Management of multiligament knee injuries

Ng, J.; Myint, Yulanda; Ali, Fazal

doi:10.1302/2058-5241.5.190012

Cited by 71 publications

(95 citation statements)

References 71 publications

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“…Therefore, the PMC should be treated appropriately with the damaged MCL. The MCL and PMC can be treated with either primary repair or reconstruction [7]. Since the quality of the damaged medial structures is usually robust enough to facilitate a satisfactory repair [26], these structures should be repaired during the acute phase.…”

Section: Discussionmentioning

confidence: 99%

“…Since MLKIs and KDs are uncommon and often heterogeneous, as mentioned above, minimal evidence is available, resulting in a lack of consensus regarding the most effective treatment [ 3 , 4 ]. Although conservative and surgical treatments have been reported, surgical interventions have generally been recommended because of poor outcomes after conservative treatment [ 5 – 7 ]. Currently, conservative treatment is exclusively selected for patients who are unfit for surgery, frail, or sedentary [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Although conservative and surgical treatments have been reported, surgical interventions have generally been recommended because of poor outcomes after conservative treatment [ 5 – 7 ]. Currently, conservative treatment is exclusively selected for patients who are unfit for surgery, frail, or sedentary [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Acute primary repair of extraarticular ligaments and staged surgery in multiple ligament knee injuries

et al. 2020

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Background The purpose of this study is to compare the outcomes of acute primary repair of extraarticular ligaments with staged surgery for acute knee dislocations (KDs) and multiligament knee injuries (MLKIs). Materials and methods Between January 2005 and May 2018, 61 consecutive patients diagnosed with MLKI or KD were referred to or visited our institution. Of these, 31 patients who underwent acute repair of extraarticular ligaments within 3 weeks of injury were included in this study. These patients were retrospectively classified into two groups: those who underwent only primary repair (repair group) and those who underwent staged reconstructive surgery (staged group). Follow-up examination included range of motion (ROM), knee joint stability (Lachman test, posterior drawer test, and varus and valgus stress test), Lysholm knee score, Tegner activity scale, and Knee Injury and Osteoarthritis and Outcome Score (KOOS). Results Twelve of the 31 patients did not need or desire further surgery and were included in the repair group. No significant difference was observed in demographic data between the repair and staged groups. Although staged surgery decreased positive posterior drawer test results, no significant difference was observed between the two groups regarding ROM, other knee joint stability tests, Lysholm scores, Tegner scale, or KOOS. Conclusions In this series, all patients returned to their activities of daily living and preinjury occupation levels. Acute primary repair of extraarticular ligaments provides essential knee stability without varus/valgus instability and may reduce the need for subsequent cruciate ligament reconstruction. Level of evidence Level IV, retrospective observational study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute primary repair of extraarticular ligaments and staged surgery in multiple ligament knee injuries

et al. 2020

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“…A thorough prioritized trauma evaluation is mandatory in all patients with high-velocity MLKIs. [4][5][6] The momentary deformity during a knee dislocation causes significant traction forces on important juxta-articular soft-tissue structures [ Figure 1].…”

Section: Associated Injuriesmentioning

confidence: 99%

“…[19] It also avoids the increased incidence of meniscal and cartilage injuries associated with the delayed surgery. [6,20] The disadvantage of acute surgery is the increased risk of residual instability associated with repairs, [21,22] especially of the posterolateral corner (PLC), and increased risk of arthrofibrosis. [23] Delayed reconstruction, on the other hand, may allow some extra-articular ligaments to heal and full range of motion to be recovered before surgery.…”

Section: Timing and Staging Of Surgerymentioning

confidence: 99%

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

Held

North

Bormann

et al. 2020

JASSM

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Recent advances in the management of multiligament knee injuries have led to improvements in diagnosis and management and allowed enhanced understanding of the biomechanics of ligament reconstructions. Most studies arise from subspecialist knee centers in high-income countries and can inform global strategies, but each patient encounter and environment is unique and not all recommendations may be feasible in every setting. For ligamentous injuries, the gold standard is acute arthroscopic, single-stage ligament reconstruction, although this is not always possible in the limited resource setting (LRS). For these circumstances, non-operative management, although rarely promoted, may be preferred in selected patients. Furthermore, acute surgery relies on adequate post-operative physiotherapy, otherwise a delayed surgical approach should be considered. Reconstruction remains the gold standard, but acute repair is an option for medial collateral and posterior cruciate ligaments and for avulsion fractures. For a vascular examination, a careful clinical assessment and routine angiography should be done in LRS. Due to the heterogeneity of injury and patient profile, outcomes vary widely and need to be interpreted in the context of the surgical setup. The main complications of these injuries are stiffness, residual laxity, and surgical site infections. Future trends will need to include a global perspective and provide solutions for surgeons in various parts of the world.

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A novel minimally invasive nonanatomical single‐bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients

Minator Sajjadi,

Mirahmadi,

Alizad

et al. 2024

J. exp. orthop.

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PurposeMultiligament knee injuries (MLKIs) involve various ligaments in the knee. Current double‐bundle anatomical reconstructions of the medial collateral ligament (MCL) increase the level of technical complexity, often resulting in the establishment of numerous bone tunnels and different fixation points with additional hardware. To overcome these limitations, we proposed a novel minimally invasive nonanatomical MCL reconstruction with one tibial tunnel in the metaphysis using Achilles allograft in the MLKI setting.MethodsIn a retrospective study, we enroled 24 patients with MLKIs who underwent a new single‐strand short isometric construct (SIC) nonanatomical MCL reconstruction during 2020 and 2021. We fixed an Achilles allograft in one tunnel in the distal femur on the medial epicondyle and one tunnel in the metaphyseal part of the tibia using interference screws at 2 cm below the joint line between the anatomical insertion of the superficial MCL and the posterior oblique ligament. The patients underwent clinical and radiological assessment at the last follow‐up, 1–2 years after the operation, including valgus stress radiographs, range of motion (ROM), Lysholm and International Knee Documentation Committee (IKDC) scores.ResultsThe mean postoperative IKDC score was 77.8 (range, 50.1–86.6). The mean Lysholm score was 84.1 ± 11.9 (range, 96–59). The medial knee widening difference (i.e., mean side‐to‐side difference under valgus stress x‐ray) was measured to be 1.2 mm on average. Only two patients (8%) had ROM limitation of 20° in knee flexion, one of which had surgery failure. Results showed a significant statistical difference between the patients' outcomes according to the number of involved ligaments.ConclusionsThis novel SIC‐like technique with a single tibial metaphyseal tunnel demonstrated satisfactory patient‐reported outcome measures, valgus stress radiographs, ROM and a low rate of knee stiffness and graft failure. While the number of injured ligaments in MLKI patients significantly influenced the outcomes, the results remained acceptable across all patients.Level of EvidenceLevel IV.

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Management of multiligament knee injuries

Cited by 71 publications

References 71 publications

Acute primary repair of extraarticular ligaments and staged surgery in multiple ligament knee injuries

Acute primary repair of extraarticular ligaments and staged surgery in multiple ligament knee injuries

Advances and trends in multiligament injuries of the knee relevant to low-resource settings

A novel minimally invasive nonanatomical single‐bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients

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