Surgical Treatment of Complex Bicruciate Knee Ligament Injuries in Elite Athletes

Abstract

Background: A traumatic knee dislocation represents a serious injury, particularly for athletes who have the highest demands on their knee function. Purpose: Our aim was to analyze the long-term outcome and return to sports after traumatic knee dislocation in elite athletes treated surgically according to a standardized treatment protocol and to identify predictive factors for a successful outcome. Study Design: Case series; Level of evidence, 4. Methods: A review of hospital medical records yielded 26 elite athletes with a knee dislocation (torn bicruciate ligaments and at least one torn collateral ligament), who had undergone an open complete single-stage reconstruction/primary repair of the cruciates and collateral ligaments including the posterolateral corner from January 1983 to August 2006. Return to sport (start of sport-specific training) was recorded. Return to the former level of sports activity was assessed. At a median follow-up of 8 years (range, 1-23 years), 24 patients (92%) were evaluated for instrumented anterior-posterior laxity (KT-1000 arthrometer) and scored on the visual analog scale (VAS pain, satisfaction), International Knee Documentation Committee form (IKDC), American Knee Society score, and Lysholm and Tegner score. Standard weightbearing and stress radiographs were taken. Results: Seventy-nine percent of patients (n = 19) returned to their previous sport after a median time of 5.5 months (range, 1.5-36 months), with 8 of them returning to preinjury levels. Eight percent had a VAS pain score >3. Thirteen percent of patients showed a flexion deficit >15°, and 8% showed an extension deficit >10°. The mean side-to-side differences for anterior and posterior laxity were 2.3 mm (range, 1-5 mm) and 2.0 mm (range, 2-7 mm), respectively. The total IKDC score was normal in 4, nearly normal in 12, abnormal in 6, and severely abnormal in 2 patients. The median Lysholm score was 91.8 (range, 37-100). The median Tegner score decreased from 9 (range, 7-10) to 7 (range, 2-10). The median American Knee Society score was 190 (range, 162-200). The median radiological anterior-posterior side-to-side differences in 30° and 90° flexion were 1 mm (range, 1-6 mm)/1 mm (range, 0-11 mm) and 1 mm (range, 0-7 mm)/3 mm (range, 0-11 mm), respectively. Patients treated more than 40 days after injury had a poorer outcomeon the satisfaction and relative Tegner scores. This group was also less successful in returning to sport compared with patients treated earlier. Conclusion: Athletes treated by early, open, complete single-stage reconstruction within 40 days of injury had better outcomes. Although 19 of 24 patients returned to sports with good functional outcomes and ligamentous stability, only 8 of 24 athletes reached their preinjury sports activity level.