Tag Archive for: knee reconstruction.

Nagraj Shetty

Volume 5 | Issue 1 | Jan – April 2020 | Page 53-57

Author: Nagraj Shetty [1,2,3]

[1] Department of Orthopaedics, Lilavati Hospital, Mumbai, India.
[2] Department of Orthopaedics, Hinduja Healthcare, Mumbai, India.
[3] Department of Orthopaedics, Nanavati Hospital, Mumbai, India.

Address of Correspondence
Dr. Nagraj Shetty
Consultant Arthroscopy Knee & Shoulder Surgeon
Lilavati hospital, Nanavati hospital, Hinduja Healthcare; Mumbai, India.
E-mail: orthodocshetty@gmail.com


Purpose: The purpose of this descriptive review was to study the available literature on final functional outcomes of multiligament knee injury (MLKI) reconstructions. Specific study factors included 1) Surgical vs nonoperative treatment 2) Repair vs reconstruction vs combined procedure 3) early vs late surgery; Single stage vs two stage procedures.
Methods: A PubMed search was performed from 1966 until 2020. and search terminologies included multiligament Knee injury, multiple ligament knee injury, knee dislocation, multiligament knee reconstruction and functional outcomes. Study inclusion criteria were 1) Levels I to IV evidence 2) Multiligament knee injury being defined as disruption of minimum 2 of the 4 major knee ligaments. 3) Assesment of final outcome both based on subjective clinical, functional scores like return to sports, preinjury activity level and stability scores. 4) minimum of 12 month follow up.
Results: Four high level studies compared surgical with nonoperative treatment. There were higher Lysholm scores (85 vs 67) in surgically treated patients (pts) as well as higher IKDC scores (69% vs 64%) and return to sport (41% vs 18%).The four studies comparing repair with reconstruction of damaged ligaments showed similar mean Lysholm (84 vs 84) and excellent IKDC scores. Nevertheless repair of the posterolateral corner (PLC) had a higher failure rate (39% vs 8 %) and lower return to sport activities (25% vs 51%). Similarly repair of the cruciates achieved decreased stability and range of motion. Eight articles were studied comparing early (within 3 weeks ) with delayed surgery. Early treatment resulted in higher mean Lysholm scores (89 vs v82), higher percentage of excellent IKDC scores (57% vs 41%)as well as higher mean ROM (129 degree vs 124 degrees)
Conclusions: This review suggests that the best treatment guidelines for MLKI is still awaited, but better functional and clinical outcomes have been achieved with reconstruction rather than repair. Surgery must be performed within first 3 weeks upto 6 weeks for better results.When feasible ACL reconstruction can be delayed thereby reducing rate of arthrofibrosis
Keywords: descriptive review, functional outcomes, multiligament knee injury, multiple ligament knee injury, knee reconstruction.


1. Moatshe G., etal. Demographics and Injuries Associated With Knee Dislocation: A prospective review of 303 patients”. Orthopaedic Journal of Sports Medicine 5.5 (2017):232596711770652.
2. Wascher DC, Dvirnak pc, DeCoster TA. Knee dislocation:Initial assessment and implications for treatment . J Orthop Trauma 1997;11(7):525-529
3. Medina O, Arom GA, Yeranosian MG, ,Petrigliano FA , McAllister DR. Vascular and Nerve injury after knee dislocation: a systematic review . Clin OrthopRelat Res 2014;472:2621-9
4. Engebretsen L, Robertson B, Ludvigsen TC. Outcome after knee dislocations : a 2-9 years follow up of 85 consecutive patients . Knee Surg Sports TraumatolArthrosc 2009; 17(9):1013-26
5. Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries : an evidence based review .Sports Med Arthrosc 2011; 19(2):167-173
6. Hefti F, Muller W, Jakob RP, Staubli HU. Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports TraumatolArthrosc 1993;1(3-4):226-234
7. Wascher DC , Becker JR, Dexter JG, Blevins FT. Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation, Results using fresh noniradiated allografts . Am J Sports Med 1999;27(2):189-196
8. Biau DJ, Tournoux C, Katsahian S, Schranz P, Nizard R.ACL reconstruction : a meta analysis of functional scores . Clin OrthopRelat Res 2007; 458:180-187
9. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries . Clin OrthopRelat Res 1985;(198):43-49
10. Wright RW.Knee injury outcome measures. J Am AcadOrthop Surg 2009;17(1) 31-39
11. Marx RG, Stump TJ, Jones EC, Wickiewicz TL, Warren RF. Development and evaluation of an activity rating scale for disorders of the knee. Am J Sports Med 2001; 29(2):213-218
12. Wong CH, Tang JL, Chang HC, Khin LW, Low CO. Knee dislocations -a retrospective study comparing operative vs closed immobilization treatment outcomes . Knee Surg Sports TraumatolArthrosc 2004; 12(6):54-544
13. Rios A, Villa A, Fahandezh H, de Jose C, Vaquero J. Results after treatment of traumatic knee dislocations : a report of 26 cases. J Trauma 2003;55(3):489-494
14. Richter M, Bosch U, Wippermann B, Hoffman A, KrettekC.Comparison of surgical repair or reconstruction of the cruciate ligament versus non surgical treatment in patients with traumatic knee dislocations. Am J Sports Med 2002;30(5):718-727
15. Plancher KD, Siliski J. Long term functional results and complications in patients with knee dislocations . J Knee Surg 2008;21(4) 261-268
16. Dedmond BT, Almekinders LC. Operative vs nonoperative treatment of knee dislocations : a metaanalysis. Am J Knee Surg 2001; 14(1):33-38
17. Fanelli GC, Stannard JP, Stuart MJ, etal. Management of complex knee ligament injuries. J Bone Joint Surg Am 2010;92(12):2235-2246
18. Laprade RF, Chahla j, DePhillipoNN..etal.Single -stage Multiple-ligament Knee Reconstructions for Sports related injuries.Am J Sports Med 2019:1-9
19. Hirschmann MT, Zimmermann N, Rychen T, etal. Clinical and radiological outcomes after management of traumatic knee dislocation by open single stage complete reconstruction /repair. BMC MusculoskeletDisord2010;11:102
20. Tzurbakis M, Diamantopoulos A, Xenakis T, GeorgoulisA.Surgical treatment of multiple knee ligament injuries in 44 pts:208 years follow up results.Knee Surg Sports TraumatolArthrosc 2006;14(8): 739-749
21. Fanelli GC, Edson CJ.Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee:2 to 10 year follow up.Arthroscopy 2002;18(7):703-714
22. Karataglis D, Bisbinas I, Green MA, Learmonth DJ.Functional outcome following reconstruction in chronic multiple ligament deficient knees. Knee Surg Sports TraumatolArthrosc 2006; 14(9):843-847
23. Hua X, Tao H, Fang W, Tang J.Single stage in situ repair of multi-ligament knee injury: a retrospective study of 17 patients. BMC Musculoskeletal disorders 2016;17(41)
24. Vermeijden HD, Jonkergouw A, Van der list AP, DiFeliceGS.The multiple ligament -injured knee. When is primary repair an option .The Knee 2019
25. Frosch K, Preiss A, Heider S, Stengel D, Wohlmuth P, Hoffmann M.Primary ligament sutures as a treatment option of knee dislocations:a meta-analysis.Knee Surg Sports TraumatolArthrosc 2013;1502-9
26. Levy BA, Dajani KA, Morgan JA, Shah JP, Dahm DL, Stuart MJ.Repair vs reconstruction of the fibular collateral ligament and posterolateral corner in the multiligament injured knee.Am J Sports Med 2010;38:804-9
27. Stannard JP. The posterolateral corner of the knee: repair vs reconstruction.Am J Sports Med 2005;33:881-8
28. Mariani PP, Santoriello P, Iannone S, Condello V, AdrianiE.Comparison of surgical treatments for knee dislocation. Am J Knee Surg 1999;12:214-21
29. Liow RYL, McNicholas MJ, Keating JF, Nutton RW. Ligament repair and knee reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br 2003;85B:845-85
30. Harner CD, WaltripRL, Bennett CH, Francis KA, Cole B,IrrgangJJ.Surgical management of knee dislocation. J Bone Joint Surg Am 2004;86A:262-73
31. Subbiah M, Pandey V, Rao SK, Rao S.Staged reconstructive arthroscopic surgery for multiple ligament injuries of the knee. J Orthop Surg 2011;19(3):297-302
32. Li X, Liu T. Surgical management of multiple knee ligament injuries. Eur J OrthopTrauamatol2013;23:691-7.
33. Zhang Y, Zhang X, Hao Y, Zhang YM, Wang M, Zhou Y.Surgical management of the multiple-ligament injured knee: a case series.Orthop Surg2013;5:239-49
34. Wajsifisz A, BjardPlaweski S, DijianP,DemeyG,etal.Surgical management of combined anterior or posterior cruciate ligament and posterolateral corner tears:OrthopTraumatol Surg Res 2014;100S:S379-83
35. Vicenti G, Solarino G, etl.Major concern in the multiligament-injured knee treatment:A systematic review.Injury 2019;:S89-S94
36. Black BS, Stannard JP. Repair vs reconstruction in acute posterolateral instability of the knee .Sports Med Arthrosc 2015;23:22-6
37. Gwathmey FW, ShafiqueDA,MillerMD.Our approach to the management of the multiple-ligament knee injury.Oper Tech Sports mED.2010;18(4):235-44.
38. Van der Wal WA, HeesterbeekPJC..etal.Anatomical reconstruction of posterolateral corner and combined injuries of the knee.Knee Surg Sports TraumatolArthrosc 2014;3369-7
39. Fanelli GC, Harris JD.Surgical treatment of acute medial collateral ligament and posteromedial corners of the knee.Sports Med Arthrosc Rev 2006;14(02):78-83
40. Moatshe G, Getgood A, LaPrade RF, EngebretsenL.Medial-sided injuries in the multiple ligament knee injury.J Knee Surg 2020:02-19
41. Fanelli GC.Evaluation and treatment of medial instability of the knee. Sports Med Arthrosc Rev 2015;23(02):61-62
42. Owens BD, Neault M, Benson E, BusconiBD.Primary repair of knee dislocations :results in 25 patients at a mean follow up of four years. J Orthop Trauma 2007;21(2):92-96
43. Stannard JP, Black BS, Azbell C, VolgasDA.Posteromedial corner injury in knee dislocations . J Knee Surg 2012;25:429-34
44. Twaddle BC, Bidwell TA, Chapman JR.Kneedislocations:where are the lesions ?A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 2003;17(3):198-202.

How to Cite this article: Shetty N | Functional outcomes following Multiligament Knee Reconstruction | Asian Journal Arthroscopy | January-April 2020; 5(1): 53-57.

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