IC 05-2025 Masterclass in Multiligamentous Knee Injuries: Expert Perspectives (CME)-IC 05-2025 Masterclass in Multiligamentous Knee Injuries: Expert Perspectives (CME)

Video Transcription

Video Summary

This expert panel session from the 2024 ICL Master Class focused on multiligamentous knee injuries (MLKI), covering initial approaches, surgical techniques, and rehabilitation challenges. Dr. Mike Galea emphasized that not all MLKIs involve knee dislocations, noting dislocated knees have higher risks of nerve and arterial injuries, and require overnight admission with careful neurovascular monitoring. Swift evaluation to address vascular injury and soft tissue damage is critical. Early initiation of therapy, cryotherapy, and DVT prophylaxis supports improved outcomes, with surgical reconstruction ideally done within 2-3 weeks. Patient-specific factors such as age, obesity, and compliance affect prognosis.<br /><br />Dr. Brian Waterman delved into controversies in surgical techniques, particularly the posterior lateral corner (PLC) reconstruction, advocating individualized approaches between fibular-based (Arciero/Levy) and tibial-based (LaPrad) methods. For PCL reconstruction, single-bundle grafts are common, while double-bundle techniques may better restore stability but risk over-constraint; synthetic augmentation and spring-loaded braces are promising adjuncts. Medial side injuries require nuanced repair or reconstruction based on tissue quality and injury chronicity.<br /><br />Dr. Volker Musall discussed high-grade medial collateral ligament (MCL) injuries, favoring early operative management and repair when possible, highlighting risks of stiffness and graft failure. Bioinductive materials are an emerging but still experimental augmentation option. Rehabilitation protocols, currently under study in the STAR trial, are key to outcome.<br /><br />Dr. Alan Getgood addressed revision MLKI surgery challenges, focusing on causes of failure such as arthrofibrosis and infection. He described arthroscopic lysis of adhesions and careful post-op management, emphasizing early intervention for stiffness. Imaging and clinical exam guide revision planning, with graft choice and alignment assessment critical for success.<br /><br />The panel highlighted the complexity of MLKI management requiring tailored surgical strategies, vigilant post-op care, and multidisciplinary rehabilitation, while ongoing trials like STAR seek to refine optimal timing and techniques.

Keywords

multiligamentous knee injuries

MLKI

knee dislocation

neurovascular monitoring

surgical reconstruction

posterior lateral corner reconstruction

PCL reconstruction

medial collateral ligament injuries

revision MLKI surgery

rehabilitation protocols