Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian...

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Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher D. Harner J Bone Joint Surg Am Volume 87(1 suppl 1):1-21 March 1, 2005 ©2005 by The Journal of Bone and Joint Surgery, Inc.

Transcript of Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian...

Page 1: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Surgical Management of Knee Dislocations

by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher D. Harner

J Bone Joint Surg AmVolume 87(1 suppl 1):1-21

March 1, 2005

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 2: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Overview of the setup.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 3: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Overview of the surface anatomy and skin incisions used for repair of a medial-side injury.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 4: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Overview of the surface anatomy and skin incisions used for repair of a lateral-side injury.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 5: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 6: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 7: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Arthroscopic view from the posteromedial portal demonstrating débridement of the posterior cruciate ligament stump on the tibia and the proximity to the posterior capsule.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 8: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Arthroscopic image demonstrating placement of the posterior cruciate ligament guide on the tibial insertion site.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 9: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Arthroscopic image demonstrating the Kirschner wire at the site of the tibial insertion of the posterior cruciate ligament.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 10: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Radiographic confirmation of the placement of the tibial guide wires for the anterior cruciate ligament and posterior cruciate ligament.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 11: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Arthroscopic image demonstrating safe drilling of the tibial tunnel for the posterior cruciate ligament.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 12: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Schematic of the tibial tunnels for the anterior cruciate ligament and posterior cruciate ligament.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 13: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Arthroscopic image demonstrating the starting point of the femoral tunnel for the posterior cruciate ligament.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 14: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Schematic of the femoral and tibial tunnels for the anterior cruciate ligament and posterior cruciate ligament.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 15: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Bone-patellar tendon-bone allograft for anterior cruciate ligament reconstruction.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 16: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Achilles tendon allograft for posterior cruciate ligament reconstruction.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 17: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anatomic relationships of the structures on the lateral side of the knee.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 18: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 19: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 20: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 21: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 22: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 23: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 24: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 25: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 26: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Drilling of the femoral tunnel.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 27: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Drilling of the fibular head tunnel.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 28: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Passing of graft through the fibular head.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 29: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Fixing the graft on the femoral side.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 30: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Fixing the graft on the fibular side.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 31: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Reinforcing the graft by suturing it onto itself.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 32: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Final lateral-side reconstruction.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 33: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Arthroscopic image depicting preservation of an intact bundle of the posterior cruciate ligament (posteromedial bundle).

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 34: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Arthroscopic image of posterior cruciate ligament augmentation (anterolateral bundle) after graft passage.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 35: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Posterior oblique ligament imbrication procedure.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 36: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Postoperative radiographs showing reconstruction of the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.

Page 37: Surgical Management of Knee Dislocations by Anikar Chhabra, Peter S. Cha, Jeffrey A. Rihn, Brian Cole, Craig H. Bennett, Robert L. Waltrip, and Christopher.

Postoperative radiographs showing reconstruction of the anterior cruciate ligament, posterior cruciate ligament, and posterolateral corner.

Anikar Chhabra et al. J Bone Joint Surg Am 2005;87:1-21

©2005 by The Journal of Bone and Joint Surgery, Inc.