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![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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/1.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/2.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/3.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/4.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/5.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/6.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/7.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/8.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/9.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/10.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/11.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/12.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/13.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/14.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/15.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/16.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/17.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/18.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/19.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/20.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/21.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/22.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/23.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/24.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/25.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/26.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/27.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/28.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/29.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/30.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/31.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/32.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/33.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/34.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/35.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/36.jpg)
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.](https://reader037.fdocuments.in/reader037/viewer/2022110103/56649c7e5503460f949340fc/html5/thumbnails/37.jpg)
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.