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Controversies in the Treatment of Knee Dislocations and Multiligament Reconstruction

Perspectives on Modern Orthopaedics articles provide an objective appraisal of new or controversial techniques or areas of investigation in orthopaedic surgery.

Dr. Levy is Assistant Professor, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN. Dr. Fanelli is Orthopaedic Surgeon, Geisinger Medical Center, Danville, PA. Dr. Whelan is Assistant Professor, Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada. Dr. Stannard is Professor of Surgery and Associate Director, University Hospital, Division of Orthopaedic Surgery, and Chief, Section of Orthopaedic Trauma, University of Alabama at Birmingham, Birmingham, AL. Dr. MacDonald is Professor and Head, Section of Orthopaedics, University of Manitoba, Winnipeg, Manitoba, Canada. Dr. Boyd is Orthopaedic Surgeon, TRIA Orthopedic Center, Minneapolis, MN. Dr. Marx is Associate Professor, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY. Dr. Stuart is Professor and Vice-Chairman, Department of Orthopedic Surgery, and Co-Director, Mayo Clinic Sports Medicine Center, Mayo Clinic.

Reprint requests: Dr. Levy, Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.

Dr. Levy or a member of his immediate family serves as a paid consultant to or is an employee of Valpo Orthotec. Dr. Fanelli or a member of his immediate family is affiliated with the publications Arthroscopy, Orthopedics Today, Journal of Knee Surgery, and SMAR. Dr. Stannard or a member of his immediate family serves as a board member, owner, officer, or committee member of the Orthopaedic Trauma Association; is a member of a speakers’ bureau or has made paid presentations on behalf of Medtronic and Synthes; serves as a paid consultant to or an employee of Medtronic and Osteolign; has received research or institutional support from Kinetic Concepts, Medtronic, Smith & Nephew, and Synthes; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research–related funding (such as paid travel) from Thieme Medical Publishers. Dr. MacDonald or a member of his immediate family has received research or institutional support from Linvatec and is a consultant to or an employee of Linvatec. Dr. Stuart or a member of his immediate family is affiliated with the publication American Journal of Sports Medicine; serves as a paid consultant to or is an employee of Stryker and Fios; and has received research or institutional support from DePuy, Biomet, Stryker, and Zimmer. None of the following authors or a member of their immediate families has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Whelan, Dr. Boyd, and Dr. Marx.

A systematic approach to evaluation and treatment is needed for the patient with knee dislocation. There is a paucity of high-level evidence on which to base treatment decisions. Reported controversies related to the treatment of the multiligament-injured knee include the selective use of arteriography for vascular assessment, serial physical examination with the ankle-brachial index, acute surgical treatment of all damaged structures, the selective application of preoperative and postoperative joint-spanning external fixation, arthroscopic reconstruction of the anterior cruciate ligament and posterior cruciate ligament, simultaneous open reconstruction with repair of the posterolateral corner, reconstruction and/or repair of the posteromedial corner, and the use of allograft tissue.