Abstract
PurposeThis article aims to evaluate patterns of chronic multiligament injuries and outcomes of treatment with single-stage reconstruction using autografts.MethodsAll patients with clinicoradiologically diagnosed multiligament knee injury (MKI) were included in this prospective observational study. As the time since injury was more than 6 weeks in all of the patients, they were categorized as having chronic MKI. Patients were assessed clinically for laxity, and the diagnosis was confirmed radiologically. Ipsilateral hamstring tendons were used for medial collateral ligament (MCL) or posterolateral corner reconstruction in a patient with Schenck knee dislocation (KD) type III. In these cases, the posterior cruciate ligament (PCL) and anterior cruciate ligament (ACL) were reconstructed by using the peroneus longus and contralateral hamstring tendons respectively. Ipsilateral hamstring tendons were used for ACL reconstruction and an ipsilateral peroneus longus tendon graft was used for reconstruction of the PCL in a KD type II injury. In two cases of KD type IV injury, the lateral laxity was only grade II and was managed conservatively; the rest of the ligaments were addressed like a KD type III injury. Outcome evaluation was done using a visual analogue scale (VAS) for pain, International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner activity level, preoperatively and postoperatively at 2 years’ follow-up.ResultsA total of 27 patients of mean age 33.48 ± 9.9 years with MKI were included in the study. The patients were classified as eight KD type II, 17 KD type III, and two KD type IV. The majority of the patients had associated meniscal (59.2%) or chondral (40.7%) injuries. At the 2 years’ follow-up visit, there were significant improvements in VAS score (p = 0.0001) IKDC score (p = 0.0001), Lysholm score (p = 0.0001), and range of motion (p = 0.001). None of the patients had residual laxity on clinical examination of the knee joint at the 2 years’ follow-up. All but two of the patients went back to their previous activity level. These two patients had progressive knee arthritis and needed knee arthroplasty.ConclusionSingle-stage surgical reconstruction for chronic MKI has favourable functional outcomes.Level of evidenceLevel IV, case series.
Highlights
Multiligament injuries are serious injuries of the knee joint [1,2,3,4,5]
Materials and methods From July 2016 to June 2018, all patients with chronic multiligament knee injury (MKI) were included in this prospective observational study
Patients presenting with injury to two or more major ligaments: anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL), were included and classified according to the Schenck knee dislocation (KD) classification system [21]
Summary
Multiligament injuries are serious injuries of the knee joint [1,2,3,4,5]. They are rare, contributing to approximately only 0.02–0.2% of all orthopaedic injuries [6]. For the collateral ligaments, behave and are treated differently compared to acute injuries. Management of these chronic injuries is controversial. Different treatment options have been proposed in different studies [2, 7, 10, 12,13,14] These studies focus on the acute treatment of knee dislocation and multiligament injuries. Allografts may have disadvantages like limited availability and risk of disease transmission. They may increase the costs of the surgery as well [15,16,17,18]. With many alternative autograft options available, reconstruction of multiple ligaments with autografts is possible
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