Management of a chronic multiligament knee injury

Knee
ACL
Multi ligament
Sport related injury
Management of a chronic multiligament knee injury

In this clinical case involving a 24-year-old patient, we explore the various physical examination tests used to assess a multiligament knee injury. What is the most appropriate surgical treatment, and how should post-operative rehabilitation be managed?

Etienne Cavaignac
CHU Toulouse, FRANCE
Course Director

I am an orthopedic surgeon specialized in knee surgery. I practice at the University Hospital of Toulouse in the University Sports Clinic located in the Pierre Paul Riquet Hospital.
In addition to teaching at the Faculty of Medicine, I participate in courses for the professional societies to which I belong such as the SFA, ESSKA and SOFCOT.
My clinical activity (more than 800 surgeries per year) is exclusively focused on knee surgery. An important part of my surgeries is related to sports traumatology, in particular anterior cruciate ligament injuries (350+ ACL reconstructions per year).
My research activity is also focused on the knee. I have contributed to more than 110 publications in international journals. I am developing an à la carte approach in order to propose a personalized surgery to the patient. In the context of degenerative activity, the aim is to better analyze the variability of the anatomy in order to be able to propose prostheses adapted to the patient's anatomy. In the context of sports traumatology, it is a question of improving the dismemberment of all the lesions in order to propose an adequate therapy.
Since May 2022, I am a member of the board of ESSKA (European Society of Sports Traumatology Knee Surgery and Arthroscopy) as treasurer.

Part one
Clinical presentation
  • Patient :  24-year-old male patient , farmer
  • Mechanism of injury: High-Energy trauma ( Motorcycle Accident)
  • Initial Injury: knee sprain without associated fractures
  • Initial treatment: Knee Brace Immobilization for 6 weeks, followed by physiotherapy
  • The patient presented to our hospital 6 months later with persistent daily knee joint instability

Pre-op Testing

  • Varus Stress Test: varus laxity at 0° and 30°of knee flexion
  • Valgus Stress Test: Absence of valgus laxity at 0° and 30° of knee Flexion
Management of a chronic multiligament knee injury: Pre-op Testing

Pre operative MRI

  • Knee X-ray: No fractures or bony avulsion
  • Knee MRI Findings:
    • Rupture of the  PCL, PLC and LCL
    • Intact ACL
    • No meniscal tear
    • No cartilage injury 
Management of a chronic multiligament knee injury: Pre operative MRI
Management of a chronic multiligament knee injury: PCL Rupture
Management of a chronic multiligament knee injury: PCL Remnant
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