Pattern of multiligament knee injuries and their outcomes in a single stage reconstruction: Experience at a tertiary orthopedic care centre

Abstract

IntroductionMulti-ligamentous knee injuries (MLKI) are rare orthopedic injuries with diverse approaches to its management protocol. The purpose of this study was to determine the epidemiology of MLKI in our centre and its outcome in single stage reconstruction. Methods60 patients who were surgically treated for MLKI between 2014 and 2018 were included in this study, data was collected pre and postoperatively and their Lysholm and IKDC scores were used to evaluate the outcomes. ResultsA male predominance was noted in the present study. Road traffic accidents (RTA) were the most common mode of injury (66.7%). ACL & MCL combination constituted the most common injury pattern (36.7%). 41.7% of our patients were treated within 3 weeks from injury and 58.3% were treated 3 weeks after injury and there was no statistically significant difference in their outcomes with a p value > 0.05 for their post op Lysholm scores and post op IKDC scores. Overall, there was a statistically significant difference in outcomes post surgery with regards to pre-operative and post-operative Lysholm and IKDC scores in our patients with a p value < 0.0001, substantiating the need for surgical management of MLKI. With a mean post-operative Lysholm score of 89.11 and mean post operative IKDC score of 85.25, this study showed functionally good results in the patients treated in a single sitting. 28 of 60 patients could get back to their sports activities after atleast 6 months of rehabilitation. ConclusionMLKI are relatively uncommon injuries eluding a large scale prospective clinical studies and consensus regarding its management. In the present study, a male predominance was noted, high velocity injuries like RTA was the most common mechanism of injury. A combination of ACL & MCL accounted for the most common pattern of injury. We could also conclude that surgical management yields good results irrespective of the time since injury i.e. either early (<3 weeks) or delayed (>3 weeks) surgery. Single stage surgical management of MLKI produce considerably better outcomes compared to staged management. It was also found that surgical management of MLKI with reconstruction could help patients to return to their pre operative level of sports activities with a proper rehabilitation protocol.