The outcomes of one-stage treatment for multiple knee ligament injuries combined with extensor apparatus rupture

Abstract

Background: Multiple knee ligament injuries combined with extensor apparatus rupture are serious and complex knee injuries that are rare in clinical practice. The management is extremely challenging and controversial. The aim of this study is to describe a patient collective with multiple knee ligament injuries combined with extensor apparatus injuries in detail and to report the mid-term outcomes of a one-stage surgical treatment regarding subjective outcome scores, complications, knee instability, and ROM. Methods: Eleven of 425 patients with multiple knee ligament injuries combined with extensor apparatus injuries admitted to our hospital were reviewed from July 2008 to May 2017. All patients underwent one-stage repair and reconstruction of multiple knee ligaments and extensor apparatus. The Lysholm knee score and the International Knee Documentation Committee (IKDC) score were adopted to evaluate the surgical effect preoperatively and at a minimum of 2 years' follow-up. Clinical data, including range of motion and knee stability, were also recorded at the final follow-up. Results: Ten patients were followed up with a mean time of 40 (range, 24-60) months. At the last follow-up, 8 patients had joint flexion range of motion greater than or equal to120 degrees, 2 patients had joint flexion range of motion of 100-120 degrees, and 1 patient had active knee extension limitation of 5 degrees. Stress radiographs showed that the mean differences in posterior displacement were reduced from 10.8 ± 3.0 mm preoperatively to 2.0 ± 2.5 mm at the last follow-up. There were significant improvements in stress radiographs from pre-to postoperative states for all patients with multiple knee ligament injuries. The Lysholm score ranged from 85 to 96, with a mean of 92.1 (compared with 33 before surgery, P < 0.05). The final IKDC scores were A in 2 patients (20%), B in 7 (70%), and C in 1 (10%). Nine of the 10 patients (90%) returned to their former activity level. Conclusion: Multiple knee ligament injuries combined with extensor apparatus rupture are rare. Single-stage management of the repair and reconstruction of multiple knee ligaments and extensor apparatus with proper rehabilitation is an effective and reliable procedure to restore knee stability and function. Level of evidence: Level IV, therapeutic case series.

A Meta-Analysis of Systemic Evaluation of Knee Ligament Injury or Intervention of Knee Proprioceptive Function Recovery

“…According to the inclusion and exclusion criteria, 507 documents that obviously did not meet the inclusion criteria were eliminated by reading the title and abstract. Reading the full text, 32 related documents were excluded, and finally, 11 documents were included [ 3 ], including 8 Chinese documents and 3 foreign documents. A total of 843 patients were included, including 472 cases in the disabled group and 371 cases in the nondisabled group (see Table 1 ).…”

Anatomical repair and ligament bracing of Schenck III and IV knee joint dislocations leads to acceptable subjective and kinematic outcomes

“…Since nonsurgical therapy in the case of acute KD yields unsatisfactory results [ 14 , 29 , 35 , 38 ], various surgical procedures have been developed. These strategies range from early to late surgery [ 18 ] and repair to reconstruction and one- to two-stage procedures, with comparably satisfactory results [ 1 , 4 , 9 , 15 , 19 , 24 , 30 , 34 , 43 , 54 ], even if most authors recommend a staged procedure for the repair of peripheral structures and reconstruction of cruciate ligaments [ 5 , 14 , 16 , 22 ]. Furthermore, both open and arthroscopic treatment strategies in the early and late stages have been described as practicable [ 12 , 20 , 46 ].…”

Extensor Mechanism Disruption Impacts Treatment of Dislocated and Multiligament Injured Knees

“…This was consistent with the series reported by Liu et al, in which most of the 15 patients treated with 2-stage procedures (initial reduction and repair of the EM followed by multiple ligament reconstruction after at least 6 weeks) achieved a normal range of motion and knee stability 10 . On the other hand, Zhao et al reported favorable outcomes in 10 patients after single-stage surgery for MLKI and concomitant EM injury 11 . However, they selected only active and young patients for ACL procedures and did not perform ACL reconstruction in patients who had posterolateral corner (PLC) or MCL injuries 11 .…”

“…On the other hand, Zhao et al reported favorable outcomes in 10 patients after single-stage surgery for MLKI and concomitant EM injury 11 . However, they selected only active and young patients for ACL procedures and did not perform ACL reconstruction in patients who had posterolateral corner (PLC) or MCL injuries 11 . Further investigation is therefore warranted, given the few clinical outcome studies on this topic.…”

“…Given the rarity of these injuries, there is a paucity of literature to guide optimal treatment strategies for MLKI with concomitant EM injury [7][8][9][10][11] . One study reported on a series of 15 patients, most of whom achieved favorable outcomes after undergoing staged EM repair followed by ligament reconstruction 10 , whereas another study reported a 90% rate of return to the prior activity level after single-stage MLKI treatment combined with EM repair 11 . However, both studies were limited by small patient cohorts with various knee injuries and lacked clinical comparison with a control group.…”