Outcomes of Operative Management of Multi-Ligament Knee Injuries in an Adolescent Population: A Retrospective Case Series

Abstract

Background: Multi-ligament knee injuries in adolescent patients are rare. The aim of this study was to describe the presentation, surgical management, and patient outcomes following multi-ligament knee injuries in an adolescent cohort.Methods: A retrospective case series was conducted involving all patients aged ≤18 years who underwent surgery for a multi-ligament knee injury at a single institution between March 2005 and January 2015. Outcome questionnaires were administered, including the pediatric version of the International Knee Documentation Committee (Pedi-IKDC), Lysholm score, Tegner activity scale, and an internal physical activity questionnaire.Results: Twenty-three knees from 23 patients were included with a mean (SD) age of 16.4 (± 2.3) years at time of injury. In this study, multi-ligament knee injuries in adolescents resulted mainly from sports-related accidents. The most commonly injured structures requiring reconstruction or repair were the anterior cruciate ligament (91%), the medial collateral ligament (57%), posterior cruciate ligament (22%), posterolateral corner (22%), and lateral collateral ligament (15%). Meniscal procedures were performed concurrently in 65% of knees. Examination at final follow-up, occurring at a median of 20.1 months, demonstrated 100% knees could achieve full extension, and 87% could achieve full flexion. Subsequent manipulation under anesthesia and arthroscopic lysis of adhesions was performed in four (17%) knees. Prior to the management of arthrofibrosis, the average range of motion was 13 degrees fixed flexion to 95 degrees flexion, which increased postoperatively to 2 degrees fixed flexion to 120 degrees flexion at a median of 20 months. Questionnaires were returned by 12 patients (52%) at a median of 3.7 years postoperatively. The mean Pedi-IKDC, Lysholm, and Tegner scores were 81.0 ± 18.1, 82.5 ± 15.5, and 8.3, respectively.Conclusions: The most commonly injured structure requiring reconstruction or repair was the anterior cruciate ligament after multi-ligament knee injury. Patients with multi-ligament knee injuries should be investigated for concomitant meniscal injuries. Patients were generally able to achieve good functional outcomes at short-term follow-up.Level of Evidence: IV retrospective case seriesKey Concepts•In this study, multi-ligament knee injuries in children and adolescents resulted mainly from sports-related injuries, and a smaller number were related to traffic accidents.•The most commonly injured structures requiring reconstruction or repair were the anterior cruciate ligament, followed by the medial collateral ligament, posterior cruciate ligament, posterolateral corner, and lateral collateral ligament.•Meniscal injuries should be investigated in this population, as concomitant meniscal procedures were required in 65% of knees.•• Postoperative functional results following operative management of multi-ligament knee injuries were good at shortterm follow-up and return to sport activities was possible.