A case of extensive heterotopic ossification following multiple ligament reconstruction after severe knee trauma

Abstract

We present a case of extensive heterotopic ossification (HO) around the knee joint following multiple ligament reconstruction after severe trauma. A 50-year-old female sustained a motor vehicle accident and underwent multiple trauma. The initial diagnosis of the knee included avulsion fracture of the tibial attachment of the posterior cruciate ligament, multiple ligament injury including the anterior cruciate ligament and medial collateral ligament, medial and lateral meniscal tears, and the fracture of the inferior pole of the patella. The surgical treatment was delivered in 2 stages including reconstructions of the anterior and posterior cruciate ligaments reconstruction, and repair of the medial collateral ligament and menisci. At postoperative 2 months, HO was observed around the knee joint, especially on the medial and posterior aspect, and proceeded gradually. At postoperative 1 year, the ossification appears matured with clear trabeculation and round margin. The motion arc was fairly preserved from 20° to 70°. Considering the benefits and risks of the further operative management, the patient opted for conservative management. The etiology of HO is not thoroughly known, and its therapy is empiric. Although prevention is not always possible, feasible preventive measure should be exerted to avoid the irreversible pathology. This unique sequelae should be kept in mind of orthopedic surgeon to devise pertinent management plan and deliver it to the injured.