Neglected bilateral multi-ligament knee injury managed by single-stage limb reconstructive surgery: A very rare case report with literature review

Abstract

Abstract A multi-ligament knee injury (MLKI) can be a devastating injury. A poorly managed, missed, or neglected injury presenting with a painful arthritic crippling unstable limb needs reconstructive surgery. We present a case report of bilateral MLKI presenting with late neglected knee dislocations (KD) in a 37-year-old male. A rotating hinge arthroplasty for a KD5 right knee MLKI and an arthroscopic reconstruction combined with an open repair of the KD3M left knee MLKI have been presented. The strategy for simultaneous reconstructive procedures has been detailed. The preoperative clinical assessment, imaging, anticipated per-operative technical challenges, and adapting a postoperative guided rehabilitation protocol were important considerations. The advantages of a single-stage MLKI management were multi-fold. The single-stage limb reconstructive surgery gave a good functional outcome. A comprehensive review of case reports and studies for chronic or neglected KD provides an update on the various treatment strategies. The bilateral affection allowed for the utilization of contralateral autografts for the reconstructive surgery of the other knee. The combined arthroplasty and ligament repair for two knees as a single-stage procedure allowed an immediate weight-bearing potential to a wheelchair-bound bedridden adult. The precise decision-making, sound reconstruction principles, and meticulous coordinated surgical skills gave a favorable clinical and functional outcome.