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Functional outcomes following Multiligament Knee Reconstrcution

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


Abstract

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.


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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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Complications of Multiple Ligament Knee Injury Surgery : Prevention and Salvage

Dinshaw N. Pardiwala, Kushalappa Subbiah, Nandan Rao, Vicky Jain

Volume 5 | Issue 1 | Jan – April 2020 | Page 58-65


Author: Dinshaw N. Pardiwala [1], Kushalappa Subbiah [1], Nandan Rao [1], Vicky Jain [1]

[1] Department of Orthopaedics, okilaben Dhirubhai Ambani Hospital, Mumbai, India.

Address of Correspondence
Dr. Dinshaw Pardiwala,
Kokilaben Dhirubhai Ambani Hospital
Four Bungalows, Andheri (W), Mumbai 400053, India.
E-mail: pardiwala@outlook.com


Abstract

Multiple ligament injuries of the knee are a complex group of injuries with diverse presentations, varying treatment options, and the potential for an array of significant complications. These include iatrogenic neurovascular injuries, fluid extravasation with compartment syndrome, intraoperative technical complications related to tunnel placement and graft tensioning, tourniquet complications, wound problems and infection, venous thromboembolic events, arthrofibrosis with loss of motion, residual knee instability, heterotopic ossification, and missed postoperative knee dislocations. Prevention of these complications is based on a comprehensive knowledge of knee ligament anatomy and biomechanics, understanding the unique and complex nature of these uncommon injuries, detailed preoperative clinico-radiological evaluation, astute surgical planning, careful operative execution, close postoperative monitoring, and a proper rehabilitation program. Early recognition of complications with appropriate and immediate management is critical for satisfactory functional outcomes.
Keywords: Multiple ligament knee injury, Knee dislocation, Complications, Prevention, Salvage, Surgical reconstruction


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How to Cite this article: Pardiwala DN, Subbiah K, Rao N, Jain V | Complications of Multiple Ligament Knee Injury Surgery : Prevention and Salvage | Asian Journal of Arthroscopy | January-April 2020; 5(1): 58-65.


(Abstract)      (Full Text HTML)      (Download PDF)