Summary

Presentation, management, complications and outcomes of 40 patients that underwent multiligament knee reconstructions at our Level I Trauma Center. In spite of the severity of these injuries and their associated comorbidities, our experience so far in the management of these patients has proven to be challenging but resulting in good functional outcomes and overall patient satisfaction.

Abstract

OBJECTIVES:
Report the presentation, management, complications and results of surgically treated multiligamentous knee injuries (MLKI).

Methods

Retrospective cohort study of patients who underwent multiligament knee surgery at a Level I Trauma Center between 2016 - 2017. All patients who underwent surgical stabilization of at least 2 of the four major knee ligament structures, in one-step surgery, by the same surgical team, were included. Patients with less than 6 months follow-up were excluded.

Results

Sample consisted of 40 patients (42 knees), with an average age of 38yo (18-60) and an average follow-up of 9 months (6-22). MLKI resulted from a high-energy mechanism in 83% of the cases. At presentation, patterns of injury were as follows: 33% Anterior Cruciate Ligament (ACL) + Posterior Cruciate Ligament (PCL) + Posteromedial Corner (PMC), 31% ACL + Posterolateral Corner (PLC), 17% ACL + PMC, 12% ACL + PCL + PLC, 5% PCL + PMC, and 2% PCL + PLC. Both cruciate ligaments were injured in 45% of the cases, thereby considered knee dislocations. Vascular injury was present in 3 patients, and neurological injuries in 4 patients. Two patients had open MLKI, but only one required soft tissue coverage. Transient external fixator was used in 5 cases, for an average of 18 days (8-35). Only in 2 cases of collateral ligament bony avulsions, surgical repair was performed prior to multiligamentous knee reconstruction. Two-ligament reconstructions were performed in 27 knees (64%), and three-ligament reconstructions in 15 knees (36%). The most frequently reconstructed structures were ACL + PLC (29%), followed by ACL + PCL + PMC (24%). Allografts were used in 98% of the cases. Stiffness was the most common complication, with 5 cases requiring a mobilization under anesthesia. Only one patients had residual instability at physical examination. At last follow-up, average Lysholm was 65 (18-100) and overall patient satisfaction was excellent (All patients answered "yes" to the following questions: would you have surgery again? Or would you recommend it to a friend?).

Conclusion

Surgical treatment of multiligament knee injuries is complex and challenging. However, our experience so far in the management of these patients has shown good results and a low-rate of complications at short-term follow-up.