Abstract：Objective To discuss the treatment strategy of knee dislocation with multiple ligament injuries and to evaluate its outcome. Methods From March 2010 to May 2014, sixteen patients with knee dislocation with multiple ligament injuries were studied retrospectively by stages in the Bone Joint Department of the Wuhu Traditional Chinese Medical Hospital, including 11 males and 5 females with an average age of 36.5 years old(range, 22-68 years old). According to the modified Schenck′s classification of knee dislocation, there were 1 KD-Ⅰ, 2 KD-Ⅱ, 6 KD-ⅢM, 2 KD-ⅢL, 3 KD-Ⅳ, 2 KD-Ⅴ, and 16 patients had anterior cruciate ligament (ACL), 15 patients had posterior cruciate ligament (PCL), 11 patients had medial collateral ligament (MCL), 7 patients had lateral collateral ligament (LCL), 2 patients had posterolateral complex (PLC), 3 patients had posteromedial complex (PMC). All patients underwent one-stage surgery repair and reconstruction of multiple ligament injuries under arthroscopy with small incision during 3 weeks. The stability of the knee was observed at last follow-up. The paired t test was applied for statistical analysis at preoperation and at the last follow-up according to IKDC score, Lysholm score and knee range of motion. Results Of 16 patients, 1 patient had popliteal artery injury during operative, 2 patients had lateral tibia bone tunnel poor healing of incision at postoperative and 2 patients had infection, to the corresponding recovery after treatment. All patients taken X-ray slice in joint involution were good after 3 days. Reconstruction of bone tunnel location and internal fixation was good. All 16 patients were followed up for an average of 28 months (range, 12-48 months). At the time of the last follow-up X-ray film showed no obvious enlargement at reconstruction of bone tunnel internal and fixation loosening. There was no ligament revision. The knee range of flexion for an average of 124°(ranges from 115° to 135°), The IKDC score 89.64±3.15 , the Lysholm score 82.88±6.57 and knee range of motion 123.56°±5.20° at final followed-up showed a statistically significantl improvement compared with preoperative results(t=57.791, 71.563, 25.998, all P values＜0.01). At last follow-up had 4 patients residual knee instability in 16 patients. According to IKDC scores, Lysholm knee score evaluation of knee joint function, the optimal 9 patients, 4 patients were good, 2 patients were fair, 1 patient was poor. Conclusions Knee dislocation with multiple ligament injuries is a kind of serious and complex injury, patient condition need systematic evaluation, according to the extent of the injury patients make personalized treatment options, one-stage repair and reconstruction under arthroscopy can effectively restore the function of the knee joint, reduce disability rate.
Skendzel JG, Sekiya JK, Wojtys EM. Diagnosis and management of the multiligament-injured knee[J]. J Orthop Sports Phys Ther, 2012, 42(3): 234-242. DOI:10.2519/jospt.2012.3678.
[2]
Ibrahim SA, Ghafar S, Salah M, et al. Surgical management of traumatic knee dislocation with posterolateral corner injury[J]. Arthroscopy, 2013, 29(4): 733-741. DOI:10.1016/j.arthro.2012.11.021.
[3]
Peskun CJ, Whelan DB. Outcomes of operative and nonoperative treatment of multiligament knee injuries: an evidence-based review[J]. Sports Med Arthrosc, 2011, 19(2): 167-173. DOI:10.1097/JSA.0b013e3182107d5f.
[4]
Heitmann M, Gerau M, Htzel J, et al. Ligament bracing—augmented primary suture repair in multiligamentous knee injuries[J]. Oper Orthop Traumatol, 2014, 26(1): 19-29. DOI:10.1007/s00064-013-0263-2.
[5]
Subbiah M, Pandey V, Rao SK, et al. Staged arthroscopic reconstructive surgery for multiple ligament injuries of the knee[J]. J Orthop Surg (Hong Kong), 2011, 19(3): 297-302.
Fanelli GC, Sousa PL, Edson CJ. Long-term followup of surgically treated knee dislocations: stability restored, but arthritis is common[J]. Clin Orthop Relat Res, 2014, 472(9): 2712-2717. DOI:10.1007/s11999-014-3707-6.
[8]
Kovachevich R, Shah JP, Arens AM, et al. Operative management of the medial collateral ligament in the multi-ligament injured knee: an evidence-based systematic review[J]. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 823-829. DOI:10.1007/s00167-009-0810-4.
[9]
Hubert MG, Stannard JP. Surgical treatment of acute and chronic anterior and posterior cruciate ligament and medial-side injuries of the knee[J]. Sports Med Arthrosc, 2011, 19(2): 104-109. DOI:10.1097/JSA.0b013e3182191874.
[10]
Engebretsen L, Risberg MA, Robertson B, et al. Outcome after knee dislocations: a 2-9 years follow-up of 85 consecutive patients[J]. Knee Surg Sports Traumatol Arthrosc, 2009, 17(9): 1013-1026. DOI:10.1007/s00167-009-0869-y.
[11]
Marchant MH Jr, Tibor LM, Sekiya JK, et al. Management of medial-sided knee injuries, part 1: medial collateral ligament[J]. Am J Sports Med, 2010, 39(5): 1102-1113. DOI:10.1177/0363546510385999.
[12]
Fanelli GC, Beck JD, Edson CJ. Combined PCL-ACL lateral and medial side injuries: treatment and results[J]. Sports Med Arthrosc, 2011, 19(2): 120-130. DOI:10.1097/JSA.0b013e318219149c.
Zhang Y, Zhang X, Hao Y, et al. Surgical management of the multiple-ligament injured knee: a case series from Chongqing, China and review of published reports[J]. Orthop Surg, 2013, 5(4): 239-249. DOI:10.1111/os.12077.
[19]
Rochecongar G, Plaweski S, Azar M, et al. Management of combined anterior or posterior cruciate ligament and posterolateral corner injuries: a systematic review[J]. Orthop Traumatol Surg Res, 2014, 100(8 Suppl): S371-S378. DOI:10.1016/j.otsr.2014.09.010.
[20]
Howells NR, Brunton LR, Robinson J, et al. Acute knee dislocation: an evidence based approach to the management of the multiligament injured knee[J]. Injury, 2011, 42(11): 1198-1204. DOI:10.1016/j.injury.2010.11.018.
[21]
Jenkins PJ, Clifton R, Gillespie GN, et al. Strength and function recovery after multiple-ligament reconstruction of the knee[J]. Injury, 2011, 42(12): 1426-1429. DOI:10.1016/j.injury.2011.03.026.
2016, Vol. 21 
