Results of multiple ligament reconstruction after knee dislocation\u2014\u2014A prospective study with 95 patients and minimum 2-year follow up

Tao Li,Wei Li Fu,Jian Li,Xin Tang,Gang Chen,Yan Xiong,Zhong Zhang,Qi Li

doi:10.1186/s12891-021-04596-9

Abstract

BackgroundThere is still a lack of clinical data in arthroscopic treatment for treating multiple ligament injuries. This study aims to evaluate the clinical outcomes of patients with multiple ligament injuries undergoing treatment based on the classification stage and type of injury.MethodsA prospective, clinical trial on multiple ligament injuries was planned, which included 95 patients (58 men and 37 women; age: 42.8 ± 11.9 [range, 18–63] years) from October 2017 to June 2018. Injuries were classified into three stages (emergency stage < 24 h; acute stage: 24 h to 3 weeks, and chronic stage: > 3 weeks) and six types (KD I–VI) based on injuries time and structures, which indicated appropriate treatments. The clinical outcomes were evaluated at 2, 4, 6, 8, and 12 weeks and at 6, 9, 12 months and 24 months after surgery. The final choices in efficacy index included International Knee Documentation Committee (IKDC) score, Lysholm score, visual analog scale (VAS) score, and range of motion.ResultsDuring the follow-up, all patients exhibited statistically significant functional improvement in the injured limb compared with their preoperative situation. The mean postoperative scores of acute stage patients at 2-year follow-up were IKDC subjective score, 77.54 ± 11.53; Lysholm score, 85.96 ± 9.39; Tegner score, 4.13 ± 1.08; and VAS score, 1.21 ± 0.76. The mean postoperative scores of chronic stage patents at 2-year follow-up were IKDC subjective score, 74.61 ± 12.38; Lysholm score, 81.71 ± 10.80; Tegner score, 3.96 ± 1.14; and VAS score, 1.71 ± 0.60. The IKDC subjective score, Lysholm score, and Tegner score were significantly improved (P < 0.01) and the VAS score was significantly decreased (P < 0.01) at 2-year follow-up. Regarding the multiple ligament injuries classification, patients with more structural damage in stages V and VI showed less progress in functional recovery than those in stages I–IV.ConclusionsThis new classification with three stages and six types helps to identify the severity of injury and plan the management effectively. The outcomes were encouraging and the subjective functional results showed significant improvement at 2-year follow-up.Study designProspective clinical trial.Level of evidenceII

Highlights

Multiple ligament injuries is one of the most severe situations in sports medicine
Li et al BMC Musculoskeletal Disorders (2021) 22:904. This new classification with three stages and six types helps to identify the severity of injury and plan the management effectively
In case of other injuries, it is reported that combined common fibular injury occurs in approximately 14–40% of all cases, fracture combined with knee dislocation occurs in 16% of all cases, and meniscus injury occurs as collateral damage of knee dislocation in 15–20% of all cases [2,3,4]

Summary

Introduction

The incidence rate of multiple ligament injuries is 0.02–0.2% of orthopedic injuries and < 0.5% of all joint dislocations [1]. Among the patients with multiple ligament injuries, vascular injury occurs at a rate of 7–32%, with an average of 30% [2]. It was reported that surgical management was predictable when specifying the grade and topographic location of each ligament injury [5]. It is essential to use staging and individualized management of multiple ligament injuries depending on the patient’s condition. There is still a lack of clinical data in arthroscopic treatment for treating multiple ligament injuries. This study aims to evaluate the clinical outcomes of patients with multiple ligament injuries undergoing treatment based on the classification stage and type of injury

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Results

Conclusion