Results of multiple ligament injured knees operated by three different strategies

Abstract

Background:Multiple ligament injured knee is generally described for a scenario when at least 2 of the 4 major ligaments are ruptured. The most effective treatment for these injuries remains controversial. This study presents the clinical outcome of 3 surgical strategies based on personalized treatment.Materials and Methods:Thirty two patients with multiple ligament injured knee were treated by 3 surgical strategies in the acute phase. (1) One-stage: Twelve patients treated by repair and reconstruction of all ruptured ligaments in a single operation. (2) Staged: Eleven patients treated by repair or reconstruction of the extraarticular (EA) ligaments and then intraarticular ligaments in 2nd stage. (3) EA ligament repair: Nine patients underwent only EA ligaments repair.Results:The patients were followed up for an average of 34.7 ± 12.1 months. Significant improvements in knee stabilities (P < 0.01), Lysholm score (P < 0.01) and International Knee Documentation Committee grade (P < 0.01) were noticed in all groups. Of the 32 patients, none had gross mal alignment or gait abnormalities at the latest followup. Comparing the 3 groups, a significant difference in Lysholm score was shown between the one stage group and the EA repair group (P = 0.040); additionally, significant differences were found in 2 subscales of knee injury and osteoarthritis outcome score (P < 0.05).Conclusion:Satisfactory clinical and functional outcomes could be achieved adopting the 3 surgical strategies based on personalized treatment. However, a combination of EA repair and intraarticular repair or reconstruction might be more reasonable options for the young and active patients.

Reconstruction and/or Repair of The Multi-Ligament Knee Injury: A Systematic Review

“…In our review, reconstruction typically occurred for the ACL and PCL while repair occurred for medial collateral ligament (MCL), lateral collateral ligament (LCL), posteromedial complex (PMC), posterolateral complex (PLC). One cohort Sun L, et al [12] used repair only technique and this did not appear to have an inferior result in improvement of post-operative Lysholm score. Certain structures such as the posterolateral corner may be amenable to reconstruction vs repair [16].…”

“…One hundred and nine studies were initially retrieved, with 7 satisfying all inclusion criteria [7][8][9][10][11][12]. There were no additional articles from the Cochrane database.…”

“…Injured knee ligaments were specified and are detailed in and was therefore included as 3 different cohorts in (Table 2) [12].…”

“…When breaking up Sun et al study, a total of nine cohorts of data were identified. One of nine cohorts used only reconstruction [6], 7 of nine cohorts used a combination of reconstruction and repair [7][8][9][10][11][12], and one of nine cohorts used only repair [12]. Seven of nine cohorts used a one stage surgical approach where reconstruction and repair was performed during the same procedure [6][7][8][9]11,12].…”

“…Two of nine cohorts used a two-stage surgical approach where anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) were reconstructed during a second surgery [10,12].…”