Short-Term Outcome of Multi-Ligament Knee Injury among Sudanese Patients

Abstract

BACKGROUND: Multi-ligament knee injury is the state of having two or more of the major knee ligaments, namely: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), the lateral collateral ligament (LCL), the posteromedial corner (PMC), and the posterolateral corner (PLC). The knee is a hinge joint; this dictates two direction movements on the y-axis plane. The knee joints carry the weight load of the body uniquely. The role of the knee ligaments is not conserved only to maintain knee in a rigid position while standing, but also orchestrates the biomechanics of knee motion in harmony. Multi-ligament knee injury is very rare (incidence < 10:10,000 of trauma cases). Patients with multiple ligaments injuries of the knee become disabled for a long period. This disability rises from the pain and stiffness of the knee joint. A disability that might be associated with increased frequencies of sick leave from work, or much more dire consequences, such as quitting a job or being relieved of duty.
 AIM: To assess the functional outcome of the knee of patients with a multi-ligament knee injury after treatment using a standard scoring system and to determine the recovery rates of each treatment option to a multi-ligament knee injury.
 METHODS: it is a cross-sectional study conducted from January 2018 to January 2019. All patients with multi-ligament knee injuries that were diagnosed by MRI, and underwent reconstruction surgeries or on the waiting list, at Ribat University Hospital and Alyaa Specialized Hospital, Alkuwiti specialised hospital, and Haj Alsafi Hospital for the past 2 years were included. Lyshlome knee scoring scale was used to assess the functional outcome of each patient.
 RESULTS: 24 patients were enrolled in this study (16 had reconstruction surgery, 8 did not). 3 had excellent outcome (LKSS = 95 – 100), 8 of them had good score (LKSS = 84-94), 5 had fair outcome (LKSS = 65-83). All those who did not have reconstruction had a poor score (LKSS < 64).
 CONCLUSION: Reconstruction of multi-ligament knee injury shows a good outcome than it was left alone. Post-operative physiotherapy increases the potential of reconstruction. While our data is limited because of the rare condition, we plan to expand our study area to include a larger sample size. We also recommend extending the post-operative physiotherapy to improve the outcome of a multi-ligament knee injury.

Proprioception After Multiligament Knee Injury: Does Ligament Repair Lead to Better Proprioceptive Acuity Than Ligament Reconstruction?

“…Multiligament knee injuries are uncommon but serious injuries that have historically been associated with poor clinical outcomes [1]. There clinical incidence is less than 10 in 10,000 of trauma cases [2]. By definition, they are an injury that involves damage to two or more ligaments of the knee that control knee stability; these include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament, lateral collateral ligament, posteromedial corner and posterolateral corner.…”

Lesiones multiligamentarias de rodilla asociadas a ruptura de tendón rotuliano

“…La lesión multiligamentaria de la articulación de la rodilla se define como el daño a dos o más ligamentos principales: 1 ligamento cruzado anterior (ACL), ligamento cruzado posterior (PCL), ligamento colateral medial (MCL), ligamento colateral lateral (LCL), esquina posteromedial (PMC) y esquina posterolateral (PLC). 2 Estas lesiones son poco comunes, se presentan principalmente en pacientes de entre la tercera y cuarta décadas de la vida con mayor frecuencia en el sexo masculino 2 y están íntimamente relacionadas con luxación de rodilla, con una incidencia de ˂ 10:10,000. 2 Constituyen menos de 0.02% de todas la lesiones ortopédicas 3 y es aún menos frecuente encontrar asociación de éstas a una ruptura del tendón patelar, la cual se presenta con una prevalencia 2.4%.…”

“…2 Estas lesiones son poco comunes, se presentan principalmente en pacientes de entre la tercera y cuarta décadas de la vida con mayor frecuencia en el sexo masculino 2 y están íntimamente relacionadas con luxación de rodilla, con una incidencia de ˂ 10:10,000. 2 Constituyen menos de 0.02% de todas la lesiones ortopédicas 3 y es aún menos frecuente encontrar asociación de éstas a una ruptura del tendón patelar, la cual se presenta con una prevalencia 2.4%. 4 Las lesiones multiligamentarias de rodilla asociadas a luxación pueden estar ligadas con lesión de la arteria poplítea (23-32%), lesión del nervio peroneo (14-40%), lesión de meniscos (37.3%), lesiones del cartílago articular en 28.3% 5 y las luxaciones expuestas varían desde 9% 6 hasta 20 a 35%.…”

“…Son causadas por traumatismos de alta energía, 8 con excepción de las personas obesas, en las cuales pueden ser causadas por mecanismos de baja velocidad. 5 La dirección de las fuerzas dicta que los ligamentos se ven afectados: 2 1. La traslación anterior desgarraría ACL seguido de MCL y LCL.…”

“…Una traslación posterior sólo afectaría PCL. 2 3. La aplicación de fuerza en varo desgarraría el LCL seguido de ACL y PCL.…”