The Treatment Algorithm for Chronic Multiple Ligament Knee Injury

• Published in: Indian journal of orthopaedics Vol. 58; no. 11; pp. 1512 - 1517
• Main Authors: Pardiwala, Dinshaw N., Desouza, Clevio, Jesia, Arzan
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.11.2024
• Subjects: Conservative Orthopedics; Medicine; Medicine & Public Health; Orthopedics; Review Article; Surgical Orthopedics; Deformity correction; Chronic knee dislocation; Limb malalignment; Chronic multiple ligament knee injury (MLKI); Multiple ligament reconstruction; Treatment algorithm
• ISSN: 0019-5413; 1998-3727
• DOI: 10.1007/s43465-024-01242-z

Background Multiple ligament knee injuries (MLKI) are a complex group of injuries ideally treated in the acute phase, though delayed presentation is common. Chronic MLKI varies in presentation, requiring individualized management strategies. This review aims to differentiate chronic MLKI types and propose an algorithm that facilitates a tailored treatment plan. Methods Chronic MLKI is classified into three types based on knee joint status and limb alignment. Type 1 involves ligament deficiency in a reduced knee with normal alignment, treated with soft-tissue ligament reconstruction. Type 2 includes ligament deficiency with malalignment, where deformity correction precedes ligament surgery. Type 3 entails chronic unreduced knee dislocations, necessitating open reduction and extensive release prior to reconstruction. Results Treatment depends on classification, emphasizing realignment for Type 2 and reduction for Type 3 before soft-tissue procedures. Individualized approaches are critical due to the complexity and variability of chronic MLKI. Conclusion A treatment algorithm is essential to manage chronic MLKI. Joint reduction, limb realignment, and ligament reconstruction are important to ensure optimal functional outcomes.