Multiligament Injury of Knee and ACL & PCL Reconstruction

ARTHROSCOPIC MULTILIGAMENT – ACL & PCL RECONSTRUCTION IN SINGLE STAGE

Dr. G. M. Jahangir Hossain Assistant Professor

National Institute of Traumatology and Orthopaedic Rehabilitation

Multi ligament knee injury is a complex problem

ACL & PCL with or without other ligament injury

High-velocity injury – MCA, fall from height

Low-velocity injury – Twisting and contact sports

Associate with fracture and neurovascular injury

MULTI LIGAMENT KNEE INJURY : LITERATURE REVIEW

PCL : Double bundle

AL bundle - tighten in flexion - loosen in extension

PM bundle - tighten in extension - loosen in flexion

AL b

undl

e

PM b

undl

e

AM bundle - tighten in Knee flexion - loosen in knee extension - limits anterior tibial translation

PL bundle - tighten in knee extension - loosen in flexion - limits tibial internal rotation

Sagittal T2 weight Image

● Disorganisedly oriented● Altered signal intensity

STRESS X-RAY KNEE : PTT

ARTHROSCOPIC VIEW OF ACL AND PCL

INTACT ACL & PCLVIDEO : INJURED ACL & PCL

● Hamstring tendons from ipsilateral and opposite side● Anatomic single bundle ligament - fixed with bioscrews ● Transtibial PCL recons with help of C-ARM ● Combined ACL & PCL in 7 male patients with minimum f/up 6 months and maximum 30 months

Reconstruction of ACL and PCL

ANTERIOR AND POSTERIOR TIBIAL TRANSLATION

TRANSTIBIAL TUNNEL TECHNIQUE FOR PCL

C-arm to check Zig and guide wire placement for Tibial Tunnel

PM portal

Tibial Tunnel for PCL

RECONS ACL & PCL

6 months after ACL & PCL reconstruction

PRE OP AP TT

POST OP AP TT

POST OP

CONCLUSION

ACL & PCL reconstruction -Stability of the jointRegain normal range of motionRestoration function of the jointReturn to preinjury level of activity

When, MCL, LCL and PLC are intact or improved preoperatively

THANKS FOR

ATTENTION