Abstract
Till date, there are no clear guidelines regarding the treatment of multiple ligament knee injuries. Ligament repair is advantageous as it preserves proprioception and does not involve grafting. Many studies have reported the use of open repair and reconstruction for multiple ligament knee injuries; however, reports on arthroscopic-combined single-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) repairs are scarce. In this report, we describe a case of type III knee dislocation (ACL, PCL, and medial collateral ligament (MCL) injuries) in a 43-year-old man, caused by contact while playing futsal. On the sixth day after injury, arthroscopic ACL and PCL repairs were performed with open MCL repair. The proximal lesions in the three ligaments that were injured were sutured using no. 2 strong surgical sutures. The ACL was pulled out to the lateral condyle of the femur and fixed using a suspensory fixation device. The PCL was pulled out to the medial condyle of the femur, and the MCL was pulled towards the proximal end of the femur; both were fixed using suture anchors. Early mobilization was performed, and both, clinical and imaging outcomes, were good two years after surgery.
Highlights
There is no current gold standard for treating multiple ligament knee injuries [1]
The radiograph demonstrated the Pellegrini-Stieda lesion but did not show progression of osteoarthritis (Figures 3(a) and 3(b)); the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL) were in tension, and fiber continuity was maintained on magnetic resonance imaging (MRI) (Figures 3(c)–3(e))
Surgery is recommended for multiple ligament knee injuries as after conservative treatment, the rate of return to sports and work, the Lysholm score, the International Knee Documentation Committee (IKDC) score, and the Lachman test results are all inferior to those observed after surgical treatment [3]
Summary
There is no current gold standard for treating multiple ligament knee injuries [1]. This type of injury is rare, accounting for less than 0.02% of orthopedic injuries [2], the instability of the knee results in persistent severe symptoms if appropriate treatment is not administered. Few studies have reported on arthroscopic-combined single-stage repair [4]. Five main types of knee dislocation have been identified [5]; in this case, we treated a type III knee dislocation, as per the Schenck classification in a 43-year-old man, with arthroscopic repair of the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and open repair of the medial collateral ligament (MCL)
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