ISAKOS: 2019 Congress in Cancun, Mexico

2019 ISAKOS Biennial Congress Paper #82


Long-Term Clinical and Radiological Outcomes After Knee Multi-Ligament Knee Using a Delayed Ligament Reconstruction Approach.

Michail E. Hantes, Prof., Larissa GREECE
Apostolos Fyllos, MD, PhD, Larissa GREECE
Fotios Papageorgiou, MD, Larissa GREECE
Ilias Tseronis, MD, Larissa GREECE
Panagiotis Karakitsios, MD, Larissa GREECE
Dimitrios Morfis, MD, Volos GREECE

University Hospital of Larissa, University of Thessalia, Larissa, GREECE

FDA Status Not Applicable


Delayed ligament reconstruction for multi-ligament knee injuries.


Objectives: The purpose of this study was to evaluate the clinical and radiological long-term outcomes after a delayed reconstruction protocol of multiligament knee injuries.

Methods. Between January 2004 and December 2011, 36 patients (mean age 28.75 years, 31 male-5 female patients, mean ??? 25.68) were treated surgically for multiligament knee injuries. Mean time from injury to surgery was 10.8 months. Knee ligament severity was graded using the Schenk Classification. Patients were evaluated pre and postoperatively using the IKDC, KOOS, Tegner Activity Level, Lysholm Knee Scoring Scale and EuroQol (EQ-5D) subjective knee evaluation form. Anteroposterior knee laxity was assessed using the KT-1000 arthrometer. Radiographic evaluation of osteoarthritis progression was evaluated according to the Kellgren–Lawrence classification.

Results. The mean follow-up time was 9.7 years (range 7 to 13 years). Twenty-one (58%) patients had a torn ACL plus PCL and injury to the medial or lateral side of the knee (KDIIIM or KDIIIL). Four patients (11%) suffered from peroneal nerve palsy while 2 patients (5.5%) had vascular injury. At the latest follow-up, no patient had knee extension deficit. Clinical examination revealed an average passive knee flexion of 137o ± 14o and average active knee flexion of 128o ±11o. No patient required manipulation under anaesthesia for knee stiffness. All clinical outcome scores, improved significantly post-operatively. The mean IKDC, KOOS, Tegner, Lysholm and Euroqol-5D scores were 75.13±17.52, 81.02±13.76, 4.93±1.98, 83.12±10.34 and 73.77±21.21 respectively. Progression by one grade or more in the K-L scale was evident in 28 patients (77%) involving osteophyte formation in all cases. Average KT-1000 side-to-side difference was 1.9 ± 1.5 mm.

Conclusions. A delayed reconstruction of the torn ligaments in a multiligament injured knee offers good functional results in the vast majority of the patients. The main advantage of this approach is avoidance of knee stiffness and the necessity for manipulation under anaesthesia or arthrolysis. However, development of knee arthritis in a long-term follow-up is expected, in these complex knee injuries.