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How to avoid tunnel convergence during multiple-ligament knee surgery: a practical guide

Published in N° 002 - July / August 2019
Article viewed 27 times

How to avoid tunnel convergence during multiple-ligament knee surgery: a practical guide

By Philippe Landreau in category UPDATE
Orthopaedic Surgeon DXBone, Bone and Joint Excellence Center FIFA Medical Center of Excellence Dubai, UAE

Multiple ligament knee injuries occur either in the context of a violent trauma such as a road accident or during sports practice, with ball sports such as football accounting for 7 to 10% of knee dislocations in the literature.

1. Introduction

Multiple ligament knee injuries occur either in the context of a violent trauma such as a road accident or during sports practice, with ball sports such as football accounting for 7 to 10% of knee dislocations in the literature. In addition to the initial vascular and neurological risks, ligament injuries themselves can seriously compromise the resumption of sporting activities and jeopardize the career of a top-level athlete. Their appropriate treatment is therefore essential for functional recovery.

Multiple ligament knee surgery often poses a challenge for several reasons. One of them, which is often understated, is the risk of tunnel convergence. In fact, to repair a multiligament injured knee, the surgeon has to create tunnels to fix or integrate the grafts. These tunnels may lie very close together and, if they converge, carry a serious risk of collision. The width of the tunnels will depend on whether they are being used to insert an implant or an anchor. However, whatever the size of the tunnels, their convergence can compromise the quality of the fixation or integration and even carry a risk of fracture.

This article offers a practice guide to help surgeons when performing multiple-ligament reconstructions of the knee. It also covers Lemaire...

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