Surgical treatment of multiligament knee injuries

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 23; no. 10; pp. 2983 - 2991
• Main Authors: Cook, Shane, Ridley, T. J., McCarthy, Mark A., Gao, Yubo, Wolf, Brian R., Amendola, Annunziato, Bollier, Matthew J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2015; Springer Nature B.V
• Subjects: Adult; Complex patients; Female; Humans; Injuries; Knee; Knee Injuries - surgery; Ligaments; Ligaments, Articular - injuries; Ligaments, Articular - surgery; Male; Medicine; Medicine & Public Health; Obesity - complications; Orthopedics; Postoperative Complications; Reconstructive surgery; Reoperation; Retrospective Studies; Sports medicine; Surgeons; Multiligament knee injury; Treatment; Knee dislocation; Complications
• DOI: 10.1007/s00167-014-3451-1
• ISSN: 0942-2056

Purpose To analyse one institution’s experience with multiligament knee injuries. Methods Over 10 years, 133 multiligament knee injuries including 130 patients were included in the study. Inclusion criteria included: (1) injury to two or more knee ligaments (2) multiligament knee repair/reconstructive surgery. Results The average age at time of injury was 26 years old, and 76 % were male. Fifty-one (38 %) multiligament knee injuries had >2 ligaments injured. Peroneal injuries occurred in 26 patients (20 %), and four (3 %) had associated vascular injuries. A high energy mechanism of injury was noted in 39 %. Twenty-five per cent of patients had an additional orthopaedic injury and, 11.5 % suffered additional non-orthopaedic injuries. Definitive surgical intervention was performed acutely (<3 weeks) in 47 %. Ninety-one per cent of multiligament knee injuries underwent reconstruction with or without repair. Forty-three complications occurred in 37 patients. Patients who suffered >2 ligament injury or had surgery acutely were at an increased risk of knee stiffness requiring manipulation under anaesthesia (MUA) ( p  = 0.016 and p  = 0.047, respectively). Knees with >2 ligaments injured were associated with higher post-operative complications ( p  = 0.007). Knee dislocation IV knees were at increased risk to undergo revision surgery ( p  = 0.041). Obese patients were more likely to have a post-operative infection ( p  = 0.038). Repair, reconstruction or type of graft used had no impact on need for revision surgery. Conclusions Multiligament knee injured patients undergoing surgical intervention are a highly complex patient population. This study outlines the patient population, treatment, and complications of one academic institution over 10 years. Overall complications were higher in patients with >2 ligaments injured. Knee stiffness requiring MUA was more common in patients who had >2 ligaments ruptured and those treated acutely. Knees with all four ligaments injured were more likely to undergo revision surgery. Level of evidence Retrospective case series, Level IV.