Outcomes of single-stage reconstruction with ipsilateral peroneus longus and hamstring graft in multiligament knee injuries: A case series

Abstract

Abstract Background: The diagnosis and management of patients presenting with more than one ligament injury in the knee have been a controversial topic for several decades and it is difficult to draw any firm conclusions. No single approach has proven optimal for the treatment of multiligament knee injuries (MLKI) and there is no consensus between most specialists. This case series seeks to describe and clarify management's current state and future. Objective: The purpose of this study was to determine the outcome of single staged MLKI reconstruction. Materials and Methods: It is a hospital-based case series conducted on 10 patients. Patients who were surgically treated for MLKI between 2017 and 2020 were included in this study. In our study, we included patients with grade 3 or grade 4 cruciate ligament injury with grade 3 or 4 collaterals injury for arthroscopic reconstruction. Data were collected pre- and postoperatively and their Lysholm and International knee documentation committee (IKDC) scores were used to evaluate the outcomes. Results: A male predominance was noted in the present study. Road traffic accidents were the most common mode of injury (70%). Anterior cruciate ligament and medial collateral ligament combination constituted the most common injury pattern (70%). Overall, there was a statistically significant difference in outcomes postsurgery with regards to pre-operative and postoperative Lysholm and IKDC scores in our patients with a P-value of less than 0.0001, substantiating the need for surgical management of MLKI. With a mean postoperative Lysholm score of 89 and a mean postoperative IKDC score of 85, this study showed functionally good results in the patients treated in a single sitting. At the end of 1 year, none of the patients showed positive results for anterior drawer and valgus or varus stress tests. None of the patients showed extensor lag at the last follow-up. Conclusion: A wide variety of management approaches have been described for MLKI. Proper evaluation and full diagnosis are key in multiligament injury of the knee. Failure to treat all injured structures can lead to changes in knee kinematics, poorer outcomes, and increased risk for graft failure. Single-stage early surgical treatment with proper rehabilitation yields good functional and clinical outcomes with early return to work and sports activity.