reconstruction. RESULTS: The modern preservation-first algorithm provides a tailored approach to MLKI treatment, addressing the complexity and heterogeneity of these injuries, and aims to mitigate risks like postoperative arthrofibrosis. CONCLUSION: MLKI management remains complex and controversial. The presented algorithm offers a structured, individualized treatment strategy that integrates modern surgical and rehabilitation advancements. © Indian Orthopaedics Association 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. DOI: 10.1007/s43465-024-01252-x PMCID: PMC11555188