Anshu Shekhar, Siddharth Reddy, Sachin Tapasvi
Volume 5 | Issue 1 | Jan – April 2020 | Page 14-19
Author: Anshu Shekhar , Siddharth Reddy , Sachin Tapasvi 
 The Orthopaedic Speciality Clinic, Pune
Address of Correspondence
Dr. Anshu Shekhar,
The Orthopaedic Speciality Clinic, Pune
Acute multilagment knee injuries (MLKI) are those in which more than two ligaments are injured and which present within a period of three weeks. Treatment of life threatening conditions, neurovascular injuries, peri-articular fractures and irreducible dislocations take precedence over ligaments in setting of an acute MLKI associated with or without knee dislocations. There is no consensus or well defined guidelines regarding management of these complex injuries. For medial sided injuries, early repair for avulsions with good tissue quality and reconstruction for mid substance tears or poor tissue quality is a reasonable approach. Early repairs of posterolateral corner structures have had good functional outcomes but failure rates of such repairs are higher compared to a reconstruction. Better stability and better knee range of motion have been reported in knees with cruciate reconstructions than repairs in an acute setting. Primary suture repair in indicated low demand patients has shown promising outcomes. However, the risks of arthrofibrosis and revision surgery must be explained to the patients undergoing and arthrotomy for cruciate repairs. Use of synthetic augmentation seems reasonable although there is no strong science to support this presumption. A comparative study between homogenous injury groups would perhaps shed more light on the relevance of repair or reconstruction in acute surgery for MLKI.
Keywords: Knee dislocation, Multiligament knee injury, Acute, Ligament repair, Ligament reconstruction.
1. Moatshe G, Chahla J, LaPrade RF, et al Diagnosis and treatment of multiligament knee injury: state of the art Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine 2017;2:152-161.
2. Harner CD, Waltrip RL, Bennett CH, et al. Surgical management of knee dislocations. J Bone Joint Surg Am 2004;86-A:262–73.
3. Mariani PP, Santoriello P, Iannone S, et al. Comparison of surgical treatments for knee dislocation. Am J Knee Surg 1999;12:214–21.
4. Geeslin AG, LaPrade RF. Outcomes of treatment of acute grade-III isolated and combined posterolateral knee injuries: a prospective case series and surgical technique. J Bone Joint Surg Am 2011;93:1672–83.
5. Liow RY, McNicholas MJ, Keating JF, Nutton RW. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br. 2003;85(6):845–851.
6. Tardy N, Boisrenoult P, Teissier P, Steltzlen C, Beaufils P, Pujol N. Clinical outcomes after multiligament injured knees: medial versus lateral reconstructions. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):524–531. doi:10.1007/s00167-016-4067-4
7. Wijdicks CA, Griffith CJ, Johansen S, Engebretsen L, LaPrade RF. Injuries to the medial collateral ligament and associated medial structures of the knee. J Bone Joint Surg Am. 2010 May;92(5):1266-80. doi: 10.2106/JBJS.I.01229.
8. Cinque ME, Chahla J, Kruckeberg BM, DePhillipo NN, Moatshe G, LaPrade RF. Posteromedial Corner Knee Injuries: Diagnosis, Management, and Outcomes: A Critical Analysis Review. JBJS Rev. 2017 Nov;5(11):e4. doi: 10.2106/JBJS.RVW.17.00004.
9. Chahal J, Al-Taki M, Pearce D, Leibenberg A, Whelan DB. Injury patterns to the posteromedial corner of the knee in high-grade multiligament knee injuries: a MRI study. Knee Surg Sports Traumatol Arthrosc. 2010;18(8):1098–1104. doi:10.1007/s00167-009-1011-x
10. Andrews K, Lu A, McKean L, Ebraheim N. Review: Medial collateral ligament injuries. Journal of Orthopaedics. 2017;14(4):550-554.
11. Werner BC, Hadeed MM, Gwathmey FW Jr, Gaskin CM, Hart JM, Miller MD. Medial injury in knee dislocations: what are the common injury patterns and surgical outcomes?. Clin Orthop Relat Res. 2014;472(9):2658–2666. doi:10.1007/s11999-014-3483-3
12. Dold AP, Swensen S, Strauss E, Alaia M. The Posteromedial Corner of the Knee: Anatomy, Pathology, and Management Strategies. J Am Acad Orthop Surg. 2017;25(11):752–761. doi:10.5435/JAAOS-D-16-00020
13. Kovachevich R, Shah JP, Arens AM, Stuart MJ, Dahm DL, Levy BA. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review. Knee Surg Sports Traumatol Arthrosc. 2009;17(7):823–829. doi:10.1007/s00167-009-0810-4
14. Stannard JP, Black BS, Azbell C, Volgas DA. Posteromedial corner injury in knee dislocations. J Knee Surg. 2012;25(5):429–434. doi:10.1055/s-0032-1322605
15. Mehl JT, Kia C, Murphy M, et al. Posteromedial Ligament Repair of the Knee With Suture Tape Augmentation: A Biomechanical Study. Am J Sports Med. 2019;47(12):2952–2959. doi:10.1177/0363546519868961
16. van der List JP, DiFelice GS. Primary Repair of the Medial Collateral Ligament With Internal Bracing. Arthrosc Tech. 2017;6(4):e933–e937. Published 2017 Jul 3. doi:10.1016/j.eats.2017.03.003
17. Vicenti G, Solarino G, Carrozzo M, et al. Major concern in the multiligament-injured knee treatment: A systematic review. Injury. 2019;50 Suppl 2:S89–S94. doi:10.1016/j.injury.2019.01.052
18. Shelbourne KD, Haro MS, Gray T. Knee dislocation with lateral side injury: results of an en masse surgical repair technique of the lateral side. Am J Sports Med. 2007;35(7):1105–1116. doi:10.1177/0363546507299444
19. Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ. Repair versus reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament-injured knee. Am J Sports Med 2010;38:804–9, doi:http:// dx.doi.org/10.1177/0363546509352459.
20. Stannard JP. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med 2005;33:881–8, doi:http://dx.doi.org/ 10.1177/0363546504271208.
21. McCarthy M, Ridley TJ, Bollier M, Cook S, Wolf B, Amendola A. Posterolateral Knee Reconstruction Versus Repair. Iowa Orthop J. 2015;35:20–25.
22. Westermann RW, Marx RG, Spindler KP, et al. No Difference Between Posterolateral Corner Repair and Reconstruction With Concurrent ACL Surgery: Results From a Prospective Multicenter Cohort. Orthop J Sports Med. 2019;7(7):2325967119861062. Published 2019 Jul 30. doi:10.1177/2325967119861062
23. Richter M, Bosch U, Wippermann B, Hofmann A, Krettek C. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med. 2002;30(5):718–727. doi:10.1177/03635465020300051601
24. Mariani PP, Santoriello P, Iannone S, Condello V, Adriani E. Comparison of surgical treatments for knee dislocation. Am J Knee Surg. 1999;12(4):214–221.
25. Tapasvi SR, Shekhar A, Patil SS. Primary Anterior Cruciate Ligament Repair With Augmentation. Arthrosc Tech. 2018;7(2):e139–e145. Published 2018 Jan 22. doi:10.1016/j.eats.2017.08.063
26. Frosch KH, Preiss A, Heider S, et al. Primary ligament sutures as a treatment option of knee dislocations: a meta-analysis. Knee Surg Sports Traumatol Arthrosc. 2013;21(7):1502–1509. doi:10.1007/s00167-012-2154-8
27. Martinek V, Steinbacher G, Friederich NF, Müller WE. Operative treatment of combined anterior and posterior cruciate ligament injuries in complex knee trauma: can the cruciate ligaments be preserved?. Am J Knee Surg. 2000;13(2):74–82.
28. Tapasvi SR, Shekhar A, Patil SS. Primary Anterior Cruciate Ligament Repair With Augmentation. Arthrosc Tech. 2018;7(2):e139–e145. Published 2018 Jan 22. doi:10.1016/j.eats.2017.08.063
29. Owens BD, Neault M, Benson E, Busconi BD. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma. 2007;21(2):92–96. doi:10.1097/BOT.0b013e3180321318
30. Hua X, Tao H, Fang W, Tang J. Single-stage in situ suture repair of multiple-ligament knee injury: a retrospective study of 17 patients (18 knees). BMC Musculoskelet Disord. 2016;17:41. Published 2016 Jan 22. doi:10.1186/s12891-016-0894-1
31. Heitmann M, Akoto R, Krause M, et al. Management of acute knee dislocations: anatomic repair and ligament bracing as a new treatment option-results of a multicentre study. Knee Surg Sports Traumatol Arthrosc. 2019;27(8):2710–2718. doi:10.1007/s00167-018-5317-4
32. Ranger P, Senay A, Gratton GR, Lacelle M, Delisle J. LARS synthetic ligaments for the acute management of 111 acute knee dislocations: effective surgical treatment for most ligaments. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):3673–3681. doi:10.1007/s00167-018-4940-4
33. Kohl S, Stock A, Ahmad SS, et al. Dynamic intraligamentary stabilization and primary repair: a new concept for the treatment of knee dislocation. Injury. 2015;46(4):724–728. doi:10.1016/j.injury.2014.10.012.
|How to Cite this article: Shekhar A, Reddy S, Tapasvi S | Primary repair in acute multiligament knee injury | Asian Journal of Arthroscopy | January- April 2020; 5(1): 14-19.|