Abstract
BackgroundMultiple knee ligament injuries combined with extensor apparatus rupture are serious and complex knee injuries that are rare in clinical practice. The management is extremely challenging and controversial.The aim of this study is to describe a patient collective with multiple knee ligament injuries combined with extensor apparatus injuries in detail and to report the mid-term outcomes of a one-stage surgical treatment regarding subjective outcome scores, complications, knee instability, and ROM.MethodsEleven of 425 patients with multiple knee ligament injuries combined with extensor apparatus injuries admitted to our hospital were reviewed from July 2008 to May 2017. All patients underwent one-stage repair and reconstruction of multiple knee ligaments and extensor apparatus. The Lysholm knee score and the International Knee Documentation Committee (IKDC) score were adopted to evaluate the surgical effect preoperatively and at a minimum of 2 years’ follow-up. Clinical data, including range of motion and knee stability, were also recorded at the final follow-up.ResultsTen patients were followed up with a mean time of 40 (range, 24–60) months. At the last follow-up, 8 patients had joint flexion range of motion greater than or equal to120 degrees, 2 patients had joint flexion range of motion of 100–120 degrees, and 1 patient had active knee extension limitation of 5 degrees. Stress radiographs showed that the mean differences in posterior displacement were reduced from 10.8 ± 3.0 mm preoperatively to 2.0 ± 2.5 mm at the last follow-up. There were significant improvements in stress radiographs from pre- to postoperative states for all patients with multiple knee ligament injuries. The Lysholm score ranged from 85 to 96, with a mean of 92.1 (compared with 33 before surgery, P < 0.05). The final IKDC scores were A in 2 patients (20%), B in 7 (70%), and C in 1 (10%). Nine of the 10 patients (90%) returned to their former activity level.ConclusionMultiple knee ligament injuries combined with extensor apparatus rupture are rare. Single-stage management of the repair and reconstruction of multiple knee ligaments and extensor apparatus with proper rehabilitation is an effective and reliable procedure to restore knee stability and function.Level of evidenceLevel IV, therapeutic case series.
Highlights
Multiple knee ligament injuries combined with extensor apparatus rupture are serious and complex knee injuries that are rare in clinical practice
Multiple knee ligament injuries combined with extensor apparatus rupture are rare complex knee injuries that can lead to extreme instability of the knee, or, when combined with nerve and vascular injury, can threaten the affected limb
There have been few clinical reports on multiple knee ligament injuries combined with extensor apparatus rupture [6, 7]
Summary
Multiple knee ligament injuries combined with extensor apparatus rupture are serious and complex knee injuries that are rare in clinical practice. The aim of this study is to describe a patient collective with multiple knee ligament injuries combined with extensor apparatus injuries in detail and to report the mid-term outcomes of a one-stage surgical treatment regarding subjective outcome scores, complications, knee instability, and ROM. Multiple knee ligament injuries combined with extensor apparatus rupture are rare complex knee injuries that can lead to extreme instability of the knee, or, when combined with nerve and vascular injury, can threaten the affected limb. There have not been any reports about one-stage procedures for these cases In this series, we described a patient collective with multiple knee ligament injuries combined with extensor apparatus injuries in detail and reported the mid-term outcomes of a one-stage surgical treatment regarding subjective outcome scores, complications, knee instability, and range of motion (ROM). We hypothesized that complex multi-ligament injuries with extensor apparatus rupture can be treated with a one-stage procedure and that good function and knee stability could be obtained
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