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Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow-up results

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

The purpose of the study was to evaluate the mid-term results of surgical treatment in different groups of patients with multiple knee ligament injuries. Review of our patients’ records revealed that 48 acute and chronic patients were surgically treated for combined knee injury. Due to severe capsular damage in these injuries, open techniques were used. In our treatment protocol, avulsed ligaments and tears of the posterolateral and posteromedial corner were repaired if possible, whereas midsubstance tears of cruciate ligaments and chronic cases were reconstructed with autografts. Postoperatively, an accelerated program of rehabilitation was introduced, aiming to progressively mobilize the joint and improve muscle endurance. For the follow-up evaluation we designed a protocol composed of two parts. In the first part, anatomical lesions were recorded and in the second part, clinical evaluation was performed using the Lysholm score, the Tegner rating system, the IKDC evaluation form, and the KT1000. Student’s t tests and chi-square tests were used for data analysis. Forty-eight patients (mean age 28.6±11.9 years; 41 males) were classified according to the specific anatomical structures involved. Group A included 12 anterior cruciate ligament (ACL) and medial structure injuries, group B included 11 ACL or posterior cruciate ligament (PCL) ruptures combined with posterolateral injuries, and group C consisted of 25 knee dislocations (ACL and PCL ruptures which might be combined with damage of the collateral ligaments). Thirty-eight patients were surgically treated during the acute phase and ten patients were treated chronically. Forty-four patients (91.6%) were followed up at a mean of 51.3±29.9 months. Average Lysholm score was 87±12.3; average Tegner score was 5.09±2.19 before accident and 4.34±2.12 in re-examination; IKDC score was A in 10 cases, B in 22, C in 6, and D in 6. The mean range of motion was 129.9°±12.5°. The average loss of extension and flexion were 1.6°±2.5° and 7.6°±7.9°, respectively. The side-to-side difference in corrected anterior and posterior translation in quadriceps neutral angle and in anterior translation in 30° angle was <3 mm for about 65% of our patients. Surgical treatment of multiple knee ligament injuries, using autografts, provided satisfactory stability, range of motion, and subjective functional results. However, despite the improvement of the quality of life, the preinjury patients’ activity level was not fully obtained in re-examination. Patients underwent surgical treatment during the acute phase had better scores in several points, but finally there was no statistical significance between acute and chronic patients. Moreover, no statistically significant differences were observed among the groups with specific damaged anatomical structures.

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References

  1. Hertel P, Lais E, Bernard M (1989) Optimal treatment of complex ligament injuries and biomechanical aspects. Zentralbl Chir 114(23):1489–1500

    PubMed  CAS  Google Scholar 

  2. Kim SJ, Choi NH, Shin SJ (2001) Semitendinosus tenodesis for medial instability of the knee. Arthroscopy 17(6):660–663

    Article  PubMed  CAS  Google Scholar 

  3. Sims WF, Jacobson KE (2004) The posteromedial corner of the knee: medial-sided injury patterns revisited. Am J Sports Med 32(2):337–345

    Article  PubMed  Google Scholar 

  4. O’Brien SJ, Warren RF, Pavlov H, Panariello R, Wickiewicz TL (1991) Reconstruction of the chronically insufficient anterior cruciate ligament with the central third of the patellar ligament. J Bone Joint Surg Am 73(2):278–286

    PubMed  CAS  Google Scholar 

  5. Fanelli GC, Edson CJ (2002) Arthroscopically assisted combined anterior and posterior cruciate ligament reconstruction in the multiple ligament injured knee: 2- to 10-year follow-up. Arthroscopy 18(7):703–714

    Article  PubMed  Google Scholar 

  6. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ (2004) Surgical management of knee dislocations. J Bone Joint Surg Am 86-A(2):262–273

    PubMed  Google Scholar 

  7. Mariani PP, Margheritini F, Camillieri G (2001) One-stage arthroscopically assisted anterior and posterior cruciate ligament reconstruction. Arthroscopy 17(7):700–707

    Article  PubMed  CAS  Google Scholar 

  8. Montgomery TJ, Savoie FH, White JL, Roberts TS, Hughes JL (1995) Orthopedic management of knee dislocations. Comparison of surgical reconstruction and immobilization. Am J Knee Surg 8(3):97–103

    PubMed  CAS  Google Scholar 

  9. Noyes FR, Barber-Westin SD (1997) Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Use of early protected postoperative motion to decrease arthrofibrosis. Am J Sports Med 25(6):769–778

    Article  PubMed  CAS  Google Scholar 

  10. Wascher DC, Becker JR, Dexter JG, Blevins FT (1999) Reconstruction of the anterior and posterior cruciate ligaments after knee dislocation. Results using fresh-frozen nonirradiated allografts. Am J Sports Med 27(2):189–196

    PubMed  CAS  Google Scholar 

  11. Yeh WL, Tu YK, Su JY, Hsu RW (1999) Knee dislocation: treatment of high-velocity knee dislocation. J Trauma 46(4):693–701

    PubMed  CAS  Google Scholar 

  12. Μüller W (1982) Das Knie—Form, Funktionen und ligamentäre Wiederherstellungschirurgie. Springer, Berlin Heidelberg New York

    Google Scholar 

  13. Hefti F, Muller W, Jakob RP, Staubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc 1(3–4):226–234

    Article  PubMed  CAS  Google Scholar 

  14. Daniel DM, Stone ML, Barnett P, Sachs R (1988) Use of the quadriceps active test to diagnose posterior cruciate-ligament disruption and measure posterior laxity of the knee. J Bone Joint Surg Am 70(3):386–391

    PubMed  CAS  Google Scholar 

  15. Makris CA, Georgoulis AD, Papageorgiou CD, Moebius UG, Soucacos PN (2000) Posterior cruciate ligament architecture: evaluation under microsurgical dissection. Arthroscopy 16(6):627–632

    Article  PubMed  CAS  Google Scholar 

  16. Noyes FR, Barber-Westin SD (1995) The treatment of acute combined ruptures of the anterior cruciate and medial ligaments of the knee. Am J Sports Med 23(4):380–389

    Article  PubMed  CAS  Google Scholar 

  17. Lobenhoffer P (1999) Knee ligament injuries. Anatomy, biomechanics, diagnosis, indications. Chirurg 70(2):219–230

    Article  PubMed  CAS  Google Scholar 

  18. Pressman A, Johnson DH (2003) A review of ski injuries resulting in combined injury to the anterior cruciate ligament and medial collateral ligaments. Arthroscopy 19(2):194–202

    Article  PubMed  Google Scholar 

  19. Shelbourne KD, Wilckens JH, Mollabashy A, DeCarlo M (1991) Arthrofibrosis in acute anterior cruciate ligament reconstruction. The effect of timing of reconstruction and rehabilitation. Am J Sports Med 19(4):332–336

    Article  PubMed  CAS  Google Scholar 

  20. Irrgang JJ, Harner CD (1995) Loss of motion following knee ligament reconstruction. Sports Med 19(2):150–159

    Article  PubMed  CAS  Google Scholar 

  21. Dandy DJ, Edwards DJ (1994) Problems in regaining full extension of the knee after anterior cruciate ligament reconstruction: does arthrofibrosis exist? Knee Surg Sports Traumatol Arthrosc 2(2):76–79

    Article  PubMed  CAS  Google Scholar 

  22. Hillard-Sembell D, Daniel DM, Stone ML, Dobson BE, Fithian DC (1996) Combined injuries of the anterior cruciate and medial collateral ligaments of the knee. Effect of treatment on stability and function of the joint. J Bone Joint Surg Am 78(2):169–176

    PubMed  CAS  Google Scholar 

  23. Petersen W, Laprell H (1998) Therapie von Kombinatiosverletzungen des vorderen Kreuzbands und des medialen Seitenbands. Arthroskopie 11:304–308

    Article  Google Scholar 

  24. Fanelli GC, Larson RV (2002) Practical management of posterolateral instability of the knee. Arthroscopy 18(2 Suppl 1):1–8

    Article  PubMed  Google Scholar 

  25. Diamantopoulos A, Tokis A, Tzurbakis M, Patsopoulos I, Georgoulis A (2005) The posterolateral corner of the knee: evaluation under microsurgical dissection. Arthroscopy 21(7):826–833

    Article  PubMed  Google Scholar 

  26. Hoher J, Harner CD, Vogrin TM, Baek GH, Carlin GJ, Woo SL (1998) In situ forces in the posterolateral structures of the knee under posterior tibial loading in the intact and posterior cruciate ligament-deficient knee. J Orthop Res 16(6):675–681

    Article  PubMed  CAS  Google Scholar 

  27. Veltri DM, Warren RF (1994) Operative treatment of posterolateral instability of the knee. Clin Sports Med 13(3):615–627

    PubMed  CAS  Google Scholar 

  28. Malizos KN, Xenakis T, Mavrodontidis AN, Xanthis A, Korobilias AB, Soucacos PN (1997) Knee dislocations and their management. A report of 16 cases. Acta Orthop Scand Suppl 275:80–83

    PubMed  CAS  Google Scholar 

  29. Twaddle BC, Bidwell TA, Chapman JR (2003) Knee dislocations: where are the lesions? A prospective evaluation of surgical findings in 63 cases. J Orthop Trauma 17(3):198–202

    Article  PubMed  Google Scholar 

  30. Shields L, Mital M, Cave EF (1969) Complete dislocation of the knee: experience at the Massachusetts General Hospital. J Trauma 9(3):192–215

    PubMed  CAS  Google Scholar 

  31. Bratt HD, Newman AP (1993) Complete dislocation of the knee without disruption of both cruciate ligaments. J Trauma 34(3):383–389

    Article  PubMed  CAS  Google Scholar 

  32. Pointinger H, Munk P, Poeschl GP (1999) Rupture of the pes anserinus superficialis and partial rupture of the patellar ligament. Rare concomitant injures in complex knee injuries. Unfallchirurg 102(1):69–73

    Article  PubMed  CAS  Google Scholar 

  33. Rae PJ, Davies DRA (1991) Simultaneous rupture of the ligamentum patellae, medial collateral and anterior cruciate ligaments. A case report. Am J Sports Med 19:529–530

    Article  PubMed  CAS  Google Scholar 

  34. Shapiro MS, Freedman EL (1995) Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. Am J Sports Med 23(5):580–587

    Article  PubMed  CAS  Google Scholar 

  35. Chhabra A, Cha PS, Rihn JA, Cole B, Bennett CH, Waltrip RL, Harner CD. (2005) Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg Am. 87 Suppl 1(Pt 1):1–21

    Article  PubMed  Google Scholar 

  36. Liow RY, McNicholas MJ, Keating JF, Nutton RW (2003) Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg Br 85(6):845–851

    PubMed  CAS  Google Scholar 

  37. Meyers MH, Moore TM, Harvey JP Jr (1975) Traumatic dislocation of the knee joint. J Bone Joint Surg Am 57(3):430–433

    PubMed  CAS  Google Scholar 

  38. Richter M, Lobenhoffer P, Tscherne H (1999) Knee dislocation. Long-term results after operative treatment. Chirurg 70(11):1294–1301

    Article  PubMed  CAS  Google Scholar 

  39. Wong CH, Tan JL, Chang HC, Khin LW, Low CO (2004) Knee dislocations—a retrospective study comparing operative versus closed immobilization treatment outcomes. Knee Surg Sports Traumatol Arthrosc 12(6):540–544

    Article  PubMed  Google Scholar 

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Acknowledgment

This clinical study is a part of the Ph.D. thesis of the second author. This Ph.D. thesis was supervised by the Orthopaedic Sports Medicine Center, Department of Orthopaedic Surgery, University of Ioannina, Greece.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, “Evangelismos” General Hospital, Diocharous 10, 11528, Athens, Greece

    Matheus Tzurbakis

  2. Center for Knee and Foot Surgery and Sports Trauma, ATOS Clinic, Bismarckstrasse 9–15, 69115, Heidelberg, Germany

    Andreas Diamantopoulos

  3. Department of Orthopaedic Surgery, University of Ioannina, Ioannina, Greece

    Theodoros Xenakis & Anastasios Georgoulis

  4. Methodiou Anthrakitou 1, 45221, Ioannina, Greece

    Anastasios Georgoulis

Authors
  1. Matheus Tzurbakis
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  2. Andreas Diamantopoulos
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  3. Theodoros Xenakis
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  4. Anastasios Georgoulis
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Correspondence to Anastasios Georgoulis.

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Tzurbakis, M., Diamantopoulos, A., Xenakis, T. et al. Surgical treatment of multiple knee ligament injuries in 44 patients: 2–8 years follow-up results. Knee Surg Sports Traumatol Arthr 14, 739–749 (2006). https://doi.org/10.1007/s00167-006-0039-4

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  • DOI: https://doi.org/10.1007/s00167-006-0039-4

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