Background. In recent years, there has been an increase in the number of the patients with multiligament knee injuries. A significant proportion of unsatisfactory outcomes of such injuries treatment is associated with this injury features and the objective difficulties of its surgical correction. This determines the need for searching the optimal methods of diagnosis and treatment of such an injury. The purpose of this study was to compare the results of surgical treatment of the patients with multiligament knee injury, including the injury of the ligament-tendon complex of the knee posterolateral angle with two different techniques. Materials and Methods. The study included 51 patients with multiligament knee injury undergone the surgical treatment from 2007 to 2019. The average age of the patients was 32.1±9.2 years. The patients were divided into two groups. The patients of the main group (24 patients) underwent reconstruction of the cruciate ligaments and the main structures of the posterolateral angle: the fibular collateral ligament, the popliteofibular ligament, and the popliteus tendon. The patients of the comparison group (27 patients) underwent the reconstruction of the cruciate ligaments supplemented with isolated fibular collateral ligament grafting. The results obtained were evaluated clinically using the Lysholm scale (1982), by determining the subjective assessment of treatment outcomes, and by functional X-ray and MRI. The results of the treatment were studied in all injures: in the main group in 9 months, in the comparison group on average in 16 months after the surgery (from 9 to 43 months). Results. The use of the developed diagnostic and surgical methods made it possible to improve the clinical and functional results by the Lysholm scale: the main group 82 [70; 86] points vs the control group 68 [64; 76] points (p = 0.003). The II degree residual lateral instability was observed in 2 patients of the main group and in 7 patients of the control. 19 (79.2%) patients in the main group and 18 (66.7%) in the control were satisfied with treatment outcomes according to the scale of subjective assessment. There were no patients who rated the result of their treatment as “good” in the both groups. Conclusion. The practical employment of the proposed modification of the fibular collateral ligament grafting by the LaPrade in the patients with multiligament knee injury makes it possible the statistically significant improvement of the treatment functional results after the reconstructive surgery in the medium term (9 months) compared with the patients undergone isolated fibular collateral ligament grafting. The unsatisfactory results of the treatment caused by the severity and morphological features of the injuries. They require further study, as well as the improvement of the surgical techniques.

The authors conducted an analysis of national and foreign scientific publications dedicated to the problems in treatment of patients with ruptures of the anterior cruciate ligament of the knee joint. The results of the analysis demonstrated that such lesions still remain the key knee pathology resulting from sports injuries that significantly affect knee function and require timely reconstructive surgical correction. Based on the study the key areas of improvement in treatment for mentioned category of patients have been identified. This is the biomechanically justified single bundle anatomical ACL reconstruction which is currently widely applied in the clinical practice by using of an isometrically located autograft. Such technique represents a radically new stage in the development of treatment methods for young and middle-aged patients with high functional demands.

The analysis of foreign and domestic scientific publications of recent years, devoted to the problem of revision reconstructions of the anterior cruciate ligament of the knee joint in young and middle-aged patients with high functional demands. The key directions for improving the treatment of this category of patients have been determined. It was found that the main trend in the improvement of revision reconstructions of the anterior cruciate ligament of the knee in patients with high functional demands, which primarily include professional athletes and military personnel, is the desire for enhanced stabilization of the joint by eliminating residual, primarily rotational instability and increasing protection the main graft from high stress overload. Of particular importance is a strictly individual approach to the choice of the method of revision reconstruction of the anterior cruciate ligament, which makes it possible to implement the principles underlying the primary plastic of the ligament. The solution of these two problems requires, firstly, a more detailed examination of patients in order to identify factors of increased risk for the development of recurrent joint instability, which must be eliminated during surgical treatment. Secondly, the strict anatomical nature of restoration, and more often reconstruction, of the main and auxiliary functionally incompetent stabilizing structures of the joint against an unfavorable anatomical background caused by previous operations in the form of bone defects and deformities of the condyles with destruction of hyaline cartilage and previously resected menisci. Third, the use of reinforced grafts of increased strength for the reconstruction of the anterior cruciate ligament, as the main structure that stabilizes the joint. Moreover, such reinforcement can be direct, by strengthening the cruciate ligament graft directly, or indirectly, by strengthening the anterolateral part of the joint. The most appropriate is a combination of these two directions in order to obtain the maximum positive effect. Promising options for extra-articular reinforcement today are anatomical reconstruction of the anterolateral ligament and lateral extra-articular tenodesis of the iliotibial tract as part of the anterolateral joint complex. This makes it possible to compensate for the forced resections of the menisci and, without correction, at least at the first revision, the increased posterior inclination of the articular surface of the tibial condyles. The main advantages of these operations in combination with the reconstruction of the anterior cruciate ligament are their proven efficiency, versatility, technical simplicity and availability, which are of particular importance for the introduction into wide clinical practice of trauma departments of military hospitals.