From: Controversies in acute multiligamentary knee injuries (MLKI)
1 | Always work as a team In the Emergency Room. Two heads think more than one. |
2 | Always, in all cases, rule out a Vascular lesion with accurate tests. Pedal pulse may not be your best friend. |
3 | Always in all cases, rule out a Peroneal Nerve injury with clinical test. The exam of the other leg will help you to diagnose partial injuries. |
4 | Always use an external fixator after a vascular repair. Use hinged if is available. Control Motion is better than not. |
5 | Always accompany yourself in surgery with trained personnel. This is not a 5 min surgery. |
6 | Always reinsert/repair the ligaments avulsions early. The best graft will never be better than the original tissue. Have high strength sutures, tapes, anchors, knotless on hand. |
7 | Always use appropriate measures to reduce surgical trauma in acute surgery. Use allografts instead autografts. Apply anatomical principles to repair /reconstructed ligaments. Remember than in this complex situation, the simple is better. |
8 | Always recover joint motion as soon as possible. Stiffness has a worse prognosis than residual instability. |
9 | Always Correct dynamic or severe angular deformity in chronic cases, before ligaments reconstruction. A varus knee deformity will spoil out your best PLC reconstruction. |
10 | Always remember that these lesions are not comparable in their results with mono-ligamentary surgery. Probably patients never will go back to their same level work and sports. Do not forget to explain them and family. |