Postoperative Rehabilitation of Multiligament Knee Reconstruction: A Systematic Review

Abstract

Background: Multiligamentous knee injuries (MLKIs) are rare, and heterogeneous in presentation and treatment options. Consequently, optimal postoperative rehabilitation of MLKI remains unclear.Objective: To summarize the latest evidence for postoperative rehabilitation protocols following multiligamentous knee reconstruction (MLKR).Patients and Methods: A multidatabase search was conducted with the aid of a health sciences librarian. Blinded reviewers conducted multiple screenings of studies evaluating postoperative rehabilitation protocols following MLKR. All included studies were then graded based on level of evidence, and data concerning patient demographics and rehabilitation protocols were extracted.Results: MLKR rehabilitation protocols differ widely in terms of weightbearing, bracing, initiation, and types of physical therapy, yet several established protocols were referenced frequently throughout the literature. Such protocols resulted in good outcomes, with patients returning to running in 6 to 12 months and returning to sport in 8 to 12 months. Conclusion:The rare nature of MLKI hinders the ability to create a standardized rehabilitation protocol. However, early postoperative physical therapy and range of motion consistently lead to improved outcomes. Randomized studies are needed to determine optimal postoperative rehabilitation following MLKR.

[Retracted] Application of Nanoscaffold Material Combined with Exercise Rehabilitation Therapy in the Treatment of Athletes with Hip Injuries

“…Superior biomimetic scaffolds, especially biopolymer self-assembled hydrogels, are formed for this purpose. Nanoscaffolds have great prospects for drug control and regenerative medicine [11,12].…”

Diagnosis and treatment strategies of the multiligament injured knee: a scoping review

“…More recently, there has been greater understanding of the significance of associated soft-tissue knee structures and their relative significance in conferring knee stability, leading to studies expanding this definition to include the posterolateral corner (PLC) and posteromedial corner (PMC) of the knee 22. Several recent systematic reviews assessing MLKI define the term specifically as ‘disruption of at least two of the four major knee ligaments, comprising the ACL, PCL, MCL (and PMC) and LCL (and PLC)’ 1 4 15 23. Numerous original research studies and systematic reviews do not explicitly define their interpretation of MLKI, or do not define their interpretation of the ‘four primary knee ligaments’ 24–30.…”

“…Despite recent attempts at pooling existing literature, there remains considerable variation in the strategies employed for investigation, treatment, rehabilitation and outcome assessment following MLKI. Examples of variations in approach to management include repair versus reconstruction of injured ligaments, early versus delayed surgery, single-stage versus staged surgery and a variety of rehabilitation strategies ranging from early casting to early mobilisation 1 11–15. No study has yet provided a comprehensive overview evaluating the extent, range and overall summary of literature relating to MLKI injuries.…”

Synovial Fluid Inflammatory Profiles did not Differ between Isolated Anterior Cruciate Ligament and Multi-ligament Knee Injuries

“…Similarly, while postoperative rehabilitation protocols after MLKI will differ based on the structures involved and procedures performed, one of the primary goals of the early postoperative rehabilitation is to restore knee range of motion and activation of the quadriceps without over-stressing the involved tissues. [15] Until recently, many rehabilitation protocols advocated immobilization of the knee after surgery for MLKI for anywhere from 1 to 6 weeks; [11] however, early initiation of range of motion has led to better range of motion outcomes without negatively affecting stability. [17] As such, reducing effusion and safely restoring range of motion and activating the quadriceps both prior to and following surgery are imperative to reduce the risk of arthro brosis no matter if treating a single or multiple ligament injury.…”