Multiligament Repair With Suture Augmentation in a Knee Dislocation With Medial-Sided Injury

Abstract

Knee dislocations often result in a severe multiligament injured knee (MLIK) with complex instability. Multiligament reconstruction can successfully restore knee stability and is commonly recommended, although surgical morbidity is induced by graft harvesting and tunnel drilling, and convergence of multiple tunnels can complicate the surgery. Therefore, as an alternative, primary repair of knee ligaments is currently reconsidered. The main advantages of primary repair consist of tissue preservation and decrease of surgical morbidity, which might improve knee functionality. Techniques in which avulsed ligaments are reapproximated to their anatomic origin have resulted in good clinical outcomes in selected patients over the past decade. More recently, repaired ligaments have been augmented with suture tape, to protect them from excessive stretch, which can improve healing and allows early rehabilitation. The surgical technique of primary repair in the multiligament injured knee has not yet been described. The purpose of this Technical Note is to explain suture augmented primary repair in KDIII-M injury, including the anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament.

Single-Stage Arthroscopic Anterior and Posterior Cruciate Ligament Repairs and Open Medial Collateral Ligament Repair for Acute Knee Dislocation

“…Multiple ligament knee injuries are rare; however, strong knee instability remains without proper treatment, and symptoms persist. Surgery is recommended for multiple ligament knee injuries as after conservative treatment, the rate of return to sports and work, the Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Lachman test results are all inferior to those observed after surgical treatment [3]. However, there are no clearly established guidelines regarding surgical methods or the timing of surgery [1].…”

“…Although this type of injury is rare, accounting for less than 0.02% of orthopedic injuries [2], the instability of the knee results in persistent severe symptoms if appropriate treatment is not administered. Surgical treatment is recommended [3]; however, the specifications regarding the timing and surgical technique remain controversial. Few studies have reported on arthroscopic-combined single-stage repair [4].…”

The multiple ligament-injured knee: When is primary repair an option?

“…The primary repair techniques for ACL and PCL tears will be discussed here, but have been previously described in more detail [18,32,33]. ACL and PCL repairs were all performed arthroscopically, using a Scorpion suture passer (Arthrex, Naples, FL).…”

“…The primary repair techniques used for collateral ligaments are briefly described here as they have been previously described in more detail [18,36]. The medial and lateral extra-articular structures were treated first to enable fluid control during later knee arthroscopy.…”

“…As a result of this less invasive surgery, primary repair is thought to have a quicker return of range of motion and could potentially reduce the incidence of postoperative stiffness [17]. Therefore, some surgeons now prefer primary repair of all ligaments as this procedure is significantly less invasive than reconstruction surgery [18][19][20]. Historically, high failure rates of primary repair of both cruciate and collateral ligaments have been reported [21][22][23].…”