Single-Stage Multiple-Ligament Knee Reconstructions for Sports-Related Injuries: Outcomes in 194 Patients
Multi-ligament knee injuries in the young and active population can be devastating. This case series sought to report outcomes following sports-related single-stage multi-ligament knee reconstructions. Over a 6-year period, 194 patients that sustained injury to least two out of four major knee ligaments (anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), superficial medial collateral ligament (MCL), or fibular collateral ligament (FCL)) or had a torn popliteus were identified. All patients were treated with a single surgical reconstruction of the damaged ligaments and underwent a course of rehabilitation immediately following that surgery.
At the time of surgery, over half of the patients also had a meniscus injury, and a third of the patients had a chondral defect. At an average of 3.5 years following surgery, combined ACL and PCL injury led to the worst outcomes. Patients with PCL-based injuries tended to be less satisfied with surgical results compared to patients with ACL-based injuries. Regardless of being ACL- or PCL-based, all injury combinations that were surgically managed led to improvement in function compared to before surgery and showed a very low complication rate. The amount of time between injury and surgery did not affect function. These results are useful in surgical planning and in counseling sports medicine patients on outcomes following single stage multi-ligament reconstructive surgery.
Figure 2. Reconstruction techniques used for multiligament knee reconstruction. (A) Anterolateral view of a right knee shows a single-bundle ACL reconstruction with a patellar tendon graft. (B) Double-bundle PCL reconstruction on a right knee with allografts for the anterolateral and posteromedial bundles. The grafts were fixed on the tibia with interference screws and washers.17 (C) A complete medial knee reconstruction (left knee).5 (D) An sMCL augmentation with gracilis and semitendinosus autograft on a left knee. (E) A full posterolateral knee reconstruction. (F) FCL reconstruction on a right knee.27 ACL, anterior cruciate ligament; ACLR, anterior cruciate ligament reconstruction; ALB, anterolateral bundle; DB, double bundle; FCL, fibular collateral ligament; FCLR, fibular collateral ligament reconstruction; PCL, posterior cruciate ligament; PCLR, posterior cruciate ligament reconstruction; PFL, popliteofibular ligament; PLCR, posterolateral corner reconstruction; PMB, posteromedial bundle; PMCR, posteromedial corner reconstruction; POL, posterior oblique ligament; sMCL, superficial medial collateral ligament.
